|
HC SOM VITAMIN A
|
Facility
IP
|
$17.90
|
|
|
Service Code
|
CPT 84590
|
| Hospital Charge Code |
900911173
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.24 |
| Max. Negotiated Rate |
$13.42 |
| Rate for Payer: Adventist Health Commercial |
$3.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.30
|
| Rate for Payer: Cash Price |
$8.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.12
|
| Rate for Payer: Heritage Provider Network Senior |
$12.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.48
|
| Rate for Payer: Multiplan Commercial |
$13.42
|
|
|
HC SOM VITAMIN A
|
Facility
OP
|
$17.90
|
|
|
Service Code
|
CPT 84590
|
| Hospital Charge Code |
900911173
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.24 |
| Max. Negotiated Rate |
$97.04 |
| Rate for Payer: Adventist Health Commercial |
$3.58
|
| Rate for Payer: Aetna of CA Gatekeeper |
$33.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.42
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12.77
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.04
|
| Rate for Payer: Blue Shield of California Commercial |
$90.56
|
| Rate for Payer: Blue Shield of California EPN |
$70.79
|
| Rate for Payer: Cash Price |
$8.06
|
| Rate for Payer: Cash Price |
$8.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.77
|
| Rate for Payer: Dignity Health Senior |
$11.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.64
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.08
|
| Rate for Payer: Heritage Provider Network Senior |
$11.08
|
| Rate for Payer: Humana Medicare |
$11.61
|
| Rate for Payer: IEHP Medi-Cal |
$15.93
|
| Rate for Payer: IEHP Medicare Advantage |
$11.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$22.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.63
|
| Rate for Payer: Multiplan Commercial |
$13.42
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.61
|
| Rate for Payer: TriValley Medical Group Senior |
$11.61
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.77
|
| Rate for Payer: Vantage Medical Group Senior |
$11.61
|
|
|
HC SOM VITAMIN B1 (THIAMINE)
|
Facility
IP
|
$22.00
|
|
|
Service Code
|
CPT 84425
|
| Hospital Charge Code |
900911048
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$16.50 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.11
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.89
|
| Rate for Payer: Heritage Provider Network Senior |
$14.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.50
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
|
|
HC SOM VITAMIN B1 (THIAMINE)
|
Facility
OP
|
$22.00
|
|
|
Service Code
|
CPT 84425
|
| Hospital Charge Code |
900911048
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$165.86 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$61.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$31.84
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$23.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.96
|
| Rate for Payer: Blue Shield of California Commercial |
$165.86
|
| Rate for Payer: Blue Shield of California EPN |
$129.66
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.35
|
| Rate for Payer: Dignity Health Senior |
$21.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$21.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.62
|
| Rate for Payer: Heritage Provider Network Senior |
$13.62
|
| Rate for Payer: Humana Medicare |
$21.23
|
| Rate for Payer: IEHP Medi-Cal |
$29.44
|
| Rate for Payer: IEHP Medicare Advantage |
$21.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$40.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.75
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.23
|
| Rate for Payer: TriValley Medical Group Senior |
$21.23
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.35
|
| Rate for Payer: Vantage Medical Group Senior |
$21.23
|
|
|
HC SOM VITAMIN B6
|
Facility
OP
|
$28.25
|
|
|
Service Code
|
CPT 84207
|
| Hospital Charge Code |
900911400
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.11 |
| Max. Negotiated Rate |
$219.41 |
| Rate for Payer: Adventist Health Commercial |
$5.65
|
| Rate for Payer: Aetna of CA Gatekeeper |
$81.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$42.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$30.91
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$28.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$199.60
|
| Rate for Payer: Blue Shield of California Commercial |
$219.41
|
| Rate for Payer: Blue Shield of California EPN |
$171.52
|
| Rate for Payer: Cash Price |
$12.71
|
| Rate for Payer: Cash Price |
$12.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.91
|
| Rate for Payer: Dignity Health Senior |
$28.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.36
|
| Rate for Payer: EPIC Health Plan Medicare |
$28.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.49
|
| Rate for Payer: Heritage Provider Network Senior |
$17.49
|
| Rate for Payer: Humana Medicare |
$28.10
|
| Rate for Payer: IEHP Medi-Cal |
$38.95
|
