|
HC MRI PROCEDURE
|
Facility
|
OP
|
$3,164.00
|
|
|
Service Code
|
CPT 76498
|
| Hospital Charge Code |
908801008
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$111.88 |
| Max. Negotiated Rate |
$2,847.60 |
| Rate for Payer: Adventist Health Commercial |
$632.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,921.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,532.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,858.22
|
| Rate for Payer: Blue Shield of California Commercial |
$1,920.55
|
| Rate for Payer: Blue Shield of California EPN |
$1,256.11
|
| Rate for Payer: Cash Price |
$1,423.80
|
| Rate for Payer: Cash Price |
$1,423.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,531.20
|
| Rate for Payer: Cigna of CA HMO |
$2,024.96
|
| Rate for Payer: Cigna of CA PPO |
$2,341.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$2,689.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,898.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,847.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: InnovAge PACE Commercial |
$167.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,110.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$632.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$2,373.00
|
| Rate for Payer: Networks By Design Commercial |
$2,056.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.88
|
| Rate for Payer: Prime Health Services Commercial |
$2,689.40
|
| Rate for Payer: Prime Health Services Medicare |
$118.59
|
| Rate for Payer: Riverside University Health System MISP |
$123.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,898.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,898.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| Rate for Payer: United Healthcare All Other HMO |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC MRI SPECTROSCOPY
|
Facility
|
OP
|
$4,177.00
|
|
|
Service Code
|
CPT 76390
|
| Hospital Charge Code |
908801255
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$111.88 |
| Max. Negotiated Rate |
$3,759.30 |
| Rate for Payer: Adventist Health Commercial |
$835.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,536.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,332.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,453.15
|
| Rate for Payer: Blue Shield of California Commercial |
$2,535.44
|
| Rate for Payer: Blue Shield of California EPN |
$1,658.27
|
| Rate for Payer: Cash Price |
$1,879.65
|
| Rate for Payer: Cash Price |
$1,879.65
|
| Rate for Payer: Central Health Plan Commercial |
$3,341.60
|
| Rate for Payer: Cigna of CA HMO |
$2,673.28
|
| Rate for Payer: Cigna of CA PPO |
$3,090.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$3,550.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,506.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,759.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: InnovAge PACE Commercial |
$167.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,786.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,591.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$835.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$3,132.75
|
| Rate for Payer: Networks By Design Commercial |
$2,715.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.88
|
| Rate for Payer: Prime Health Services Commercial |
$3,550.45
|
| Rate for Payer: Prime Health Services Medicare |
$118.59
|
| Rate for Payer: Riverside University Health System MISP |
$123.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,506.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,506.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,065.68
|
| Rate for Payer: United Healthcare All Other HMO |
$1,065.68
|
| Rate for Payer: United Healthcare HMO Rider |
$1,065.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,065.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC MRI SPECTROSCOPY
|
Facility
|
IP
|
$5,489.00
|
|
|
Service Code
|
CPT 76390
|
| Hospital Charge Code |
908801255
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,097.80 |
| Max. Negotiated Rate |
$4,940.10 |
| Rate for Payer: Adventist Health Commercial |
$1,097.80
|
| Rate for Payer: Cash Price |
$2,470.05
|
| Rate for Payer: Central Health Plan Commercial |
$4,391.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,195.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,195.60
|
| Rate for Payer: Galaxy Health WC |
$4,665.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,293.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,940.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,661.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,091.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,397.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,097.80
|
| Rate for Payer: Multiplan Commercial |
$4,116.75
|
| Rate for Payer: Networks By Design Commercial |
$3,567.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,665.65
|
|
|
HC MRI THORACIC SPINE WITH CONTRA
|
Facility
|
OP
|
$5,150.00
|
|
|
Service Code
|
CPT 72147
|
| Hospital Charge Code |
908801112
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$453.77 |
| Max. Negotiated Rate |
$4,635.00 |
| Rate for Payer: Adventist Health Commercial |
$1,030.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$453.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,766.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,024.59
|
| Rate for Payer: Blue Shield of California Commercial |
$3,126.05
|
| Rate for Payer: Blue Shield of California EPN |
$2,044.55
|
| Rate for Payer: Cash Price |
$2,317.50
|
| Rate for Payer: Cash Price |
$2,317.50
|
| Rate for Payer: Cash Price |
$2,317.50
|
| Rate for Payer: Central Health Plan Commercial |
$4,120.00
|
| Rate for Payer: Cigna of CA HMO |
$3,296.00
|
