|
HC SOM STRONGYLOIDES AB
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
900915435
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.88 |
| Max. Negotiated Rate |
$119.85 |
| Rate for Payer: Adventist Health Commercial |
$7.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$20.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.85
|
| Rate for Payer: Blue Shield of California Commercial |
$104.66
|
| Rate for Payer: Blue Shield of California EPN |
$83.95
|
| Rate for Payer: Cash Price |
$38.00
|
| Rate for Payer: Cash Price |
$38.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.31
|
| Rate for Payer: Dignity Health Senior |
$13.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.52
|
| Rate for Payer: Heritage Provider Network Senior |
$23.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$18.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.39
|
| Rate for Payer: Multiplan Commercial |
$28.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.01
|
| Rate for Payer: TriValley Medical Group Senior |
$13.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.31
|
| Rate for Payer: Vantage Medical Group Senior |
$13.01
|
|
|
HC SOM STRONGYLOIDES AB
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
900915435
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.88 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Adventist Health Commercial |
$7.60
|
| Rate for Payer: Cash Price |
$38.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.73
|
| Rate for Payer: Heritage Provider Network Senior |
$25.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.50
|
| Rate for Payer: Multiplan Commercial |
$28.50
|
|
|
HC SOM SULFA DRUGS
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911100
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.96 |
| Max. Negotiated Rate |
$41.25 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.23
|
| Rate for Payer: Heritage Provider Network Senior |
$37.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.75
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
|
|
HC SOM SULFA DRUGS
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911100
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.96 |
| Max. Negotiated Rate |
$132.94 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$29.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.94
|
| Rate for Payer: Blue Shield of California Commercial |
$110.19
|
| Rate for Payer: Blue Shield of California EPN |
$88.38
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Senior |
$18.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.05
|
| Rate for Payer: Heritage Provider Network Senior |
$34.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.49
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.64
|
| Rate for Payer: TriValley Medical Group Senior |
$18.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC SOM TAPENTADOL URINE
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 80372
|
| Hospital Charge Code |
900914715
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$177.26 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$21.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.26
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.00
|
| Rate for Payer: Dignity Health Senior |
$34.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.76
|
| Rate for Payer: Heritage Provider Network Senior |
$24.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$19.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.00
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.00
|
| Rate for Payer: Vantage Medical Group Senior |
$34.00
|
|
|
HC SOM TAPENTADOL URINE
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 80372
|
| Hospital Charge Code |
900914715
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.08
|
| Rate for Payer: Heritage Provider Network Senior |
$27.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
|
|
HC SOM TCP 86359
|
Facility
|
OP
|
$115.35
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
900914880
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$20.88 |
| Max. Negotiated Rate |
$344.99 |
| Rate for Payer: Adventist Health Commercial |
$23.07
|
| Rate for Payer: Aetna of CA Gatekeeper |
$61.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$79.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$344.99
|
| Rate for Payer: Blue Shield of California Commercial |
$303.55
|
| Rate for Payer: Blue Shield of California EPN |
$243.47
|
| Rate for Payer: Cash Price |
$115.35
|
| Rate for Payer: Cash Price |
$115.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$74.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.50
|
| Rate for Payer: Dignity Health Senior |
$37.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.98
|
| Rate for Payer: EPIC Health Plan Medicare |
$37.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$71.40
|
| Rate for Payer: Heritage Provider Network Senior |
$71.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$54.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$55.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.54
|
| Rate for Payer: Multiplan Commercial |
$86.51
|
| Rate for Payer: TriValley Medical Group Commercial |
$37.73
|
| Rate for Payer: TriValley Medical Group Senior |
$37.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$40.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$40.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Vantage Medical Group Senior |
$37.73
|
|
|
HC SOM TCP 86359
|
Facility
|
IP
|
$115.35
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
900914880
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$20.88 |
| Max. Negotiated Rate |
$86.51 |
| Rate for Payer: Adventist Health Commercial |
