|
HC MRI BILATERAL TMJ
|
Facility
|
IP
|
$7,989.00
|
|
|
Service Code
|
CPT 70336
|
| Hospital Charge Code |
908801055
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,917.36 |
| Max. Negotiated Rate |
$6,790.65 |
| Rate for Payer: Cash Price |
$3,595.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,195.60
|
| Rate for Payer: Galaxy Health WC |
$6,790.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,793.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,328.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,043.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,917.36
|
| Rate for Payer: Multiplan Commercial |
$6,391.20
|
| Rate for Payer: Networks By Design Commercial |
$5,192.85
|
| Rate for Payer: Prime Health Services Commercial |
$6,790.65
|
|
|
HC MRI BN MARROW(2 SEQ)
|
Facility
|
OP
|
$3,063.00
|
|
|
Service Code
|
CPT 77084
|
| Hospital Charge Code |
908801140
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$306.16 |
| Max. Negotiated Rate |
$2,603.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,328.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,824.94
|
| Rate for Payer: Blue Distinction Transplant |
$1,837.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,810.23
|
| Rate for Payer: Blue Shield of California EPN |
$1,436.55
|
| Rate for Payer: Cash Price |
$1,378.35
|
| Rate for Payer: Cash Price |
$1,378.35
|
| Rate for Payer: Cigna of CA HMO |
$1,960.32
|
| Rate for Payer: Cigna of CA PPO |
$2,266.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Media |
$306.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$306.16
|
| Rate for Payer: Galaxy Health WC |
$2,603.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,837.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,297.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$502.10
|
| Rate for Payer: Heritage Provider Network Transplant |
$502.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$495.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$495.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,043.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,167.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$735.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410.25
|
| Rate for Payer: Multiplan Commercial |
$2,450.40
|
| Rate for Payer: Networks By Design Commercial |
$1,990.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,603.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,837.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,837.80
|
| 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: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC MRI BN MARROW(2 SEQ)
|
Facility
|
IP
|
$5,238.00
|
|
|
Service Code
|
CPT 77084
|
| Hospital Charge Code |
908801140
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,257.12 |
| Max. Negotiated Rate |
$4,452.30 |
| Rate for Payer: Cash Price |
$2,357.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,095.20
|
| Rate for Payer: Galaxy Health WC |
$4,452.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,142.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,493.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,995.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,257.12
|
| Rate for Payer: Multiplan Commercial |
$4,190.40
|
| Rate for Payer: Networks By Design Commercial |
$3,404.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,452.30
|
|
|
HC MRI BRAIN ASSESS W CONTRAST
|
Facility
|
OP
|
$1,322.00
|
|
|
Service Code
|
CPT 70558
|
| Hospital Charge Code |
908870558
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$229.56 |
| Max. Negotiated Rate |
$2,328.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,328.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$787.65
|
| Rate for Payer: Blue Distinction Transplant |
$793.20
|
| Rate for Payer: Blue Shield of California Commercial |
$781.30
|
| Rate for Payer: Blue Shield of California EPN |
$620.02
|
| Rate for Payer: Cash Price |
$594.90
|
| Rate for Payer: Cash Price |
$594.90
|
| Rate for Payer: Cigna of CA HMO |
$846.08
|
| Rate for Payer: Cigna of CA PPO |
$978.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Media |
$229.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$229.56
|
| Rate for Payer: Galaxy Health WC |
$1,123.70
|
| Rate for Payer: Global Benefits Group Commercial |
$793.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$991.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$376.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$376.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$371.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$371.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$881.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$336.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$317.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$307.61
|
| Rate for Payer: Multiplan Commercial |
$1,057.60
|
| Rate for Payer: Networks By Design Commercial |
$859.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,123.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$793.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$793.20
|
| 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: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC MRI BRAIN ASSESS W CONTRAST
|
Facility
|
IP
|
$1,322.00
|
|
|
Service Code
|
CPT 70558
|
| Hospital Charge Code |
908870558
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$317.28 |
| Max. Negotiated Rate |
$1,123.70 |
| Rate for Payer: Cash Price |
$594.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$528.80
|
| Rate for Payer: Galaxy Health WC |
$1,123.70
|
| Rate for Payer: Global Benefits Group Commercial |