| Rate for Payer: Cigna of CA PPO |
$3,811.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.59
|
| Rate for Payer: EPIC Health Plan Senior |
$453.77
|
| Rate for Payer: Galaxy Health WC |
$4,377.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,090.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,635.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$460.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: InnovAge PACE Commercial |
$680.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,435.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$508.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,030.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$608.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$608.05
|
| Rate for Payer: Multiplan Commercial |
$3,862.50
|
| Rate for Payer: Networks By Design Commercial |
$3,347.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$453.77
|
| Rate for Payer: Prime Health Services Commercial |
$4,377.50
|
| Rate for Payer: Prime Health Services Medicare |
$481.00
|
| Rate for Payer: Riverside University Health System MISP |
$499.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,090.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,090.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,115.74
|
| Rate for Payer: United Healthcare All Other HMO |
$1,115.74
|
| Rate for Payer: United Healthcare HMO Rider |
$1,115.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,115.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$453.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
HC MRI THORACIC SPINE WITH CONTRA
|
Facility
|
IP
|
$11,302.00
|
|
|
Service Code
|
CPT 72147
|
| Hospital Charge Code |
908801112
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$2,260.40 |
| Max. Negotiated Rate |
$10,171.80 |
| Rate for Payer: Adventist Health Commercial |
$2,260.40
|
| Rate for Payer: Cash Price |
$5,085.90
|
| Rate for Payer: Central Health Plan Commercial |
$9,041.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,520.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,520.80
|
| Rate for Payer: Galaxy Health WC |
$9,606.70
|
| Rate for Payer: Global Benefits Group Commercial |
$6,781.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,171.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,538.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,306.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,995.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,260.40
|
| Rate for Payer: Multiplan Commercial |
$8,476.50
|
| Rate for Payer: Networks By Design Commercial |
$7,346.30
|
| Rate for Payer: Prime Health Services Commercial |
$9,606.70
|
|
|
HC MRI THORACIC SPINE WO CON
|
Facility
|
OP
|
$4,965.00
|
|
|
Service Code
|
CPT 72146
|
| Hospital Charge Code |
908801110
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$4,468.50 |
| Rate for Payer: Adventist Health Commercial |
$993.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$307.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,015.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,556.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,915.94
|
| Rate for Payer: Blue Shield of California Commercial |
$3,013.76
|
| Rate for Payer: Blue Shield of California EPN |
$1,971.11
|
| Rate for Payer: Cash Price |
$2,234.25
|
| Rate for Payer: Cash Price |
$2,234.25
|
| Rate for Payer: Central Health Plan Commercial |
$3,972.00
|
| Rate for Payer: Cigna of CA HMO |
$3,177.60
|
| Rate for Payer: Cigna of CA PPO |
$3,674.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$4,220.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,979.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,468.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$318.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: InnovAge PACE Commercial |
$460.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,311.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$352.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$993.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$411.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$3,723.75
|
| Rate for Payer: Networks By Design Commercial |
$3,227.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$307.13
|
| Rate for Payer: Prime Health Services Commercial |
$4,220.25
|
| Rate for Payer: Prime Health Services Medicare |
$325.56
|
| Rate for Payer: Riverside University Health System MISP |
$337.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,979.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,979.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| Rate for Payer: United Healthcare All Other HMO |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC MRI THORACIC SPINE WO CON
|
Facility
|
IP
|
$10,276.00
|
|
|
Service Code
|
CPT 72146
|
| Hospital Charge Code |
908801110
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$2,055.20 |
| Max. Negotiated Rate |
$9,248.40 |
| Rate for Payer: Adventist Health Commercial |
$2,055.20
|
| Rate for Payer: Cash Price |
$4,624.20
|
| Rate for Payer: Central Health Plan Commercial |
$8,220.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,110.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,110.40
|
| Rate for Payer: Galaxy Health WC |
$8,734.60
|
| Rate for Payer: Global Benefits Group Commercial |
$6,165.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,248.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,854.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,915.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,360.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,055.20
|
| Rate for Payer: Multiplan Commercial |
$7,707.00
|
| Rate for Payer: Networks By Design Commercial |
$6,679.40
|
| Rate for Payer: Prime Health Services Commercial |
