|
HC SOM TAPENTADOL URINE
|
Facility
OP
|
$40.00
|
|
|
Service Code
|
CPT 80372
|
| Hospital Charge Code |
900914715
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$162.52 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$34.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$22.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$30.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$162.52
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.00
|
| Rate for Payer: Dignity Health Senior |
$34.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.76
|
| Rate for Payer: Heritage Provider Network Senior |
$24.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$19.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.00
|
| Rate for Payer: Vantage Medical Group Senior |
$34.00
|
|
|
HC SOM TAPENTADOL URINE
|
Facility
IP
|
$40.00
|
|
|
Service Code
|
CPT 80372
|
| Hospital Charge Code |
900914715
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.48
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.08
|
| Rate for Payer: Heritage Provider Network Senior |
$27.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
|
|
HC SOM TCP 86359
|
Facility
OP
|
$115.35
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
900914880
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$20.88 |
| Max. Negotiated Rate |
$316.30 |
| Rate for Payer: Adventist Health Commercial |
$23.07
|
| Rate for Payer: Aetna of CA Gatekeeper |
$109.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$79.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$56.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$37.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$316.30
|
| Rate for Payer: Blue Shield of California Commercial |
$294.59
|
| Rate for Payer: Blue Shield of California EPN |
$230.30
|
| Rate for Payer: Cash Price |
$51.91
|
| Rate for Payer: Cash Price |
$51.91
|
| Rate for Payer: Cigna of CA HMO/PPO |
$74.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.50
|
| Rate for Payer: Dignity Health Senior |
$37.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.98
|
| Rate for Payer: EPIC Health Plan Medicare |
$37.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$71.40
|
| Rate for Payer: Heritage Provider Network Senior |
$71.40
|
| Rate for Payer: Humana Medicare |
$37.73
|
| Rate for Payer: IEHP Medi-Cal |
$52.31
|
| Rate for Payer: IEHP Medicare Advantage |
$37.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$71.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.84
|
| 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 |
$86.51
|
| 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 |
$40.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$40.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Vantage Medical Group Senior |
$37.73
|
|
|
HC SOM TCP 86359
|
Facility
IP
|
$115.35
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
900914880
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$20.88 |
| Max. Negotiated Rate |
$86.51 |
| Rate for Payer: Adventist Health Commercial |
$23.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$79.25
|
| Rate for Payer: Cash Price |
$51.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$78.09
|
| Rate for Payer: Heritage Provider Network Senior |
$78.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.84
|
| Rate for Payer: Multiplan Commercial |
$86.51
|
|
|
HC SOM TCP 86361
|
Facility
IP
|
$81.87
|
|
|
Service Code
|
CPT 86361
|
| Hospital Charge Code |
900914881
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$14.82 |
| Max. Negotiated Rate |
$61.40 |
| Rate for Payer: Adventist Health Commercial |
$16.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$56.24
|
| Rate for Payer: Cash Price |
$36.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$55.43
|
| Rate for Payer: Heritage Provider Network Senior |
$55.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.47
|
| Rate for Payer: Multiplan Commercial |
$61.40
|
|
|
HC SOM TCP 86361
|
Facility
OP
|
$81.87
|
|
|
Service Code
|
CPT 86361
|
| Hospital Charge Code |
900914881
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$14.82 |
| Max. Negotiated Rate |
$225.40 |
| Rate for Payer: Adventist Health Commercial |
$16.37
|
| Rate for Payer: Aetna of CA Gatekeeper |
$77.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$56.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$40.17
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$29.46
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$26.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$225.40
|
| Rate for Payer: Blue Shield of California Commercial |
$209.12
|
| Rate for Payer: Blue Shield of California EPN |
$163.48
|
| Rate for Payer: Cash Price |
$36.84
|
| Rate for Payer: Cash Price |
$36.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$53.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.46
|
| Rate for Payer: Dignity Health Senior |
$26.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.22
|
| Rate for Payer: EPIC Health Plan Medicare |
$26.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.68
|
| Rate for Payer: Heritage Provider Network Senior |
$50.68
|
| Rate for Payer: Humana Medicare |
$26.78
|
| Rate for Payer: IEHP Medi-Cal |
