|
HC CHEMODENRVTN 1 EXT 1 TO 4 MUSC
|
Facility
|
IP
|
$1,898.00
|
|
|
Service Code
|
CPT 64642
|
| Hospital Charge Code |
912964642
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$343.54 |
| Max. Negotiated Rate |
$1,423.50 |
| Rate for Payer: Adventist Health Commercial |
$379.60
|
| Rate for Payer: Cash Price |
$1,043.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,284.95
|
| Rate for Payer: Heritage Provider Network Senior |
$1,284.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$343.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$474.50
|
| Rate for Payer: Multiplan Commercial |
$1,423.50
|
|
|
HC CHEMODENRVTN 1 EXT 1 TO 4 MUSC
|
Facility
|
OP
|
$1,898.00
|
|
|
Service Code
|
CPT 64642
|
| Hospital Charge Code |
912964642
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$379.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,303.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,043.90
|
| Rate for Payer: Cash Price |
$1,043.90
|
| Rate for Payer: Cash Price |
$1,043.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,233.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$967.91
|
| Rate for Payer: Dignity Health Senior |
$879.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,138.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$879.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,174.86
|
| Rate for Payer: Heritage Provider Network Senior |
$1,082.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$147.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,671.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$343.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,011.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$474.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,108.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,108.70
|
| Rate for Payer: Multiplan Commercial |
$1,423.50
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$967.91
|
| Rate for Payer: TriValley Medical Group Senior |
$967.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Vantage Medical Group Senior |
$879.92
|
|
|
HC CHEST 2 VIEWS
|
Facility
|
OP
|
$833.00
|
|
|
Service Code
|
CPT 71046
|
| Hospital Charge Code |
909001407
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$44.50 |
| Max. Negotiated Rate |
$624.75 |
| Rate for Payer: Adventist Health Commercial |
$166.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$445.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$572.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$212.97
|
| Rate for Payer: Blue Shield of California Commercial |
$110.54
|
| Rate for Payer: Blue Shield of California EPN |
$88.90
|
| Rate for Payer: Cash Price |
$458.15
|
| Rate for Payer: Cash Price |
$458.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$541.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Senior |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$541.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$515.63
|
| Rate for Payer: Heritage Provider Network Senior |
$515.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$44.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$397.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$150.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.97
|
| Rate for Payer: Multiplan Commercial |
$624.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.88
|
| Rate for Payer: TriValley Medical Group Senior |
$111.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$99.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$99.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC CHEST 2 VIEWS
|
Facility
|
IP
|
$833.00
|
|
|
Service Code
|
CPT 71046
|
| Hospital Charge Code |
909001407
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$150.77 |
| Max. Negotiated Rate |
$624.75 |
| Rate for Payer: Adventist Health Commercial |
$166.60
|
| Rate for Payer: Cash Price |
$458.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$563.94
|
| Rate for Payer: Heritage Provider Network Senior |
$563.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$150.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.25
|
| Rate for Payer: Multiplan Commercial |
$624.75
|
|
|
HC CHEST COMP 4 VIEWS
|
Facility
|
IP
|
$1,002.00
|
|
|
Service Code
|
CPT 71048
|
| Hospital Charge Code |
909001402
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$181.36 |
| Max. Negotiated Rate |
$751.50 |
| Rate for Payer: Adventist Health Commercial |
$200.40
|
| Rate for Payer: Cash Price |
$551.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$678.35
|
| Rate for Payer: Heritage Provider Network Senior |
$678.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$181.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$250.50
|
| Rate for Payer: Multiplan Commercial |
$751.50
|
|
|
HC CHEST COMP 4 VIEWS
|
Facility
|
OP
|
$1,002.00
|
|
|
Service Code
|
CPT 71048
|
| Hospital Charge Code |
909001402
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$751.50 |
| Rate for Payer: Adventist Health Commercial |
$200.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$535.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$688.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$279.29
|
| Rate for Payer: Blue Shield of California Commercial |
$144.86
|
| Rate for Payer: Blue Shield of California EPN |
$116.49
|
| Rate for Payer: Cash Price |
$551.10
|
| Rate for Payer: Cash Price |
$551.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$651.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Senior |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$135.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$620.24
|
| Rate for Payer: Heritage Provider Network Senior |
$620.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$61.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$477.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$181.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$250.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.25
|
| Rate for Payer: Multiplan Commercial |
$751.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$135.12
|
| Rate for Payer: TriValley Medical Group Senior |
