|
HC MRI LOWER EXTREM JOIN W & WO CONT
|
Facility
|
OP
|
$5,355.00
|
|
|
Service Code
|
CPT 73723
|
| Hospital Charge Code |
908801377
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$480.50 |
| Max. Negotiated Rate |
$4,551.75 |
| 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 |
$3,190.51
|
| Rate for Payer: Blue Distinction Transplant |
$3,213.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,164.80
|
| Rate for Payer: Blue Shield of California EPN |
$2,511.50
|
| Rate for Payer: Cash Price |
$2,409.75
|
| Rate for Payer: Cash Price |
$2,409.75
|
| Rate for Payer: Cigna of CA HMO |
$3,427.20
|
| Rate for Payer: Cigna of CA PPO |
$3,962.70
|
| 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 |
$4,551.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,213.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,016.25
|
| 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 |
$3,571.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,089.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,285.20
|
| 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 |
$4,284.00
|
| Rate for Payer: Networks By Design Commercial |
$3,480.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,551.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,213.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,213.00
|
| 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 LOWER EXTREM W/ CON
|
Facility
|
OP
|
$3,687.00
|
|
|
Service Code
|
CPT 73719
|
| Hospital Charge Code |
908801403
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$480.50 |
| Max. Negotiated Rate |
$3,133.95 |
| 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 |
$2,196.71
|
| Rate for Payer: Blue Distinction Transplant |
$2,212.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,179.02
|
| Rate for Payer: Blue Shield of California EPN |
$1,729.20
|
| Rate for Payer: Cash Price |
$1,659.15
|
| Rate for Payer: Cash Price |
$1,659.15
|
| Rate for Payer: Cigna of CA HMO |
$2,359.68
|
| Rate for Payer: Cigna of CA PPO |
$2,728.38
|
| 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 |
$3,133.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,212.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,765.25
|
| 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 |
$2,459.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$908.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$884.88
|
| 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 |
$2,949.60
|
| Rate for Payer: Networks By Design Commercial |
$2,396.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,133.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,212.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,212.20
|
| 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 |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC MRI LOWER EXTREM W/ CON
|
Facility
|
IP
|
$6,304.00
|
|
|
Service Code
|
CPT 73719
|
| Hospital Charge Code |
908801403
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,512.96 |
| Max. Negotiated Rate |
$5,358.40 |
| Rate for Payer: Cash Price |
$2,836.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,521.60
|
| Rate for Payer: Galaxy Health WC |
$5,358.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,782.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,204.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,401.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,512.96
|
| Rate for Payer: Multiplan Commercial |
$5,043.20
|
| Rate for Payer: Networks By Design Commercial |
$4,097.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,358.40
|
|
|
HC MRI LOWER EXTREM WO CONT
|
Facility
|
OP
|
$4,142.00
|
|
|
Service Code
|
CPT 73720
|
| Hospital Charge Code |
908801399
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$480.50 |
| Max. Negotiated Rate |
$3,520.70 |
| 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 |
$2,467.80
|
| Rate for Payer: Blue Distinction Transplant |
$2,485.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,447.92
|
| Rate for Payer: Blue Shield of California EPN |
$1,942.60
|
| Rate for Payer: Cash Price |
$1,863.90
|
| Rate for Payer: Cash Price |
$1,863.90
|
| Rate for Payer: Cigna of CA HMO |
$2,650.88
|
| Rate for Payer: Cigna of CA PPO |
$3,065.08
|
| 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 |
$3,520.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,485.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,106.50
|
| 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 |
$2,762.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$632.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$994.08
|
| 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 |
$3,313.60
|
| Rate for Payer: Networks By Design Commercial |
$2,692.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,520.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,485.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,485.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,367.12
|
| Rate for Payer: United Healthcare All Other HMO |
$1,367.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1,367.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,367.12
|
| Rate for Payer: 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 LOWER EXTREM WO CONT
|
Facility
|
IP
|
$8,852.00
|
|
|
Service Code
|
CPT 73720
|
| Hospital Charge Code |
908801399
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,124.48 |
| Max. Negotiated Rate |
$7,524.20 |
| Rate for Payer: Cash Price |
$3,983.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,540.80
|
| Rate for Payer: Galaxy Health WC |