$8,734.60
|
|
|
HC MRI T-SPINE W & WO CONTRAST
|
Facility
|
IP
|
$12,346.00
|
|
|
Service Code
|
CPT 72157
|
| Hospital Charge Code |
908801114
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$2,469.20 |
| Max. Negotiated Rate |
$11,111.40 |
| Rate for Payer: Adventist Health Commercial |
$2,469.20
|
| Rate for Payer: Cash Price |
$5,555.70
|
| Rate for Payer: Central Health Plan Commercial |
$9,876.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,938.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,938.40
|
| Rate for Payer: Galaxy Health WC |
$10,494.10
|
| Rate for Payer: Global Benefits Group Commercial |
$7,407.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,111.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,234.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,703.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,642.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,469.20
|
| Rate for Payer: Multiplan Commercial |
$9,259.50
|
| Rate for Payer: Networks By Design Commercial |
$8,024.90
|
| Rate for Payer: Prime Health Services Commercial |
$10,494.10
|
|
|
HC MRI T-SPINE W & WO CONTRAST
|
Facility
|
OP
|
$5,667.00
|
|
|
Service Code
|
CPT 72157
|
| Hospital Charge Code |
908801114
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$453.77 |
| Max. Negotiated Rate |
$5,100.30 |
| Rate for Payer: Adventist Health Commercial |
$1,133.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$453.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,441.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,535.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,328.23
|
| Rate for Payer: Blue Shield of California Commercial |
$3,439.87
|
| Rate for Payer: Blue Shield of California EPN |
$2,249.80
|
| Rate for Payer: Cash Price |
$2,550.15
|
| Rate for Payer: Cash Price |
$2,550.15
|
| Rate for Payer: Central Health Plan Commercial |
$4,533.60
|
| Rate for Payer: Cigna of CA HMO |
$3,626.88
|
| Rate for Payer: Cigna of CA PPO |
$4,193.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.59
|
| Rate for Payer: EPIC Health Plan Senior |
$453.77
|
| Rate for Payer: Galaxy Health WC |
$4,816.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,400.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,100.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$539.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: InnovAge PACE Commercial |
$680.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,779.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$595.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,133.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$608.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$608.05
|
| Rate for Payer: Multiplan Commercial |
$4,250.25
|
| Rate for Payer: Networks By Design Commercial |
$3,683.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$453.77
|
| Rate for Payer: Prime Health Services Commercial |
$4,816.95
|
| Rate for Payer: Prime Health Services Medicare |
$481.00
|
| Rate for Payer: Riverside University Health System MISP |
$499.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,400.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,400.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,367.12
|
| Rate for Payer: United Healthcare All Other HMO |
$1,367.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1,367.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,367.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$453.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
HC MRI UPPER EXT JNT W & WO CONT
|
Facility
|
IP
|
$12,961.00
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
908801435
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,592.20 |
| Max. Negotiated Rate |
$11,664.90 |
| Rate for Payer: Adventist Health Commercial |
$2,592.20
|
| Rate for Payer: Cash Price |
$5,832.45
|
| Rate for Payer: Central Health Plan Commercial |
$10,368.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,184.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,184.40
|
| Rate for Payer: Galaxy Health WC |
$11,016.85
|
| Rate for Payer: Global Benefits Group Commercial |
$7,776.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,664.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,644.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,938.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,022.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,592.20
|
| Rate for Payer: Multiplan Commercial |
$9,720.75
|
| Rate for Payer: Networks By Design Commercial |
$8,424.65
|
| Rate for Payer: Prime Health Services Commercial |
$11,016.85
|
|
|
HC MRI UPPER EXT JNT W & WO CONT
|
Facility
|
OP
|
$5,612.00
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
908801435
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$453.77 |
| Max. Negotiated Rate |
$5,198.91 |
| Rate for Payer: Adventist Health Commercial |
$1,122.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$453.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,198.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,295.93
|
| Rate for Payer: Blue Shield of California Commercial |
$3,406.48
|
| Rate for Payer: Blue Shield of California EPN |
$2,227.96
|
| Rate for Payer: Cash Price |
$2,525.40
|
| Rate for Payer: Cash Price |
$2,525.40
|
| Rate for Payer: Cash Price |
$2,525.40
|
| Rate for Payer: Central Health Plan Commercial |
$4,489.60
|
| Rate for Payer: Cigna of CA HMO |
$3,591.68
|
| Rate for Payer: Cigna of CA PPO |
$4,152.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.59
|
| Rate for Payer: EPIC Health Plan Senior |
$453.77
|
| Rate for Payer: Galaxy Health WC |
