▸ Hospital · NV · CCN 290005
North Vista Hospital
1409 EAST LAKE MEAD BLVD, NORTH LAS VEGAS, NV, 89030
161 bedsAcute Care Hospitals4
Compliance grade
A
100/100
Procedures tracked
164
of 209 target codes
Payers
26
with negotiated rates
Rates published
5,617
last crawl 2026-05-22
Procedures & rates
| Procedure | Type | Code | Payers | Gross | Cash | Neg min | Neg median | Neg max |
|---|---|---|---|---|---|---|---|---|
| behavioral | ||||||||
| Psychoses | MS-DRG | 885 | 18 | — | $12,934 | $3,773 | $13,193 | $23,928 |
| Psychiatric diagnostic evaluation | CPT | 90791 | 17 | $353.94 | $193 | $191.13 | $289.59 | $353.94 |
| Psychiatric eval with medical services | CPT | 90792 | 17 | $409.62 | $193 | $191.13 | $289.59 | $409.62 |
| Psychotherapy 30 minutes | CPT | 90832 | 17 | $528.7 | $193 | $191.13 | $254.75 | $528.7 |
| Psychotherapy 45 minutes | CPT | 90834 | 17 | $375.12 | $193 | $191.13 | $254.75 | $375.12 |
| Psychotherapy 60 minutes | CPT | 90837 | 17 | $335.48 | $193 | $191.13 | $254.75 | $335.48 |
| Crisis psychotherapy 60 minutes | CPT | 90839 | 17 | $577.6 | $193 | $191.13 | $254.75 | $577.6 |
| emergency | ||||||||
| ED visit level 1 | CPT | 99281 | 22 | $825 | $91 | $19.14 | $92.64 | $825 |
| ED visit level 2 | CPT | 99282 | 20 | $1,443 | $167 | $37.66 | $202.08 | $1,303 |
| ED visit level 3 | CPT | 99283 | 22 | $2,219 | $296 | $30 | $296.92 | $1,303 |
| ED visit level 4 | CPT | 99284 | 22 | $3,195 | $453 | $30 | $453.86 | $1,510.67 |
| ED visit level 5 | CPT | 99285 | 22 | $4,391 | $647 | $30 | $647.76 | $2,156.07 |
| Critical care, first hour | CPT | 99291 | 22 | $5,500 | $898 | $30 | $898.49 | $2,990.62 |
| imaging | ||||||||
| CT head without contrast | CPT | 70450 | 21 | $3,878 | $113 | $30 | $113.71 | $585 |
| CT head with contrast | CPT | 70460 | 18 | $2,594.43 | $190 | $118.62 | $190.78 | $635.01 |
| CT head with and without contrast | CPT | 70470 | 19 | $6,313.56 | $190 | $30 | $190.78 | $635.01 |
| CT neck with contrast | CPT | 70491 | 20 | $7,019.29 | $190 | $30 | $190.78 | $635.01 |
| MRI brain without contrast | CPT | 70551 | 20 | $6,636.72 | $259 | $30 | $259.52 | $918 |
| MRI brain with contrast | CPT | 70552 | 19 | $8,947.48 | $379 | $30 | $379.47 | $1,263.07 |
| MRI brain with and without contrast | CPT | 70553 | 20 | $16,199 | $379 | $30 | $379.47 | $1,263.07 |
| Chest X-ray single view | CPT | 71045 | 21 | $4,715.17 | $94 | $10.78 | $94.65 | $315.04 |
| Chest X-ray 2 views | CPT | 71046 | 21 | $997.58 | $94 | $19.79 | $94.65 | $315.04 |
| Chest X-ray 3 views | CPT | 71047 | 18 | $517.17 | $94 | $25.21 | $94.65 | $315.04 |
| CT chest without contrast | CPT | 71250 | 19 | $2,462 | $113 | $30 | $149.3 | $585 |
| CT chest with contrast | CPT | 71260 | 20 | $6,276.47 | $190 | $30 | $190.78 | $635.01 |
| CT chest with and without contrast | CPT | 71270 | 19 | $6,109.32 | $190 | $30 | $233.96 | $635.01 |
| MRI chest without contrast | CPT | 71550 | 18 | $6,746.86 | $259 | $184.45 | $365.1 | $918 |