$37.13
|
| Rate for Payer: IEHP Medicare Advantage |
$26.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$50.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.74
|
| Rate for Payer: Multiplan Commercial |
$61.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$26.78
|
| Rate for Payer: TriValley Medical Group Senior |
$26.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$28.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$28.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.46
|
| Rate for Payer: Vantage Medical Group Senior |
$26.78
|
|
|
HC SOM TCP 88184
|
Facility
OP
|
$199.38
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
900914882
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$36.09 |
| Max. Negotiated Rate |
$853.31 |
| Rate for Payer: Adventist Health Commercial |
$39.88
|
| Rate for Payer: Aetna of CA Gatekeeper |
$186.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$136.97
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$673.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$494.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$449.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$326.50
|
| Rate for Payer: Blue Shield of California Commercial |
$123.81
|
| Rate for Payer: Blue Shield of California EPN |
$117.04
|
| Rate for Payer: Cash Price |
$89.72
|
| Rate for Payer: Cash Price |
$89.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$129.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$494.02
|
| Rate for Payer: Dignity Health Senior |
$449.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$129.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$449.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$123.42
|
| Rate for Payer: Heritage Provider Network Senior |
$123.42
|
| Rate for Payer: Humana Medicare |
$449.11
|
| Rate for Payer: IEHP Medi-Cal |
$65.80
|
| Rate for Payer: IEHP Medicare Advantage |
$449.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$853.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$529.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$565.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$565.88
|
| Rate for Payer: Multiplan Commercial |
$149.54
|
| Rate for Payer: TriValley Medical Group Commercial |
$449.11
|
| Rate for Payer: TriValley Medical Group Senior |
$449.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$321.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$321.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$494.02
|
| Rate for Payer: Vantage Medical Group Senior |
$449.11
|
|
|
HC SOM TCP 88184
|
Facility
IP
|
$199.38
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
900914882
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$36.09 |
| Max. Negotiated Rate |
$149.54 |
| Rate for Payer: Adventist Health Commercial |
$39.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$136.97
|
| Rate for Payer: Cash Price |
$89.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$134.98
|
| Rate for Payer: Heritage Provider Network Senior |
$134.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.84
|
| Rate for Payer: Multiplan Commercial |
$149.54
|
|
|
HC SOM TESTOSTERONE FREE
|
Facility
IP
|
$8.94
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
900911131
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$6.70 |
| Rate for Payer: Adventist Health Commercial |
$1.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.14
|
| Rate for Payer: Cash Price |
$4.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.05
|
| Rate for Payer: Heritage Provider Network Senior |
$6.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.24
|
| Rate for Payer: Multiplan Commercial |
$6.70
|
|
|
HC SOM TESTOSTERONE FREE
|
Facility
OP
|
$8.94
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
900911131
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$217.68 |
| Rate for Payer: Adventist Health Commercial |
$1.79
|
| Rate for Payer: Aetna of CA Gatekeeper |
$74.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$38.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$28.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$25.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$217.68
|
| Rate for Payer: Blue Shield of California Commercial |
$198.84
|
| Rate for Payer: Blue Shield of California EPN |
$155.44
|
| Rate for Payer: Cash Price |
$4.02
|
| Rate for Payer: Cash Price |
$4.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.02
|
| Rate for Payer: Dignity Health Senior |
$25.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.81
|
| Rate for Payer: EPIC Health Plan Medicare |
$25.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.53
|
| Rate for Payer: Heritage Provider Network Senior |
$5.53
|
| Rate for Payer: Humana Medicare |
$25.47
|
| Rate for Payer: IEHP Medi-Cal |
$35.32
|
| Rate for Payer: IEHP Medicare Advantage |
$25.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$48.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.09
|
| Rate for Payer: Multiplan Commercial |
$6.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$25.47
|
| Rate for Payer: TriValley Medical Group Senior |
$25.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.02
|
