|
HC MRI CERVICAL SPINE W CONTRA
|
Facility
|
IP
|
$7,358.00
|
|
|
Service Code
|
CPT 72142
|
| Hospital Charge Code |
908801102
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,765.92 |
| Max. Negotiated Rate |
$6,254.30 |
| Rate for Payer: Cash Price |
$3,311.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,943.20
|
| Rate for Payer: Galaxy Health WC |
$6,254.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,414.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,907.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,803.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,765.92
|
| Rate for Payer: Multiplan Commercial |
$5,886.40
|
| Rate for Payer: Networks By Design Commercial |
$4,782.70
|
| Rate for Payer: Prime Health Services Commercial |
$6,254.30
|
|
|
HC MRI CERVICAL SPINE W CONTRA
|
Facility
|
OP
|
$4,256.00
|
|
|
Service Code
|
CPT 72142
|
| Hospital Charge Code |
908801102
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$480.50 |
| Max. Negotiated Rate |
$3,617.60 |
| 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 |
$2,535.72
|
| Rate for Payer: Blue Distinction Transplant |
$2,553.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,515.30
|
| Rate for Payer: Blue Shield of California EPN |
$1,996.06
|
| Rate for Payer: Cash Price |
$1,915.20
|
| Rate for Payer: Cash Price |
$1,915.20
|
| Rate for Payer: Cigna of CA HMO |
$2,723.84
|
| Rate for Payer: Cigna of CA PPO |
$3,149.44
|
| 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 |
$3,617.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,553.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,192.00
|
| 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 |
$2,838.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$514.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,021.44
|
| 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 |
$3,404.80
|
| Rate for Payer: Networks By Design Commercial |
$2,766.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,617.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,553.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,553.60
|
| 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: 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 CERVICAL SPINE WO CONT
|
Facility
|
OP
|
$4,104.00
|
|
|
Service Code
|
CPT 72141
|
| Hospital Charge Code |
908801100
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$306.16 |
| Max. Negotiated Rate |
$3,488.40 |
| 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 |
$2,445.16
|
| Rate for Payer: Blue Distinction Transplant |
$2,462.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,425.46
|
| Rate for Payer: Blue Shield of California EPN |
$1,924.78
|
| Rate for Payer: Cash Price |
$1,846.80
|
| Rate for Payer: Cash Price |
$1,846.80
|
| Rate for Payer: Cigna of CA HMO |
$2,626.56
|
| Rate for Payer: Cigna of CA PPO |
$3,036.96
|
| 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 |
$3,488.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,462.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,078.00
|
| 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 |
$2,737.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$352.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$984.96
|
| 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 |
$3,283.20
|
| Rate for Payer: Networks By Design Commercial |
$2,667.60
|
| Rate for Payer: Prime Health Services Commercial |
$3,488.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,462.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,462.40
|
| 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: 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 CERVICAL SPINE WO CONT
|
Facility
|
IP
|
$7,016.00
|
|
|
Service Code
|
CPT 72141
|
| Hospital Charge Code |
908801100
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,683.84 |
| Max. Negotiated Rate |
$5,963.60 |
| Rate for Payer: Cash Price |
$3,157.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,806.40
|
| Rate for Payer: Galaxy Health WC |
$5,963.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,209.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,679.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,673.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,683.84
|
| Rate for Payer: Multiplan Commercial |
$5,612.80
|
| Rate for Payer: Networks By Design Commercial |
$4,560.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,963.60
|
|
|
HC MRI CHEST W/ CONTRAST
|
Facility
|
OP
|
$4,104.00
|
|
|
Service Code
|
CPT 71551
|
| Hospital Charge Code |
908801201
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$710.85 |
| Max. Negotiated Rate |
$3,488.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,000.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,445.16
|
| Rate for Payer: Blue Distinction Transplant |
$2,462.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,425.46
|
| Rate for Payer: Blue Shield of California EPN |
$1,924.78
|
| Rate for Payer: Cash Price |
$1,846.80
|
| Rate for Payer: Cash Price |
$1,846.80
|
| Rate for Payer: Cigna of CA HMO |
$2,626.56
|
| Rate for Payer: Cigna of CA PPO |
$3,036.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Dignity Health Media |
$1,000.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,100.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,350.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,000.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,000.40
|
| Rate for Payer: Galaxy Health WC |
$3,488.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,462.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,078.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,640.66