| MRI chest with contrast | CPT | 71551 | 18 | $4,042 | $852 | $404.47 | $852.68 | $2,838.15 |
| MRI chest with and without contrast | CPT | 71552 | 18 | $4,380 | $379 | $308.7 | $510.22 | $1,263.07 |
| Lumbosacral spine X-ray | CPT | 72100 | 19 | $1,138.42 | $113 | $25.84 | $113.71 | $378.48 |
| CT cervical spine without contrast | CPT | 72125 | 21 | $6,959.97 | $113 | $30 | $150.44 | $585 |
| CT thoracic spine without contrast | CPT | 72128 | 18 | $5,511.2 | $113 | $90.01 | $150.43 | $585 |
| CT lumbar spine without contrast | CPT | 72131 | 19 | $8,490.17 | $113 | $30 | $149.68 | $585 |
| MRI cervical spine without contrast | CPT | 72141 | 19 | $12,112 | $259 | $30 | $259.52 | $918 |
| MRI thoracic spine without contrast | CPT | 72146 | 18 | $10,470 | $259 | $177.37 | $259.52 | $918 |
| MRI lumbar spine without contrast | CPT | 72148 | 19 | $11,370 | $259 | $30 | $259.52 | $918 |
| MRI lumbar spine with and without contrast | CPT | 72149 | 18 | $4,278 | $379 | $252.95 | $379.47 | $1,263.07 |
| MRI cervical spine with and without contrast | CPT | 72156 | 18 | $13,476 | $379 | $293.36 | $379.47 | $1,263.07 |
| MRI lumbar spine with contrast | CPT | 72158 | 19 | $14,836 | $379 | $60 | $379.47 | $1,263.07 |
| CT pelvis without contrast | CPT | 72192 | 19 | $1,223.4 | $113 | $30 | $113.71 | $585 |
| CT pelvis with contrast | CPT | 72193 | 18 | $5,775.48 | $190 | $161.39 | $190.78 | $635.01 |
| Shoulder X-ray | CPT | 73030 | 20 | $2,666.4 | $94 | $22.46 | $94.65 | $315.04 |
| Humerus X-ray | CPT | 73060 | 19 | $1,543.86 | $94 | $21.72 | $94.65 | $315.04 |
| Hand X-ray 3 views | CPT | 73130 | 20 | $2,466.86 | $94 | $25.84 | $94.65 | $315.04 |
| MRI upper extremity joint without contrast | CPT | 73221 | 19 | $20,285 | $259 | $30 | $259.52 | $918 |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 18 | $22,313 | $379 | $308.7 | $399.87 | $1,263.07 |
| Knee X-ray 1-2 views | CPT | 73560 | 19 | $1,545.76 | $94 | $22.84 | $94.65 | $315.04 |
| Ankle X-ray 3 views | CPT | 73610 | 20 | $1,831.98 | $94 | $26.58 | $94.65 | $315.04 |
| MRI lower extremity joint without contrast | CPT | 73721 | 20 | $14,563 | $259 | $30 | $259.52 | $918 |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 18 | $3,408.45 | $379 | $308.7 | $401.38 | $1,263.07 |
| CT abdomen without contrast | CPT | 74150 | 18 | $1,223.4 | $113 | $90.01 | $113.71 | $585 |
| CT abdomen with contrast | CPT | 74160 | 18 | $3,382.99 | $190 | $161.39 | $190.78 | $635.01 |
| CT abdomen with and without contrast | CPT | 74170 | 18 | $5,776.2 | $190 | $161.39 | $220.35 | $635.01 |
| CT abdomen and pelvis without contrast | CPT | 74176 | 20 | $11,441 | $259 | $30 | $259.52 | $863.81 |
| CT abdomen and pelvis with contrast | CPT | 74177 | 20 | $12,736 | $379 | $30 | $379.47 | $1,263.07 |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 20 | $15,515 | $379 | $30 | $379.47 | $1,263.07 |
| MRI abdomen without contrast | CPT | 74181 | 19 | $8,829.95 | $259 | $30 | $280.82 | $918 |