| Rate for Payer: IEHP Medicare Advantage |
$28.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$53.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.41
|
| Rate for Payer: Multiplan Commercial |
$21.19
|
| Rate for Payer: TriValley Medical Group Commercial |
$28.10
|
| Rate for Payer: TriValley Medical Group Senior |
$28.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$30.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$30.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.91
|
| Rate for Payer: Vantage Medical Group Senior |
$28.10
|
|
|
HC SOM VITAMIN B6
|
Facility
IP
|
$28.25
|
|
|
Service Code
|
CPT 84207
|
| Hospital Charge Code |
900911400
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.11 |
| Max. Negotiated Rate |
$21.19 |
| Rate for Payer: Adventist Health Commercial |
$5.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.41
|
| Rate for Payer: Cash Price |
$12.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.13
|
| Rate for Payer: Heritage Provider Network Senior |
$19.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.06
|
| Rate for Payer: Multiplan Commercial |
$21.19
|
|
|
HC SOM VITAMIN D 25-HYDROXY
|
Facility
OP
|
$8.00
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
900911032
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$247.78 |
| Rate for Payer: Adventist Health Commercial |
$1.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$86.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$44.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$32.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$29.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$247.78
|
| Rate for Payer: Blue Shield of California Commercial |
$231.20
|
| Rate for Payer: Blue Shield of California EPN |
$180.74
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.56
|
| Rate for Payer: Dignity Health Senior |
$29.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$29.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.95
|
| Rate for Payer: Heritage Provider Network Senior |
$4.95
|
| Rate for Payer: Humana Medicare |
$29.60
|
| Rate for Payer: IEHP Medi-Cal |
$32.32
|
| Rate for Payer: IEHP Medicare Advantage |
$29.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$56.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.30
|
| Rate for Payer: Multiplan Commercial |
$6.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$29.60
|
| Rate for Payer: TriValley Medical Group Senior |
$29.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$31.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.56
|
| Rate for Payer: Vantage Medical Group Senior |
$29.60
|
|
|
HC SOM VITAMIN D 25-HYDROXY
|
Facility
IP
|
$8.00
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
900911032
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Adventist Health Commercial |
$1.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.50
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.42
|
| Rate for Payer: Heritage Provider Network Senior |
$5.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Multiplan Commercial |
$6.00
|
|
|
HC SOM VOLATILES BLOOD
|
Facility
IP
|
$45.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
900910583
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$33.75 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.92
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.46
|
| Rate for Payer: Heritage Provider Network Senior |
$30.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.25
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
|
|
HC SOM VOLATILES BLOOD
|
Facility
OP
|
$45.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
900910583
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$86.78 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$38.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$33.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.78
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.25
|
| Rate for Payer: Dignity Health Senior |
$38.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.86
|
| Rate for Payer: Heritage Provider Network Senior |
$27.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$21.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.25
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.25
|
| Rate for Payer: Vantage Medical Group Senior |
$38.25
|
|
|
HC SOM VOLATILES URINE
|
Facility
OP
|
$45.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
900910584
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$86.78 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$38.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$33.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.78
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.25
|
| Rate for Payer: Dignity Health Senior |
$38.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.86
|
| Rate for Payer: Heritage Provider Network Senior |
$27.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$21.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.25
