|
HC VENOUS M-THROMBECTOMY ADD-ON
|
Facility
|
IP
|
$19,760.00
|
|
|
Service Code
|
CPT 37188
|
| Hospital Charge Code |
909081847
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,952.00 |
| Max. Negotiated Rate |
$17,784.00 |
| Rate for Payer: Adventist Health Commercial |
$3,952.00
|
| Rate for Payer: Cash Price |
$8,892.00
|
| Rate for Payer: Central Health Plan Commercial |
$15,808.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13,832.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,904.00
|
| Rate for Payer: EPIC Health Plan Senior |
$7,904.00
|
| Rate for Payer: Galaxy Health WC |
$16,796.00
|
| Rate for Payer: Global Benefits Group Commercial |
$11,856.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,784.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12,547.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11,658.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,952.00
|
| Rate for Payer: Multiplan Commercial |
$14,820.00
|
| Rate for Payer: Networks By Design Commercial |
$12,844.00
|
| Rate for Payer: Prime Health Services Commercial |
$16,796.00
|
|
|
HC VENOUS M-THROMBECTOMY ADD-ON
|
Facility
|
OP
|
$19,760.00
|
|
|
Service Code
|
CPT 37188
|
| Hospital Charge Code |
909081847
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$764.59 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$3,952.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,061.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,372.03
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$8,892.00
|
| Rate for Payer: Cash Price |
$8,892.00
|
| Rate for Payer: Cash Price |
$8,892.00
|
| Rate for Payer: Central Health Plan Commercial |
$15,808.00
|
| Rate for Payer: Cigna of CA HMO |
$12,646.40
|
| Rate for Payer: Cigna of CA PPO |
$14,622.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13,832.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| Rate for Payer: Galaxy Health WC |
$16,796.00
|
| Rate for Payer: Global Benefits Group Commercial |
$11,856.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,784.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$764.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12,547.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$844.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,952.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$14,820.00
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$12,844.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Preferred Health Network WC |
$6,502.07
|
| Rate for Payer: Prime Health Services Commercial |
$16,796.00
|
| Rate for Payer: Prime Health Services Medicare |
$4,304.71
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Riverside University Health System MISP |
$4,467.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,856.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,880.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC VENOUS PORT EXCHANGE
|
Facility
|
OP
|
$10,415.00
|
|
|
Service Code
|
CPT 37799
|
| Hospital Charge Code |
906811800
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$806.82 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,083.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$806.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$806.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,042.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,058.41
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,251.66
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$4,686.75
|
| Rate for Payer: Cash Price |
$4,686.75
|
| Rate for Payer: Cash Price |
$4,686.75
|
| Rate for Payer: Central Health Plan Commercial |
$8,332.00
|
| Rate for Payer: Cigna of CA HMO |
$6,665.60
|
| Rate for Payer: Cigna of CA PPO |
$7,707.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$887.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$806.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,290.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,331.25
|
| Rate for Payer: EPIC Health Plan Senior |
$887.50
|
| Rate for Payer: Galaxy Health WC |
$8,852.75
|
| Rate for Payer: Global Benefits Group Commercial |
$6,249.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,373.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,323.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$806.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,613.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,129.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,083.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,081.14
|
| Rate for Payer: Multiplan Commercial |
$7,811.25
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: Networks By Design Commercial |
$6,769.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$806.82
|
| Rate for Payer: Preferred Health Network WC |
$1,277.20
|
| Rate for Payer: Prime Health Services Commercial |
$8,852.75
|
| Rate for Payer: Prime Health Services Medicare |
$855.23
|
| Rate for Payer: Prime Health Services WC |
$1,238.88
|
| Rate for Payer: Riverside University Health System MISP |
$887.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,249.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,207.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$806.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Vantage Medical Group Senior |
$806.82
|
|
|
HC VENOUS PORT EXCHANGE
|
Facility
|
IP
|
$10,415.00
|
|
|
Service Code
|
CPT 37799
|
| Hospital Charge Code |
906811800
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,083.00 |
| Max. Negotiated Rate |
$9,373.50 |
| Rate for Payer: Adventist Health Commercial |
$2,083.00
|
| Rate for Payer: Cash Price |
$4,686.75
|
| Rate for Payer: Central Health Plan Commercial |
$8,332.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,290.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,166.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,166.00
|
| Rate for Payer: Galaxy Health WC |
$8,852.75
|
| Rate for Payer: Global Benefits Group Commercial |
$6,249.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,373.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,613.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,144.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,083.00
|