| MRI abdomen with and without contrast | CPT | 74183 | 19 | $10,691 | $379 | $30 | $432.75 | $1,263.07 |
| Abdominal ultrasound complete | CPT | 76700 | 19 | $1,910.85 | $113 | $30 | $113.71 | $378.48 |
| Abdominal ultrasound limited | CPT | 76705 | 20 | $1,260.85 | $113 | $30 | $113.71 | $378.48 |
| Retroperitoneal ultrasound complete | CPT | 76770 | 19 | $1,034 | $113 | $30 | $113.71 | $378.48 |
| Obstetric ultrasound first trimester | CPT | 76801 | 19 | $851 | $113 | $60 | $113.71 | $378.48 |
| Obstetric ultrasound after first trimester | CPT | 76805 | 19 | $1,960.61 | $113 | $60 | $113.71 | $378.48 |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 18 | $1,138.35 | $259 | $94.68 | $259.52 | $863.81 |
| Transvaginal ultrasound | CPT | 76830 | 20 | $810 | $113 | $30 | $113.71 | $378.48 |
| Pelvic ultrasound complete | CPT | 76856 | 19 | $3,633.53 | $113 | $30 | $113.71 | $378.48 |
| Scrotal ultrasound | CPT | 76870 | 19 | $2,070.61 | $113 | $44.16 | $113.71 | $378.48 |
| Diagnostic mammography unilateral | CPT | 77065 | 18 | $743.8 | $86 | $75.25 | $96.26 | $172.4 |
| Diagnostic mammography bilateral | CPT | 77066 | 18 | $906.9 | $110 | $96.3 | $122.95 | $221.12 |
| Screening mammography bilateral | CPT | 77067 | 18 | $242.62 | $91 | $79.58 | $101.66 | $182.44 |
| EKG tracing only | CPT | 93005 | 21 | $647.98 | $64 | $7.33 | $64.16 | $346 |
| Transthoracic echocardiogram complete | CPT | 93306 | 20 | $3,036.41 | $594 | $30 | $594.34 | $1,978.26 |
| Transthoracic echocardiogram | CPT | 93307 | 18 | $1,501 | $259 | $76.98 | $259.52 | $863.81 |
| Stress echocardiogram | CPT | 93350 | 18 | $2,174.77 | $594 | $150.76 | $594.34 | $1,978.26 |
| inpatient | ||||||||
| Intracranial hemorrhage/CVA w MCC | MS-DRG | 064 | 18 | — | $17,992 | $3,773 | $22,133 | $33,286 |
| Intracranial hemorrhage/CVA w CC | MS-DRG | 065 | 18 | — | $9,751 | $3,773 | $11,133 | $18,039 |
| Intracranial hemorrhage/CVA w/o CC/MCC | MS-DRG | 066 | 18 | — | $7,067 | $3,773 | $9,187.18 | $13,074 |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 18 | — | $14,300 | $3,773 | $14,586 | $26,455 |
| COPD w MCC | MS-DRG | 190 | 18 | — | $10,553 | $3,773 | $10,764 | $19,523 |
| COPD w CC | MS-DRG | 191 | 18 | — | $8,373 | $3,773 | $8,540.66 | $15,490 |
| COPD w/o CC/MCC | MS-DRG | 192 | 18 | — | $6,717 | $3,773 | $6,852.24 | $12,428 |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 18 | — | $8,067 | $3,773 | $8,229.02 | $14,925 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 19 | — | $6,606 | $3,773 | $7,663.77 | $12,222 |
| AMI discharged alive w MCC | MS-DRG | 280 | 18 | — | $14,641 | $3,773 | $15,705 | $27,086 |
| AMI discharged alive w CC | MS-DRG | 281 | 19 | — | $8,999 | $3,773 | $10,694 | $16,650 |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 19 | — | $7,385 | $3,773 | $8,573.25 | $13,664 |
| Heart failure & shock w MCC | MS-DRG | 291 | 19 | — | $12,003 | $3,773 | $13,924 | $22,206 |