$135.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$189.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$189.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC CHEST FLUORO/PACEMKR
|
Facility
|
IP
|
$872.00
|
|
| Hospital Charge Code |
909001469
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$157.83 |
| Max. Negotiated Rate |
$654.00 |
| Rate for Payer: Adventist Health Commercial |
$174.40
|
| Rate for Payer: Cash Price |
$479.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$590.34
|
| Rate for Payer: Heritage Provider Network Senior |
$590.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.00
|
| Rate for Payer: Multiplan Commercial |
$654.00
|
|
|
HC CHEST FLUORO/PACEMKR
|
Facility
|
OP
|
$872.00
|
|
| Hospital Charge Code |
909001469
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$157.83 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$174.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$599.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$741.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$479.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$654.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$479.60
|
| Rate for Payer: Cash Price |
$479.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$566.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$741.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$741.20
|
| Rate for Payer: Dignity Health Senior |
$741.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$539.77
|
| Rate for Payer: Heritage Provider Network Senior |
$539.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$415.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$610.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$610.40
|
| Rate for Payer: Multiplan Commercial |
$654.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$436.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$436.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$741.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$741.20
|
| Rate for Payer: Vantage Medical Group Senior |
$741.20
|
|
|
HC CHEST FOUR OR MORE VIEWS
|
Facility
|
IP
|
$1,002.00
|
|
|
Service Code
|
CPT 71048
|
| Hospital Charge Code |
909071048
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$181.36 |
| Max. Negotiated Rate |
$751.50 |
| Rate for Payer: Adventist Health Commercial |
$200.40
|
| Rate for Payer: Cash Price |
$551.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$678.35
|
| Rate for Payer: Heritage Provider Network Senior |
$678.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$181.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$250.50
|
| Rate for Payer: Multiplan Commercial |
$751.50
|
|
|
HC CHEST FOUR OR MORE VIEWS
|
Facility
|
OP
|
$1,002.00
|
|
|
Service Code
|
CPT 71048
|
| Hospital Charge Code |
909071048
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$751.50 |
| Rate for Payer: Adventist Health Commercial |
$200.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$535.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$688.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$279.29
|
| Rate for Payer: Blue Shield of California Commercial |
$144.86
|
| Rate for Payer: Blue Shield of California EPN |
$116.49
|
| Rate for Payer: Cash Price |
$551.10
|
| Rate for Payer: Cash Price |
$551.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$651.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Senior |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$135.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$620.24
|
| Rate for Payer: Heritage Provider Network Senior |
$620.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$61.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$477.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$181.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$250.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.25
|
| Rate for Payer: Multiplan Commercial |
$751.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$135.12
|
| Rate for Payer: TriValley Medical Group Senior |
$135.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$189.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$189.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC CHEST PORT
|
Facility
|
IP
|
$2,139.00
|
|
|
Service Code
|
CPT C1788
|
| Hospital Charge Code |
909081700
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$387.16 |
| Max. Negotiated Rate |
$1,604.25 |
| Rate for Payer: Adventist Health Commercial |
$427.80
|
| Rate for Payer: Cash Price |
$1,176.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,448.10
|
| Rate for Payer: Heritage Provider Network Senior |
$1,448.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$387.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$534.75
|
| Rate for Payer: Multiplan Commercial |
$1,604.25
|
|
|
HC CHEST PORT
|
Facility
|
OP
|
$2,139.00
|
|
|
Service Code
|
CPT C1788
|
| Hospital Charge Code |
909081700
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$387.16 |
| Max. Negotiated Rate |
$1,818.15 |
| Rate for Payer: Adventist Health Commercial |
$427.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,143.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,469.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,818.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,176.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,604.25
|
| Rate for Payer: Blue Shield of California Commercial |
$1,304.79
|
| Rate for Payer: Blue Shield of California EPN |
$1,043.83
|
| Rate for Payer: Cash Price |
$1,176.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,390.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,818.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,818.15
|
| Rate for Payer: Dignity Health Senior |
$1,818.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,390.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,324.04
|
| Rate for Payer: Heritage Provider Network Senior |
$1,324.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,020.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$387.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$534.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,497.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,497.30