$7,524.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,311.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,904.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,372.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,124.48
|
| Rate for Payer: Multiplan Commercial |
$7,081.60
|
| Rate for Payer: Networks By Design Commercial |
$5,753.80
|
| Rate for Payer: Prime Health Services Commercial |
$7,524.20
|
|
|
HC MRI L-SPINE W & WO CONTRAST
|
Facility
|
IP
|
$8,429.00
|
|
|
Service Code
|
CPT 72158
|
| Hospital Charge Code |
908801124
|
|
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 L-SPINE W & WO CONTRAST
|
Facility
|
OP
|
$4,480.00
|
|
|
Service Code
|
CPT 72158
|
| Hospital Charge Code |
908801124
|
|
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 |
$593.35
|
| 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 LUMBAR SPINE W CONTRAST
|
Facility
|
IP
|
$8,075.00
|
|
|
Service Code
|
CPT 72149
|
| Hospital Charge Code |
908801122
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,938.00 |
| Max. Negotiated Rate |
$6,863.75 |
| Rate for Payer: Cash Price |
$3,633.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,230.00
|
| Rate for Payer: Galaxy Health WC |
$6,863.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,845.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,386.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,076.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,938.00
|
| Rate for Payer: Multiplan Commercial |
$6,460.00
|
| Rate for Payer: Networks By Design Commercial |
$5,248.75
|
| Rate for Payer: Prime Health Services Commercial |
$6,863.75
|
|
|
HC MRI LUMBAR SPINE W CONTRAST
|
Facility
|
OP
|
$4,256.00
|
|
|
Service Code
|
CPT 72149
|
| Hospital Charge Code |
908801122
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$480.50 |
| Max. Negotiated Rate |
$3,617.60 |
| 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 |
$2,535.72
|
| 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 |
$504.51
|
| 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 LUMBAR SPINE WO CONTR
|
Facility
|
OP
|
$4,104.00
|
|
|
Service Code
|
CPT 72148
|
| Hospital Charge Code |
908801120
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$306.16 |
| 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 |
$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 |
$353.40
|
| 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 LUMBAR SPINE WO CONTR
|
Facility
|
IP
|
$7,211.00
|
|
|
Service Code
|
CPT 72148
|
| Hospital Charge Code |
908801120
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,730.64 |
| Max. Negotiated Rate |
$6,129.35 |
| Rate for Payer: Cash Price |
$3,244.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,884.40
|
| Rate for Payer: Galaxy Health WC |
$6,129.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,326.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,809.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,747.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,730.64
|
| Rate for Payer: Multiplan Commercial |
$5,768.80
|
| Rate for Payer: Networks By Design Commercial |
$4,687.15
|
| Rate for Payer: Prime Health Services Commercial |
$6,129.35
|
|
|
HC MRI ORBIT FACE/NECK W CON
|
Facility
|
IP
|
$6,474.00
|
|
|
Service Code
|
CPT 70542
|
| Hospital Charge Code |
908801081
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,553.76 |
| Max. Negotiated Rate |
$5,502.90 |
| Rate for Payer: Cash Price |
$2,913.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,589.60
|
| Rate for Payer: Galaxy Health WC |
$5,502.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,884.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,318.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,466.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,553.76
|
| Rate for Payer: Multiplan Commercial |
$5,179.20
|
| Rate for Payer: Networks By Design Commercial |
$4,208.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,502.90
|
|
|
HC MRI ORBIT FACE/NECK W CON
|
Facility
|
OP
|
$4,146.00
|
|
|
Service Code
|
CPT 70542
|
| Hospital Charge Code |
908801081
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$480.50 |
| Max. Negotiated Rate |
$3,524.10 |
| 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 |
$2,470.19
|
| Rate for Payer: Blue Distinction Transplant |
$2,487.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,450.29
|
| Rate for Payer: Blue Shield of California EPN |
$1,944.47
|
| Rate for Payer: Cash Price |
$1,865.70
|
| Rate for Payer: Cash Price |
$1,865.70
|
| Rate for Payer: Cigna of CA HMO |
$2,653.44
|
| Rate for Payer: Cigna of CA PPO |
$3,068.04
|
| 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 |
$3,524.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,487.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,109.50
|
| 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 |
$2,765.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$503.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$995.04
|
| 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 |
$3,316.80
|
| Rate for Payer: Networks By Design Commercial |
$2,694.90
|
| Rate for Payer: Prime Health Services Commercial |
$3,524.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,487.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,487.60
|
| 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 ORBIT FACE/NECK WO CON
|
Facility
|
IP
|
$5,887.00
|
|
|
Service Code
|
CPT 70540
|
| Hospital Charge Code |
908801080
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,412.88 |
| Max. Negotiated Rate |
$5,003.95 |
| Rate for Payer: Cash Price |
$2,649.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,354.80
|
| Rate for Payer: Galaxy Health WC |
