|
HC SOM SEX HORMN BINDNG GLOBU SER
|
Facility
IP
|
$13.00
|
|
|
Service Code
|
CPT 84270
|
| Hospital Charge Code |
900913804
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$9.75 |
| Rate for Payer: Adventist Health Commercial |
$2.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.93
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.80
|
| Rate for Payer: Heritage Provider Network Senior |
$8.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.25
|
| Rate for Payer: Multiplan Commercial |
$9.75
|
|
|
HC SOM SMA CARRIER BY DEL/DUP
|
Facility
OP
|
$200.00
|
|
|
Service Code
|
CPT 81329
|
| Hospital Charge Code |
900915323
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$712.84 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$283.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$137.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$205.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$150.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$712.84
|
| Rate for Payer: Blue Shield of California Commercial |
$124.20
|
| Rate for Payer: Blue Shield of California EPN |
$117.40
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$130.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$205.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$150.70
|
| Rate for Payer: Dignity Health Senior |
$137.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$123.80
|
| Rate for Payer: Heritage Provider Network Senior |
$123.80
|
| Rate for Payer: Humana Medicare |
$137.00
|
| Rate for Payer: IEHP Medi-Cal |
$170.98
|
| Rate for Payer: IEHP Medicare Advantage |
$137.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$161.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$172.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$172.62
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.00
|
| Rate for Payer: TriValley Medical Group Senior |
$137.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$147.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$147.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$205.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$150.70
|
| Rate for Payer: Vantage Medical Group Senior |
$137.00
|
|
|
HC SOM SMA CARRIER BY DEL/DUP
|
Facility
IP
|
$200.00
|
|
|
Service Code
|
CPT 81329
|
| Hospital Charge Code |
900915323
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$137.40
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$135.40
|
| Rate for Payer: Heritage Provider Network Senior |
$135.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
|
|
HC SOM SMOOTH MUSCLE AB TITER REFLEX
|
Facility
OP
|
$16.93
|
|
|
Service Code
|
CPT 86015
|
| Hospital Charge Code |
900915437
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$64.45 |
| Rate for Payer: Adventist Health Commercial |
$3.39
|
| Rate for Payer: Aetna of CA Gatekeeper |
$23.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.63
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.10
|
| Rate for Payer: Blue Shield of California Commercial |
$64.45
|
| Rate for Payer: Blue Shield of California EPN |
$50.39
|
| Rate for Payer: Cash Price |
$7.62
|
| Rate for Payer: Cash Price |
$7.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.48
|
| Rate for Payer: Heritage Provider Network Senior |
$10.48
|
| Rate for Payer: Humana Medicare |
$12.05
|
| Rate for Payer: IEHP Medi-Cal |
$17.99
|
| Rate for Payer: IEHP Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$22.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.18
|
| Rate for Payer: Multiplan Commercial |
$12.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.05
|
| Rate for Payer: TriValley Medical Group Senior |
$12.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM SMOOTH MUSCLE AB TITER REFLEX
|
Facility
IP
|
$16.93
|
|
|
Service Code
|
CPT 86015
|
| Hospital Charge Code |
900915437
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$12.70 |
| Rate for Payer: Adventist Health Commercial |
$3.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.63
|
| Rate for Payer: Cash Price |
$7.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.46
|
| Rate for Payer: Heritage Provider Network Senior |
$11.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.23
|
| Rate for Payer: Multiplan Commercial |
$12.70
|
|
|
HC SOM SOMATOSTATIN
|
Facility
IP
|
$245.00
|
|
|
Service Code
|
CPT 84307
|
| Hospital Charge Code |
900911327
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.34 |
| Max. Negotiated Rate |
$183.75 |
| Rate for Payer: Adventist Health Commercial |
$49.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$168.32
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$165.86
|
| Rate for Payer: Heritage Provider Network Senior |
$165.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.25
|
| Rate for Payer: Multiplan Commercial |
$183.75
|
|
|
HC SOM SOMATOSTATIN
|
Facility
OP
|
$245.00
|
|
|
Service Code
|
CPT 84307
|
| Hospital Charge Code |
900911327
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.28 |
| Max. Negotiated Rate |
$183.75 |
| Rate for Payer: Adventist Health Commercial |
$49.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$53.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$168.32
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$27.42
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$148.09
|
| Rate for Payer: Blue Shield of California Commercial |
$142.77
|
| Rate for Payer: Blue Shield of California EPN |