| Rate for Payer: Vantage Medical Group Senior |
$25.47
|
|
|
HC SOM TETANUS ANTITOXOID (ELISA)
|
Facility
IP
|
$20.42
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900911757
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.70 |
| Max. Negotiated Rate |
$15.32 |
| Rate for Payer: Adventist Health Commercial |
$4.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.03
|
| Rate for Payer: Cash Price |
$9.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.82
|
| Rate for Payer: Heritage Provider Network Senior |
$13.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.10
|
| Rate for Payer: Multiplan Commercial |
$15.32
|
|
|
HC SOM TETANUS ANTITOXOID (ELISA)
|
Facility
OP
|
$20.42
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900911757
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.70 |
| Max. Negotiated Rate |
$125.49 |
| Rate for Payer: Adventist Health Commercial |
$4.08
|
| Rate for Payer: Aetna of CA Gatekeeper |
$43.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.49
|
| Rate for Payer: Blue Shield of California Commercial |
$117.11
|
| Rate for Payer: Blue Shield of California EPN |
$91.55
|
| Rate for Payer: Cash Price |
$9.19
|
| Rate for Payer: Cash Price |
$9.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.49
|
| Rate for Payer: Dignity Health Senior |
$14.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.27
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.64
|
| Rate for Payer: Heritage Provider Network Senior |
$12.64
|
| Rate for Payer: Humana Medicare |
$14.99
|
| Rate for Payer: IEHP Medi-Cal |
$16.36
|
| Rate for Payer: IEHP Medicare Advantage |
$14.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$28.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.89
|
| Rate for Payer: Multiplan Commercial |
$15.32
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.99
|
| Rate for Payer: TriValley Medical Group Senior |
$14.99
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: Vantage Medical Group Senior |
$14.99
|
|
|
HC SOM TGFBR2 FULL SEQUENCE
|
Facility
IP
|
$1,362.50
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
900914669
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$246.61 |
| Max. Negotiated Rate |
$1,021.88 |
| Rate for Payer: Adventist Health Commercial |
$272.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$936.04
|
| Rate for Payer: Cash Price |
$613.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$922.41
|
| Rate for Payer: Heritage Provider Network Senior |
$922.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$246.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$340.62
|
| Rate for Payer: Multiplan Commercial |
$1,021.88
|
|
|
HC SOM TGFBR2 FULL SEQUENCE
|
Facility
OP
|
$1,362.50
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
900914669
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$145.94 |
| Max. Negotiated Rate |
$1,252.63 |
| Rate for Payer: Adventist Health Commercial |
$272.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$145.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$936.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$277.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$203.72
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$185.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,252.63
|
| Rate for Payer: Blue Shield of California Commercial |
$846.11
|
| Rate for Payer: Blue Shield of California EPN |
$799.79
|
| Rate for Payer: Cash Price |
$613.13
|
| Rate for Payer: Cash Price |
$613.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$885.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$277.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$203.72
|
| Rate for Payer: Dignity Health Senior |
$185.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$885.62
|
| Rate for Payer: EPIC Health Plan Medicare |
$185.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$843.39
|
| Rate for Payer: Heritage Provider Network Senior |
$843.39
|
| Rate for Payer: Humana Medicare |
$185.20
|
| Rate for Payer: IEHP Medi-Cal |
$288.91
|
| Rate for Payer: IEHP Medicare Advantage |
$185.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$351.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$246.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$218.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$340.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$233.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$233.35
|
| Rate for Payer: Multiplan Commercial |
$1,021.88
|
| Rate for Payer: TriValley Medical Group Commercial |
$185.20
|
| Rate for Payer: TriValley Medical Group Senior |
$185.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$200.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$200.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$277.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$203.72
|
| Rate for Payer: Vantage Medical Group Senior |
$185.20
|
|
|
HC SOM THALLIUM URINE
|
Facility
IP
|
$129.00
|
|
|
Service Code
|
CPT 83018
|
| Hospital Charge Code |
900911102
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.35 |
| Max. Negotiated Rate |
$96.75 |
| Rate for Payer: Adventist Health Commercial |
$25.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$88.62
