|
HC SOM NEURON SPECIFIC ENOLASE CSF
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900910766
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$118.19 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$16.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.19
|
| Rate for Payer: Blue Shield of California Commercial |
$104.20
|
| Rate for Payer: Blue Shield of California EPN |
$83.58
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Senior |
$17.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.57
|
| Rate for Payer: Heritage Provider Network Senior |
$18.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.76
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.27
|
| Rate for Payer: TriValley Medical Group Senior |
$17.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC SOM NEURON SPECIFIC ENOLASE SERUM
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900910767
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$118.19 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.19
|
| Rate for Payer: Blue Shield of California Commercial |
$104.20
|
| Rate for Payer: Blue Shield of California EPN |
$83.58
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Senior |
$17.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.47
|
| Rate for Payer: Heritage Provider Network Senior |
$15.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.76
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.27
|
| Rate for Payer: TriValley Medical Group Senior |
$17.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC SOM NEURON SPECIFIC ENOLASE SERUM
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900910767
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.93
|
| Rate for Payer: Heritage Provider Network Senior |
$16.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
|
|
HC SOM NEUROTENSIN
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900910768
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$144.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$185.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.36
|
| Rate for Payer: Blue Shield of California Commercial |
$108.75
|
| Rate for Payer: Blue Shield of California EPN |
$87.23
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$175.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.24
|
| Rate for Payer: Dignity Health Senior |
$18.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$175.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$167.13
|
| Rate for Payer: Heritage Provider Network Senior |
$167.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$128.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.18
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.40
|
| Rate for Payer: TriValley Medical Group Senior |
$18.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Vantage Medical Group Senior |
$18.40
|
|
|
HC SOM NEUROTENSIN
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900910768
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.87 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$182.79
|
| Rate for Payer: Heritage Provider Network Senior |
$182.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.50
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
|
|
HC SOM NEUROTRANSMITTER METAB
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914688
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.09 |
| Max. Negotiated Rate |
$164.17 |
| Rate for Payer: Adventist Health Commercial |
$39.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$104.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$133.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$164.17
|
| Rate for Payer: Blue Shield of California Commercial |
$145.32
|
| Rate for Payer: Blue Shield of California EPN |
$116.56
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$126.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.50
|
| Rate for Payer: Dignity Health Senior |
$24.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$24.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$120.70
|
| Rate for Payer: Heritage Provider Network Senior |
$120.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$93.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.35
|
| Rate for Payer: Multiplan Commercial |
$146.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.09
|
| Rate for Payer: TriValley Medical Group Senior |
$24.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24.09
|
|
|
HC SOM NEUROTRANSMITTER METAB
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914688
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.30 |
| Max. Negotiated Rate |
$146.25 |
| Rate for Payer: Adventist Health Commercial |
$39.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$132.01
|
| Rate for Payer: Heritage Provider Network Senior |
$132.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.75
|
| Rate for Payer: Multiplan Commercial |
$146.25
|
|
|
HC SOM N.GONORRHOEAE AMP DNA FEMALE U
|
Facility
|
OP
|
$194.68
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
900912876
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$310.02 |
| Rate for Payer: Adventist Health Commercial |
$38.94
|
| Rate for Payer: Aetna of CA Gatekeeper |
