|
HC SOM PROTEIN TOTAL URINE
|
Facility
IP
|
$5.12
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
900912826
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$3.84 |
| Rate for Payer: Adventist Health Commercial |
$1.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.52
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.47
|
| Rate for Payer: Heritage Provider Network Senior |
$3.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.28
|
| Rate for Payer: Multiplan Commercial |
$3.84
|
|
|
HC SOM PROTOPORPH FR RBC
|
Facility
IP
|
$334.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900911168
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$60.45 |
| Max. Negotiated Rate |
$250.50 |
| Rate for Payer: Adventist Health Commercial |
$66.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$229.46
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$226.12
|
| Rate for Payer: Heritage Provider Network Senior |
$226.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.50
|
| Rate for Payer: Multiplan Commercial |
$250.50
|
|
|
HC SOM PROTOPORPH FR RBC
|
Facility
OP
|
$334.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900911168
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.95 |
| Max. Negotiated Rate |
$250.50 |
| Rate for Payer: Adventist Health Commercial |
$66.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$52.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$229.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$36.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$24.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.51
|
| Rate for Payer: Blue Shield of California Commercial |
$141.04
|
| Rate for Payer: Blue Shield of California EPN |
$110.26
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$217.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.50
|
| Rate for Payer: Dignity Health Senior |
$24.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$217.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$24.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$206.75
|
| Rate for Payer: Heritage Provider Network Senior |
$206.75
|
| Rate for Payer: Humana Medicare |
$24.09
|
| Rate for Payer: IEHP Medi-Cal |
$23.95
|
| Rate for Payer: IEHP Medicare Advantage |
$24.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$45.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.35
|
| Rate for Payer: Multiplan Commercial |
$250.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.09
|
| Rate for Payer: TriValley Medical Group Senior |
$24.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24.09
|
|
|
HC SOM PSA ULTRASENSITIVE
|
Facility
IP
|
$123.40
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
900913953
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.34 |
| Max. Negotiated Rate |
$92.55 |
| Rate for Payer: Adventist Health Commercial |
$24.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$84.78
|
| Rate for Payer: Cash Price |
$55.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$83.54
|
| Rate for Payer: Heritage Provider Network Senior |
$83.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.85
|
| Rate for Payer: Multiplan Commercial |
$92.55
|
|
|
HC SOM PSA ULTRASENSITIVE
|
Facility
OP
|
$123.40
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
900913953
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.39 |
| Max. Negotiated Rate |
$153.95 |
| Rate for Payer: Adventist Health Commercial |
$24.68
|
| Rate for Payer: Aetna of CA Gatekeeper |
$53.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$84.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$27.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.95
|
| Rate for Payer: Blue Shield of California Commercial |
$143.66
|
| Rate for Payer: Blue Shield of California EPN |
$112.31
|
| Rate for Payer: Cash Price |
$55.53
|
| Rate for Payer: Cash Price |
$55.53
|
| Rate for Payer: Cigna of CA HMO/PPO |
$80.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.23
|
| Rate for Payer: Dignity Health Senior |
$18.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.21
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$76.38
|
| Rate for Payer: Heritage Provider Network Senior |
$76.38
|
| Rate for Payer: Humana Medicare |
$18.39
|
| Rate for Payer: IEHP Medi-Cal |
$25.51
|
| Rate for Payer: IEHP Medicare Advantage |
$18.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$34.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.17
|
| Rate for Payer: Multiplan Commercial |
$92.55
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.39
|
| Rate for Payer: TriValley Medical Group Senior |
$18.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.23
|
| Rate for Payer: Vantage Medical Group Senior |
$18.39
|
|
|
HC SOM PST
|
Facility
IP
|
$103.35
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
900914755
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$18.71 |
| Max. Negotiated Rate |
$77.51 |
| Rate for Payer: Adventist Health Commercial |