|
| Rate for Payer: Cash Price |
$58.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$87.33
|
| Rate for Payer: Heritage Provider Network Senior |
$87.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.25
|
| Rate for Payer: Multiplan Commercial |
$96.75
|
|
|
HC SOM THALLIUM URINE
|
Facility
OP
|
$129.00
|
|
|
Service Code
|
CPT 83018
|
| Hospital Charge Code |
900911102
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.96 |
| Max. Negotiated Rate |
$171.50 |
| Rate for Payer: Adventist Health Commercial |
$25.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$63.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$88.62
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$32.94
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24.16
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.98
|
| Rate for Payer: Blue Shield of California Commercial |
$171.50
|
| Rate for Payer: Blue Shield of California EPN |
$134.07
|
| Rate for Payer: Cash Price |
$58.05
|
| Rate for Payer: Cash Price |
$58.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$83.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.16
|
| Rate for Payer: Dignity Health Senior |
$21.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$21.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$79.85
|
| Rate for Payer: Heritage Provider Network Senior |
$79.85
|
| Rate for Payer: Humana Medicare |
$21.96
|
| Rate for Payer: IEHP Medi-Cal |
$30.45
|
| Rate for Payer: IEHP Medicare Advantage |
$21.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$41.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.67
|
| Rate for Payer: Multiplan Commercial |
$96.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.96
|
| Rate for Payer: TriValley Medical Group Senior |
$21.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.16
|
| Rate for Payer: Vantage Medical Group Senior |
$21.96
|
|
|
HC SOM THC CONFIRMATION, U
|
Facility
OP
|
$31.60
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
900912921
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$190.18 |
| Rate for Payer: Adventist Health Commercial |
$6.32
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.71
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$26.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$17.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$23.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$190.18
|
| Rate for Payer: Cash Price |
$14.22
|
| Rate for Payer: Cash Price |
$14.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.86
|
| Rate for Payer: Dignity Health Senior |
$26.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.56
|
| Rate for Payer: Heritage Provider Network Senior |
$19.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$15.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.90
|
| Rate for Payer: Multiplan Commercial |
$23.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.86
|
| Rate for Payer: Vantage Medical Group Senior |
$26.86
|
|
|
HC SOM THC CONFIRMATION, U
|
Facility
IP
|
$31.60
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
900912921
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$23.70 |
| Rate for Payer: Adventist Health Commercial |
$6.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.71
|
| Rate for Payer: Cash Price |
$14.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.39
|
| Rate for Payer: Heritage Provider Network Senior |
$21.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.90
|
| Rate for Payer: Multiplan Commercial |
$23.70
|
|
|
HC SOM THIOPURINE METAB
|
Facility
IP
|
$178.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900914912
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$32.22 |
| Max. Negotiated Rate |
$133.50 |
| Rate for Payer: Adventist Health Commercial |
$35.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$122.29
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$120.51
|
| Rate for Payer: Heritage Provider Network Senior |
$120.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.50
|
| Rate for Payer: Multiplan Commercial |
$133.50
|
|
|
HC SOM THIOPURINE METAB
|
Facility
OP
|
$178.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900914912
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$133.50 |
| Rate for Payer: Adventist Health Commercial |
$35.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$38.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$122.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.89
|
| Rate for Payer: Blue Shield of California Commercial |
$106.94
|
| Rate for Payer: Blue Shield of California EPN |
$83.60
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$115.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Senior |
$18.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$110.18
|
| Rate for Payer: Heritage Provider Network Senior |
$110.18
|
| Rate for Payer: Humana Medicare |
$18.64
|
| Rate for Payer: IEHP Medi-Cal |
$19.64
|
| Rate for Payer: IEHP Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$35.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.49
|
| Rate for Payer: Multiplan Commercial |
$133.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.64
|
| Rate for Payer: TriValley Medical Group Senior |