| Rate for Payer: Multiplan Commercial |
$7,811.25
|
| Rate for Payer: Networks By Design Commercial |
$6,769.75
|
| Rate for Payer: Prime Health Services Commercial |
$8,852.75
|
|
|
HC VENOUS SAMPLING
|
Facility
|
OP
|
$11,533.00
|
|
|
Service Code
|
CPT 75893
|
| Hospital Charge Code |
909081644
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$969.75 |
| Max. Negotiated Rate |
$11,808.82 |
| Rate for Payer: Adventist Health Commercial |
$2,306.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$7,156.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$969.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,156.86
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,608.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,626.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,265.79
|
| Rate for Payer: Blue Shield of California EPN |
$4,578.60
|
| Rate for Payer: Cash Price |
$5,189.85
|
| Rate for Payer: Cash Price |
$5,189.85
|
| Rate for Payer: Central Health Plan Commercial |
$9,226.40
|
| Rate for Payer: Cigna of CA HMO |
$7,381.12
|
| Rate for Payer: Cigna of CA PPO |
$8,534.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,872.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,156.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,073.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,808.82
|
| Rate for Payer: EPIC Health Plan Senior |
$7,872.55
|
| Rate for Payer: Galaxy Health WC |
$9,803.05
|
| Rate for Payer: Global Benefits Group Commercial |
$6,919.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,379.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,737.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,156.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,323.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,019.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,306.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,590.19
|
| Rate for Payer: Multiplan Commercial |
$8,649.75
|
| Rate for Payer: Networks By Design Commercial |
$7,496.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,156.86
|
| Rate for Payer: Prime Health Services Commercial |
$9,803.05
|
| Rate for Payer: Prime Health Services Medicare |
$7,586.27
|
| Rate for Payer: Riverside University Health System MISP |
$7,872.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,919.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,919.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,341.78
|
| Rate for Payer: United Healthcare All Other HMO |
$5,341.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5,341.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,341.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,156.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Vantage Medical Group Senior |
$7,156.86
|
|
|
HC VENOUS SAMPLING
|
Facility
|
IP
|
$11,533.00
|
|
|
Service Code
|
CPT 75893
|
| Hospital Charge Code |
909081644
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,306.60 |
| Max. Negotiated Rate |
$10,379.70 |
| Rate for Payer: Adventist Health Commercial |
$2,306.60
|
| Rate for Payer: Cash Price |
$5,189.85
|
| Rate for Payer: Central Health Plan Commercial |
$9,226.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,073.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,613.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,613.20
|
| Rate for Payer: Galaxy Health WC |
$9,803.05
|
| Rate for Payer: Global Benefits Group Commercial |
$6,919.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,379.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,323.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,804.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,306.60
|
| Rate for Payer: Multiplan Commercial |
$8,649.75
|
| Rate for Payer: Networks By Design Commercial |
$7,496.45
|
| Rate for Payer: Prime Health Services Commercial |
$9,803.05
|
|
|
HC VENOUS THROMBUS SCAN
|
Facility
|
IP
|
$1,160.00
|
|
|
Service Code
|
CPT 78458
|
| Hospital Charge Code |
909301387
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$232.00 |
| Max. Negotiated Rate |
$1,044.00 |
| Rate for Payer: Adventist Health Commercial |
$232.00
|
| Rate for Payer: Cash Price |
$522.00
|
| Rate for Payer: Central Health Plan Commercial |
$928.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$812.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$464.00
|
| Rate for Payer: EPIC Health Plan Senior |
$464.00
|
| Rate for Payer: Galaxy Health WC |
$986.00
|
| Rate for Payer: Global Benefits Group Commercial |
$696.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,044.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$736.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$684.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$232.00
|
| Rate for Payer: Multiplan Commercial |
$870.00
|
| Rate for Payer: Networks By Design Commercial |
$754.00
|
| Rate for Payer: Prime Health Services Commercial |
$986.00
|
|
|
HC VENOUS THROMBUS SCAN
|
Facility
|
OP
|
$1,160.00
|
|
|
Service Code
|
CPT 78458
|
| Hospital Charge Code |
909301387
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$162.23 |
| Max. Negotiated Rate |
$1,044.00 |
| Rate for Payer: Adventist Health Commercial |
$232.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$514.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$974.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$514.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$830.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$674.77
|
| Rate for Payer: Blue Shield of California Commercial |
$730.80
|
| Rate for Payer: Blue Shield of California EPN |
$460.52
|
| Rate for Payer: Cash Price |
$522.00
|
| Rate for Payer: Cash Price |
$522.00
|
| Rate for Payer: Central Health Plan Commercial |
$928.00
|
| Rate for Payer: Cigna of CA HMO |
$742.40
|
| Rate for Payer: Cigna of CA PPO |
$858.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$771.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$812.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$848.38
|
| Rate for Payer: EPIC Health Plan Senior |
$565.59
|
| Rate for Payer: Galaxy Health WC |
$986.00
|
| Rate for Payer: Global Benefits Group Commercial |