$104.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$133.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$310.02
|
| Rate for Payer: Blue Shield of California Commercial |
$282.47
|
| Rate for Payer: Blue Shield of California EPN |
$226.56
|
| Rate for Payer: Cash Price |
$194.68
|
| Rate for Payer: Cash Price |
$194.68
|
| Rate for Payer: Cigna of CA HMO/PPO |
$126.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.54
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$120.51
|
| Rate for Payer: Heritage Provider Network Senior |
$120.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$41.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$92.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.21
|
| Rate for Payer: Multiplan Commercial |
$146.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$35.09
|
| Rate for Payer: TriValley Medical Group Senior |
$35.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM N.GONORRHOEAE AMP DNA FEMALE U
|
Facility
|
IP
|
$194.68
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
900912876
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.24 |
| Max. Negotiated Rate |
$146.01 |
| Rate for Payer: Adventist Health Commercial |
$38.94
|
| Rate for Payer: Cash Price |
$194.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$131.80
|
| Rate for Payer: Heritage Provider Network Senior |
$131.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.67
|
| Rate for Payer: Multiplan Commercial |
$146.01
|
|
|
HC SOM NICOTINE
|
Facility
|
OP
|
$20.35
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
900910769
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.68 |
| Max. Negotiated Rate |
$262.88 |
| Rate for Payer: Adventist Health Commercial |
$4.07
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$262.88
|
| Rate for Payer: Cash Price |
$20.35
|
| Rate for Payer: Cash Price |
$20.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.30
|
| Rate for Payer: Dignity Health Senior |
$17.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.60
|
| Rate for Payer: Heritage Provider Network Senior |
$12.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.24
|
| Rate for Payer: Multiplan Commercial |
$15.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.30
|
| Rate for Payer: Vantage Medical Group Senior |
$17.30
|
|
|
HC SOM NICOTINE
|
Facility
|
IP
|
$20.35
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
900910769
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.68 |
| Max. Negotiated Rate |
$15.26 |
| Rate for Payer: Adventist Health Commercial |
$4.07
|
| Rate for Payer: Cash Price |
$20.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.78
|
| Rate for Payer: Heritage Provider Network Senior |
$13.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.09
|
| Rate for Payer: Multiplan Commercial |
$15.26
|
|
|
HC SOM NITROGEN STOOL
|
Facility
|
IP
|
$422.40
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900911229
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$76.45 |
| Max. Negotiated Rate |
$316.80 |
| Rate for Payer: Adventist Health Commercial |
$84.48
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$285.96
|
| Rate for Payer: Heritage Provider Network Senior |
$285.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.60
|
| Rate for Payer: Multiplan Commercial |
$316.80
|
|
|
HC SOM NITROGEN STOOL
|
Facility
|
OP
|
$422.40
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900911229
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$76.45 |
| Max. Negotiated Rate |
$359.04 |
| Rate for Payer: Adventist Health Commercial |
$84.48
|
| Rate for Payer: Aetna of CA Gatekeeper |
$225.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$290.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$359.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$232.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$316.80
|
| Rate for Payer: Blue Shield of California Commercial |
$257.66
|
| Rate for Payer: Blue Shield of California EPN |
$206.13
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$274.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$359.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$359.04
|
| Rate for Payer: Dignity Health Senior |
$359.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$274.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$261.47
|
| Rate for Payer: Heritage Provider Network Senior |
$261.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$201.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$295.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$295.68
|
| Rate for Payer: Multiplan Commercial |
$316.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$211.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$211.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$359.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$359.04
|
| Rate for Payer: Vantage Medical Group Senior |
$359.04
|
|
|
HC SOM NMDCS 86255
|
Facility
|
IP
|
$344.33
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900914769
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$62.32 |
| Max. Negotiated Rate |
$258.25 |
| Rate for Payer: Adventist Health Commercial |
$68.87
|
| Rate for Payer: Cash Price |
$344.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$233.11
|
| Rate for Payer: Heritage Provider Network Senior |