$111.61
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$159.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.11
|
| Rate for Payer: Dignity Health Senior |
$18.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$159.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$151.66
|
| Rate for Payer: Heritage Provider Network Senior |
$151.66
|
| Rate for Payer: Humana Medicare |
$18.28
|
| Rate for Payer: IEHP Medi-Cal |
$25.35
|
| Rate for Payer: IEHP Medicare Advantage |
$18.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$34.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.03
|
| Rate for Payer: Multiplan Commercial |
$183.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.28
|
| Rate for Payer: TriValley Medical Group Senior |
$18.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.11
|
| Rate for Payer: Vantage Medical Group Senior |
$18.28
|
|
|
HC SOM SOTALOL
|
Facility
IP
|
$82.23
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910789
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.88 |
| Max. Negotiated Rate |
$61.67 |
| Rate for Payer: Adventist Health Commercial |
$16.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$56.49
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$55.67
|
| Rate for Payer: Heritage Provider Network Senior |
$55.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.56
|
| Rate for Payer: Multiplan Commercial |
$61.67
|
|
|
HC SOM SOTALOL
|
Facility
OP
|
$82.23
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910789
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.88 |
| Max. Negotiated Rate |
$121.89 |
| Rate for Payer: Adventist Health Commercial |
$16.45
|
| Rate for Payer: Aetna of CA Gatekeeper |
$38.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$56.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.89
|
| Rate for Payer: Blue Shield of California Commercial |
$106.94
|
| Rate for Payer: Blue Shield of California EPN |
$83.60
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$53.45
|
| 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 |
$53.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.90
|
| Rate for Payer: Heritage Provider Network Senior |
$50.90
|
| Rate for Payer: Humana Medicare |
$18.64
|
| Rate for Payer: IEHP Medi-Cal |
$19.64
|
| Rate for Payer: IEHP Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$35.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.56
|
| 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 |
$61.67
|
| 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 SPCL HC COAG INTERPRETATION
|
Facility
OP
|
$36.00
|
|
|
Service Code
|
CPT 85390
|
| Hospital Charge Code |
900913972
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$43.16 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.73
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$23.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$17.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.16
|
| Rate for Payer: Blue Shield of California Commercial |
$40.36
|
| Rate for Payer: Blue Shield of California EPN |
$31.55
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.03
|
| Rate for Payer: Dignity Health Senior |
$15.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.28
|
| Rate for Payer: Heritage Provider Network Senior |
$22.28
|
| Rate for Payer: Humana Medicare |
$15.48
|
| Rate for Payer: IEHP Medi-Cal |
$8.78
|
| Rate for Payer: IEHP Medicare Advantage |
$15.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$29.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.50
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.48
|
| Rate for Payer: TriValley Medical Group Senior |
$15.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.03
|
| Rate for Payer: Vantage Medical Group Senior |
$15.48
|
|
|
HC SOM SPCL HC COAG INTERPRETATION
|
Facility
IP
|
$36.00
|
|
|
Service Code
|
CPT 85390
|
| Hospital Charge Code |
900913972
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.73
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.37
|
| Rate for Payer: Heritage Provider Network Senior |
$24.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
|
|
HC SOM SPN 87206
|
Facility
IP
|
$48.68
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
900914919
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.81 |
| Max. Negotiated Rate |
$36.51 |
| Rate for Payer: Adventist Health Commercial |
$9.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33.44
|
| Rate for Payer: Cash Price |
$21.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.96
|
| Rate for Payer: Heritage Provider Network Senior |
$32.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.17
|
| Rate for Payer: Multiplan Commercial |
$36.51
|
|
|
HC SOM SPN 87206
|
Facility
OP
|
$48.68
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
900914919
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$44.97 |
| Rate for Payer: Adventist Health Commercial |
$9.74
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.97
|
| Rate for Payer: Blue Shield of California Commercial |
$41.92
|
| Rate for Payer: Blue Shield of California EPN |
$32.78
|
| Rate for Payer: Cash Price |
$21.91
|
| Rate for Payer: Cash Price |
$21.91
|
| Rate for Payer: Cigna of CA HMO/PPO |
$31.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.93
|
| Rate for Payer: Dignity Health Senior |
$5.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.64
