|
HC ANGIO JET THROM CATH 60CM
|
Facility
|
IP
|
$1,350.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081716
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$270.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$648.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$927.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$621.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$729.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$913.95
|
| Rate for Payer: Heritage Provider Network Senior |
$913.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$675.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$675.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$675.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$337.50
|
| Rate for Payer: Multiplan Commercial |
$1,012.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$492.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$451.04
|
|
|
HC ANGIO JET THROM CATH 60CM
|
Facility
|
OP
|
$1,350.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081716
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$270.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$648.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$927.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,147.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$742.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,012.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$838.35
|
| Rate for Payer: Blue Shield of California EPN |
$792.45
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$621.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,147.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,147.50
|
| Rate for Payer: Dignity Health Senior |
$1,147.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$864.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$625.05
|
| Rate for Payer: Heritage Provider Network Senior |
$625.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$675.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$675.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$675.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$337.50
|
| Rate for Payer: Multiplan Commercial |
$1,012.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$492.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$451.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,147.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,147.50
|
|
|
HC ANGIO LV/OR LA
|
Facility
|
IP
|
$2,194.00
|
|
|
Service Code
|
CPT 93565
|
| Hospital Charge Code |
906820071
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$397.11 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$438.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,507.28
|
| Rate for Payer: Cash Price |
$987.30
|
| Rate for Payer: Cash Price |
$987.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$397.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$548.50
|
| Rate for Payer: Multiplan Commercial |
$1,645.50
|
|
|
HC ANGIO LV/OR LA
|
Facility
|
OP
|
$1,913.00
|
|
|
Service Code
|
CPT 93565
|
| Hospital Charge Code |
906811414
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$56.21 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$382.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7,402.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,314.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,626.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,052.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,434.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$860.85
|
| Rate for Payer: Cash Price |
$860.85
|
| Rate for Payer: Cash Price |
$860.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,626.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,626.05
|
| Rate for Payer: Dignity Health Senior |
$1,626.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,243.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,184.15
|
| Rate for Payer: Heritage Provider Network Senior |
$1,184.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$56.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$922.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$346.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$478.25
|
| Rate for Payer: Multiplan Commercial |
$1,434.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,626.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,626.05
|
|
|
HC ANGIO LV/OR LA
|
Facility
|
OP
|
$2,194.00
|
|
|
Service Code
|
CPT 93565
|
| Hospital Charge Code |
906820071
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$56.21 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$438.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7,402.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,507.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,864.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,206.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,645.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$987.30
|
| Rate for Payer: Cash Price |
$987.30
|
| Rate for Payer: Cash Price |
$987.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,864.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,864.90
|
| Rate for Payer: Dignity Health Senior |
$1,864.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,426.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,358.09
|
| Rate for Payer: Heritage Provider Network Senior |
$1,358.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$56.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,057.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$397.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$548.50
|
| Rate for Payer: Multiplan Commercial |
$1,645.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,864.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,864.90
|
|
|
HC ANGIO LV/OR LA
|
Facility
|
IP
|
$1,913.00
|
|
|
Service Code
|
CPT 93565
|
| Hospital Charge Code |
906811414
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$346.25 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$382.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,314.23
|
| Rate for Payer: Cash Price |
$860.85
|
| Rate for Payer: Cash Price |
$860.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$346.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$478.25
|
| Rate for Payer: Multiplan Commercial |
$1,434.75
|
|
|
HC ANGIOPLASTY/ENDEAVOR
|
Facility
|
OP
|
$1,530.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081807