$23.07
|
| Rate for Payer: Cash Price |
$115.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$78.09
|
| Rate for Payer: Heritage Provider Network Senior |
$78.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.84
|
| Rate for Payer: Multiplan Commercial |
$86.51
|
|
|
HC SOM TCP 86361
|
Facility
|
IP
|
$81.87
|
|
|
Service Code
|
CPT 86361
|
| Hospital Charge Code |
900914881
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$14.82 |
| Max. Negotiated Rate |
$61.40 |
| Rate for Payer: Adventist Health Commercial |
$16.37
|
| Rate for Payer: Cash Price |
$81.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$55.43
|
| Rate for Payer: Heritage Provider Network Senior |
$55.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.47
|
| Rate for Payer: Multiplan Commercial |
$61.40
|
|
|
HC SOM TCP 86361
|
Facility
|
OP
|
$81.87
|
|
|
Service Code
|
CPT 86361
|
| Hospital Charge Code |
900914881
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$14.82 |
| Max. Negotiated Rate |
$245.85 |
| Rate for Payer: Adventist Health Commercial |
$16.37
|
| Rate for Payer: Aetna of CA Gatekeeper |
$43.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$56.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$245.85
|
| Rate for Payer: Blue Shield of California Commercial |
$215.48
|
| Rate for Payer: Blue Shield of California EPN |
$172.83
|
| Rate for Payer: Cash Price |
$81.87
|
| Rate for Payer: Cash Price |
$81.87
|
| Rate for Payer: Cigna of CA HMO/PPO |
$53.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.46
|
| Rate for Payer: Dignity Health Senior |
$26.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.22
|
| Rate for Payer: EPIC Health Plan Medicare |
$26.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.68
|
| Rate for Payer: Heritage Provider Network Senior |
$50.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$38.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$39.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.74
|
| Rate for Payer: Multiplan Commercial |
$61.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$26.78
|
| Rate for Payer: TriValley Medical Group Senior |
$26.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$28.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$28.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.46
|
| Rate for Payer: Vantage Medical Group Senior |
$26.78
|
|
|
HC SOM TCP 88184
|
Facility
|
IP
|
$199.38
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
900914882
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$36.09 |
| Max. Negotiated Rate |
$149.53 |
| Rate for Payer: Adventist Health Commercial |
$39.88
|
| Rate for Payer: Cash Price |
$199.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$134.98
|
| Rate for Payer: Heritage Provider Network Senior |
$134.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.84
|
| Rate for Payer: Multiplan Commercial |
$149.53
|
|
|
HC SOM TCP 88184
|
Facility
|
OP
|
$199.38
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
900914882
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$36.09 |
| Max. Negotiated Rate |
$685.59 |
| Rate for Payer: Adventist Health Commercial |
$39.88
|
| Rate for Payer: Aetna of CA Gatekeeper |
$106.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$136.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$685.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$502.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$457.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$356.12
|
| Rate for Payer: Blue Shield of California Commercial |
$269.52
|
| Rate for Payer: Blue Shield of California EPN |
$216.74
|
| Rate for Payer: Cash Price |
$199.38
|
| Rate for Payer: Cash Price |
$199.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$129.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$685.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$502.77
|
| Rate for Payer: Dignity Health Senior |
$457.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$129.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$457.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$123.42
|
| Rate for Payer: Heritage Provider Network Senior |
$123.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$68.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$457.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$95.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$525.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$575.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$575.90
|
| Rate for Payer: Multiplan Commercial |
$149.53
|
| Rate for Payer: TriValley Medical Group Commercial |
$457.06
|
| Rate for Payer: TriValley Medical Group Senior |
$457.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$321.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$321.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$685.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$502.77
|
| Rate for Payer: Vantage Medical Group Senior |
$457.06
|
|
|
HC SOM TESTOSTERONE FREE
|
Facility
|
OP
|
$8.94
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
900911131
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$237.43 |
| Rate for Payer: Adventist Health Commercial |
$1.79
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$237.43
|
| Rate for Payer: Blue Shield of California Commercial |
$204.88
|
| Rate for Payer: Blue Shield of California EPN |
$164.33
|
| Rate for Payer: Cash Price |
$8.94
|
| Rate for Payer: Cash Price |
$8.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.02
|
| Rate for Payer: Dignity Health Senior |
$25.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.81
|
| Rate for Payer: EPIC Health Plan Medicare |
