|
HC VENOUS THROMBUS SCAN
|
Facility
OP
|
$1,146.00
|
|
|
Service Code
|
CPT 78458
|
| Hospital Charge Code |
909301387
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$147.14 |
| Max. Negotiated Rate |
$979.11 |
| Rate for Payer: Adventist Health Commercial |
$229.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$341.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$787.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Blue Shield of California Commercial |
$821.70
|
| Rate for Payer: Blue Shield of California EPN |
$467.27
|
| Rate for Payer: Cash Price |
$515.70
|
| Rate for Payer: Cash Price |
$515.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$744.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: Dignity Health Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$744.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$515.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$709.37
|
| Rate for Payer: Heritage Provider Network Senior |
$709.37
|
| Rate for Payer: Humana Medicare |
$515.32
|
| Rate for Payer: IEHP Medi-Cal |
$147.14
|
| Rate for Payer: IEHP Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$979.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$207.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$608.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$286.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$649.30
|
| Rate for Payer: Multiplan Commercial |
$859.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$566.85
|
| Rate for Payer: TriValley Medical Group Senior |
$515.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC VENOUS THROMBUS SCAN
|
Facility
IP
|
$1,146.00
|
|
|
Service Code
|
CPT 78458
|
| Hospital Charge Code |
909301387
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$207.43 |
| Max. Negotiated Rate |
$859.50 |
| Rate for Payer: Adventist Health Commercial |
$229.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$787.30
|
| Rate for Payer: Cash Price |
$515.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$775.84
|
| Rate for Payer: Heritage Provider Network Senior |
$775.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$207.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$286.50
|
| Rate for Payer: Multiplan Commercial |
$859.50
|
|
|
HC VENT ASSIST& MGT-INITIAL DAILY
|
Facility
IP
|
$4,590.00
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
900800100
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$830.79 |
| Max. Negotiated Rate |
$3,442.50 |
| Rate for Payer: Adventist Health Commercial |
$918.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,153.33
|
| Rate for Payer: Cash Price |
$2,065.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,107.43
|
| Rate for Payer: Heritage Provider Network Senior |
$3,107.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$830.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,147.50
|
| Rate for Payer: Multiplan Commercial |
$3,442.50
|
|
|
HC VENT ASSIST& MGT-INITIAL DAILY
|
Facility
OP
|
$4,590.00
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
900800100
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$69.89 |
| Max. Negotiated Rate |
$3,442.50 |
| Rate for Payer: Adventist Health Commercial |
$918.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$202.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,153.33
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,174.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$861.27
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$782.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$2,065.50
|
| Rate for Payer: Cash Price |
$2,065.50
|
| Rate for Payer: Cash Price |
$2,065.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,983.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,174.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$861.27
|
| Rate for Payer: Dignity Health Senior |
$782.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,983.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$782.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,841.21
|
| Rate for Payer: Heritage Provider Network Senior |
$2,841.21
|
| Rate for Payer: Humana Medicare |
$782.97
|
| Rate for Payer: IEHP Medi-Cal |
$69.89
|
| Rate for Payer: IEHP Medicare Advantage |
$782.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,487.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$830.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$923.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,147.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$986.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$986.54
|
| Rate for Payer: Multiplan Commercial |
$3,442.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$358.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$304.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,174.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$861.27
|
| Rate for Payer: Vantage Medical Group Senior |
$782.97
|
|
|
HC VENT ASSIST & MGT SUB DAILY
|
Facility
IP
|
$4,246.00
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
900800101
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$768.53 |
| Max. Negotiated Rate |
$3,184.50 |
| Rate for Payer: Adventist Health Commercial |
$849.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,917.00
|
| Rate for Payer: Cash Price |
$1,910.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,874.54
|
| Rate for Payer: Heritage Provider Network Senior |
$2,874.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$768.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,061.50
|
| Rate for Payer: Multiplan Commercial |
$3,184.50
|
|
|
HC VENT ASSIST & MGT SUB DAILY
|
Facility
OP
|
$4,246.00
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
900800101
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$55.07 |
| Max. Negotiated Rate |
$3,184.50 |
| Rate for Payer: Adventist Health Commercial |
$849.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$146.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,917.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,174.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$861.27
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$782.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$1,910.70
|
| Rate for Payer: Cash Price |
$1,910.70
|
| Rate for Payer: Cash Price |
$1,910.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,759.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,174.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$861.27
|
| Rate for Payer: Dignity Health Senior |
$782.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,759.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$782.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,628.27
|
| Rate for Payer: Heritage Provider Network Senior |
$2,628.27
|
| Rate for Payer: Humana Medicare |
$782.97
|
| Rate for Payer: IEHP Medi-Cal |
$55.07
|