$20.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$71.00
|
| Rate for Payer: Cash Price |
$46.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$69.97
|
| Rate for Payer: Heritage Provider Network Senior |
$69.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.84
|
| Rate for Payer: Multiplan Commercial |
$77.51
|
|
|
HC SOM PST
|
Facility
OP
|
$103.35
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
900914755
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$15.32 |
| Max. Negotiated Rate |
$128.31 |
| Rate for Payer: Adventist Health Commercial |
$20.67
|
| Rate for Payer: Aetna of CA Gatekeeper |
$44.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$71.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$22.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$128.31
|
| Rate for Payer: Blue Shield of California Commercial |
$119.68
|
| Rate for Payer: Blue Shield of California EPN |
$93.56
|
| Rate for Payer: Cash Price |
$46.51
|
| Rate for Payer: Cash Price |
$46.51
|
| Rate for Payer: Cigna of CA HMO/PPO |
$67.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.85
|
| Rate for Payer: Dignity Health Senior |
$15.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.18
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$63.97
|
| Rate for Payer: Heritage Provider Network Senior |
$63.97
|
| Rate for Payer: Humana Medicare |
$15.32
|
| Rate for Payer: IEHP Medi-Cal |
$21.25
|
| Rate for Payer: IEHP Medicare Advantage |
$15.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$29.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.30
|
| Rate for Payer: Multiplan Commercial |
$77.51
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.32
|
| Rate for Payer: TriValley Medical Group Senior |
$15.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.85
|
| Rate for Payer: Vantage Medical Group Senior |
$15.32
|
|
|
HC SOM PTH RELATED PROTEIN
|
Facility
OP
|
$15.62
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
900911417
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.83 |
| Max. Negotiated Rate |
$118.28 |
| Rate for Payer: Adventist Health Commercial |
$3.12
|
| Rate for Payer: Aetna of CA Gatekeeper |
$41.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.73
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$21.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15.53
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.28
|
| Rate for Payer: Blue Shield of California Commercial |
$110.35
|
| Rate for Payer: Blue Shield of California EPN |
$86.26
|
| Rate for Payer: Cash Price |
$7.03
|
| Rate for Payer: Cash Price |
$7.03
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.53
|
| Rate for Payer: Dignity Health Senior |
$14.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.67
|
| Rate for Payer: Heritage Provider Network Senior |
$9.67
|
| Rate for Payer: Humana Medicare |
$14.12
|
| Rate for Payer: IEHP Medi-Cal |
$19.58
|
| Rate for Payer: IEHP Medicare Advantage |
$14.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.79
|
| Rate for Payer: Multiplan Commercial |
$11.72
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.12
|
| Rate for Payer: TriValley Medical Group Senior |
$14.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.53
|
| Rate for Payer: Vantage Medical Group Senior |
$14.12
|
|
|
HC SOM PTH RELATED PROTEIN
|
Facility
IP
|
$15.62
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
900911417
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.83 |
| Max. Negotiated Rate |
$11.72 |
| Rate for Payer: Adventist Health Commercial |
$3.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.73
|
| Rate for Payer: Cash Price |
$7.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.57
|
| Rate for Payer: Heritage Provider Network Senior |
$10.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.90
|
| Rate for Payer: Multiplan Commercial |
$11.72
|
|
|
HC SOM PWDNA 81331
|
Facility
OP
|
$561.17
|
|
|
Service Code
|
CPT 81331
|
| Hospital Charge Code |
900914888
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$51.07 |
| Max. Negotiated Rate |
$420.88 |
| Rate for Payer: Adventist Health Commercial |
$112.23
|
| Rate for Payer: Aetna of CA Gatekeeper |
$85.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$385.52
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$76.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$56.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$51.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$337.26
|
| Rate for Payer: Blue Shield of California Commercial |
$348.49
|
| Rate for Payer: Blue Shield of California EPN |
$329.41
|
| Rate for Payer: Cash Price |
$252.53
|
| Rate for Payer: Cash Price |
$252.53
|
| Rate for Payer: Cigna of CA HMO/PPO |
$364.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.18
|
| Rate for Payer: Dignity Health Senior |
$51.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$364.76
|
| Rate for Payer: EPIC Health Plan Medicare |