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.13
|
| Rate for Payer: Heritage Provider Network Senior |
$30.13
|
| Rate for Payer: Humana Medicare |
$5.39
|
| Rate for Payer: IEHP Medi-Cal |
$7.47
|
| Rate for Payer: IEHP Medicare Advantage |
$5.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.79
|
| Rate for Payer: Multiplan Commercial |
$36.51
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.39
|
| Rate for Payer: TriValley Medical Group Senior |
$5.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: Vantage Medical Group Senior |
$5.39
|
|
|
HC SOM SSDNA 86226
|
Facility
IP
|
$55.00
|
|
|
Service Code
|
CPT 86226
|
| Hospital Charge Code |
900914817
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.96 |
| Max. Negotiated Rate |
$41.25 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.78
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.24
|
| Rate for Payer: Heritage Provider Network Senior |
$37.24
|
| 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 SSDNA 86226
|
Facility
OP
|
$55.00
|
|
|
Service Code
|
CPT 86226
|
| Hospital Charge Code |
900914817
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.96 |
| Max. Negotiated Rate |
$101.38 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$35.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$101.38
|
| Rate for Payer: Blue Shield of California Commercial |
$94.58
|
| Rate for Payer: Blue Shield of California EPN |
$73.94
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.32
|
| Rate for Payer: Dignity Health Senior |
$12.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.04
|
| Rate for Payer: Heritage Provider Network Senior |
$34.04
|
| Rate for Payer: Humana Medicare |
$12.11
|
| Rate for Payer: IEHP Medi-Cal |
$16.79
|
| Rate for Payer: IEHP Medicare Advantage |
$12.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$23.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.26
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.11
|
| Rate for Payer: TriValley Medical Group Senior |
$12.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.32
|
| Rate for Payer: Vantage Medical Group Senior |
$12.11
|
|
|
HC SOM ST2
|
Facility
IP
|
$145.73
|
|
|
Service Code
|
CPT 83006
|
| Hospital Charge Code |
900915314
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.38 |
| Max. Negotiated Rate |
$109.30 |
| Rate for Payer: Adventist Health Commercial |
$29.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$100.12
|
| Rate for Payer: Cash Price |
$65.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$98.66
|
| Rate for Payer: Heritage Provider Network Senior |
$98.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.43
|
| Rate for Payer: Multiplan Commercial |
$109.30
|
|
|
HC SOM ST2
|
Facility
OP
|
$145.73
|
|
|
Service Code
|
CPT 83006
|
| Hospital Charge Code |
900915314
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.38 |
| Max. Negotiated Rate |
$167.31 |
| Rate for Payer: Adventist Health Commercial |
$29.15
|
| Rate for Payer: Aetna of CA Gatekeeper |
$61.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$100.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$113.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$83.16
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$75.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.17
|
| Rate for Payer: Blue Shield of California Commercial |
$167.31
|
| Rate for Payer: Blue Shield of California EPN |
$130.79
|
| Rate for Payer: Cash Price |
$65.58
|
| Rate for Payer: Cash Price |
$65.58
|
| Rate for Payer: Cigna of CA HMO/PPO |
$94.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.16
|
| Rate for Payer: Dignity Health Senior |
$75.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.72
|
| Rate for Payer: EPIC Health Plan Medicare |
$75.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$90.21
|
| Rate for Payer: Heritage Provider Network Senior |
$90.21
|
| Rate for Payer: Humana Medicare |
$75.60
|
| Rate for Payer: IEHP Medicare Advantage |
$75.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$143.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$89.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$95.26
|
| Rate for Payer: Multiplan Commercial |
$109.30
|
| Rate for Payer: TriValley Medical Group Commercial |
$75.60
|
| Rate for Payer: TriValley Medical Group Senior |
$75.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$81.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$81.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.16
|
| Rate for Payer: Vantage Medical Group Senior |
$75.60
|
|
|
HC SOM ST LOUIS ENCEPH AB IGM
|
Facility
IP
|
$25.00
|
|
|
Service Code
|
CPT 86653
|
| Hospital Charge Code |
900912812
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.18
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.92
|
| Rate for Payer: Heritage Provider Network Senior |
$16.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
|
|
HC SOM ST LOUIS ENCEPH AB IGM
|
Facility
OP
|
$25.00
|
|
|
Service Code
|
CPT 86653
|
| Hospital Charge Code |
900912812
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$110.39 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$38.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.39
|
| Rate for Payer: Blue Shield of California Commercial |
$103.02
|
| Rate for Payer: Blue Shield of California EPN |
$80.54
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.51
|
| Rate for Payer: Dignity Health Senior |