| Rate for Payer: IEHP Medicare Advantage |
$782.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,487.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$768.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$923.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,061.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$986.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$986.54
|
| Rate for Payer: Multiplan Commercial |
$3,184.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$358.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$304.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,174.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$861.27
|
| Rate for Payer: Vantage Medical Group Senior |
$782.97
|
|
|
HC VENT PUNC THR PREV BURR HOLE
|
Facility
IP
|
$1,653.00
|
|
|
Service Code
|
CPT 61020
|
| Hospital Charge Code |
900501253
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$299.19 |
| Max. Negotiated Rate |
$1,239.75 |
| Rate for Payer: Adventist Health Commercial |
$330.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,135.61
|
| Rate for Payer: Cash Price |
$743.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,119.08
|
| Rate for Payer: Heritage Provider Network Senior |
$1,119.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$299.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$413.25
|
| Rate for Payer: Multiplan Commercial |
$1,239.75
|
|
|
HC VENT PUNC THR PREV BURR HOLE
|
Facility
OP
|
$1,653.00
|
|
|
Service Code
|
CPT 61020
|
| Hospital Charge Code |
900501253
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$299.19 |
| Max. Negotiated Rate |
$3,237.00 |
| Rate for Payer: Adventist Health Commercial |
$330.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,135.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,138.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$743.85
|
| Rate for Payer: Cash Price |
$743.85
|
| Rate for Payer: Cash Price |
$743.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,074.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,252.71
|
| Rate for Payer: Dignity Health Senior |
$1,138.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,074.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,138.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,119.08
|
| Rate for Payer: Heritage Provider Network Senior |
$1,119.08
|
| Rate for Payer: Humana Medicare |
$1,138.83
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$1,138.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$796.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$299.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,343.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$413.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,434.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,434.93
|
| Rate for Payer: Multiplan Commercial |
$1,239.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$600.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$552.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Vantage Medical Group Senior |
$1,138.83
|
|
|
HC VENT TUBE
|
Facility
OP
|
$300.00
|
|
| Hospital Charge Code |
909081809
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.30 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$160.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$206.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$165.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$225.00
|
| Rate for Payer: Blue Shield of California Commercial |
$186.30
|
| Rate for Payer: Blue Shield of California EPN |
$176.10
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$195.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$255.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$255.00
|
| Rate for Payer: Dignity Health Senior |
$255.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$185.70
|
| Rate for Payer: Heritage Provider Network Senior |
$185.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$144.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$255.00
|
| Rate for Payer: Vantage Medical Group Senior |
$255.00
|
|
|
HC VENT TUBE
|
Facility
IP
|
$300.00
|
|
| Hospital Charge Code |
909081809
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.30 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$206.10
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$203.10
|
| Rate for Payer: Heritage Provider Network Senior |
$203.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
|
|
HC VERTEBRAL UNI
|
Facility
OP
|
$17,995.00
|
|
|
Service Code
|
CPT 36226
|
| Hospital Charge Code |
906820224
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$439.08 |
| Max. Negotiated Rate |
$13,496.25 |
| Rate for Payer: Adventist Health Commercial |
$3,599.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,362.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,866.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$8,097.75
|
| Rate for Payer: Cash Price |
$8,097.75
|
| Rate for Payer: Cash Price |
$8,097.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,696.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,552.68
|
| Rate for Payer: Dignity Health Senior |
$6,866.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,866.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,138.90
|
| Rate for Payer: Heritage Provider Network Senior |
$8,445.27
|
| Rate for Payer: Humana Medicare |
$6,866.07
|
| Rate for Payer: IEHP Medi-Cal |
$439.08
|
| Rate for Payer: IEHP Medicare Advantage |
$6,866.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,045.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,257.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,101.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,498.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,651.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,651.25
|
| Rate for Payer: Multiplan Commercial |
$13,496.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,552.68
|
| Rate for Payer: TriValley Medical Group Senior |
$7,552.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6,866.07
|
|
|
HC VERTEBRAL UNI
|
Facility
IP
|
$17,995.00
|
|
|
Service Code
|
CPT 36226
|
| Hospital Charge Code |
906820224
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,257.10 |
| Max. Negotiated Rate |
$13,496.25 |
| Rate for Payer: Adventist Health Commercial |
$3,599.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,362.56
|
| Rate for Payer: Cash Price |
$8,097.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,182.62
|
| Rate for Payer: Heritage Provider Network Senior |
$12,182.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,257.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,498.75
|
| Rate for Payer: Multiplan Commercial |
$13,496.25
|
|
|
HC VERTEBRAL UNI
|
Facility
OP
|
$29,291.00
|
|
|
Service Code
|
CPT 36226
|
| Hospital Charge Code |
909020149
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$439.08 |
| Max. Negotiated Rate |