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.25
|
| Rate for Payer: Vantage Medical Group Senior |
$38.25
|
|
|
HC SOM VOLATILES URINE
|
Facility
IP
|
$45.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
900910584
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$33.75 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.92
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.46
|
| Rate for Payer: Heritage Provider Network Senior |
$30.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.25
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
|
|
HC SOM VONWILLEBRAND AG
|
Facility
OP
|
$25.34
|
|
|
Service Code
|
CPT 85246
|
| Hospital Charge Code |
900910112
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.59 |
| Max. Negotiated Rate |
$192.04 |
| Rate for Payer: Adventist Health Commercial |
$5.07
|
| Rate for Payer: Aetna of CA Gatekeeper |
$66.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$34.41
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$25.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$192.04
|
| Rate for Payer: Blue Shield of California Commercial |
$179.22
|
| Rate for Payer: Blue Shield of California EPN |
$140.10
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.23
|
| Rate for Payer: Dignity Health Senior |
$22.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.47
|
| Rate for Payer: EPIC Health Plan Medicare |
$22.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.69
|
| Rate for Payer: Heritage Provider Network Senior |
$15.69
|
| Rate for Payer: Humana Medicare |
$22.94
|
| Rate for Payer: IEHP Medi-Cal |
$31.81
|
| Rate for Payer: IEHP Medicare Advantage |
$22.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$43.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.90
|
| Rate for Payer: Multiplan Commercial |
$19.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$22.94
|
| Rate for Payer: TriValley Medical Group Senior |
$22.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$24.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$24.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.23
|
| Rate for Payer: Vantage Medical Group Senior |
$22.94
|
|
|
HC SOM VONWILLEBRAND AG
|
Facility
IP
|
$25.34
|
|
|
Service Code
|
CPT 85246
|
| Hospital Charge Code |
900910112
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.59 |
| Max. Negotiated Rate |
$19.00 |
| Rate for Payer: Adventist Health Commercial |
$5.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.41
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.16
|
| Rate for Payer: Heritage Provider Network Senior |
$17.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.34
|
| Rate for Payer: Multiplan Commercial |
$19.00
|
|
|
HC SOM VON WILLEBRAND FACTOR ACTIVITY
|
Facility
IP
|
$74.20
|
|
|
Service Code
|
CPT 85397
|
| Hospital Charge Code |
900912874
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.43 |
| Max. Negotiated Rate |
$55.65 |
| Rate for Payer: Adventist Health Commercial |
$14.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$50.98
|
| Rate for Payer: Cash Price |
$33.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.23
|
| Rate for Payer: Heritage Provider Network Senior |
$50.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.55
|
| Rate for Payer: Multiplan Commercial |
$55.65
|
|
|
HC SOM VON WILLEBRAND FACTOR ACTIVITY
|
Facility
OP
|
$74.20
|
|
|
Service Code
|
CPT 85397
|
| Hospital Charge Code |
900912874
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.43 |
| Max. Negotiated Rate |
$191.48 |
| Rate for Payer: Adventist Health Commercial |
$14.84
|
| Rate for Payer: Aetna of CA Gatekeeper |
$66.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$50.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$46.29
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$33.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$30.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$191.48
|
| Rate for Payer: Blue Shield of California Commercial |
$187.32
|
| Rate for Payer: Blue Shield of California EPN |
$146.44
|
| Rate for Payer: Cash Price |
$33.39
|
| Rate for Payer: Cash Price |
$33.39
|
| Rate for Payer: Cigna of CA HMO/PPO |
$48.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.95
|
| Rate for Payer: Dignity Health Senior |
$30.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.23
|
| Rate for Payer: EPIC Health Plan Medicare |
$30.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$45.93
|
| Rate for Payer: Heritage Provider Network Senior |
$45.93
|
| Rate for Payer: Humana Medicare |
$30.86
|
| Rate for Payer: IEHP Medi-Cal |
$38.50
|
| Rate for Payer: IEHP Medicare Advantage |
$30.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$58.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$38.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$38.88
|
| Rate for Payer: Multiplan Commercial |
$55.65
|
| Rate for Payer: TriValley Medical Group Commercial |
$30.86
|
| Rate for Payer: TriValley Medical Group Senior |