$13.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.48
|
| Rate for Payer: Heritage Provider Network Senior |
$15.48
|
| Rate for Payer: Humana Medicare |
$13.19
|
| Rate for Payer: IEHP Medi-Cal |
$18.28
|
| Rate for Payer: IEHP Medicare Advantage |
$13.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.62
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.19
|
| Rate for Payer: TriValley Medical Group Senior |
$13.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Vantage Medical Group Senior |
$13.19
|
|
|
HC SOM ST LOUIS ENCEPHALITIS AB IGG
|
Facility
IP
|
$25.00
|
|
|
Service Code
|
CPT 86653
|
| Hospital Charge Code |
900911336
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.18
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.92
|
| Rate for Payer: Heritage Provider Network Senior |
$16.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
|
|
HC SOM ST LOUIS ENCEPHALITIS AB IGG
|
Facility
OP
|
$25.00
|
|
|
Service Code
|
CPT 86653
|
| Hospital Charge Code |
900911336
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$110.39 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$38.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.39
|
| Rate for Payer: Blue Shield of California Commercial |
$103.02
|
| Rate for Payer: Blue Shield of California EPN |
$80.54
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.51
|
| Rate for Payer: Dignity Health Senior |
$13.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.48
|
| Rate for Payer: Heritage Provider Network Senior |
$15.48
|
| Rate for Payer: Humana Medicare |
$13.19
|
| Rate for Payer: IEHP Medi-Cal |
$18.28
|
| Rate for Payer: IEHP Medicare Advantage |
$13.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.62
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.19
|
| Rate for Payer: TriValley Medical Group Senior |
$13.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Vantage Medical Group Senior |
$13.19
|
|
|
HC SOM STONE ANALYSIS
|
Facility
OP
|
$16.63
|
|
|
Service Code
|
CPT 82365
|
| Hospital Charge Code |
900911025
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$107.97 |
| Rate for Payer: Adventist Health Commercial |
$3.33
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.42
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.19
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.97
|
| Rate for Payer: Blue Shield of California Commercial |
$100.68
|
| Rate for Payer: Blue Shield of California EPN |
$78.70
|
| Rate for Payer: Cash Price |
$7.48
|
| Rate for Payer: Cash Price |
$7.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.19
|
| Rate for Payer: Dignity Health Senior |
$12.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.81
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.29
|
| Rate for Payer: Heritage Provider Network Senior |
$10.29
|
| Rate for Payer: Humana Medicare |
$12.90
|
| Rate for Payer: IEHP Medi-Cal |
$17.88
|
| Rate for Payer: IEHP Medicare Advantage |
$12.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.25
|
| Rate for Payer: Multiplan Commercial |
$12.47
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.90
|
| Rate for Payer: TriValley Medical Group Senior |
$12.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.19
|
| Rate for Payer: Vantage Medical Group Senior |
$12.90
|
|
|
HC SOM STONE ANALYSIS
|
Facility
IP
|
$16.63
|
|
|
Service Code
|
CPT 82365
|
| Hospital Charge Code |
900911025
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$12.47 |
| Rate for Payer: Adventist Health Commercial |
$3.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.42
|
| Rate for Payer: Cash Price |
$7.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.26
|
| Rate for Payer: Heritage Provider Network Senior |
$11.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.16
|
| Rate for Payer: Multiplan Commercial |
$12.47
|
|
|
HC SOM STREP PNEUMO SEROTYPE 10A (34)
|
Facility
IP
|
$5.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900912860
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$3.75 |
| Rate for Payer: Adventist Health Commercial |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.44
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.38
|
| Rate for Payer: Heritage Provider Network Senior |
$3.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.25
|
| Rate for Payer: Multiplan Commercial |
$3.75
|
|
|
HC SOM STREP PNEUMO SEROTYPE 10A (34)
|
Facility
OP
|
$5.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900912860
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$125.49 |
| Rate for Payer: Adventist Health Commercial |
$1.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$43.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.49
|
| Rate for Payer: Blue Shield of California Commercial |
$117.11
|
| Rate for Payer: Blue Shield of California EPN |
$91.55
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.25
|
| 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 |
$3.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.10
|
| Rate for Payer: Heritage Provider Network Senior |
$3.10
|
| Rate for Payer: Humana Medicare |
$14.99
|
| Rate for Payer: IEHP Medi-Cal |
$16.36
|
| Rate for Payer: IEHP Medicare Advantage |
$14.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$28.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.25
|
| 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 |
$3.75
|
| 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
|
|