$21,968.25 |
| Rate for Payer: Adventist Health Commercial |
$5,858.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20,122.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,866.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$13,180.95
|
| Rate for Payer: Cash Price |
$13,180.95
|
| Rate for Payer: Cash Price |
$13,180.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19,039.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,552.68
|
| Rate for Payer: Dignity Health Senior |
$6,866.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,866.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$18,131.13
|
| Rate for Payer: Heritage Provider Network Senior |
$8,445.27
|
| Rate for Payer: Humana Medicare |
$6,866.07
|
| Rate for Payer: IEHP Medi-Cal |
$439.08
|
| Rate for Payer: IEHP Medicare Advantage |
$6,866.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,045.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,301.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,101.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,322.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,651.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,651.25
|
| Rate for Payer: Multiplan Commercial |
$21,968.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,552.68
|
| Rate for Payer: TriValley Medical Group Senior |
$7,552.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6,866.07
|
|
|
HC VERTEBRAL UNI
|
Facility
IP
|
$29,291.00
|
|
|
Service Code
|
CPT 36226
|
| Hospital Charge Code |
909020149
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,301.67 |
| Max. Negotiated Rate |
$21,968.25 |
| Rate for Payer: Adventist Health Commercial |
$5,858.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20,122.92
|
| Rate for Payer: Cash Price |
$13,180.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$19,830.01
|
| Rate for Payer: Heritage Provider Network Senior |
$19,830.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,301.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,322.75
|
| Rate for Payer: Multiplan Commercial |
$21,968.25
|
|
|
HC VERTEBROPLASTY ADDL INJECT
|
Facility
IP
|
$9,269.00
|
|
|
Service Code
|
CPT 22512
|
| Hospital Charge Code |
909022512
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,677.69 |
| Max. Negotiated Rate |
$6,951.75 |
| Rate for Payer: Adventist Health Commercial |
$1,853.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,367.80
|
| Rate for Payer: Cash Price |
$4,171.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,275.11
|
| Rate for Payer: Heritage Provider Network Senior |
$6,275.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,677.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,317.25
|
| Rate for Payer: Multiplan Commercial |
$6,951.75
|
|
|
HC VERTEBROPLASTY ADDL INJECT
|
Facility
OP
|
$9,269.00
|
|
|
Service Code
|
CPT 22512
|
| Hospital Charge Code |
909022512
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$283.42 |
| Max. Negotiated Rate |
$10,500.11 |
| Rate for Payer: Adventist Health Commercial |
$1,853.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,367.80
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,878.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,097.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,951.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,500.11
|
| Rate for Payer: Blue Shield of California EPN |
$9,024.37
|
| Rate for Payer: Cash Price |
$4,171.05
|
| Rate for Payer: Cash Price |
$4,171.05
|
| Rate for Payer: Cash Price |
$4,171.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,024.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,878.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,878.65
|
| Rate for Payer: Dignity Health Senior |
$7,878.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,737.51
|
| Rate for Payer: Heritage Provider Network Senior |
$5,737.51
|
| Rate for Payer: IEHP Medi-Cal |
$283.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,467.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,677.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,317.25
|
| Rate for Payer: Multiplan Commercial |
$6,951.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,878.65
|
| Rate for Payer: Vantage Medical Group Senior |
$7,878.65
|
|
|
HC VESTIBULE OF MOUTH
|
Facility
IP
|
$1,324.00
|
|
|
Service Code
|
CPT 40808
|
| Hospital Charge Code |
900501785
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$239.64 |
| Max. Negotiated Rate |
$993.00 |
| Rate for Payer: Adventist Health Commercial |
$264.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$909.59
|
| Rate for Payer: Cash Price |
$595.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$896.35
|
| Rate for Payer: Heritage Provider Network Senior |
$896.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$239.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$331.00
|
| Rate for Payer: Multiplan Commercial |
$993.00
|
|
|
HC VESTIBULE OF MOUTH
|
Facility
OP
|
$1,324.00
|
|
|
Service Code
|
CPT 40808
|
| Hospital Charge Code |
900501785
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$239.64 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$264.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$909.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$687.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$595.80
|
| Rate for Payer: Cash Price |
$595.80
|
| Rate for Payer: Cash Price |
$595.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$860.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$756.18
|
| Rate for Payer: Dignity Health Senior |
$687.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$687.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$896.35
|
| Rate for Payer: Heritage Provider Network Senior |
$896.35
|
| Rate for Payer: Humana Medicare |
$687.44
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$687.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$638.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$239.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$811.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$331.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$866.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$866.17
|
| Rate for Payer: Multiplan Commercial |
$993.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$480.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$442.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Vantage Medical Group Senior |
$687.44
|
|
|
HC VITAL CAPACITY TOTAL
|
Facility
IP
|
$562.00
|
|
|
Service Code
|
CPT 94150
|
| Hospital Charge Code |
900800430
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$101.72 |
| Max. Negotiated Rate |
$421.50 |
| Rate for Payer: Adventist Health Commercial |
$112.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$386.09
|
| Rate for Payer: Cash Price |
$252.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$380.47