$4,770.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,367.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,050.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$664.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: InnovAge PACE Commercial |
$680.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,743.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$733.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,122.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$608.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$608.05
|
| Rate for Payer: Multiplan Commercial |
$4,209.00
|
| Rate for Payer: Networks By Design Commercial |
$3,647.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$453.77
|
| Rate for Payer: Prime Health Services Commercial |
$4,770.20
|
| Rate for Payer: Prime Health Services Medicare |
$481.00
|
| Rate for Payer: Riverside University Health System MISP |
$499.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,367.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,367.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,367.12
|
| Rate for Payer: United Healthcare All Other HMO |
$1,367.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1,367.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,367.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$453.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
HC MRI UPPER EXTREM JOINT W/CONT
|
Facility
|
IP
|
$8,757.00
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
908801433
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,751.40 |
| Max. Negotiated Rate |
$7,881.30 |
| Rate for Payer: Adventist Health Commercial |
$1,751.40
|
| Rate for Payer: Cash Price |
$3,940.65
|
| Rate for Payer: Central Health Plan Commercial |
$7,005.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,502.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,502.80
|
| Rate for Payer: Galaxy Health WC |
$7,443.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,254.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,881.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,840.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,336.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,420.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,751.40
|
| Rate for Payer: Multiplan Commercial |
$6,567.75
|
| Rate for Payer: Networks By Design Commercial |
$5,692.05
|
| Rate for Payer: Prime Health Services Commercial |
$7,443.45
|
|
|
HC MRI UPPER EXTREM JOINT W/CONT
|
Facility
|
OP
|
$3,846.00
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
908801433
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$537.26 |
| Max. Negotiated Rate |
$3,461.40 |
| Rate for Payer: Adventist Health Commercial |
$769.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,003.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,104.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,003.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,808.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,258.76
|
| Rate for Payer: Blue Shield of California Commercial |
$2,334.52
|
| Rate for Payer: Blue Shield of California EPN |
$1,526.86
|
| Rate for Payer: Cash Price |
$1,730.70
|
| Rate for Payer: Cash Price |
$1,730.70
|
| Rate for Payer: Cash Price |
$1,730.70
|
| Rate for Payer: Central Health Plan Commercial |
$3,076.80
|
| Rate for Payer: Cigna of CA HMO |
$2,461.44
|
| Rate for Payer: Cigna of CA PPO |
$2,846.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,104.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,003.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,355.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,003.85
|
| Rate for Payer: Galaxy Health WC |
$3,269.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,307.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,461.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,646.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$537.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,003.85
|
| Rate for Payer: InnovAge PACE Commercial |
$1,505.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,565.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$593.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,003.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$769.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,345.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,345.16
|
| Rate for Payer: Multiplan Commercial |
$2,884.50
|
| Rate for Payer: Networks By Design Commercial |
$2,499.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,003.85
|
| Rate for Payer: Prime Health Services Commercial |
$3,269.10
|
| Rate for Payer: Prime Health Services Medicare |
$1,064.08
|
| Rate for Payer: Riverside University Health System MISP |
$1,104.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,307.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,307.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,115.74
|
| Rate for Payer: United Healthcare All Other HMO |
$1,115.74
|
| Rate for Payer: United Healthcare HMO Rider |
$1,115.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,115.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,003.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,104.23
|
| Rate for Payer: Vantage Medical Group Senior |
$1,003.85
|
|
|
HC MRI UPPER EXTREM JOINT WO CONT
|
Facility
|
OP
|
$3,431.00
|
|
|
Service Code
|
CPT 73221
|
| Hospital Charge Code |
908801431
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$3,087.90 |
| Rate for Payer: Adventist Health Commercial |
$686.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$307.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,295.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,015.03
|
| Rate for Payer: Blue Shield of California Commercial |
$2,082.62
|
| Rate for Payer: Blue Shield of California EPN |