$696.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,044.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$843.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$162.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$514.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$736.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$179.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$719.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$232.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$688.99
|
| Rate for Payer: Multiplan Commercial |
$870.00
|
| Rate for Payer: Networks By Design Commercial |
$754.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$514.17
|
| Rate for Payer: Prime Health Services Commercial |
$986.00
|
| Rate for Payer: Prime Health Services Medicare |
$545.02
|
| Rate for Payer: Riverside University Health System MISP |
$565.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$696.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$696.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.46
|
| Rate for Payer: United Healthcare All Other HMO |
$396.46
|
| Rate for Payer: United Healthcare HMO Rider |
$396.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$396.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$514.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Vantage Medical Group Senior |
$514.17
|
|
|
HC VENOVENOUS COLLATERALS AT ABOVE HEART
|
Facility
|
OP
|
$2,989.00
|
|
|
Service Code
|
CPT 93587
|
| Hospital Charge Code |
906811587
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$119.11 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$597.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,540.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,643.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,241.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,447.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,738.70
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$1,345.05
|
| Rate for Payer: Cash Price |
$1,345.05
|
| Rate for Payer: Cash Price |
$1,345.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,391.20
|
| Rate for Payer: Cigna of CA HMO |
$1,942.85
|
| Rate for Payer: Cigna of CA PPO |
$2,211.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,540.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,540.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,540.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,092.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,195.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,195.60
|
| Rate for Payer: Galaxy Health WC |
$2,540.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,793.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,690.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$119.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,898.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$131.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,763.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$597.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,092.30
|
| Rate for Payer: Multiplan Commercial |
$2,241.75
|
| Rate for Payer: Networks By Design Commercial |
$1,942.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,540.65
|
| Rate for Payer: Riverside University Health System MISP |
$1,195.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,793.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,793.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,494.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,494.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,494.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,494.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,540.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,540.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,540.65
|
|
|
HC VENOVENOUS COLLATERALS AT ABOVE HEART
|
Facility
|
IP
|
$2,989.00
|
|
|
Service Code
|
CPT 93587
|
| Hospital Charge Code |
906811587
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$597.80 |
| Max. Negotiated Rate |
$2,690.10 |
| Rate for Payer: Adventist Health Commercial |
$597.80
|
| Rate for Payer: Cash Price |
$1,345.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,391.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,092.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,195.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,195.60
|
| Rate for Payer: Galaxy Health WC |
$2,540.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,793.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,690.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,898.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,763.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$597.80
|
| Rate for Payer: Multiplan Commercial |
$2,241.75
|
| Rate for Payer: Networks By Design Commercial |
$1,942.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,540.65
|
|
|
HC VENOVENOUS COLLATERALS BELOW HEART
|
Facility
|
OP
|
$2,989.00
|
|
|
Service Code
|
CPT 93588
|
| Hospital Charge Code |
906811588
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$120.06 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$597.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,540.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,643.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,241.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,447.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,738.70
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$1,345.05
|
| Rate for Payer: Cash Price |
$1,345.05
|
| Rate for Payer: Cash Price |
$1,345.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,391.20
|
| Rate for Payer: Cigna of CA HMO |
$1,942.85
|
| Rate for Payer: Cigna of CA PPO |
$2,211.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,540.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,540.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,540.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,092.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,195.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,195.60
|
| Rate for Payer: Galaxy Health WC |