| Heart failure & shock w CC | MS-DRG | 292 | 18 | — | $8,422 | $3,773 | $8,630.55 | $15,582 |
| Heart failure & shock w/o CC/MCC | MS-DRG | 293 | 18 | — | $6,091 | $3,773 | $6,213.82 | $11,270 |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 18 | — | $11,346 | $3,773 | $11,573 | $20,990 |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 19 | — | $7,489 | $3,773 | $8,687.87 | $13,856 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 19 | — | $6,092 | $3,773 | $7,067.66 | $11,272 |
| GI hemorrhage w CC | MS-DRG | 378 | 19 | — | $9,507 | $3,773 | $11,028 | $17,588 |
| GI hemorrhage w/o CC/MCC | MS-DRG | 379 | 19 | — | $6,622 | $3,773 | $7,821.39 | $12,251 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 19 | — | $7,851 | $3,773 | $9,107.25 | $14,525 |
| Fractures of femur w/o MCC | MS-DRG | 533 | 18 | — | $14,341 | $3,773 | $17,449 | $26,532 |
| Kidney/UTI w MCC | MS-DRG | 689 | 19 | — | $10,986 | $3,773 | $12,888 | $20,325 |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 19 | — | $8,097 | $3,773 | $9,392.9 | $14,980 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 19 | — | $17,428 | $3,773 | $19,913 | $32,242 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 19 | — | $9,858 | $3,773 | $11,435 | $18,237 |
| lab | ||||||||
| Basic metabolic panel (BMP) | CPT | 80048 | 21 | $878.04 | $8 | $5.64 | $8.46 | $60 |
| General health panel | CPT | 80050 | 6 | $520 | — | $24.07 | $24.56 | $44.65 |
| Electrolyte panel | CPT | 80051 | 18 | $240 | $7 | $4.67 | $7.01 | $14.02 |
| Comprehensive metabolic panel | CPT | 80053 | 21 | $917.1 | $10 | $7.04 | $10.56 | $60 |
| Lipid panel | CPT | 80061 | 20 | $590.33 | $13 | $8.93 | $13.39 | $60 |
| Renal function panel | CPT | 80069 | 19 | $94.8 | $8 | $5.79 | $8.68 | $30 |
| Hepatic function panel | CPT | 80076 | 20 | $712.49 | $8 | $5.45 | $8.17 | $60 |
| Urinalysis non-automated | CPT | 81002 | 18 | $95 | $3 | $1.73 | $3.48 | $6.96 |
| Urinalysis automated | CPT | 81003 | 20 | $113 | $2 | $1.49 | $2.25 | $60 |
| Glucose quantitative | CPT | 82947 | 20 | $86.62 | $3 | $2.62 | $3.93 | $60 |
| Hemoglobin A1c | CPT | 83036 | 19 | $314.71 | $9 | $6.47 | $9.71 | $60 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 20 | $874.24 | $16 | $11.2 | $16.8 | $60 |
| Complete blood count with automated differential | CPT | 85025 | 21 | $250.34 | $7 | $5.18 | $7.77 | $60 |
| Complete blood count without differential | CPT | 85027 | 19 | $139 | $6 | $4.31 | $6.47 | $60 |
| Urine culture bacterial | CPT | 87086 | 21 | $553.85 | $8 | $5.38 | $8.07 | $60 |
| Urine culture identification | CPT | 87088 | 20 | $434 | $8 | $5.39 | $8.09 | $60 |
| Tissue exam by pathologist level IV | CPT | 88305 | 18 | $664.83 | $56 | $16.85 | $56.68 | $188.66 |
| maternity | ||||||||
| Fetal non-stress test | CPT | 59025 | 9 | $702.95 | — | $21.31 | $62.13 | $702.95 |
| Vaginal delivery only | CPT | 59409 | 21 | $4,199 | $3,521 | $814.38 | $3,521.07 | $4,199 |