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,640.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,620.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,620.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,000.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,737.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$710.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,000.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$984.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,260.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,340.54
|
| Rate for Payer: Multiplan Commercial |
$3,283.20
|
| Rate for Payer: Networks By Design Commercial |
$2,667.60
|
| Rate for Payer: Prime Health Services Commercial |
$3,488.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,462.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,462.40
|
| 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 |
$1,500.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: Vantage Medical Group Senior |
$1,000.40
|
|
|
HC MRI CHEST W/ CONTRAST
|
Facility
|
IP
|
$7,016.00
|
|
|
Service Code
|
CPT 71551
|
| Hospital Charge Code |
908801201
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,683.84 |
| Max. Negotiated Rate |
$5,963.60 |
| Rate for Payer: Cash Price |
$3,157.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,806.40
|
| Rate for Payer: Galaxy Health WC |
$5,963.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,209.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,679.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,673.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,683.84
|
| Rate for Payer: Multiplan Commercial |
$5,612.80
|
| Rate for Payer: Networks By Design Commercial |
$4,560.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,963.60
|
|
|
HC MRI CHEST, W/O CONT
|
Facility
|
OP
|
$3,671.00
|
|
|
Service Code
|
CPT 71550
|
| Hospital Charge Code |
908801200
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$306.16 |
| Max. Negotiated Rate |
$3,443.00 |
| 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 |
$2,187.18
|
| Rate for Payer: Blue Distinction Transplant |
$2,202.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,169.56
|
| Rate for Payer: Blue Shield of California EPN |
$1,721.70
|
| Rate for Payer: Cash Price |
$1,651.95
|
| Rate for Payer: Cash Price |
$1,651.95
|
| Rate for Payer: Cigna of CA HMO |
$2,349.44
|
| Rate for Payer: Cigna of CA PPO |
$2,716.54
|
| 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 |
$3,120.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,202.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,753.25
|
| 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 |
$2,448.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$643.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$881.04
|
| 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 |
$2,936.80
|
| Rate for Payer: Networks By Design Commercial |
$2,386.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,120.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,202.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,202.60
|
| 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 CHEST, W/O CONT
|
Facility
|
IP
|
$6,278.00
|
|
|
Service Code
|
CPT 71550
|
| Hospital Charge Code |
908801200
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,506.72 |
| Max. Negotiated Rate |
$5,336.30 |
| Rate for Payer: Cash Price |
$2,825.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,511.20
|
| Rate for Payer: Galaxy Health WC |
$5,336.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,766.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,187.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,391.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,506.72
|
| Rate for Payer: Multiplan Commercial |
$5,022.40
|
| Rate for Payer: Networks By Design Commercial |
$4,080.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,336.30
|
|
|
HC MRI CHEST W WO CONTRAST
|
Facility
|
IP
|
$10,384.00
|
|
|
Service Code
|
CPT 71552
|
| Hospital Charge Code |
908801202
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,492.16 |
| Max. Negotiated Rate |
$8,826.40 |
| Rate for Payer: Cash Price |
$4,672.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,153.60
|
| Rate for Payer: Galaxy Health WC |
$8,826.40
|
| Rate for Payer: Global Benefits Group Commercial |
$6,230.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,926.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,956.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,492.16
|
| Rate for Payer: Multiplan Commercial |
$8,307.20
|
| Rate for Payer: Networks By Design Commercial |
$6,749.60
|
| Rate for Payer: Prime Health Services Commercial |
$8,826.40
|
|
|
HC MRI CHEST W WO CONTRAST
|
Facility
|
OP
|
$4,859.00
|
|
|
Service Code
|
CPT 71552
|
| Hospital Charge Code |
908801202
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$480.50 |
| Max. Negotiated Rate |
$4,130.15 |
| 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 |
$2,894.99
|
| Rate for Payer: Blue Distinction Transplant |
$2,915.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,871.67
|
| Rate for Payer: Blue Shield of California EPN |
$2,278.87
|
| Rate for Payer: Cash Price |
$2,186.55
|
| Rate for Payer: Cash Price |
$2,186.55
|
| Rate for Payer: Cigna of CA HMO |
$3,109.76
|
| Rate for Payer: Cigna of CA PPO |
$3,595.66
|
| 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 |
$4,130.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,915.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,644.25
|
| 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 |
$3,240.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$897.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,166.16
|
| 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 |
$3,887.20
|
| Rate for Payer: Networks By Design Commercial |
$3,158.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,130.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,915.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,915.40
|
| 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 |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC MRI C-SPINE W & WO CONTRAST