$793.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$881.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$503.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$317.28
|
| Rate for Payer: Multiplan Commercial |
$1,057.60
|
| Rate for Payer: Networks By Design Commercial |
$859.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,123.70
|
|
|
HC MRI BRAIN ASSESS WO CONTRAST
|
Facility
|
OP
|
$701.00
|
|
|
Service Code
|
CPT 70557
|
| Hospital Charge Code |
908870557
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$168.24 |
| Max. Negotiated Rate |
$2,328.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,328.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$689.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$417.66
|
| Rate for Payer: Blue Distinction Transplant |
$420.60
|
| Rate for Payer: Blue Shield of California Commercial |
$414.29
|
| Rate for Payer: Blue Shield of California EPN |
$328.77
|
| Rate for Payer: Cash Price |
$315.45
|
| Rate for Payer: Cash Price |
$315.45
|
| Rate for Payer: Cigna of CA HMO |
$448.64
|
| Rate for Payer: Cigna of CA PPO |
$518.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Dignity Health Media |
$689.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$758.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$930.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$689.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$689.28
|
| Rate for Payer: Galaxy Health WC |
$595.85
|
| Rate for Payer: Global Benefits Group Commercial |
$420.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$525.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,130.42
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,130.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,116.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,116.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$689.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$467.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$326.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$689.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$868.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$923.64
|
| Rate for Payer: Multiplan Commercial |
$560.80
|
| Rate for Payer: Networks By Design Commercial |
$455.65
|
| Rate for Payer: Prime Health Services Commercial |
$595.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$420.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$420.60
|
| 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: Vantage Medical Group Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: Vantage Medical Group Senior |
$689.28
|
|
|
HC MRI BRAIN ASSESS WO CONTRAST
|
Facility
|
IP
|
$701.00
|
|
|
Service Code
|
CPT 70557
|
| Hospital Charge Code |
908870557
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$168.24 |
| Max. Negotiated Rate |
$595.85 |
| Rate for Payer: Cash Price |
$315.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.40
|
| Rate for Payer: Galaxy Health WC |
$595.85
|
| Rate for Payer: Global Benefits Group Commercial |
$420.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$467.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$267.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.24
|
| Rate for Payer: Multiplan Commercial |
$560.80
|
| Rate for Payer: Networks By Design Commercial |
$455.65
|
| Rate for Payer: Prime Health Services Commercial |
$595.85
|
|
|
HC MRI BRAIN ASSESS WO W CONTRAST
|
Facility
|
OP
|
$1,389.00
|
|
|
Service Code
|
CPT 70559
|
| Hospital Charge Code |
908870559
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$229.56 |
| Max. Negotiated Rate |
$2,328.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,328.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$827.57
|
| Rate for Payer: Blue Distinction Transplant |
$833.40
|
| Rate for Payer: Blue Shield of California Commercial |
$820.90
|
| Rate for Payer: Blue Shield of California EPN |
$651.44
|
| Rate for Payer: Cash Price |
$625.05
|
| Rate for Payer: Cash Price |
$625.05
|
| Rate for Payer: Cigna of CA HMO |
$888.96
|
| Rate for Payer: Cigna of CA PPO |
$1,027.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Media |
$229.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$229.56
|
| Rate for Payer: Galaxy Health WC |
$1,180.65
|
| Rate for Payer: Global Benefits Group Commercial |
$833.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,041.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$376.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$376.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$371.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$371.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$926.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$316.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$333.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$307.61
|
| Rate for Payer: Multiplan Commercial |
$1,111.20
|
| Rate for Payer: Networks By Design Commercial |
$902.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,180.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$833.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$833.40
|
| 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: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC MRI BRAIN ASSESS WO W CONTRAST
|
Facility
|
IP
|
$1,389.00
|
|
|
Service Code
|
CPT 70559
|
| Hospital Charge Code |
908870559
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$333.36 |
| Max. Negotiated Rate |
$1,180.65 |
| Rate for Payer: Cash Price |
$625.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$555.60
|
| Rate for Payer: Galaxy Health WC |