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$306.00 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$306.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$734.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,051.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,300.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$841.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,147.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$950.13
|
| Rate for Payer: Blue Shield of California EPN |
$898.11
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$703.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,300.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,300.50
|
| Rate for Payer: Dignity Health Senior |
$1,300.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$979.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$708.39
|
| Rate for Payer: Heritage Provider Network Senior |
$708.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$765.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$765.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$765.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$382.50
|
| Rate for Payer: Multiplan Commercial |
$1,147.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$557.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$511.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,300.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,300.50
|
|
|
HC ANGIOPLASTY/ENDEAVOR
|
Facility
|
IP
|
$1,530.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081807
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$306.00 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$306.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$734.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,051.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$703.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$826.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,035.81
|
| Rate for Payer: Heritage Provider Network Senior |
$1,035.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$765.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$765.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$765.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$382.50
|
| Rate for Payer: Multiplan Commercial |
$1,147.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$557.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$511.17
|
|
|
HC ANGIOPLASTY INTRACRANIAL
|
Facility
|
IP
|
$8,332.00
|
|
|
Service Code
|
CPT 61630
|
| Hospital Charge Code |
909081013
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,508.09 |
| Max. Negotiated Rate |
$6,249.00 |
| Rate for Payer: Adventist Health Commercial |
$1,666.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,724.08
|
| Rate for Payer: Cash Price |
$3,749.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,640.76
|
| Rate for Payer: Heritage Provider Network Senior |
$5,640.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,508.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,083.00
|
| Rate for Payer: Multiplan Commercial |
$6,249.00
|
|
|
HC ANGIOPLASTY INTRACRANIAL
|
Facility
|
OP
|
$8,332.00
|
|
|
Service Code
|
CPT 61630
|
| Hospital Charge Code |
909081013
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,508.09 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$1,666.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,724.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,082.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,582.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,249.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$3,749.40
|
| Rate for Payer: Cash Price |
$3,749.40
|
| Rate for Payer: Cash Price |
$3,749.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,415.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,082.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,082.20
|
| Rate for Payer: Dignity Health Senior |
$7,082.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,999.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,157.51
|
| Rate for Payer: Heritage Provider Network Senior |
$5,157.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,016.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,508.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,083.00
|
| Rate for Payer: Multiplan Commercial |
$6,249.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,082.20
|
| Rate for Payer: Vantage Medical Group Senior |
$7,082.20
|
|
|
HC ANGIO RV/OR RA
|
Facility
|
IP
|
$1,793.00
|
|
|
Service Code
|
CPT 93566
|
| Hospital Charge Code |
906811415
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$324.53 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$358.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,231.79
|
| Rate for Payer: Cash Price |
$806.85
|
| Rate for Payer: Cash Price |
$806.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$324.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$448.25
|
| Rate for Payer: Multiplan Commercial |
$1,344.75
|
|
|
HC ANGIO RV/OR RA
|
Facility
|
OP
|
$1,956.00
|
|
|
Service Code
|
CPT 93566
|
| Hospital Charge Code |
906820072
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$241.32 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$391.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7,402.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,343.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,662.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,075.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,467.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$880.20
|
| Rate for Payer: Cash Price |
$880.20
|
| Rate for Payer: Cash Price |
$880.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,662.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,662.60
|
| Rate for Payer: Dignity Health Senior |
$1,662.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,271.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,210.76
|
| Rate for Payer: Heritage Provider Network Senior |
$1,210.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$241.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$942.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$354.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$489.00
|
| Rate for Payer: Multiplan Commercial |
$1,467.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,662.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,662.60
|
|
|
HC ANGIO RV/OR RA
|
Facility
|
OP
|
$1,793.00