|
| Rate for Payer: Multiplan Commercial |
$1,604.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,069.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,069.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,818.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,818.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,818.15
|
|
|
HC CHEST SINGLE VIEW
|
Facility
|
IP
|
$760.00
|
|
|
Service Code
|
CPT 71045
|
| Hospital Charge Code |
909001408
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$137.56 |
| Max. Negotiated Rate |
$570.00 |
| Rate for Payer: Adventist Health Commercial |
$152.00
|
| Rate for Payer: Cash Price |
$418.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$514.52
|
| Rate for Payer: Heritage Provider Network Senior |
$514.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.00
|
| Rate for Payer: Multiplan Commercial |
$570.00
|
|
|
HC CHEST SINGLE VIEW
|
Facility
|
OP
|
$760.00
|
|
|
Service Code
|
CPT 71045
|
| Hospital Charge Code |
909001408
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$28.59 |
| Max. Negotiated Rate |
$570.00 |
| Rate for Payer: Adventist Health Commercial |
$152.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$406.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$522.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.18
|
| Rate for Payer: Blue Shield of California Commercial |
$60.00
|
| Rate for Payer: Blue Shield of California EPN |
$48.25
|
| Rate for Payer: Cash Price |
$418.00
|
| Rate for Payer: Cash Price |
$418.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$494.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Senior |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$494.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$470.44
|
| Rate for Payer: Heritage Provider Network Senior |
$470.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$28.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$362.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.97
|
| Rate for Payer: Multiplan Commercial |
$570.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.88
|
| Rate for Payer: TriValley Medical Group Senior |
$111.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$99.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$99.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC CHEST THREE VIEWS
|
Facility
|
IP
|
$922.00
|
|
|
Service Code
|
CPT 71047
|
| Hospital Charge Code |
909071047
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$166.88 |
| Max. Negotiated Rate |
$691.50 |
| Rate for Payer: Adventist Health Commercial |
$184.40
|
| Rate for Payer: Cash Price |
$507.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$624.19
|
| Rate for Payer: Heritage Provider Network Senior |
$624.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$166.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.50
|
| Rate for Payer: Multiplan Commercial |
$691.50
|
|
|
HC CHEST THREE VIEWS
|
Facility
|
OP
|
$922.00
|
|
|
Service Code
|
CPT 71047
|
| Hospital Charge Code |
909071047
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$57.12 |
| Max. Negotiated Rate |
$691.50 |
| Rate for Payer: Adventist Health Commercial |
$184.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$492.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$633.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$271.42
|
| Rate for Payer: Blue Shield of California Commercial |
$140.83
|
| Rate for Payer: Blue Shield of California EPN |
$113.25
|
| Rate for Payer: Cash Price |
$507.10
|
| Rate for Payer: Cash Price |
$507.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$599.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Senior |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$599.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$570.72
|
| Rate for Payer: Heritage Provider Network Senior |
$570.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$57.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$439.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$166.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.97
|
| Rate for Payer: Multiplan Commercial |
$691.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.88
|
| Rate for Payer: TriValley Medical Group Senior |
$111.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$99.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$99.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC CHEST TOMO FULL LUNG
|
Facility
|
IP
|
$1,173.00
|
|
|
Service Code
|
CPT 76102
|
| Hospital Charge Code |
909001465
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$212.31 |
| Max. Negotiated Rate |
$879.75 |
| Rate for Payer: Adventist Health Commercial |
$234.60
|
| Rate for Payer: Cash Price |
$645.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$794.12
|
| Rate for Payer: Heritage Provider Network Senior |
$794.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$212.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$293.25
|
| Rate for Payer: Multiplan Commercial |
$879.75
|
|
|
HC CHEST TOMO FULL LUNG
|
Facility
|
OP
|
$1,173.00
|
|
|
Service Code
|
CPT 76102
|
| Hospital Charge Code |
909001465
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$212.31 |
| Max. Negotiated Rate |
$997.05 |
| Rate for Payer: Adventist Health Commercial |
$234.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$626.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$805.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$997.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$645.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$452.86
|
| Rate for Payer: Blue Shield of California Commercial |
$715.53
|
| Rate for Payer: Blue Shield of California EPN |
$572.42
|
| Rate for Payer: Cash Price |
$645.15
|
| Rate for Payer: Cash Price |
$645.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$762.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$997.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$997.05
|
| Rate for Payer: Dignity Health Senior |
$997.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$762.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$726.09
|
| Rate for Payer: Heritage Provider Network Senior |