$1,180.65
|
| Rate for Payer: Global Benefits Group Commercial |
$833.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$926.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$529.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$333.36
|
| Rate for Payer: Multiplan Commercial |
$1,111.20
|
| Rate for Payer: Networks By Design Commercial |
$902.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,180.65
|
|
|
HC MRI BRAIN WITH CONTRAST
|
Facility
|
IP
|
$7,980.00
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
908801013
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,915.20 |
| Max. Negotiated Rate |
$6,783.00 |
| Rate for Payer: Cash Price |
$3,591.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,192.00
|
| Rate for Payer: Galaxy Health WC |
$6,783.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,788.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,322.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,040.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,915.20
|
| Rate for Payer: Multiplan Commercial |
$6,384.00
|
| Rate for Payer: Networks By Design Commercial |
$5,187.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,783.00
|
|
|
HC MRI BRAIN WITH CONTRAST
|
Facility
|
OP
|
$4,480.00
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
908801013
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$480.50 |
| Max. Negotiated Rate |
$3,808.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,328.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,669.18
|
| Rate for Payer: Blue Distinction Transplant |
$2,688.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,647.68
|
| Rate for Payer: Blue Shield of California EPN |
$2,101.12
|
| Rate for Payer: Cash Price |
$2,016.00
|
| Rate for Payer: Cash Price |
$2,016.00
|
| Rate for Payer: Cigna of CA HMO |
$2,867.20
|
| Rate for Payer: Cigna of CA PPO |
$3,315.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: Dignity Health Media |
$480.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$480.50
|
| Rate for Payer: Galaxy Health WC |
$3,808.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,688.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,360.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$788.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$788.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$778.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$778.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$480.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,988.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$502.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,075.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$605.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.87
|
| Rate for Payer: Multiplan Commercial |
$3,584.00
|
| Rate for Payer: Networks By Design Commercial |
$2,912.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,808.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,688.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,688.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC MRI BRAIN WITH CONTRAST
|
Facility
|
OP
|
$4,480.00
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
908801012
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$480.50 |
| Max. Negotiated Rate |
$3,808.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,328.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,669.18
|
| Rate for Payer: Blue Distinction Transplant |
$2,688.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,647.68
|
| Rate for Payer: Blue Shield of California EPN |
$2,101.12
|
| Rate for Payer: Cash Price |
$2,016.00
|
| Rate for Payer: Cash Price |
$2,016.00
|
| Rate for Payer: Cigna of CA HMO |
$2,867.20
|
| Rate for Payer: Cigna of CA PPO |
$3,315.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: Dignity Health Media |
$480.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$480.50
|
| Rate for Payer: Galaxy Health WC |
$3,808.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,688.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,360.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$788.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$788.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$778.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$778.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$480.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,988.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$502.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,075.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$605.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.87
|
| Rate for Payer: Multiplan Commercial |
$3,584.00
|
| Rate for Payer: Networks By Design Commercial |
$2,912.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,808.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,688.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,688.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC MRI BRAIN WITH CONTRAST
|
Facility
|
IP
|
$7,980.00
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
908801012
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,915.20 |
| Max. Negotiated Rate |
$6,783.00 |
| Rate for Payer: Cash Price |
$3,591.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,192.00
|
| Rate for Payer: Galaxy Health WC |
$6,783.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,788.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,322.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,040.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,915.20
|
| Rate for Payer: Multiplan Commercial |