$1,362.11
|
| Rate for Payer: Cash Price |
$1,543.95
|
| Rate for Payer: Cash Price |
$1,543.95
|
| Rate for Payer: Cash Price |
$1,543.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,744.80
|
| Rate for Payer: Cigna of CA HMO |
$2,195.84
|
| Rate for Payer: Cigna of CA PPO |
$2,538.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$2,916.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,058.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,087.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$339.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: InnovAge PACE Commercial |
$460.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,288.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$374.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$686.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$411.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$2,573.25
|
| Rate for Payer: Networks By Design Commercial |
$2,230.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$307.13
|
| Rate for Payer: Prime Health Services Commercial |
$2,916.35
|
| Rate for Payer: Prime Health Services Medicare |
$325.56
|
| Rate for Payer: Riverside University Health System MISP |
$337.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,058.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,058.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| Rate for Payer: United Healthcare All Other HMO |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC MRI UPPER EXTREM JOINT WO CONT
|
Facility
|
IP
|
$8,424.00
|
|
|
Service Code
|
CPT 73221
|
| Hospital Charge Code |
908801431
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,684.80 |
| Max. Negotiated Rate |
$7,581.60 |
| Rate for Payer: Adventist Health Commercial |
$1,684.80
|
| Rate for Payer: Cash Price |
$3,790.80
|
| Rate for Payer: Central Health Plan Commercial |
$6,739.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,369.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,369.60
|
| Rate for Payer: Galaxy Health WC |
$7,160.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,054.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,581.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,618.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,209.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,214.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,684.80
|
| Rate for Payer: Multiplan Commercial |
$6,318.00
|
| Rate for Payer: Networks By Design Commercial |
$5,475.60
|
| Rate for Payer: Prime Health Services Commercial |
$7,160.40
|
|
|
HC MRI UPPER EXTREM W CONT
|
Facility
|
IP
|
$8,921.00
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
908801415
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,784.20 |
| Max. Negotiated Rate |
$8,028.90 |
| Rate for Payer: Adventist Health Commercial |
$1,784.20
|
| Rate for Payer: Cash Price |
$4,014.45
|
| Rate for Payer: Central Health Plan Commercial |
$7,136.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,568.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,568.40
|
| Rate for Payer: Galaxy Health WC |
$7,582.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,352.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,028.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,950.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,398.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,522.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,784.20
|
| Rate for Payer: Multiplan Commercial |
$6,690.75
|
| Rate for Payer: Networks By Design Commercial |
$5,798.65
|
| Rate for Payer: Prime Health Services Commercial |
$7,582.85
|
|
|
HC MRI UPPER EXTREM W CONT
|
Facility
|
OP
|
$4,310.00
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
908801415
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$453.77 |
| Max. Negotiated Rate |
$3,879.00 |
| Rate for Payer: Adventist Health Commercial |
$862.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$453.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,823.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,531.26
|
| Rate for Payer: Blue Shield of California Commercial |
$2,616.17
|
| Rate for Payer: Blue Shield of California EPN |
$1,711.07
|
| Rate for Payer: Cash Price |
$1,939.50
|
| Rate for Payer: Cash Price |
$1,939.50
|
| Rate for Payer: Cash Price |
$1,939.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,448.00
|
| Rate for Payer: Cigna of CA HMO |
$2,758.40
|
| Rate for Payer: Cigna of CA PPO |
$3,189.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.59
|
| Rate for Payer: EPIC Health Plan Senior |
$453.77
|
| Rate for Payer: Galaxy Health WC |
$3,663.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,586.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,879.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$567.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: InnovAge PACE Commercial |
$680.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,874.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$626.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$862.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$608.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$608.05
|
| Rate for Payer: Multiplan Commercial |
$3,232.50
|
| Rate for Payer: Networks By Design Commercial |
$2,801.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$453.77
|
| Rate for Payer: Prime Health Services Commercial |
$3,663.50
|
| Rate for Payer: Prime Health Services Medicare |
$481.00
|
| Rate for Payer: Riverside University Health System MISP |
$499.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,586.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,586.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,115.74
|