|
| Rate for Payer: Heritage Provider Network Senior |
$380.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.50
|
| Rate for Payer: Multiplan Commercial |
$421.50
|
|
|
HC VITAL CAPACITY TOTAL
|
Facility
OP
|
$562.00
|
|
|
Service Code
|
CPT 94150
|
| Hospital Charge Code |
900800430
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$8.69 |
| Max. Negotiated Rate |
$421.50 |
| Rate for Payer: Adventist Health Commercial |
$112.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$48.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$386.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Blue Shield of California Commercial |
$89.66
|
| Rate for Payer: Blue Shield of California EPN |
$50.99
|
| Rate for Payer: Cash Price |
$252.90
|
| Rate for Payer: Cash Price |
$252.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$365.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.69
|
| Rate for Payer: Dignity Health Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$365.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$195.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$347.88
|
| Rate for Payer: Heritage Provider Network Senior |
$347.88
|
| Rate for Payer: Humana Medicare |
$195.17
|
| Rate for Payer: IEHP Medi-Cal |
$8.69
|
| Rate for Payer: IEHP Medicare Advantage |
$195.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$370.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$230.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.91
|
| Rate for Payer: Multiplan Commercial |
$421.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$214.69
|
| Rate for Payer: TriValley Medical Group Senior |
$195.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC VITAMIN B12
|
Facility
OP
|
$30.00
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
900910830
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$126.17 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$43.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$22.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$126.17
|
| Rate for Payer: Blue Shield of California Commercial |
$117.73
|
| Rate for Payer: Blue Shield of California EPN |
$92.03
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.59
|
| Rate for Payer: Dignity Health Senior |
$15.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.57
|
| Rate for Payer: Heritage Provider Network Senior |
$18.57
|
| Rate for Payer: Humana Medicare |
$15.08
|
| Rate for Payer: IEHP Medi-Cal |
$20.79
|
| Rate for Payer: IEHP Medicare Advantage |
$15.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$28.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.00
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.08
|
| Rate for Payer: TriValley Medical Group Senior |
$15.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.59
|
| Rate for Payer: Vantage Medical Group Senior |
$15.08
|
|
|
HC VITAMIN B12
|
Facility
IP
|
$244.00
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
900910830
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.16 |
| Max. Negotiated Rate |
$183.00 |
| Rate for Payer: Adventist Health Commercial |
$48.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$167.63
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$165.19
|
| Rate for Payer: Heritage Provider Network Senior |
$165.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.00
|
| Rate for Payer: Multiplan Commercial |
$183.00
|
|
|
HC VITAMIN D TOTAL
|
Facility
OP
|
$45.00
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
900912240
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$247.78 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$86.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$44.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$32.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$29.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$247.78
|
| Rate for Payer: Blue Shield of California Commercial |
$231.20
|
| Rate for Payer: Blue Shield of California EPN |
$180.74
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.56
|
| Rate for Payer: Dignity Health Senior |
$29.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$29.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.86
|
| Rate for Payer: Heritage Provider Network Senior |
$27.86
|
| Rate for Payer: Humana Medicare |
$29.60
|
| Rate for Payer: IEHP Medi-Cal |
$32.32
|
| Rate for Payer: IEHP Medicare Advantage |
$29.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$56.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.30
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$29.60
|
| Rate for Payer: TriValley Medical Group Senior |
$29.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$31.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.56
|
| Rate for Payer: Vantage Medical Group Senior |
$29.60
|
|
|
HC VITAMIN D TOTAL
|
Facility
IP
|
$64.00
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
900912240
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.58 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.97
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.33
|
| Rate for Payer: Heritage Provider Network Senior |
$43.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.00
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
|
|
HC VNUS ABLATION CATHETER
|
Facility
OP
|
$1,740.00
|
|
|
Service Code
|
CPT C1888
|
| Hospital Charge Code |
909080043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$348.00 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$348.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$835.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,195.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,479.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$957.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,305.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,080.54
|
| Rate for Payer: Blue Shield of California EPN |
$1,021.38
|
| Rate for Payer: Cash Price |
$783.00
|
| Rate for Payer: Cash Price |
$783.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$800.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,479.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,479.00
|
| Rate for Payer: Dignity Health Senior |
$1,479.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,113.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$805.62
|
| Rate for Payer: Heritage Provider Network Senior |
$805.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$870.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$870.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$870.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$435.00
|
| Rate for Payer: Multiplan Commercial |
$1,305.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$634.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$581.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,479.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,479.00
|
|