$2,540.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,793.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,690.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$120.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,898.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$132.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,763.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$597.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,092.30
|
| Rate for Payer: Multiplan Commercial |
$2,241.75
|
| Rate for Payer: Networks By Design Commercial |
$1,942.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,540.65
|
| Rate for Payer: Riverside University Health System MISP |
$1,195.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,793.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,793.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,494.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,494.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,494.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,494.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,540.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,540.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,540.65
|
|
|
HC VENOVENOUS COLLATERALS BELOW HEART
|
Facility
|
IP
|
$2,989.00
|
|
|
Service Code
|
CPT 93588
|
| Hospital Charge Code |
906811588
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$597.80 |
| Max. Negotiated Rate |
$2,690.10 |
| Rate for Payer: Adventist Health Commercial |
$597.80
|
| Rate for Payer: Cash Price |
$1,345.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,391.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,092.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,195.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,195.60
|
| Rate for Payer: Galaxy Health WC |
$2,540.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,793.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,690.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,898.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,763.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$597.80
|
| Rate for Payer: Multiplan Commercial |
$2,241.75
|
| Rate for Payer: Networks By Design Commercial |
$1,942.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,540.65
|
|
|
HC VENT ASSIST& MGT-INITIAL DAILY
|
Facility
|
OP
|
$10,486.00
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
900800100
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$77.06 |
| Max. Negotiated Rate |
$9,437.40 |
| Rate for Payer: Adventist Health Commercial |
$2,097.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$794.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$510.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,191.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$874.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$794.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$4,718.70
|
| Rate for Payer: Cash Price |
$4,718.70
|
| Rate for Payer: Cash Price |
$4,718.70
|
| Rate for Payer: Central Health Plan Commercial |
$8,388.80
|
| Rate for Payer: Cigna of CA HMO |
$6,711.04
|
| Rate for Payer: Cigna of CA PPO |
$7,759.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,191.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$874.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$794.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,340.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,311.06
|
| Rate for Payer: EPIC Health Plan Senior |
$874.04
|
| Rate for Payer: Galaxy Health WC |
$8,913.10
|
| Rate for Payer: Global Benefits Group Commercial |
$6,291.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,437.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,303.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$77.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$794.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,658.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$85.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,112.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,097.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,064.74
|
| Rate for Payer: Multiplan Commercial |
$7,864.50
|
| Rate for Payer: Networks By Design Commercial |
$6,815.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$794.58
|
| Rate for Payer: Prime Health Services Commercial |
$8,913.10
|
| Rate for Payer: Prime Health Services Medicare |
$842.25
|
| Rate for Payer: Riverside University Health System MISP |
$874.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,291.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,291.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$794.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,191.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$874.04
|
| Rate for Payer: Vantage Medical Group Senior |
$794.58
|
|
|
HC VENT ASSIST& MGT-INITIAL DAILY
|
Facility
|
IP
|
$10,486.00
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
900800100
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$2,097.20 |
| Max. Negotiated Rate |
$9,437.40 |
| Rate for Payer: Adventist Health Commercial |
$2,097.20
|
| Rate for Payer: Cash Price |
$4,718.70
|
| Rate for Payer: Central Health Plan Commercial |
$8,388.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,340.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,194.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,194.40
|
| Rate for Payer: Galaxy Health WC |
$8,913.10
|
| Rate for Payer: Global Benefits Group Commercial |
$6,291.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,437.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,658.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,186.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,097.20
|
| Rate for Payer: Multiplan Commercial |
$7,864.50
|
| Rate for Payer: Networks By Design Commercial |
$6,815.90
|
| Rate for Payer: Prime Health Services Commercial |
$8,913.10
|
|
|
HC VENT ASSIST & MGT SUB DAILY
|
Facility
|
OP
|
$8,787.00
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
900800101
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$60.72 |
| Max. Negotiated Rate |
$7,908.30 |
| Rate for Payer: Adventist Health Commercial |