| Rate for Payer: United Healthcare All Other HMO |
$1,115.74
|
| Rate for Payer: United Healthcare HMO Rider |
$1,115.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,115.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$453.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
HC MRI UPPER EXTREM W/O CONT
|
Facility
|
OP
|
$3,852.00
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
908801413
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$3,466.80 |
| Rate for Payer: Adventist Health Commercial |
$770.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$307.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,342.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,262.28
|
| Rate for Payer: Blue Shield of California Commercial |
$2,338.16
|
| Rate for Payer: Blue Shield of California EPN |
$1,529.24
|
| Rate for Payer: Cash Price |
$1,733.40
|
| Rate for Payer: Cash Price |
$1,733.40
|
| Rate for Payer: Cash Price |
$1,733.40
|
| Rate for Payer: Central Health Plan Commercial |
$3,081.60
|
| Rate for Payer: Cigna of CA HMO |
$2,465.28
|
| Rate for Payer: Cigna of CA PPO |
$2,850.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$3,274.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,311.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,466.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$521.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: InnovAge PACE Commercial |
$460.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,569.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$576.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$770.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$411.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$2,889.00
|
| Rate for Payer: Networks By Design Commercial |
$2,503.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$307.13
|
| Rate for Payer: Prime Health Services Commercial |
$3,274.20
|
| Rate for Payer: Prime Health Services Medicare |
$325.56
|
| Rate for Payer: Riverside University Health System MISP |
$337.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,311.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,311.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| Rate for Payer: United Healthcare All Other HMO |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC MRI UPPER EXTREM W/O CONT
|
Facility
|
IP
|
$8,536.00
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
908801413
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,707.20 |
| Max. Negotiated Rate |
$7,682.40 |
| Rate for Payer: Adventist Health Commercial |
$1,707.20
|
| Rate for Payer: Cash Price |
$3,841.20
|
| Rate for Payer: Central Health Plan Commercial |
$6,828.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,414.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,414.40
|
| Rate for Payer: Galaxy Health WC |
$7,255.60
|
| Rate for Payer: Global Benefits Group Commercial |
$5,121.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,682.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,693.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,252.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,283.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,707.20
|
| Rate for Payer: Multiplan Commercial |
$6,402.00
|
| Rate for Payer: Networks By Design Commercial |
$5,548.40
|
| Rate for Payer: Prime Health Services Commercial |
$7,255.60
|
|
|
HC MRI UPPER EXTREM W & WO CONT
|
Facility
|
OP
|
$4,533.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
908801411
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$453.77 |
| Max. Negotiated Rate |
$4,079.70 |
| Rate for Payer: Adventist Health Commercial |
$906.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$453.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,303.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,662.23
|
| Rate for Payer: Blue Shield of California Commercial |
$2,751.53
|
| Rate for Payer: Blue Shield of California EPN |
$1,799.60
|
| Rate for Payer: Cash Price |
$2,039.85
|
| Rate for Payer: Cash Price |
$2,039.85
|
| Rate for Payer: Cash Price |
$2,039.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,626.40
|
| Rate for Payer: Cigna of CA HMO |
$2,901.12
|
| Rate for Payer: Cigna of CA PPO |
$3,354.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.59
|
| Rate for Payer: EPIC Health Plan Senior |
$453.77
|
| Rate for Payer: Galaxy Health WC |
$3,853.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,719.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,079.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$671.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: InnovAge PACE Commercial |
$680.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,023.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$741.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$906.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$608.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$608.05
|
| Rate for Payer: Multiplan Commercial |
$3,399.75
|
| Rate for Payer: Networks By Design Commercial |
$2,946.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$453.77
|
| Rate for Payer: Prime Health Services Commercial |
$3,853.05
|
| Rate for Payer: Prime Health Services Medicare |
$481.00
|
| Rate for Payer: Riverside University Health System MISP |
$499.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,719.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,719.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,367.12
|
| Rate for Payer: United Healthcare All Other HMO |
$1,367.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1,367.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,367.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$453.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