|
|
|
Service Code
|
CPT 93566
|
| Hospital Charge Code |
906811415
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$241.32 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$358.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7,402.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,231.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,524.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$986.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,344.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$806.85
|
| Rate for Payer: Cash Price |
$806.85
|
| Rate for Payer: Cash Price |
$806.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,524.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,524.05
|
| Rate for Payer: Dignity Health Senior |
$1,524.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,165.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,109.87
|
| Rate for Payer: Heritage Provider Network Senior |
$1,109.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$241.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$864.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$324.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$448.25
|
| Rate for Payer: Multiplan Commercial |
$1,344.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,524.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,524.05
|
|
|
HC ANGIO RV/OR RA
|
Facility
|
IP
|
$1,956.00
|
|
|
Service Code
|
CPT 93566
|
| Hospital Charge Code |
906820072
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$354.04 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$391.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,343.77
|
| Rate for Payer: Cash Price |
$880.20
|
| Rate for Payer: Cash Price |
$880.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$354.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$489.00
|
| Rate for Payer: Multiplan Commercial |
$1,467.00
|
|
|
HC ANKLE ARTHROGRAPHY INJECTION
|
Facility
|
IP
|
$790.00
|
|
|
Service Code
|
CPT 27648
|
| Hospital Charge Code |
909000118
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$142.99 |
| Max. Negotiated Rate |
$592.50 |
| Rate for Payer: Adventist Health Commercial |
$158.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$542.73
|
| Rate for Payer: Blue Shield of California Commercial |
$333.38
|
| Rate for Payer: Blue Shield of California EPN |
$317.58
|
| Rate for Payer: Cash Price |
$355.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$534.83
|
| Rate for Payer: Heritage Provider Network Senior |
$534.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$197.50
|
| Rate for Payer: Multiplan Commercial |
$592.50
|
|
|
HC ANKLE ARTHROGRAPHY INJECTION
|
Facility
|
OP
|
$790.00
|
|
|
Service Code
|
CPT 27648
|
| Hospital Charge Code |
909000118
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$142.99 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$158.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$542.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$671.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$592.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$355.50
|
| Rate for Payer: Cash Price |
$355.50
|
| Rate for Payer: Cash Price |
$355.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$513.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$671.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$671.50
|
| Rate for Payer: Dignity Health Senior |
$671.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$489.01
|
| Rate for Payer: Heritage Provider Network Senior |
$489.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$249.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$380.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$197.50
|
| Rate for Payer: Multiplan Commercial |
$592.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$671.50
|
| Rate for Payer: Vantage Medical Group Senior |
$671.50
|
|
|
HC ANKLE COMPLETE
|
Facility
|
OP
|
$646.00
|
|
|
Service Code
|
CPT 73610
|
| Hospital Charge Code |
909001648
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$39.22 |
| Max. Negotiated Rate |
$484.50 |
| Rate for Payer: Adventist Health Commercial |
$129.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$53.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$443.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.02
|
| Rate for Payer: Blue Shield of California Commercial |
$106.76
|
| Rate for Payer: Blue Shield of California EPN |
$60.71
|
| Rate for Payer: Cash Price |
$290.70
|
| Rate for Payer: Cash Price |
$290.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$419.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: Dignity Health Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$419.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$113.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$399.87
|
| Rate for Payer: Heritage Provider Network Senior |
$399.87
|
| Rate for Payer: Humana Medicare |
$113.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$39.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$215.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$143.06
|
| Rate for Payer: Multiplan Commercial |
$484.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$113.54
|
| Rate for Payer: TriValley Medical Group Senior |
$113.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC ANKLE COMPLETE
|
Facility
|
IP
|
$646.00
|
|
|
Service Code
|
CPT 73610
|
| Hospital Charge Code |
909001648
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$116.93 |
| Max. Negotiated Rate |
$484.50 |
| Rate for Payer: Adventist Health Commercial |
$129.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$443.80
|
| Rate for Payer: Cash Price |
$290.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$437.34
|
| Rate for Payer: Heritage Provider Network Senior |
$437.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.50
|
| Rate for Payer: Multiplan Commercial |
$484.50
|
|
|
HC ANKLE LIMITED
|
Facility
|
IP
|
$480.00
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
909001642
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$86.88 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Adventist Health Commercial |
$96.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$329.76
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$324.96
|
| Rate for Payer: Heritage Provider Network Senior |
$324.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.00
|
| Rate for Payer: Multiplan Commercial |
$360.00
|
|
|