$51.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$347.36
|
| Rate for Payer: Heritage Provider Network Senior |
$347.36
|
| Rate for Payer: Humana Medicare |
$51.07
|
| Rate for Payer: IEHP Medi-Cal |
$63.73
|
| Rate for Payer: IEHP Medicare Advantage |
$51.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$97.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$60.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$64.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$64.35
|
| Rate for Payer: Multiplan Commercial |
$420.88
|
| Rate for Payer: TriValley Medical Group Commercial |
$51.07
|
| Rate for Payer: TriValley Medical Group Senior |
$51.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$55.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$55.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.18
|
| Rate for Payer: Vantage Medical Group Senior |
$51.07
|
|
|
HC SOM PWDNA 81331
|
Facility
IP
|
$561.17
|
|
|
Service Code
|
CPT 81331
|
| Hospital Charge Code |
900914888
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$101.57 |
| Max. Negotiated Rate |
$420.88 |
| Rate for Payer: Adventist Health Commercial |
$112.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$385.52
|
| Rate for Payer: Cash Price |
$252.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$379.91
|
| Rate for Payer: Heritage Provider Network Senior |
$379.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.29
|
| Rate for Payer: Multiplan Commercial |
$420.88
|
|
|
HC SOM PYRUVATE KINASE
|
Facility
OP
|
$65.00
|
|
|
Service Code
|
CPT 84220
|
| Hospital Charge Code |
900911491
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.44 |
| Max. Negotiated Rate |
$78.95 |
| Rate for Payer: Adventist Health Commercial |
$13.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$27.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$44.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$14.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.95
|
| Rate for Payer: Blue Shield of California Commercial |
$73.68
|
| Rate for Payer: Blue Shield of California EPN |
$57.60
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$42.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.38
|
| Rate for Payer: Dignity Health Senior |
$9.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.24
|
| Rate for Payer: Heritage Provider Network Senior |
$40.24
|
| Rate for Payer: Humana Medicare |
$9.44
|
| Rate for Payer: IEHP Medi-Cal |
$13.09
|
| Rate for Payer: IEHP Medicare Advantage |
$9.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.89
|
| Rate for Payer: Multiplan Commercial |
$48.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.44
|
| Rate for Payer: TriValley Medical Group Senior |
$9.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.38
|
| Rate for Payer: Vantage Medical Group Senior |
$9.44
|
|
|
HC SOM PYRUVATE KINASE
|
Facility
IP
|
$65.00
|
|
|
Service Code
|
CPT 84220
|
| Hospital Charge Code |
900911491
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.76 |
| Max. Negotiated Rate |
$48.75 |
| Rate for Payer: Adventist Health Commercial |
$13.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$44.66
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.00
|
| Rate for Payer: Heritage Provider Network Senior |
$44.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.25
|
| Rate for Payer: Multiplan Commercial |
$48.75
|
|
|
HC SOM Q FEVER AB SCREEN
|
Facility
IP
|
$40.10
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
900915440
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.26 |
| Max. Negotiated Rate |
$30.08 |
| Rate for Payer: Adventist Health Commercial |
$8.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.55
|
| Rate for Payer: Cash Price |
$18.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.15
|
| Rate for Payer: Heritage Provider Network Senior |
$27.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.02
|
| Rate for Payer: Multiplan Commercial |
$30.08
|
|
|
HC SOM Q FEVER AB SCREEN
|
Facility
OP
|
$40.10
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
900915440
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.26 |
| Max. Negotiated Rate |
$105.66 |
| Rate for Payer: Adventist Health Commercial |
$8.02
|
| Rate for Payer: Aetna of CA Gatekeeper |
$35.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.55
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.33
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.66
|
| Rate for Payer: Blue Shield of California Commercial |
$94.69
|
| Rate for Payer: Blue Shield of California EPN |
$74.03
|
| Rate for Payer: Cash Price |
$18.05
|
| Rate for Payer: Cash Price |
$18.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.33
|
| Rate for Payer: Dignity Health Senior |
$12.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.06
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.82
|
| Rate for Payer: Heritage Provider Network Senior |
$24.82
|
| Rate for Payer: Humana Medicare |
$12.12
|