$233.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.08
|
| Rate for Payer: Multiplan Commercial |
$258.25
|
|
|
HC SOM NMDCS 86255
|
Facility
|
OP
|
$344.33
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900914769
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$258.25 |
| Rate for Payer: Adventist Health Commercial |
$68.87
|
| Rate for Payer: Aetna of CA Gatekeeper |
$184.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$236.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.08
|
| Rate for Payer: Blue Shield of California Commercial |
$97.00
|
| Rate for Payer: Blue Shield of California EPN |
$77.80
|
| Rate for Payer: Cash Price |
$344.33
|
| Rate for Payer: Cash Price |
$344.33
|
| Rate for Payer: Cigna of CA HMO/PPO |
$223.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$223.81
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$213.14
|
| Rate for Payer: Heritage Provider Network Senior |
$213.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$164.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.18
|
| Rate for Payer: Multiplan Commercial |
$258.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.05
|
| Rate for Payer: TriValley Medical Group Senior |
$12.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM NMHIN 83789
|
Facility
|
OP
|
$162.45
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
900914806
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.11 |
| Max. Negotiated Rate |
$164.17 |
| Rate for Payer: Adventist Health Commercial |
$32.49
|
| Rate for Payer: Aetna of CA Gatekeeper |
$86.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$111.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$164.17
|
| Rate for Payer: Blue Shield of California Commercial |
$145.32
|
| Rate for Payer: Blue Shield of California EPN |
$116.56
|
| Rate for Payer: Cash Price |
$162.45
|
| Rate for Payer: Cash Price |
$162.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$105.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.52
|
| Rate for Payer: Dignity Health Senior |
$24.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.59
|
| Rate for Payer: EPIC Health Plan Medicare |
$24.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$100.56
|
| Rate for Payer: Heritage Provider Network Senior |
$100.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$77.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.38
|
| Rate for Payer: Multiplan Commercial |
$121.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.11
|
| Rate for Payer: TriValley Medical Group Senior |
$24.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.52
|
| Rate for Payer: Vantage Medical Group Senior |
$24.11
|
|
|
HC SOM NMHIN 83789
|
Facility
|
IP
|
$162.45
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
900914806
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$121.84 |
| Rate for Payer: Adventist Health Commercial |
$32.49
|
| Rate for Payer: Cash Price |
$162.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$109.98
|
| Rate for Payer: Heritage Provider Network Senior |
$109.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.61
|
| Rate for Payer: Multiplan Commercial |
$121.84
|
|
|
HC SOM NMO/AQP4 FACS
|
Facility
|
OP
|
$227.49
|
|
|
Service Code
|
CPT 86053
|
| Hospital Charge Code |
900915463
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.02 |
| Max. Negotiated Rate |
$170.62 |
| Rate for Payer: Adventist Health Commercial |
$45.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$121.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$156.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.98
|
| Rate for Payer: Blue Shield of California Commercial |
$69.41
|
| Rate for Payer: Blue Shield of California EPN |
$55.67
|
| Rate for Payer: Cash Price |
$227.49
|
| Rate for Payer: Cash Price |
$227.49
|
| Rate for Payer: Cigna of CA HMO/PPO |
$147.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.50
|
| Rate for Payer: Dignity Health Senior |
$37.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$147.87
|
| Rate for Payer: EPIC Health Plan Medicare |
$37.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$140.82
|
| Rate for Payer: Heritage Provider Network Senior |
$140.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$108.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.54
|
| Rate for Payer: Multiplan Commercial |
$170.62
|
| Rate for Payer: TriValley Medical Group Commercial |
$37.73
|
| Rate for Payer: TriValley Medical Group Senior |
$37.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Vantage Medical Group Senior |
$37.73
|
|
|
HC SOM NMO/AQP4 FACS
|
Facility
|
IP
|
$227.49
|
|
|
Service Code
|
CPT 86053
|
| Hospital Charge Code |
900915463
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.18 |
| Max. Negotiated Rate |
$170.62 |
| Rate for Payer: Adventist Health Commercial |
$45.50
|
| Rate for Payer: Cash Price |
$227.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$154.01
|
| Rate for Payer: Heritage Provider Network Senior |
$154.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.87
|
| Rate for Payer: Multiplan Commercial |
$170.62
|
|
|
HC SOM NMO/AQP4 FACS TITER
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 86053
|
| Hospital Charge Code |
900915464