$18.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC SOM THYROBLUBULIN AB
|
Facility
IP
|
$15.00
|
|
|
Service Code
|
CPT 86800
|
| Hospital Charge Code |
900910558
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$11.25 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.16
|
| Rate for Payer: Heritage Provider Network Senior |
$10.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
|
|
HC SOM THYROBLUBULIN AB
|
Facility
OP
|
$15.00
|
|
|
Service Code
|
CPT 86800
|
| Hospital Charge Code |
900910558
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$133.10 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$46.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$23.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$17.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.10
|
| Rate for Payer: Blue Shield of California Commercial |
$124.21
|
| Rate for Payer: Blue Shield of California EPN |
$97.10
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.50
|
| Rate for Payer: Dignity Health Senior |
$15.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.28
|
| Rate for Payer: Heritage Provider Network Senior |
$9.28
|
| Rate for Payer: Humana Medicare |
$15.91
|
| Rate for Payer: IEHP Medi-Cal |
$17.38
|
| Rate for Payer: IEHP Medicare Advantage |
$15.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$30.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.05
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.91
|
| Rate for Payer: TriValley Medical Group Senior |
$15.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.50
|
| Rate for Payer: Vantage Medical Group Senior |
$15.91
|
|
|
HC SOM THYROGLOBULIN TM THYRO AB
|
Facility
IP
|
$22.78
|
|
|
Service Code
|
CPT 86800
|
| Hospital Charge Code |
900915315
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$17.08 |
| Rate for Payer: Adventist Health Commercial |
$4.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.65
|
| Rate for Payer: Cash Price |
$10.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.42
|
| Rate for Payer: Heritage Provider Network Senior |
$15.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.70
|
| Rate for Payer: Multiplan Commercial |
$17.08
|
|
|
HC SOM THYROGLOBULIN TM THYRO AB
|
Facility
OP
|
$22.78
|
|
|
Service Code
|
CPT 86800
|
| Hospital Charge Code |
900915315
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$133.10 |
| Rate for Payer: Adventist Health Commercial |
$4.56
|
| Rate for Payer: Aetna of CA Gatekeeper |
$46.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.65
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$23.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$17.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.10
|
| Rate for Payer: Blue Shield of California Commercial |
$124.21
|
| Rate for Payer: Blue Shield of California EPN |
$97.10
|
| Rate for Payer: Cash Price |
$10.25
|
| Rate for Payer: Cash Price |
$10.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.50
|
| Rate for Payer: Dignity Health Senior |
$15.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.81
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.10
|
| Rate for Payer: Heritage Provider Network Senior |
$14.10
|
| Rate for Payer: Humana Medicare |
$15.91
|
| Rate for Payer: IEHP Medi-Cal |
$17.38
|
| Rate for Payer: IEHP Medicare Advantage |
$15.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$30.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.05
|
| Rate for Payer: Multiplan Commercial |
$17.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.91
|
| Rate for Payer: TriValley Medical Group Senior |
$15.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.50
|
| Rate for Payer: Vantage Medical Group Senior |
$15.91
|
|
|
HC SOM THYROGLOBULIN TUMOR MARKER TM
|
Facility
OP
|
$10.20
|
|
|
Service Code
|
CPT 84432
|
| Hospital Charge Code |
900912645
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$137.10 |
| Rate for Payer: Adventist Health Commercial |
$2.04
|
| Rate for Payer: Aetna of CA Gatekeeper |
$46.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$24.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$17.67
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$137.10
|
| Rate for Payer: Blue Shield of California Commercial |
$125.44
|
| Rate for Payer: Blue Shield of California EPN |
$98.06
|
| Rate for Payer: Cash Price |
$4.59
|
| Rate for Payer: Cash Price |
$4.59
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.67
|
| Rate for Payer: Dignity Health Senior |
$16.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.63
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.31
|
| Rate for Payer: Heritage Provider Network Senior |
$6.31
|
| Rate for Payer: Humana Medicare |
$16.06
|
| Rate for Payer: IEHP Medi-Cal |
$22.28
|
| Rate for Payer: IEHP Medicare Advantage |
$16.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$30.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.24
|
| Rate for Payer: Multiplan Commercial |
$7.65
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.06
|
| Rate for Payer: TriValley Medical Group Senior |
$16.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.67
|
| Rate for Payer: Vantage Medical Group Senior |
$16.06
|
|