$30.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$33.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$33.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.95
|
| Rate for Payer: Vantage Medical Group Senior |
$30.86
|
|
|
HC SOM VON WILLEBRAND FACTOR MULTIMER P
|
Facility
OP
|
$51.10
|
|
|
Service Code
|
CPT 85247
|
| Hospital Charge Code |
900910113
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.25 |
| Max. Negotiated Rate |
$192.04 |
| Rate for Payer: Adventist Health Commercial |
$10.22
|
| Rate for Payer: Aetna of CA Gatekeeper |
$66.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$35.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$34.41
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$25.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$192.04
|
| Rate for Payer: Blue Shield of California Commercial |
$179.22
|
| Rate for Payer: Blue Shield of California EPN |
$140.10
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$33.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.23
|
| Rate for Payer: Dignity Health Senior |
$22.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.22
|
| Rate for Payer: EPIC Health Plan Medicare |
$22.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.63
|
| Rate for Payer: Heritage Provider Network Senior |
$31.63
|
| Rate for Payer: Humana Medicare |
$22.94
|
| Rate for Payer: IEHP Medi-Cal |
$31.81
|
| Rate for Payer: IEHP Medicare Advantage |
$22.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$43.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.90
|
| Rate for Payer: Multiplan Commercial |
$38.32
|
| Rate for Payer: TriValley Medical Group Commercial |
$22.94
|
| Rate for Payer: TriValley Medical Group Senior |
$22.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$24.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$24.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.23
|
| Rate for Payer: Vantage Medical Group Senior |
$22.94
|
|
|
HC SOM VON WILLEBRAND FACTOR MULTIMER P
|
Facility
IP
|
$51.10
|
|
|
Service Code
|
CPT 85247
|
| Hospital Charge Code |
900910113
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.25 |
| Max. Negotiated Rate |
$38.32 |
| Rate for Payer: Adventist Health Commercial |
$10.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$35.11
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.59
|
| Rate for Payer: Heritage Provider Network Senior |
$34.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.78
|
| Rate for Payer: Multiplan Commercial |
$38.32
|
|
|
HC SOM VORICONAZOLE LEVEL
|
Facility
IP
|
$27.11
|
|
|
Service Code
|
CPT 80285
|
| Hospital Charge Code |
900912707
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.91 |
| Max. Negotiated Rate |
$20.33 |
| Rate for Payer: Adventist Health Commercial |
$5.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.62
|
| Rate for Payer: Cash Price |
$12.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.35
|
| Rate for Payer: Heritage Provider Network Senior |
$18.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.78
|
| Rate for Payer: Multiplan Commercial |
$20.33
|
|
|
HC SOM VORICONAZOLE LEVEL
|
Facility
OP
|
$27.11
|
|
|
Service Code
|
CPT 80285
|
| Hospital Charge Code |
900912707
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.91 |
| Max. Negotiated Rate |
$151.54 |
| Rate for Payer: Adventist Health Commercial |
$5.42
|
| Rate for Payer: Aetna of CA Gatekeeper |
$56.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.62
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$40.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$29.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$27.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$80.41
|
| Rate for Payer: Blue Shield of California Commercial |
$151.54
|
| Rate for Payer: Blue Shield of California EPN |
$118.47
|
| Rate for Payer: Cash Price |
$12.20
|
| Rate for Payer: Cash Price |
$12.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.82
|
| Rate for Payer: Dignity Health Senior |
$27.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.62
|
| Rate for Payer: EPIC Health Plan Medicare |
$27.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.78
|
| Rate for Payer: Heritage Provider Network Senior |
$16.78
|
| Rate for Payer: Humana Medicare |
$27.11
|
| Rate for Payer: IEHP Medi-Cal |
$33.84
|
| Rate for Payer: IEHP Medicare Advantage |
$27.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$51.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.16
|
| Rate for Payer: Multiplan Commercial |
$20.33
|
| Rate for Payer: TriValley Medical Group Commercial |
$27.11
|
| Rate for Payer: TriValley Medical Group Senior |
$27.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$29.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$29.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.82
|
| Rate for Payer: Vantage Medical Group Senior |
$27.11
|
|
|
HC SOM VPHIV 87900
|
Facility
IP
|
$174.30
|
|
|
Service Code
|
CPT 87900
|
| Hospital Charge Code |