$726.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$559.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$212.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$293.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$821.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$821.10
|
| Rate for Payer: Multiplan Commercial |
$879.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$586.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$586.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$997.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$997.05
|
| Rate for Payer: Vantage Medical Group Senior |
$997.05
|
|
|
HC CHEST WALL MANIPULATION INIT
|
Facility
|
OP
|
$274.00
|
|
|
Service Code
|
CPT 94667
|
| Hospital Charge Code |
900800390
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$32.24 |
| Max. Negotiated Rate |
$376.00 |
| Rate for Payer: Adventist Health Commercial |
$54.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$146.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$188.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$150.70
|
| Rate for Payer: Cash Price |
$150.70
|
| Rate for Payer: Cash Price |
$150.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$178.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Senior |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$163.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$169.61
|
| Rate for Payer: Heritage Provider Network Senior |
$169.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$130.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$206.36
|
| Rate for Payer: Multiplan Commercial |
$205.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$376.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$319.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC CHEST WALL MANIPULATION INIT
|
Facility
|
IP
|
$274.00
|
|
|
Service Code
|
CPT 94667
|
| Hospital Charge Code |
900800390
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$49.59 |
| Max. Negotiated Rate |
$205.50 |
| Rate for Payer: Adventist Health Commercial |
$54.80
|
| Rate for Payer: Cash Price |
$150.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$185.50
|
| Rate for Payer: Heritage Provider Network Senior |
$185.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.50
|
| Rate for Payer: Multiplan Commercial |
$205.50
|
|
|
HC CHEST WALL MANIPULATION SUB
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 94668
|
| Hospital Charge Code |
900800391
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$18.95 |
| Max. Negotiated Rate |
$376.00 |
| Rate for Payer: Adventist Health Commercial |
$33.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$89.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$115.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$109.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Senior |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$163.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$103.99
|
| Rate for Payer: Heritage Provider Network Senior |
$103.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$80.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$206.36
|
| Rate for Payer: Multiplan Commercial |
$126.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$376.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$319.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC CHEST WALL MANIPULATION SUB
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 94668
|
| Hospital Charge Code |
900800391
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$30.41 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Adventist Health Commercial |
$33.60
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$113.74
|
| Rate for Payer: Heritage Provider Network Senior |
$113.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$126.00
|
|
|
HC CHICKEN FEATHERS IGE
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913634
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$144.32 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$35.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$45.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.32
|
| Rate for Payer: Blue Shield of California Commercial |
$42.05
|
| Rate for Payer: Blue Shield of California EPN |
$33.73
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$42.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Senior |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.85
|
| Rate for Payer: Heritage Provider Network Senior |
$40.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$31.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.58
|
| Rate for Payer: Multiplan Commercial |
$49.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.22
|
| Rate for Payer: TriValley Medical Group Senior |
$5.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC CHICKEN FEATHERS IGE
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913634
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.95 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.68
|
| Rate for Payer: Heritage Provider Network Senior |
$44.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.50
|
| Rate for Payer: Multiplan Commercial |
$49.50
|
|
|
HC CHILI PEPPER IGE
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913635
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$144.32 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$35.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$45.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.32
|
| Rate for Payer: Blue Shield of California Commercial |
$42.05
|
| Rate for Payer: Blue Shield of California EPN |
$33.73
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$42.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Senior |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.85
|
| Rate for Payer: Heritage Provider Network Senior |
$40.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$31.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.58
|
| Rate for Payer: Multiplan Commercial |
$49.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.22
|
| Rate for Payer: TriValley Medical Group Senior |
$5.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