$25.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.53
|
| Rate for Payer: Heritage Provider Network Senior |
$5.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$36.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.09
|
| Rate for Payer: Multiplan Commercial |
$6.71
|
| Rate for Payer: TriValley Medical Group Commercial |
$25.47
|
| Rate for Payer: TriValley Medical Group Senior |
$25.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.02
|
| Rate for Payer: Vantage Medical Group Senior |
$25.47
|
|
|
HC SOM TESTOSTERONE FREE
|
Facility
|
IP
|
$8.94
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
900911131
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$6.71 |
| Rate for Payer: Adventist Health Commercial |
$1.79
|
| Rate for Payer: Cash Price |
$8.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.05
|
| Rate for Payer: Heritage Provider Network Senior |
$6.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.23
|
| Rate for Payer: Multiplan Commercial |
$6.71
|
|
|
HC SOM TETANUS ANTITOXOID (ELISA)
|
Facility
|
OP
|
$20.42
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900911757
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.70 |
| Max. Negotiated Rate |
$136.88 |
| Rate for Payer: Adventist Health Commercial |
$4.08
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.88
|
| Rate for Payer: Blue Shield of California Commercial |
$120.67
|
| Rate for Payer: Blue Shield of California EPN |
$96.79
|
| Rate for Payer: Cash Price |
$20.42
|
| Rate for Payer: Cash Price |
$20.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.49
|
| Rate for Payer: Dignity Health Senior |
$14.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.27
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.64
|
| Rate for Payer: Heritage Provider Network Senior |
$12.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.89
|
| Rate for Payer: Multiplan Commercial |
$15.31
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.99
|
| Rate for Payer: TriValley Medical Group Senior |
$14.99
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: Vantage Medical Group Senior |
$14.99
|
|
|
HC SOM TETANUS ANTITOXOID (ELISA)
|
Facility
|
IP
|
$20.42
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900911757
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.70 |
| Max. Negotiated Rate |
$15.31 |
| Rate for Payer: Adventist Health Commercial |
$4.08
|
| Rate for Payer: Cash Price |
$20.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.82
|
| Rate for Payer: Heritage Provider Network Senior |
$13.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.11
|
| Rate for Payer: Multiplan Commercial |
$15.31
|
|
|
HC SOM TGFBR2 FULL SEQUENCE
|
Facility
|
OP
|
$1,362.50
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
900914669
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$185.20 |
| Max. Negotiated Rate |
$1,366.26 |
| Rate for Payer: Adventist Health Commercial |
$272.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$728.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$936.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$277.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$203.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$185.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,366.26
|
| Rate for Payer: Blue Shield of California Commercial |
$831.12
|
| Rate for Payer: Blue Shield of California EPN |
$664.90
|
| Rate for Payer: Cash Price |
$1,362.50
|
| Rate for Payer: Cash Price |
$1,362.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$885.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$277.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$203.72
|
| Rate for Payer: Dignity Health Senior |
$185.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$885.62
|
| Rate for Payer: EPIC Health Plan Medicare |
$185.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$843.39
|
| Rate for Payer: Heritage Provider Network Senior |
$843.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$300.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$185.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$649.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$246.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$212.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$340.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$233.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$233.35
|
| Rate for Payer: Multiplan Commercial |
$1,021.88
|
| Rate for Payer: TriValley Medical Group Commercial |
$185.20
|
| Rate for Payer: TriValley Medical Group Senior |
$185.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$200.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$200.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$277.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$203.72
|
| Rate for Payer: Vantage Medical Group Senior |
$185.20
|
|
|
HC SOM TGFBR2 FULL SEQUENCE
|
Facility
|
IP
|
$1,362.50
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
900914669
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$246.61 |
| Max. Negotiated Rate |
$1,021.88 |
| Rate for Payer: Adventist Health Commercial |
$272.50
|
| Rate for Payer: Cash Price |
$1,362.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$922.41
|
| Rate for Payer: Heritage Provider Network Senior |
$922.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$246.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$340.62
|
| Rate for Payer: Multiplan Commercial |
$1,021.88
|
|
|
HC SOM THALLIUM URINE
|
Facility
|
OP
|
$217.26
|
|
|
Service Code
|
CPT 83018
|
| Hospital Charge Code |
900911102
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.96 |
| Max. Negotiated Rate |