$1,757.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$794.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$370.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,191.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$874.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$794.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$3,954.15
|
| Rate for Payer: Cash Price |
$3,954.15
|
| Rate for Payer: Cash Price |
$3,954.15
|
| Rate for Payer: Central Health Plan Commercial |
$7,029.60
|
| Rate for Payer: Cigna of CA HMO |
$5,623.68
|
| Rate for Payer: Cigna of CA PPO |
$6,502.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,191.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$874.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$794.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,150.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,311.06
|
| Rate for Payer: EPIC Health Plan Senior |
$874.04
|
| Rate for Payer: Galaxy Health WC |
$7,468.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,272.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,908.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,303.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$60.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$794.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,579.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$67.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,112.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,757.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,064.74
|
| Rate for Payer: Multiplan Commercial |
$6,590.25
|
| Rate for Payer: Networks By Design Commercial |
$5,711.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$794.58
|
| Rate for Payer: Prime Health Services Commercial |
$7,468.95
|
| Rate for Payer: Prime Health Services Medicare |
$842.25
|
| Rate for Payer: Riverside University Health System MISP |
$874.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,272.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,272.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$794.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,191.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$874.04
|
| Rate for Payer: Vantage Medical Group Senior |
$794.58
|
|
|
HC VENT ASSIST & MGT SUB DAILY
|
Facility
|
IP
|
$8,787.00
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
900800101
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,757.40 |
| Max. Negotiated Rate |
$7,908.30 |
| Rate for Payer: Adventist Health Commercial |
$1,757.40
|
| Rate for Payer: Cash Price |
$3,954.15
|
| Rate for Payer: Central Health Plan Commercial |
$7,029.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,150.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,514.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,514.80
|
| Rate for Payer: Galaxy Health WC |
$7,468.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,272.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,908.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,579.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,184.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,757.40
|
| Rate for Payer: Multiplan Commercial |
$6,590.25
|
| Rate for Payer: Networks By Design Commercial |
$5,711.55
|
| Rate for Payer: Prime Health Services Commercial |
$7,468.95
|
|
|
HC VENT PUNC THR PREV BURR HOLE
|
Facility
|
OP
|
$3,642.00
|
|
|
Service Code
|
CPT 61020
|
| Hospital Charge Code |
900501253
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$160.57 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$728.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,137.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,802.37
|
| Rate for Payer: Cash Price |
$1,638.90
|
| Rate for Payer: Cash Price |
$1,638.90
|
| Rate for Payer: Cash Price |
$1,638.90
|
| Rate for Payer: Cash Price |
$1,638.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,913.60
|
| Rate for Payer: Cigna of CA HMO |
$2,330.88
|
| Rate for Payer: Cigna of CA PPO |
$2,695.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,251.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,137.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,549.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,877.01
|
| Rate for Payer: EPIC Health Plan Senior |
$1,251.34
|
| Rate for Payer: Galaxy Health WC |
$3,095.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,185.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,277.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,865.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,312.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$160.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,222.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$728.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,524.36
|
| Rate for Payer: Multiplan Commercial |
$2,731.50
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: Networks By Design Commercial |
$2,367.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Preferred Health Network WC |
$1,839.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,095.70
|
| Rate for Payer: Prime Health Services Medicare |
$1,205.83
|
| Rate for Payer: Prime Health Services WC |
$1,783.98
|
| Rate for Payer: Riverside University Health System MISP |
$1,251.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,185.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,821.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,821.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,821.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,821.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,137.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Vantage Medical Group Senior |
$1,137.58
|
|
|
HC VENT PUNC THR PREV BURR HOLE
|
Facility
|
IP
|
$3,642.00
|
|
|
Service Code
|
CPT 61020
|
| Hospital Charge Code |
900501253
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$728.40 |
| Max. Negotiated Rate |
$3,277.80 |
| Rate for Payer: Adventist Health Commercial |
$728.40
|
| Rate for Payer: Cash Price |
$1,638.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,913.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,549.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,456.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,456.80