$6,384.00
|
| Rate for Payer: Networks By Design Commercial |
$5,187.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,783.00
|
|
|
HC MRI BRAIN WO CONTRAST
|
Facility
|
IP
|
$7,545.00
|
|
|
Service Code
|
CPT 70551
|
| Hospital Charge Code |
908801010
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,810.80 |
| Max. Negotiated Rate |
$6,413.25 |
| Rate for Payer: Cash Price |
$3,395.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,018.00
|
| Rate for Payer: Galaxy Health WC |
$6,413.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,527.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,032.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,874.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,810.80
|
| Rate for Payer: Multiplan Commercial |
$6,036.00
|
| Rate for Payer: Networks By Design Commercial |
$4,904.25
|
| Rate for Payer: Prime Health Services Commercial |
$6,413.25
|
|
|
HC MRI BRAIN WO CONTRAST
|
Facility
|
OP
|
$4,236.00
|
|
|
Service Code
|
CPT 70551
|
| Hospital Charge Code |
908801010
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$306.16 |
| Max. Negotiated Rate |
$3,600.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,523.81
|
| Rate for Payer: Blue Distinction Transplant |
$2,541.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,503.48
|
| Rate for Payer: Blue Shield of California EPN |
$1,986.68
|
| Rate for Payer: Cash Price |
$1,906.20
|
| Rate for Payer: Cash Price |
$1,906.20
|
| Rate for Payer: Cigna of CA HMO |
$2,711.04
|
| Rate for Payer: Cigna of CA PPO |
$3,134.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Media |
$306.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$306.16
|
| Rate for Payer: Galaxy Health WC |
$3,600.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,541.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,177.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$502.10
|
| Rate for Payer: Heritage Provider Network Transplant |
$502.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$495.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$495.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,825.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$361.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,016.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410.25
|
| Rate for Payer: Multiplan Commercial |
$3,388.80
|
| Rate for Payer: Networks By Design Commercial |
$2,753.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,600.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,541.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,541.60
|
| 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: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC MRI BRAIN W WO CONTRAST
|
Facility
|
OP
|
$5,010.00
|
|
|
Service Code
|
CPT 70553
|
| Hospital Charge Code |
908801014
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$480.50 |
| Max. Negotiated Rate |
$4,258.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,984.96
|
| Rate for Payer: Blue Distinction Transplant |
$3,006.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,960.91
|
| Rate for Payer: Blue Shield of California EPN |
$2,349.69
|
| Rate for Payer: Cash Price |
$2,254.50
|
| Rate for Payer: Cash Price |
$2,254.50
|
| Rate for Payer: Cigna of CA HMO |
$3,206.40
|
| Rate for Payer: Cigna of CA PPO |
$3,707.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: Dignity Health Media |
$480.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$480.50
|
| Rate for Payer: Galaxy Health WC |
$4,258.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,006.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,757.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$788.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$788.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$778.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$778.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$480.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,341.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$591.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,202.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$605.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.87
|
| Rate for Payer: Multiplan Commercial |
$4,008.00
|
| Rate for Payer: Networks By Design Commercial |
$3,256.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,258.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,006.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,006.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC MRI BRAIN W WO CONTRAST
|
Facility
|
IP
|
$8,926.00
|
|
|
Service Code
|
CPT 70553
|
| Hospital Charge Code |
908801014
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$2,142.24 |
| Max. Negotiated Rate |
$7,587.10 |
| Rate for Payer: Cash Price |
$4,016.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,570.40
|
| Rate for Payer: Galaxy Health WC |
$7,587.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,355.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,953.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,400.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,142.24
|
| Rate for Payer: Multiplan Commercial |
$7,140.80
|
| Rate for Payer: Networks By Design Commercial |
$5,801.90
|
| Rate for Payer: Prime Health Services Commercial |
$7,587.10
|
|
|
HC MRI BREAST BILAT WO CONTRAST
|
Facility
|
OP
|
$4,011.00
|
|
|
Service Code
|
CPT 77047
|
| Hospital Charge Code |
908801212
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$306.16 |
| Max. Negotiated Rate |
$3,409.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,328.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,389.75