|
Facility
|
OP
|
$4,480.00
|
|
|
Service Code
|
CPT 72156
|
| Hospital Charge Code |
908801104
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$480.50 |
| Max. Negotiated Rate |
$3,808.00 |
| 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 |
$2,669.18
|
| 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 |
$595.16
|
| 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 |
$1,367.12
|
| 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 C-SPINE W & WO CONTRAST
|
Facility
|
IP
|
$8,429.00
|
|
|
Service Code
|
CPT 72156
|
| Hospital Charge Code |
908801104
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$2,022.96 |
| Max. Negotiated Rate |
$7,164.65 |
| Rate for Payer: Cash Price |
$3,793.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,371.60
|
| Rate for Payer: Galaxy Health WC |
$7,164.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,057.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,622.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,211.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,022.96
|
| Rate for Payer: Multiplan Commercial |
$6,743.20
|
| Rate for Payer: Networks By Design Commercial |
$5,478.85
|
| Rate for Payer: Prime Health Services Commercial |
$7,164.65
|
|
|
HC MRI FETAL PELVIC IMG 1ST FETUS
|
Facility
|
IP
|
$1,013.00
|
|
|
Service Code
|
CPT 74712
|
| Hospital Charge Code |
908874712
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$243.12 |
| Max. Negotiated Rate |
$861.05 |
| Rate for Payer: Cash Price |
$455.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$405.20
|
| Rate for Payer: Galaxy Health WC |
$861.05
|
| Rate for Payer: Global Benefits Group Commercial |
$607.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$675.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$385.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.12
|
| Rate for Payer: Multiplan Commercial |
$810.40
|
| Rate for Payer: Networks By Design Commercial |
$658.45
|
| Rate for Payer: Prime Health Services Commercial |
$861.05
|
|
|
HC MRI FETAL PELVIC IMG 1ST FETUS
|
Facility
|
OP
|
$1,013.00
|
|
|
Service Code
|
CPT 74712
|
| Hospital Charge Code |
908874712
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$243.12 |
| Max. Negotiated Rate |
$5,310.96 |
| 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 |
$5,310.96
|
| Rate for Payer: Blue Distinction Transplant |
$607.80
|
| Rate for Payer: Blue Shield of California Commercial |
$598.68
|
| Rate for Payer: Blue Shield of California EPN |
$475.10
|
| Rate for Payer: Cash Price |
$455.85
|
| Rate for Payer: Cash Price |
$455.85
|
| Rate for Payer: Cigna of CA HMO |
$648.32
|
| Rate for Payer: Cigna of CA PPO |
$749.62
|
| 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 |
$861.05
|
| Rate for Payer: Global Benefits Group Commercial |
$607.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$759.75
|
| 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 |
$675.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$762.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.12
|
| 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 |
$810.40
|
| Rate for Payer: Networks By Design Commercial |
$658.45
|
| Rate for Payer: Prime Health Services Commercial |
$861.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$607.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$607.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$700.26
|
| Rate for Payer: United Healthcare All Other HMO |
$700.26
|
| Rate for Payer: United Healthcare HMO Rider |
$700.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$700.26
|
| 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 FETAL PELVIC IMG ADD FETUS
|
Facility
|
OP
|
$506.00
|
|
|
Service Code
|
CPT 74713
|
| Hospital Charge Code |
908874713
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$121.44 |
| 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 |
$430.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$278.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$278.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,275.64
|
| Rate for Payer: Blue Distinction Transplant |
$303.60
|
| Rate for Payer: Blue Shield of California Commercial |
$299.05
|
| Rate for Payer: Blue Shield of California EPN |
$237.31
|
| Rate for Payer: Cash Price |
$227.70
|
| Rate for Payer: Cash Price |
$227.70
|
| Rate for Payer: Cigna of CA HMO |
$323.84
|
| Rate for Payer: Cigna of CA PPO |
$374.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$430.10
|
| Rate for Payer: Dignity Health Media |
$430.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$430.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$202.40
|
| Rate for Payer: Galaxy Health WC |
$430.10
|
| Rate for Payer: Global Benefits Group Commercial |
$303.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$379.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$337.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$367.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.44
|
| Rate for Payer: Multiplan Commercial |
$404.80
|
| Rate for Payer: Networks By Design Commercial |
$328.90
|
| Rate for Payer: Prime Health Services Commercial |
$430.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$303.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$303.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$253.00
|
| Rate for Payer: United Healthcare All Other HMO |
$253.00
|
| Rate for Payer: United Healthcare HMO Rider |
$253.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$253.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$430.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$430.10
|
| Rate for Payer: Vantage Medical Group Senior |
$430.10
|
|
|
HC MRI FETAL PELVIC IMG ADD FETUS
|
Facility
|
IP
|
$506.00
|
|
|
Service Code
|
CPT 74713
|
| Hospital Charge Code |
908874713
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$121.44 |