|
| Rate for Payer: Galaxy Health WC |
$3,095.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,185.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,277.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,312.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,148.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$728.40
|
| Rate for Payer: Multiplan Commercial |
$2,731.50
|
| Rate for Payer: Networks By Design Commercial |
$2,367.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,095.70
|
|
|
HC VENT PUNC THR PREV BURR HOLE
|
Facility
|
IP
|
$3,642.00
|
|
|
Service Code
|
CPT 61020
|
| Hospital Charge Code |
900501253
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$728.40 |
| Max. Negotiated Rate |
$3,277.80 |
| Rate for Payer: Adventist Health Commercial |
$728.40
|
| Rate for Payer: Cash Price |
$1,638.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,913.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,549.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,456.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,456.80
|
| Rate for Payer: Galaxy Health WC |
$3,095.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,185.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,277.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,312.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,148.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$728.40
|
| Rate for Payer: Multiplan Commercial |
$2,731.50
|
| Rate for Payer: Networks By Design Commercial |
$2,367.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,095.70
|
|
|
HC VENT PUNC THR PREV BURR HOLE
|
Facility
|
OP
|
$3,642.00
|
|
|
Service Code
|
CPT 61020
|
| Hospital Charge Code |
900501253
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$160.57 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$1,493.22
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$770.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,137.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,802.37
|
| Rate for Payer: Cash Price |
$1,638.90
|
| Rate for Payer: Cash Price |
$1,638.90
|
| Rate for Payer: Cash Price |
$1,638.90
|
| Rate for Payer: Cash Price |
$1,638.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,913.60
|
| Rate for Payer: Cigna of CA HMO |
$2,330.88
|
| Rate for Payer: Cigna of CA PPO |
$2,695.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,251.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,137.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,549.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,877.01
|
| Rate for Payer: EPIC Health Plan Senior |
$1,251.34
|
| Rate for Payer: Galaxy Health WC |
$3,095.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,185.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,277.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,865.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,312.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$160.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,222.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$728.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,524.36
|
| Rate for Payer: Multiplan Commercial |
$2,731.50
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: Networks By Design Commercial |
$2,367.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Preferred Health Network WC |
$1,839.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,095.70
|
| Rate for Payer: Prime Health Services Medicare |
$1,205.83
|
| Rate for Payer: Prime Health Services WC |
$1,783.98
|
| Rate for Payer: Riverside University Health System MISP |
$1,251.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,185.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,185.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,137.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Vantage Medical Group Senior |
$1,137.58
|
|
|
HC VENT TUBE
|
Facility
|
IP
|
$300.00
|
|
| Hospital Charge Code |
909081809
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Central Health Plan Commercial |
$240.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$210.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Senior |
$120.00
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$270.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$190.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$177.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
| Rate for Payer: Networks By Design Commercial |
$195.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
|
|
HC VENT TUBE
|
Facility
|
OP
|
$300.00
|
|
| Hospital Charge Code |
909081809
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$182.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$145.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$174.51
|
| Rate for Payer: Blue Shield of California Commercial |
$190.20
|
| Rate for Payer: Blue Shield of California EPN |
$119.70
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Central Health Plan Commercial |
$240.00
|
| Rate for Payer: Cigna of CA HMO |
$192.00
|
| Rate for Payer: Cigna of CA PPO |
$222.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$255.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$255.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$255.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$210.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Senior |
$120.00
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$270.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$190.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$108.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$177.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$210.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
| Rate for Payer: Networks By Design Commercial |
$195.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
| Rate for Payer: Riverside University Health System MISP |
$120.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$180.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$180.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.00
|
| Rate for Payer: United Healthcare All Other HMO |
$150.00
|
| Rate for Payer: United Healthcare HMO Rider |