|
| Rate for Payer: Blue Distinction Transplant |
$2,406.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,370.50
|
| Rate for Payer: Blue Shield of California EPN |
$1,881.16
|
| Rate for Payer: Cash Price |
$1,804.95
|
| Rate for Payer: Cash Price |
$1,804.95
|
| Rate for Payer: Cigna of CA HMO |
$2,567.04
|
| Rate for Payer: Cigna of CA PPO |
$2,968.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Media |
$306.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$306.16
|
| Rate for Payer: Galaxy Health WC |
$3,409.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,406.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,008.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$502.10
|
| Rate for Payer: Heritage Provider Network Transplant |
$502.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$495.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$495.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,675.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$406.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$962.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410.25
|
| Rate for Payer: Multiplan Commercial |
$3,208.80
|
| Rate for Payer: Networks By Design Commercial |
$2,607.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,409.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,406.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,406.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$590.24
|
| Rate for Payer: United Healthcare All Other HMO |
$590.24
|
| Rate for Payer: United Healthcare HMO Rider |
$590.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$590.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC MRI BREAST BILAT WO CONTRAST
|
Facility
|
IP
|
$6,857.00
|
|
|
Service Code
|
CPT 77047
|
| Hospital Charge Code |
908801212
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,645.68 |
| Max. Negotiated Rate |
$5,828.45 |
| Rate for Payer: Cash Price |
$3,085.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,742.80
|
| Rate for Payer: Galaxy Health WC |
$5,828.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,114.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,573.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,612.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,645.68
|
| Rate for Payer: Multiplan Commercial |
$5,485.60
|
| Rate for Payer: Networks By Design Commercial |
$4,457.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,828.45
|
|
|
HC MRI BREAST UNI WO CONTRAST
|
Facility
|
IP
|
$6,090.00
|
|
|
Service Code
|
CPT 77046
|
| Hospital Charge Code |
908801219
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,461.60 |
| Max. Negotiated Rate |
$5,176.50 |
| Rate for Payer: Cash Price |
$2,740.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,436.00
|
| Rate for Payer: Galaxy Health WC |
$5,176.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,654.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,062.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,320.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,461.60
|
| Rate for Payer: Multiplan Commercial |
$4,872.00
|
| Rate for Payer: Networks By Design Commercial |
$3,958.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,176.50
|
|
|
HC MRI BREAST UNI WO CONTRAST
|
Facility
|
OP
|
$3,562.00
|
|
|
Service Code
|
CPT 77046
|
| Hospital Charge Code |
908801219
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$306.16 |
| Max. Negotiated Rate |
$3,027.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,328.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,122.24
|
| Rate for Payer: Blue Distinction Transplant |
$2,137.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,105.14
|
| Rate for Payer: Blue Shield of California EPN |
$1,670.58
|
| Rate for Payer: Cash Price |
$1,602.90
|
| Rate for Payer: Cash Price |
$1,602.90
|
| Rate for Payer: Cigna of CA HMO |
$2,279.68
|
| Rate for Payer: Cigna of CA PPO |
$2,635.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Media |
$306.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$306.16
|
| Rate for Payer: Galaxy Health WC |
$3,027.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,137.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,671.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$502.10
|
| Rate for Payer: Heritage Provider Network Transplant |
$502.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$495.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$495.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,375.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$396.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$854.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410.25
|
| Rate for Payer: Multiplan Commercial |
$2,849.60
|
| Rate for Payer: Networks By Design Commercial |
$2,315.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,027.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,137.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,137.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$590.24
|
| Rate for Payer: United Healthcare All Other HMO |
$590.24
|
| Rate for Payer: United Healthcare HMO Rider |
$590.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$590.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC MRI BRST BI W WO CNTRST W CAD
|
Facility
|
IP
|
$8,354.00
|
|
|
Service Code
|
CPT 77049
|
| Hospital Charge Code |
908801210
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,004.96 |
| Max. Negotiated Rate |
$7,100.90 |
| Rate for Payer: Cash Price |
$3,759.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,341.60
|