| Max. Negotiated Rate |
$430.10 |
| Rate for Payer: Cash Price |
$227.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.40
|
| Rate for Payer: Galaxy Health WC |
$430.10
|
| Rate for Payer: Global Benefits Group Commercial |
$303.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$337.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$192.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.44
|
| Rate for Payer: Multiplan Commercial |
$404.80
|
| Rate for Payer: Networks By Design Commercial |
$328.90
|
| Rate for Payer: Prime Health Services Commercial |
$430.10
|
|
|
HC MRI GUID BX/NEEDLE LOC/ASPIR
|
Facility
|
OP
|
$5,198.00
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
909002020
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$696.84 |
| Max. Negotiated Rate |
$4,418.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,328.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,418.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,858.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,858.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,096.97
|
| Rate for Payer: Blue Distinction Transplant |
$3,118.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,072.02
|
| Rate for Payer: Blue Shield of California EPN |
$2,437.86
|
| Rate for Payer: Cash Price |
$2,339.10
|
| Rate for Payer: Cash Price |
$2,339.10
|
| Rate for Payer: Cigna of CA HMO |
$3,326.72
|
| Rate for Payer: Cigna of CA PPO |
$3,846.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,418.30
|
| Rate for Payer: Dignity Health Media |
$4,418.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,418.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,079.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,079.20
|
| Rate for Payer: Galaxy Health WC |
$4,418.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,118.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,898.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,467.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$696.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,247.52
|
| Rate for Payer: Multiplan Commercial |
$4,158.40
|
| Rate for Payer: Networks By Design Commercial |
$3,378.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,418.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,118.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,118.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,599.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,599.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,599.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,599.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,418.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,418.30
|
| Rate for Payer: Vantage Medical Group Senior |
$4,418.30
|
|
|
HC MRI GUID BX/NEEDLE LOC/ASPIR
|
Facility
|
IP
|
$8,887.00
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
909002020
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,132.88 |
| Max. Negotiated Rate |
$7,553.95 |
| Rate for Payer: Cash Price |
$3,999.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,554.80
|
| Rate for Payer: Galaxy Health WC |
$7,553.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,332.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,927.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,385.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,132.88
|
| Rate for Payer: Multiplan Commercial |
$7,109.60
|
| Rate for Payer: Networks By Design Commercial |
$5,776.55
|
| Rate for Payer: Prime Health Services Commercial |
$7,553.95
|
|
|
HC MRI LOWER EXTREMITY W/O CON
|
Facility
|
IP
|
$5,774.00
|
|
|
Service Code
|
CPT 73718
|
| Hospital Charge Code |
908801402
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,385.76 |
| Max. Negotiated Rate |
$4,907.90 |
| Rate for Payer: Cash Price |
$2,598.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,309.60
|
| Rate for Payer: Galaxy Health WC |
$4,907.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,464.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,851.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,199.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,385.76
|
| Rate for Payer: Multiplan Commercial |
$4,619.20
|
| Rate for Payer: Networks By Design Commercial |
$3,753.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,907.90
|
|
|
HC MRI LOWER EXTREMITY W/O CON
|
Facility
|
OP
|
$3,310.00
|
|
|
Service Code
|
CPT 73718
|
| Hospital Charge Code |
908801402
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$306.16 |
| Max. Negotiated Rate |
$3,443.00 |
| 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 |
$1,972.10
|
| Rate for Payer: Blue Distinction Transplant |
$1,986.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,956.21
|
| Rate for Payer: Blue Shield of California EPN |
$1,552.39
|
| Rate for Payer: Cash Price |
$1,489.50
|
| Rate for Payer: Cash Price |
$1,489.50
|
| Rate for Payer: Cigna of CA HMO |
$2,118.40
|
| Rate for Payer: Cigna of CA PPO |
$2,449.40
|
| 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 |
$2,813.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,986.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,482.50
|
| 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 |
$2,207.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$418.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$794.40
|
| 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 |
$2,648.00
|
| Rate for Payer: Networks By Design Commercial |
$2,151.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,813.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,986.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,986.00
|
| 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: 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 LOWER EXTREM JOINT W CONT
|
Facility
|
OP
|
$3,496.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
908801376