| office | ||||||||
| Office visit, new patient, 15-29 min | CPT | 99202 | 4 | $198.72 | — | $46 | $46.46 | $47.39 |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 4 | $206 | — | $70.17 | $70.88 | $72.3 |
| Office visit, new patient, 45-59 min | CPT | 99204 | 5 | $277.58 | — | $60 | $121.31 | $123.74 |
| Office visit, new patient, 60-74 min | CPT | 99205 | 4 | $379.5 | — | $154.92 | $156.48 | $159.61 |
| Office visit, established patient, 5 min | CPT | 99211 | 4 | $189 | — | $8.46 | $8.55 | $8.72 |
| Office visit, established patient, 10-19 min | CPT | 99212 | 4 | $102.88 | — | $23.15 | $23.38 | $23.85 |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 4 | $156.19 | — | $46.94 | $47.41 | $48.36 |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 6 | $224.87 | — | $30 | $72.73 | $74.18 |
| Office visit, established patient, 40-54 min | CPT | 99215 | 4 | $316.96 | — | $101.31 | $102.33 | $104.38 |
| preventive | ||||||||
| Upper GI endoscopy diagnostic | CPT | 43235 | 22 | $4,885.53 | $986 | $326.15 | $1,006.27 | $3,283.7 |
| Upper GI endoscopy with biopsy | CPT | 43239 | 22 | $4,885.53 | $986 | $326.15 | $1,210 | $3,283.7 |
| Sigmoidoscopy diagnostic | CPT | 45330 | 22 | $2,850.5 | $1,011 | $59.51 | $1,517.3 | $2,850.5 |
| Sigmoidoscopy with biopsy | CPT | 45331 | 22 | $1,945 | $1,011 | $215.47 | $1,031.76 | $1,945 |
| Colonoscopy diagnostic | CPT | 45378 | 22 | $4,750.83 | $1,011 | $329.38 | $1,313.07 | $3,366.88 |
| Colonoscopy with biopsy | CPT | 45380 | 22 | $3,686.44 | $1,301 | $329.38 | $1,327.63 | $3,686.44 |
| Colonoscopy with polyp removal | CPT | 45385 | 22 | $3,686.44 | $1,301 | $329.38 | $1,327.63 | $3,686.44 |
| surgery | ||||||||
| Shoulder arthroscopy with decompression | CPT | 29826 | 9 | $34,196 | — | $166.49 | $1,051.5 | $1,778.08 |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 22 | $28,167 | $7,892 | $1,862 | $7,892.71 | $26,271 |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 22 | $32,500 | $3,559 | $1,048.23 | $3,559.01 | $11,846 |
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 18 | — | $39,284 | $3,773 | $40,237 | $72,677 |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 18 | — | $21,172 | $3,773 | $23,889 | $39,170 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 18 | — | $15,290 | $3,773 | $19,877 | $28,287 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG | 418 | 18 | — | $15,361 | $3,773 | $19,102 | $28,419 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG | 419 | 19 | — | $12,678 | $3,773 | $14,530 | $23,456 |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG | 420 | 18 | — | $29,489 | $3,773 | $38,337 | $59,031 |
| Laparoscopic appendectomy | CPT | 44970 | 22 | $18,341 | $6,575 | $60 | $6,575.82 | $18,341 |
| Major joint replacement w MCC | MS-DRG | 469 | 18 | — | $26,410 | $3,773 | $34,334 | $48,859 |
| Major joint replacement w/o MCC | MS-DRG | 470 | 18 | — | $17,316 | $3,773 | $22,363 | $32,035 |