$176.72 |
| Rate for Payer: Adventist Health Commercial |
$43.45
|
| Rate for Payer: Aetna of CA Gatekeeper |
$116.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$149.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.13
|
| Rate for Payer: Blue Shield of California Commercial |
$176.72
|
| Rate for Payer: Blue Shield of California EPN |
$141.74
|
| Rate for Payer: Cash Price |
$217.26
|
| Rate for Payer: Cash Price |
$217.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$141.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.16
|
| Rate for Payer: Dignity Health Senior |
$21.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$141.22
|
| Rate for Payer: EPIC Health Plan Medicare |
$21.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$134.48
|
| Rate for Payer: Heritage Provider Network Senior |
$134.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$103.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.67
|
| Rate for Payer: Multiplan Commercial |
$162.94
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.96
|
| Rate for Payer: TriValley Medical Group Senior |
$21.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.16
|
| Rate for Payer: Vantage Medical Group Senior |
$21.96
|
|
|
HC SOM THALLIUM URINE
|
Facility
|
IP
|
$217.26
|
|
|
Service Code
|
CPT 83018
|
| Hospital Charge Code |
900911102
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.32 |
| Max. Negotiated Rate |
$162.94 |
| Rate for Payer: Adventist Health Commercial |
$43.45
|
| Rate for Payer: Cash Price |
$217.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$147.09
|
| Rate for Payer: Heritage Provider Network Senior |
$147.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.31
|
| Rate for Payer: Multiplan Commercial |
$162.94
|
|
|
HC SOM THC CONFIRMATION, U
|
Facility
|
OP
|
$31.60
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
900912921
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$207.44 |
| Rate for Payer: Adventist Health Commercial |
$6.32
|
| Rate for Payer: Aetna of CA Gatekeeper |
$16.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$207.44
|
| Rate for Payer: Cash Price |
$31.60
|
| Rate for Payer: Cash Price |
$31.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.86
|
| Rate for Payer: Dignity Health Senior |
$26.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.56
|
| Rate for Payer: Heritage Provider Network Senior |
$19.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$15.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.12
|
| Rate for Payer: Multiplan Commercial |
$23.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.86
|
| Rate for Payer: Vantage Medical Group Senior |
$26.86
|
|
|
HC SOM THC CONFIRMATION, U
|
Facility
|
IP
|
$31.60
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
900912921
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$23.70 |
| Rate for Payer: Adventist Health Commercial |
$6.32
|
| Rate for Payer: Cash Price |
$31.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.39
|
| Rate for Payer: Heritage Provider Network Senior |
$21.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.90
|
| Rate for Payer: Multiplan Commercial |
$23.70
|
|
|
HC SOM THIOPURINE METAB
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900914912
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$133.50 |
| Rate for Payer: Adventist Health Commercial |
$35.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$95.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$122.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.94
|
| Rate for Payer: Blue Shield of California Commercial |
$110.19
|
| Rate for Payer: Blue Shield of California EPN |
$88.38
|
| Rate for Payer: Cash Price |
$178.00
|
| Rate for Payer: Cash Price |
$178.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$115.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Senior |
$18.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$110.18
|
| Rate for Payer: Heritage Provider Network Senior |
$110.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$84.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.49
|
| Rate for Payer: Multiplan Commercial |
$133.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.64
|
| Rate for Payer: TriValley Medical Group Senior |
$18.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC SOM THIOPURINE METAB
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900914912
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$32.22 |
| Max. Negotiated Rate |
$133.50 |
| Rate for Payer: Adventist Health Commercial |
$35.60
|
| Rate for Payer: Cash Price |
$178.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$120.51
|
| Rate for Payer: Heritage Provider Network Senior |
$120.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.50
|
| Rate for Payer: Multiplan Commercial |
$133.50
|
|
|
HC SOM THYROBLUBULIN AB
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 86800
|
| Hospital Charge Code |
900910558
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$145.18 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145.18
|
| Rate for Payer: Blue Shield of California Commercial |
$127.99
|
| Rate for Payer: Blue Shield of California EPN |
$102.66
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.50
|
| Rate for Payer: Dignity Health Senior |
$15.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.29
|
| Rate for Payer: Heritage Provider Network Senior |
$9.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.05
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.91
|
| Rate for Payer: TriValley Medical Group Senior |
$15.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.50
|
| Rate for Payer: Vantage Medical Group Senior |
$15.91
|
|