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$594.72 |
| Max. Negotiated Rate |
$3,443.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,000.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,082.92
|
| Rate for Payer: Blue Distinction Transplant |
$2,097.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,066.14
|
| Rate for Payer: Blue Shield of California EPN |
$1,639.62
|
| Rate for Payer: Cash Price |
$1,573.20
|
| Rate for Payer: Cash Price |
$1,573.20
|
| Rate for Payer: Cigna of CA HMO |
$2,237.44
|
| Rate for Payer: Cigna of CA PPO |
$2,587.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Dignity Health Media |
$1,000.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,100.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,350.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,000.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,000.40
|
| Rate for Payer: Galaxy Health WC |
$2,971.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,097.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,622.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,640.66
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,640.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,620.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,620.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,000.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,331.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$594.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,000.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$839.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,260.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,340.54
|
| Rate for Payer: Multiplan Commercial |
$2,796.80
|
| Rate for Payer: Networks By Design Commercial |
$2,272.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,971.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,097.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,097.60
|
| 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: Vantage Medical Group Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: Vantage Medical Group Senior |
$1,000.40
|
|
|
HC MRI LOWER EXTREM JOINT W CONT
|
Facility
|
IP
|
$5,978.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
908801376
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,434.72 |
| Max. Negotiated Rate |
$5,081.30 |
| Rate for Payer: Cash Price |
$2,690.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,391.20
|
| Rate for Payer: Galaxy Health WC |
$5,081.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,586.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,987.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,277.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,434.72
|
| Rate for Payer: Multiplan Commercial |
$4,782.40
|
| Rate for Payer: Networks By Design Commercial |
$3,885.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,081.30
|
|
|
HC MRI LOWER EXTREM JOINT WO CONT
|
Facility
|
OP
|
$3,310.00
|
|
|
Service Code
|
CPT 73721
|
| Hospital Charge Code |
908801441
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$306.16 |
| Max. Negotiated Rate |
$3,443.00 |
| 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 |
$1,972.10
|
| Rate for Payer: Blue Distinction Transplant |
$1,986.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,956.21
|
| Rate for Payer: Blue Shield of California EPN |
$1,552.39
|
| Rate for Payer: Cash Price |
$1,489.50
|
| Rate for Payer: Cash Price |
$1,489.50
|
| Rate for Payer: Cigna of CA HMO |
$2,118.40
|
| Rate for Payer: Cigna of CA PPO |
$2,449.40
|
| 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 |
$2,813.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,986.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,482.50
|
| 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 |
$2,207.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$741.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$794.40
|
| 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 |
$2,648.00
|
| Rate for Payer: Networks By Design Commercial |
$2,151.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,813.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,986.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,986.00
|
| 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: 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 LOWER EXTREM JOINT WO CONT
|
Facility
|
IP
|
$5,658.00
|
|
|
Service Code
|
CPT 73721
|
| Hospital Charge Code |
908801441
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,357.92 |
| Max. Negotiated Rate |
$4,809.30 |
| Rate for Payer: Cash Price |
$2,546.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,263.20
|
| Rate for Payer: Galaxy Health WC |
$4,809.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,394.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,773.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,155.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,357.92
|
| Rate for Payer: Multiplan Commercial |
$4,526.40
|
| Rate for Payer: Networks By Design Commercial |
$3,677.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,809.30
|
|
|
HC MRI LOWER EXTREM JOIN W & WO CONT
|
Facility
|
IP
|
$9,158.00
|
|
|
Service Code
|
CPT 73723
|
| Hospital Charge Code |
908801377
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,197.92 |
| Max. Negotiated Rate |
$7,784.30 |
| Rate for Payer: Cash Price |
$4,121.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,663.20
|
| Rate for Payer: Galaxy Health WC |
$7,784.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,494.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,108.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,489.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,197.92
|
| Rate for Payer: Multiplan Commercial |
$7,326.40
|
| Rate for Payer: Networks By Design Commercial |
$5,952.70
|
| Rate for Payer: Prime Health Services Commercial |
$7,784.30
|
|