| Rate for Payer: IEHP Medi-Cal |
$16.82
|
| Rate for Payer: IEHP Medicare Advantage |
$12.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$23.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.27
|
| Rate for Payer: Multiplan Commercial |
$30.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.12
|
| Rate for Payer: TriValley Medical Group Senior |
$12.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.33
|
| Rate for Payer: Vantage Medical Group Senior |
$12.12
|
|
|
HC SOM Q FEVER IGG PHAS I
|
Facility
IP
|
$10.02
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
900914336
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$7.52 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.88
|
| Rate for Payer: Cash Price |
$4.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.78
|
| Rate for Payer: Heritage Provider Network Senior |
$6.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: Multiplan Commercial |
$7.52
|
|
|
HC SOM Q FEVER IGG PHAS I
|
Facility
OP
|
$10.02
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
900914336
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$105.66 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$35.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.33
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.66
|
| Rate for Payer: Blue Shield of California Commercial |
$94.69
|
| Rate for Payer: Blue Shield of California EPN |
$74.03
|
| Rate for Payer: Cash Price |
$4.51
|
| Rate for Payer: Cash Price |
$4.51
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.33
|
| Rate for Payer: Dignity Health Senior |
$12.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.51
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.20
|
| Rate for Payer: Heritage Provider Network Senior |
$6.20
|
| Rate for Payer: Humana Medicare |
$12.12
|
| Rate for Payer: IEHP Medi-Cal |
$16.82
|
| Rate for Payer: IEHP Medicare Advantage |
$12.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$23.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.27
|
| Rate for Payer: Multiplan Commercial |
$7.52
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.12
|
| Rate for Payer: TriValley Medical Group Senior |
$12.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.33
|
| Rate for Payer: Vantage Medical Group Senior |
$12.12
|
|
|
HC SOM Q FEVER IGG PHAS II
|
Facility
OP
|
$10.02
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
900914334
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$105.66 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$35.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.33
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.66
|
| Rate for Payer: Blue Shield of California Commercial |
$94.69
|
| Rate for Payer: Blue Shield of California EPN |
$74.03
|
| Rate for Payer: Cash Price |
$4.51
|
| Rate for Payer: Cash Price |
$4.51
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.33
|
| Rate for Payer: Dignity Health Senior |
$12.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.51
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.20
|
| Rate for Payer: Heritage Provider Network Senior |
$6.20
|
| Rate for Payer: Humana Medicare |
$12.12
|
| Rate for Payer: IEHP Medi-Cal |
$16.82
|
| Rate for Payer: IEHP Medicare Advantage |
$12.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$23.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.27
|
| Rate for Payer: Multiplan Commercial |
$7.52
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.12
|
| Rate for Payer: TriValley Medical Group Senior |
$12.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.33
|
| Rate for Payer: Vantage Medical Group Senior |
$12.12
|
|
|
HC SOM Q FEVER IGG PHAS II
|
Facility
IP
|
$10.02
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
900914334
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$7.52 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.88
|
| Rate for Payer: Cash Price |
$4.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.78
|
| Rate for Payer: Heritage Provider Network Senior |
$6.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: Multiplan Commercial |
$7.52
|
|
|
HC SOM Q FEVER IGM PHAS I
|
Facility
IP
|
$10.03
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
900914337
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$7.52 |
| Rate for Payer: Adventist Health Commercial |
$2.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.89
|
| Rate for Payer: Cash Price |
$4.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.79
|
| Rate for Payer: Heritage Provider Network Senior |
$6.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.51
|
| Rate for Payer: Multiplan Commercial |
$7.52
|
|
|
HC SOM Q FEVER IGM PHAS I
|
Facility
OP
|
$10.03
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
900914337
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$105.66 |
| Rate for Payer: Adventist Health Commercial |
$2.01
|
| Rate for Payer: Aetna of CA Gatekeeper |