HC MRI UPPER EXTREM W & WO CONT
|
Facility
|
IP
|
$11,420.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
908801411
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,284.00 |
| Max. Negotiated Rate |
$10,278.00 |
| Rate for Payer: Adventist Health Commercial |
$2,284.00
|
| Rate for Payer: Cash Price |
$5,139.00
|
| Rate for Payer: Central Health Plan Commercial |
$9,136.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,568.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,568.00
|
| Rate for Payer: Galaxy Health WC |
$9,707.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,852.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,278.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,617.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,351.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,068.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,284.00
|
| Rate for Payer: Multiplan Commercial |
$8,565.00
|
| Rate for Payer: Networks By Design Commercial |
$7,423.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,707.00
|
|
|
HC MRSA DNA
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 87641
|
| Hospital Charge Code |
900912328
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$249.78 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$35.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$60.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$249.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.69
|
| Rate for Payer: Blue Shield of California Commercial |
$60.70
|
| Rate for Payer: Blue Shield of California EPN |
$39.70
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Central Health Plan Commercial |
$80.00
|
| Rate for Payer: Cigna of CA HMO |
$64.00
|
| Rate for Payer: Cigna of CA PPO |
$74.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.37
|
| Rate for Payer: EPIC Health Plan Senior |
$35.09
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$53.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: InnovAge PACE Commercial |
$52.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$35.09
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: Prime Health Services Medicare |
$37.20
|
| Rate for Payer: Riverside University Health System MISP |
$38.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC MRSA DNA
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
CPT 87641
|
| Hospital Charge Code |
900912328
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.80 |
| Max. Negotiated Rate |
$165.60 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Central Health Plan Commercial |
$147.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.60
|
| Rate for Payer: EPIC Health Plan Senior |
$73.60
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$165.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.80
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
|
|
HC MR SAFETY DETERMINATION PHYSICIAN/OTHER QHP
|
Facility
|
IP
|
$308.00
|
|
|
Service Code
|
CPT 76016
|
| Hospital Charge Code |
908801502
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$61.60 |
| Max. Negotiated Rate |
$277.20 |
| Rate for Payer: Adventist Health Commercial |
$61.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Central Health Plan Commercial |
$246.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$123.20
|
| Rate for Payer: EPIC Health Plan Senior |
$123.20
|
| Rate for Payer: Galaxy Health WC |
$261.80
|
| Rate for Payer: Global Benefits Group Commercial |
$184.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$277.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$205.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$190.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.60
|
| Rate for Payer: Multiplan Commercial |
$231.00
|
| Rate for Payer: Networks By Design Commercial |
$200.20
|
| Rate for Payer: Prime Health Services Commercial |
$261.80
|
|
|
HC MR SAFETY DETERMINATION PHYSICIAN/OTHER QHP
|
Facility
|
OP
|
$308.00
|
|
|
Service Code
|
CPT 76016
|
| Hospital Charge Code |
908801502
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.91 |
| Max. Negotiated Rate |
$277.20 |
| Rate for Payer: Adventist Health Commercial |
$61.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$187.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$265.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.91
|
| Rate for Payer: Blue Shield of California Commercial |
$186.96
|
| Rate for Payer: Blue Shield of California EPN |
$122.28
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Central Health Plan Commercial |
$246.40
|
| Rate for Payer: Cigna of CA HMO |
$197.12
|
| Rate for Payer: Cigna of CA PPO |
$227.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$261.80
|
| Rate for Payer: Global Benefits Group Commercial |
$184.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$277.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: InnovAge PACE Commercial |
$167.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$205.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$231.00
|
| Rate for Payer: Networks By Design Commercial |
$200.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.88
|
| Rate for Payer: Prime Health Services Commercial |
$261.80
|
| Rate for Payer: Prime Health Services Medicare |
$118.59
|
| Rate for Payer: Riverside University Health System MISP |
$123.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$184.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$184.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$154.00
|
| Rate for Payer: United Healthcare All Other HMO |
$154.00
|
| Rate for Payer: United Healthcare HMO Rider |
$154.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$154.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