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.57 |
| Max. Negotiated Rate |
$56.25 |
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.77
|
| Rate for Payer: Heritage Provider Network Senior |
$50.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.75
|
| Rate for Payer: Multiplan Commercial |
$56.25
|
|
|
HC SOM NMO/AQP4 FACS TITER
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 86053
|
| Hospital Charge Code |
900915464
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.02 |
| Max. Negotiated Rate |
$69.41 |
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$40.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$51.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.98
|
| Rate for Payer: Blue Shield of California Commercial |
$69.41
|
| Rate for Payer: Blue Shield of California EPN |
$55.67
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$48.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.50
|
| Rate for Payer: Dignity Health Senior |
$37.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$37.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$46.42
|
| Rate for Payer: Heritage Provider Network Senior |
$46.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$35.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.54
|
| Rate for Payer: Multiplan Commercial |
$56.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$37.73
|
| Rate for Payer: TriValley Medical Group Senior |
$37.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Vantage Medical Group Senior |
$37.73
|
|
|
HC SOMN NC05 CSF P-5-P 82491
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914867
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.09 |
| Max. Negotiated Rate |
$164.17 |
| Rate for Payer: Adventist Health Commercial |
$37.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$98.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$127.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$164.17
|
| Rate for Payer: Blue Shield of California Commercial |
$145.32
|
| Rate for Payer: Blue Shield of California EPN |
$116.56
|
| Rate for Payer: Cash Price |
$101.75
|
| Rate for Payer: Cash Price |
$101.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$120.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.50
|
| Rate for Payer: Dignity Health Senior |
$24.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$24.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$114.52
|
| Rate for Payer: Heritage Provider Network Senior |
$114.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$88.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.35
|
| Rate for Payer: Multiplan Commercial |
$138.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.09
|
| Rate for Payer: TriValley Medical Group Senior |
$24.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24.09
|
|
|
HC SOMN NC05 CSF P-5-P 82491
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914867
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.48 |
| Max. Negotiated Rate |
$138.75 |
| Rate for Payer: Adventist Health Commercial |
$37.00
|
| Rate for Payer: Cash Price |
$101.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.25
|
| Rate for Payer: Heritage Provider Network Senior |
$125.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.25
|
| Rate for Payer: Multiplan Commercial |
$138.75
|
|
|
HC SOMN NC07 CSF SIALIC 82017
|
Facility
|
IP
|
$205.00
|
|
|
Service Code
|
CPT 82017
|
| Hospital Charge Code |
900914735
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.10 |
| Max. Negotiated Rate |
$153.75 |
| Rate for Payer: Adventist Health Commercial |
$41.00
|
| Rate for Payer: Cash Price |
$112.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$138.78
|
| Rate for Payer: Heritage Provider Network Senior |
$138.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.25
|
| Rate for Payer: Multiplan Commercial |
$153.75
|
|
|
HC SOMN NC07 CSF SIALIC 82017
|
Facility
|
OP
|
$205.00
|
|
|
Service Code
|
CPT 82017
|
| Hospital Charge Code |
900914735
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.87 |
| Max. Negotiated Rate |
$153.75 |
| Rate for Payer: Adventist Health Commercial |
$41.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$109.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$140.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.29
|
| Rate for Payer: Blue Shield of California Commercial |
$135.76
|
| Rate for Payer: Blue Shield of California EPN |
$108.89
|
| Rate for Payer: Cash Price |
$112.75
|
| Rate for Payer: Cash Price |
$112.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$133.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.56
|
| Rate for Payer: Dignity Health Senior |
$16.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$133.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$126.89
|
| Rate for Payer: Heritage Provider Network Senior |
$126.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$97.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.26
|
| Rate for Payer: Multiplan Commercial |
$153.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.87
|
| Rate for Payer: TriValley Medical Group Senior |
$16.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.56
|
| Rate for Payer: Vantage Medical Group Senior |
$16.87
|
|