$150.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$150.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$255.00
|
| Rate for Payer: Vantage Medical Group Senior |
$255.00
|
|
|
HC VEP, CHECKERBOARD/FLASH
|
Facility
|
OP
|
$2,116.00
|
|
|
Service Code
|
CPT 95930
|
| Hospital Charge Code |
900600218
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$59.24 |
| Max. Negotiated Rate |
$1,904.40 |
| Rate for Payer: Adventist Health Commercial |
$423.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$277.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$751.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$108.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,230.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1,333.08
|
| Rate for Payer: Blue Shield of California EPN |
$840.05
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,692.80
|
| Rate for Payer: Cigna of CA HMO |
$1,354.24
|
| Rate for Payer: Cigna of CA PPO |
$1,565.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$416.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$305.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$277.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,481.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$458.22
|
| Rate for Payer: EPIC Health Plan Senior |
$305.48
|
| Rate for Payer: Galaxy Health WC |
$1,798.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,269.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,904.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$455.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$59.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$277.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,343.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$65.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$388.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$423.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$372.13
|
| Rate for Payer: Multiplan Commercial |
$1,587.00
|
| Rate for Payer: Networks By Design Commercial |
$1,375.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$277.71
|
| Rate for Payer: Prime Health Services Commercial |
$1,798.60
|
| Rate for Payer: Prime Health Services Medicare |
$294.37
|
| Rate for Payer: Riverside University Health System MISP |
$305.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,269.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,269.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,297.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,024.00
|
| Rate for Payer: United Healthcare HMO Rider |
$776.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$711.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$277.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Vantage Medical Group Senior |
$277.71
|
|
|
HC VEP, CHECKERBOARD/FLASH
|
Facility
|
IP
|
$2,116.00
|
|
|
Service Code
|
CPT 95930
|
| Hospital Charge Code |
900600218
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$423.20 |
| Max. Negotiated Rate |
$1,904.40 |
| Rate for Payer: Adventist Health Commercial |
$423.20
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,692.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,481.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$846.40
|
| Rate for Payer: EPIC Health Plan Senior |
$846.40
|
| Rate for Payer: Galaxy Health WC |
$1,798.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,269.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,904.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,343.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,248.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$423.20
|
| Rate for Payer: Multiplan Commercial |
$1,587.00
|
| Rate for Payer: Networks By Design Commercial |
$1,375.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,798.60
|
|
|
HC VERTEBRAL UNI
|
Facility
|
OP
|
$17,590.00
|
|
|
Service Code
|
CPT 36226
|
| Hospital Charge Code |
909020149
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$484.11 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$3,518.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$7,156.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,156.86
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$10,943.70
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$7,915.50
|
| Rate for Payer: Cash Price |
$7,915.50
|
| Rate for Payer: Cash Price |
$7,915.50
|
| Rate for Payer: Central Health Plan Commercial |
$14,072.00
|
| Rate for Payer: Cigna of CA HMO |
$11,257.60
|
| Rate for Payer: Cigna of CA PPO |
$13,016.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,872.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,156.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,313.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,808.82
|
| Rate for Payer: EPIC Health Plan Senior |
$7,872.55
|
| Rate for Payer: Galaxy Health WC |
$14,951.50
|
| Rate for Payer: Global Benefits Group Commercial |
$10,554.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,831.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,737.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$484.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,156.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,169.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$534.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,019.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,518.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,590.19
|
| Rate for Payer: Multiplan Commercial |
$13,192.50
|
| Rate for Payer: Multiplan WC |
$10,943.70
|
| Rate for Payer: Networks By Design Commercial |
$11,433.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,156.86
|
| Rate for Payer: Preferred Health Network WC |
$11,167.04
|
| Rate for Payer: Prime Health Services Commercial |
$14,951.50
|
| Rate for Payer: Prime Health Services Medicare |
$7,586.27
|
| Rate for Payer: Prime Health Services WC |
$10,832.03
|
| Rate for Payer: Riverside University Health System MISP |
$7,872.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,554.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,795.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,156.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Vantage Medical Group Senior |
$7,156.86
|
|