900914741
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$31.55 |
| Max. Negotiated Rate |
$130.72 |
| Rate for Payer: Adventist Health Commercial |
$34.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$119.74
|
| Rate for Payer: Cash Price |
$78.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$118.00
|
| Rate for Payer: Heritage Provider Network Senior |
$118.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.58
|
| Rate for Payer: Multiplan Commercial |
$130.72
|
|
|
HC SOM VPHIV 87900
|
Facility
OP
|
$174.30
|
|
|
Service Code
|
CPT 87900
|
| Hospital Charge Code |
900914741
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$31.55 |
| Max. Negotiated Rate |
$1,067.23 |
| Rate for Payer: Adventist Health Commercial |
$34.86
|
| Rate for Payer: Aetna of CA Gatekeeper |
$379.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$119.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$195.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$143.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$130.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,067.23
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.99
|
| Rate for Payer: Blue Shield of California EPN |
$795.82
|
| Rate for Payer: Cash Price |
$78.44
|
| Rate for Payer: Cash Price |
$78.44
|
| Rate for Payer: Cigna of CA HMO/PPO |
$113.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$195.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$143.38
|
| Rate for Payer: Dignity Health Senior |
$130.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$130.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$107.89
|
| Rate for Payer: Heritage Provider Network Senior |
$107.89
|
| Rate for Payer: Humana Medicare |
$130.35
|
| Rate for Payer: IEHP Medi-Cal |
$180.74
|
| Rate for Payer: IEHP Medicare Advantage |
$130.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$247.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$153.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$164.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$164.24
|
| Rate for Payer: Multiplan Commercial |
$130.72
|
| Rate for Payer: TriValley Medical Group Commercial |
$130.35
|
| Rate for Payer: TriValley Medical Group Senior |
$130.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$140.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$140.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$195.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$143.38
|
| Rate for Payer: Vantage Medical Group Senior |
$130.35
|
|
|
HC SOM WESTERN EQUINE ENCEPH AB IGG
|
Facility
IP
|
$25.00
|
|
|
Service Code
|
CPT 86654
|
| Hospital Charge Code |
900911337
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.18
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.92
|
| Rate for Payer: Heritage Provider Network Senior |
$16.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
|
|
HC SOM WESTERN EQUINE ENCEPH AB IGG
|
Facility
OP
|
$25.00
|
|
|
Service Code
|
CPT 86654
|
| Hospital Charge Code |
900911337
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$110.39 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$38.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.39
|
| Rate for Payer: Blue Shield of California Commercial |
$103.02
|
| Rate for Payer: Blue Shield of California EPN |
$80.54
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.51
|
| Rate for Payer: Dignity Health Senior |
$13.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.48
|
| Rate for Payer: Heritage Provider Network Senior |
$15.48
|
| Rate for Payer: Humana Medicare |
$13.19
|
| Rate for Payer: IEHP Medi-Cal |
$18.28
|
| Rate for Payer: IEHP Medicare Advantage |
$13.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.62
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.19
|
| Rate for Payer: TriValley Medical Group Senior |
$13.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Vantage Medical Group Senior |
$13.19
|
|
|
HC SOM WESTERN EQUINE ENCEPH AB IGM
|
Facility
OP
|
$25.00
|
|
|
Service Code
|
CPT 86654
|
| Hospital Charge Code |
900912651
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$110.39 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$38.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.39
|
| Rate for Payer: Blue Shield of California Commercial |
$103.02
|
| Rate for Payer: Blue Shield of California EPN |
$80.54
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.51
|
| Rate for Payer: Dignity Health Senior |
$13.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.48
|
| Rate for Payer: Heritage Provider Network Senior |
$15.48
|
| Rate for Payer: Humana Medicare |
$13.19
|
| Rate for Payer: IEHP Medi-Cal |
$18.28
|
| Rate for Payer: IEHP Medicare Advantage |
$13.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.62
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.19
|
| Rate for Payer: TriValley Medical Group Senior |
$13.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Vantage Medical Group Senior |
$13.19
|
|