| Rate for Payer: Galaxy Health WC |
$7,100.90
|
| Rate for Payer: Global Benefits Group Commercial |
$5,012.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,572.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,182.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,004.96
|
| Rate for Payer: Multiplan Commercial |
$6,683.20
|
| Rate for Payer: Networks By Design Commercial |
$5,430.10
|
| Rate for Payer: Prime Health Services Commercial |
$7,100.90
|
|
|
HC MRI BRST BI W WO CNTRST W CAD
|
Facility
|
OP
|
$4,885.00
|
|
|
Service Code
|
CPT 77049
|
| Hospital Charge Code |
908801210
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$641.90 |
| Max. Negotiated Rate |
$4,152.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,328.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,152.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,686.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,686.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,910.48
|
| Rate for Payer: Blue Distinction Transplant |
$2,931.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,887.04
|
| Rate for Payer: Blue Shield of California EPN |
$2,291.06
|
| Rate for Payer: Cash Price |
$2,198.25
|
| Rate for Payer: Cash Price |
$2,198.25
|
| Rate for Payer: Cigna of CA HMO |
$3,126.40
|
| Rate for Payer: Cigna of CA PPO |
$3,614.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,152.25
|
| Rate for Payer: Dignity Health Media |
$4,152.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,152.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,954.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,954.00
|
| Rate for Payer: Galaxy Health WC |
$4,152.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,931.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,663.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,258.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$641.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,172.40
|
| Rate for Payer: Multiplan Commercial |
$3,908.00
|
| Rate for Payer: Networks By Design Commercial |
$3,175.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,152.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,931.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,931.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$750.08
|
| Rate for Payer: United Healthcare All Other HMO |
$750.08
|
| Rate for Payer: United Healthcare HMO Rider |
$750.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$750.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,152.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,152.25
|
| Rate for Payer: Vantage Medical Group Senior |
$4,152.25
|
|
|
HC MRI BRST UNI W WO CTRST W CAD
|
Facility
|
OP
|
$4,507.00
|
|
|
Service Code
|
CPT 77048
|
| Hospital Charge Code |
908801215
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$629.93 |
| Max. Negotiated Rate |
$3,830.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,328.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,830.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,478.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,478.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,685.27
|
| Rate for Payer: Blue Distinction Transplant |
$2,704.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,663.64
|
| Rate for Payer: Blue Shield of California EPN |
$2,113.78
|
| Rate for Payer: Cash Price |
$2,028.15
|
| Rate for Payer: Cash Price |
$2,028.15
|
| Rate for Payer: Cigna of CA HMO |
$2,884.48
|
| Rate for Payer: Cigna of CA PPO |
$3,335.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,830.95
|
| Rate for Payer: Dignity Health Media |
$3,830.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,830.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,802.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,802.80
|
| Rate for Payer: Galaxy Health WC |
$3,830.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,704.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,380.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,006.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$629.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,081.68
|
| Rate for Payer: Multiplan Commercial |
$3,605.60
|
| Rate for Payer: Networks By Design Commercial |
$2,929.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,830.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,704.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,704.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$753.76
|
| Rate for Payer: United Healthcare All Other HMO |
$753.76
|
| Rate for Payer: United Healthcare HMO Rider |
$753.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$753.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,830.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,830.95
|
| Rate for Payer: Vantage Medical Group Senior |
$3,830.95
|
|
|
HC MRI BRST UNI W WO CTRST W CAD
|
Facility
|
IP
|
$7,706.00
|
|
|
Service Code
|
CPT 77048
|
| Hospital Charge Code |
908801215
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,849.44 |
| Max. Negotiated Rate |
$6,550.10 |
| Rate for Payer: Cash Price |
$3,467.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,082.40
|
| Rate for Payer: Galaxy Health WC |
$6,550.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,623.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,139.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,935.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,849.44
|
| Rate for Payer: Multiplan Commercial |
$6,164.80
|
| Rate for Payer: Networks By Design Commercial |
$5,008.90
|
| Rate for Payer: Prime Health Services Commercial |
$6,550.10
|
|