HC ANKLE LIMITED
|
Facility
|
OP
|
$480.00
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
909001642
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.67 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Adventist Health Commercial |
$96.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$45.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$329.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.11
|
| Rate for Payer: Blue Shield of California Commercial |
$98.89
|
| Rate for Payer: Blue Shield of California EPN |
$56.23
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$312.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: Dignity Health Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$113.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$297.12
|
| Rate for Payer: Heritage Provider Network Senior |
$297.12
|
| Rate for Payer: Humana Medicare |
$113.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$215.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$143.06
|
| Rate for Payer: Multiplan Commercial |
$360.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$113.54
|
| Rate for Payer: TriValley Medical Group Senior |
$113.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC ANORECTAL MANOMETRY
|
Facility
|
OP
|
$1,842.00
|
|
|
Service Code
|
CPT 91122
|
| Hospital Charge Code |
906791122
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$94.18 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$368.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$334.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,265.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$828.90
|
| Rate for Payer: Cash Price |
$828.90
|
| Rate for Payer: Cash Price |
$828.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,197.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: Dignity Health Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,105.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$392.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,140.20
|
| Rate for Payer: Heritage Provider Network Senior |
$482.37
|
| Rate for Payer: Humana Medicare |
$392.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$94.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$392.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$745.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$333.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$462.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$460.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$494.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$494.13
|
| Rate for Payer: Multiplan Commercial |
$1,381.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC ANORECTAL MANOMETRY
|
Facility
|
IP
|
$2,534.00
|
|
|
Service Code
|
CPT 91122
|
| Hospital Charge Code |
906791122
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$458.65 |
| Max. Negotiated Rate |
$1,900.50 |
| Rate for Payer: Adventist Health Commercial |
$506.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,740.86
|
| Rate for Payer: Cash Price |
$1,140.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,715.52
|
| Rate for Payer: Heritage Provider Network Senior |
$1,715.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$458.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$633.50
|
| Rate for Payer: Multiplan Commercial |
$1,900.50
|
|
|
HC ANOSCOPY DIAGNOSTIC W WO SPEC COLLECT
|
Facility
|
IP
|
$298.00
|
|
|
Service Code
|
CPT 46600
|
| Hospital Charge Code |
900501159
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$53.94 |
| Max. Negotiated Rate |
$223.50 |
| Rate for Payer: Adventist Health Commercial |
$59.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$204.73
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$201.75
|
| Rate for Payer: Heritage Provider Network Senior |
$201.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.50
|
| Rate for Payer: Multiplan Commercial |
$223.50
|
|
|
HC ANOSCOPY DIAGNOSTIC W WO SPEC COLLECT
|
Facility
|
OP
|
$298.00
|
|
|
Service Code
|
CPT 46600
|
| Hospital Charge Code |
900501159
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$53.94 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$59.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$204.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$193.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: Dignity Health Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$159.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$201.75
|
| Rate for Payer: Heritage Provider Network Senior |
$201.75
|
| Rate for Payer: Humana Medicare |
$159.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$143.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.10
|
| Rate for Payer: Multiplan Commercial |
$223.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$108.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$99.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC ANOSCOPY DIAG W/RMVL FB
|
Facility
|
OP
|
$2,974.00
|
|
|
Service Code
|
CPT 46608
|
| Hospital Charge Code |
900501160
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$538.29 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$594.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,043.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,141.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$1,338.30
|
| Rate for Payer: Cash Price |
$1,338.30
|
| Rate for Payer: Cash Price |
$1,338.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,933.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,256.12
|
| Rate for Payer: Dignity Health Senior |
$1,141.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,141.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,013.40
|
| Rate for Payer: Heritage Provider Network Senior |
$2,013.40
|
| Rate for Payer: Humana Medicare |
$1,141.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,141.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,433.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$538.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,347.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$743.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,438.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,438.83
|
| Rate for Payer: Multiplan Commercial |
$2,230.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,079.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$993.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: Vantage Medical Group Senior |
$1,141.93
|
|