| Laparoscopic cholecystectomy | CPT | 47562 | 22 | $21,793 | $6,575 | $1,573.61 | $6,686.17 | $21,793 |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 22 | $22,712 | $6,575 | $1,573.61 | $6,575.82 | $21,888 |
| Hip & femur procedures except major joint w MCC | MS-DRG | 480 | 18 | — | $25,414 | $3,773 | $33,039 | $47,017 |
| Hip & femur procedures except major joint w CC | MS-DRG | 481 | 18 | — | $18,679 | $3,773 | $24,284 | $34,558 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG | 482 | 18 | — | $14,862 | $3,773 | $19,322 | $27,496 |
| Lap inguinal hernia repair | CPT | 49650 | 22 | $33,000 | $6,575 | $1,573.61 | $6,575.82 | $21,888 |
| OR procedure for obesity w MCC | MS-DRG | 619 | 18 | — | $25,209 | $3,773 | $25,714 | $46,638 |
| OR procedure for obesity w CC | MS-DRG | 620 | 18 | — | $14,609 | $3,773 | $17,563 | $27,028 |
| OR procedure for obesity w/o CC/MCC | MS-DRG | 621 | 18 | — | $13,853 | $3,773 | $17,987 | $25,628 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 18 | — | $11,648 | $3,773 | $13,605 | $21,550 |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG | 744 | 18 | — | $18,305 | $3,773 | $18,672 | $33,866 |
| PCI single major coronary artery | CPT | 92920 | 19 | $25,425 | $6,190 | $3,364.92 | $6,314.63 | $20,606 |
| PCI with drug-eluting stent | CPT | 92928 | 19 | $17,417 | $12,556 | $3,364.92 | $12,557 | $17,417 |
| PCI bypass graft | CPT | 92937 | 19 | $19,916 | $12,556 | $3,364.92 | $12,557 | $19,916 |
| Left heart catheterization | CPT | 93452 | 21 | $16,760 | $3,526 | $551.83 | $3,526.3 | $11,737 |
| Coronary angiography with cath | CPT | 93455 | 21 | $12,272 | $3,526 | $660.29 | $3,526.3 | $11,737 |
| Coronary angiography with bypass cath | CPT | 93458 | 21 | $16,760 | $3,526 | $673.01 | $3,526.3 | $11,737 |
Rate history available after the next quarterly refresh. We re-crawl all hospital MRFs each quarter to track rate changes over time.
Payer mix (top 26)
| Payer | Codes covered | Median rate |
|---|---|---|
| silver summit | 164 | $296.92 |
| Anthem BCBS | 164 | $340.73 |
| Molina | 164 | $193.06 |
| Aetna | 154 | $585 |
| imperial insurance companies | 152 | $569.21 |
| intermountain healthcare (hcp) | 152 | $467.14 |
| 6 degrees health | 152 | $758.94 |
| alignment | 152 | $387.06 |
| employer direct healthcare | 152 | $531.26 |
| health services coalition | 152 | $720.99 |
| Medicare | 152 | $379.47 |
| naphcare | 152 | $588.18 |
| nevada health partners | 152 | $725.66 |
| renal payor solutions | 152 | $379.47 |
| TRICARE | 152 | $379.47 |
| triwest | 152 | $375.68 |
| UnitedHealthcare | 151 | $308.7 |
| Medicaid | 112 | $119.96 |
| keenan | 64 | $30 |
| sierra health | 61 | $60 |
| national healthcare solutions, inc | 43 | $19,205 |
| Workers Comp | 28 | $1,706.38 |
| three rivers | 22 | $1,724.74 |
| prominence health first | 16 | $40 |
| provider select | 16 | $1,539.4 |
| Humana | 4 | $239.21 |
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