$35.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.33
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.66
|
| Rate for Payer: Blue Shield of California Commercial |
$94.69
|
| Rate for Payer: Blue Shield of California EPN |
$74.03
|
| Rate for Payer: Cash Price |
$4.51
|
| Rate for Payer: Cash Price |
$4.51
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.33
|
| Rate for Payer: Dignity Health Senior |
$12.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.52
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.21
|
| Rate for Payer: Heritage Provider Network Senior |
$6.21
|
| Rate for Payer: Humana Medicare |
$12.12
|
| Rate for Payer: IEHP Medi-Cal |
$16.82
|
| Rate for Payer: IEHP Medicare Advantage |
$12.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$23.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.27
|
| Rate for Payer: Multiplan Commercial |
$7.52
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.12
|
| Rate for Payer: TriValley Medical Group Senior |
$12.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.33
|
| Rate for Payer: Vantage Medical Group Senior |
$12.12
|
|
|
HC SOM Q FEVER IGM PHAS II
|
Facility
OP
|
$10.03
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
900914335
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$105.66 |
| Rate for Payer: Adventist Health Commercial |
$2.01
|
| Rate for Payer: Aetna of CA Gatekeeper |
$35.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.33
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.66
|
| Rate for Payer: Blue Shield of California Commercial |
$94.69
|
| Rate for Payer: Blue Shield of California EPN |
$74.03
|
| Rate for Payer: Cash Price |
$4.51
|
| Rate for Payer: Cash Price |
$4.51
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.33
|
| Rate for Payer: Dignity Health Senior |
$12.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.52
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.21
|
| Rate for Payer: Heritage Provider Network Senior |
$6.21
|
| Rate for Payer: Humana Medicare |
$12.12
|
| Rate for Payer: IEHP Medi-Cal |
$16.82
|
| Rate for Payer: IEHP Medicare Advantage |
$12.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$23.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.27
|
| Rate for Payer: Multiplan Commercial |
$7.52
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.12
|
| Rate for Payer: TriValley Medical Group Senior |
$12.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.33
|
| Rate for Payer: Vantage Medical Group Senior |
$12.12
|
|
|
HC SOM Q FEVER IGM PHAS II
|
Facility
IP
|
$10.03
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
900914335
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$7.52 |
| Rate for Payer: Adventist Health Commercial |
$2.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.89
|
| Rate for Payer: Cash Price |
$4.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.79
|
| Rate for Payer: Heritage Provider Network Senior |
$6.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.51
|
| Rate for Payer: Multiplan Commercial |
$7.52
|
|
|
HC SOM QUANTIFERON TB GOLD
|
Facility
IP
|
$40.00
|
|
|
Service Code
|
CPT 86480
|
| Hospital Charge Code |
900912882
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.48
|
| Rate for Payer: Cash Price |
$18.00
|
| 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 QUANTIFERON TB GOLD
|
Facility
OP
|
$40.00
|
|
|
Service Code
|
CPT 86480
|
| Hospital Charge Code |
900912882
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$507.44 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$180.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$92.97
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$68.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$61.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$507.44
|
| Rate for Payer: Blue Shield of California Commercial |
$484.04
|
| Rate for Payer: Blue Shield of California EPN |
$378.40
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$92.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.18
|
| Rate for Payer: Dignity Health Senior |
$61.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$61.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.76
|
| Rate for Payer: Heritage Provider Network Senior |
$24.76
|
| Rate for Payer: Humana Medicare |
$61.98
|
| Rate for Payer: IEHP Medi-Cal |
$67.69
|
| Rate for Payer: IEHP Medicare Advantage |
$61.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$117.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$73.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78.09
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$61.98
|
| Rate for Payer: TriValley Medical Group Senior |
$61.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$66.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$66.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$92.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.18
|
| Rate for Payer: Vantage Medical Group Senior |
$61.98
|
|