$5,003.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,532.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,926.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,242.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,412.88
|
| Rate for Payer: Multiplan Commercial |
$4,709.60
|
| Rate for Payer: Networks By Design Commercial |
$3,826.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,003.95
|
|
|
HC MRI ORBIT FACE/NECK WO CON
|
Facility
|
OP
|
$3,634.00
|
|
|
Service Code
|
CPT 70540
|
| Hospital Charge Code |
908801080
|
|
Hospital Revenue Code
|
611
|
| 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 |
$2,165.14
|
| Rate for Payer: Blue Distinction Transplant |
$2,180.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,147.69
|
| Rate for Payer: Blue Shield of California EPN |
$1,704.35
|
| Rate for Payer: Cash Price |
$1,635.30
|
| Rate for Payer: Cash Price |
$1,635.30
|
| Rate for Payer: Cigna of CA HMO |
$2,325.76
|
| Rate for Payer: Cigna of CA PPO |
$2,689.16
|
| 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 |
$3,088.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,180.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,725.50
|
| 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 |
$2,423.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$423.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$872.16
|
| 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 |
$2,907.20
|
| Rate for Payer: Networks By Design Commercial |
$2,362.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,088.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,180.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,180.40
|
| 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 ORBIT FACE/NECK W WO CON
|
Facility
|
IP
|
$9,452.00
|
|
|
Service Code
|
CPT 70543
|
| Hospital Charge Code |
908801082
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$2,268.48 |
| Max. Negotiated Rate |
$8,034.20 |
| Rate for Payer: Cash Price |
$4,253.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,780.80
|
| Rate for Payer: Galaxy Health WC |
$8,034.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,671.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,304.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,601.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,268.48
|
| Rate for Payer: Multiplan Commercial |
$7,561.60
|
| Rate for Payer: Networks By Design Commercial |
$6,143.80
|
| Rate for Payer: Prime Health Services Commercial |
$8,034.20
|
|
|
HC MRI ORBIT FACE/NECK W WO CON
|
Facility
|
OP
|
$5,307.00
|
|
|
Service Code
|
CPT 70543
|
| Hospital Charge Code |
908801082
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$480.50 |
| Max. Negotiated Rate |
$4,510.95 |
| 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 |
$3,161.91
|
| Rate for Payer: Blue Distinction Transplant |
$3,184.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,136.44
|
| Rate for Payer: Blue Shield of California EPN |
$2,488.98
|
| Rate for Payer: Cash Price |
$2,388.15
|
| Rate for Payer: Cash Price |
$2,388.15
|
| Rate for Payer: Cigna of CA HMO |
$3,396.48
|
| Rate for Payer: Cigna of CA PPO |
$3,927.18
|
| 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 |
$4,510.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,184.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,980.25
|
| 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 |
$3,539.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$633.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,273.68
|
| 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 |
$4,245.60
|
| Rate for Payer: Networks By Design Commercial |
$3,449.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,510.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,184.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,184.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,367.12
|
| Rate for Payer: United Healthcare All Other HMO |
$1,367.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1,367.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,367.12
|
| Rate for Payer: 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 PELVIS W/CONTRAST
|
Facility
|
OP
|
$4,256.00
|
|
|
Service Code
|
CPT 72196
|
| Hospital Charge Code |
908801350
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$480.50 |
| Max. Negotiated Rate |
$3,617.60 |
| 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 |
$2,535.72
|
| 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 |
$503.56
|
| 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 PELVIS W/CONTRAST
|
Facility
|
IP
|
$8,279.00
|
|
|
Service Code
|
CPT 72196
|
| Hospital Charge Code |
908801350
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,986.96 |
| Max. Negotiated Rate |
$7,037.15 |
| Rate for Payer: Cash Price |
$3,725.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,311.60
|
| Rate for Payer: Galaxy Health WC |
$7,037.15
|
| Rate for Payer: Global Benefits Group Commercial |
$4,967.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,522.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,154.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,986.96
|
| Rate for Payer: Multiplan Commercial |
$6,623.20
|
| Rate for Payer: Networks By Design Commercial |
$5,381.35
|
| Rate for Payer: Prime Health Services Commercial |
$7,037.15
|
|
|
HC MRI PELVIS W/O CONTRAST
|
Facility
|
OP
|
$3,874.00
|
|
|
Service Code
|
CPT 72195
|
| Hospital Charge Code |
908801351
|
|
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 |
$2,308.13
|
| Rate for Payer: Blue Distinction Transplant |
$2,324.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,289.53
|
| Rate for Payer: Blue Shield of California EPN |
$1,816.91
|
| Rate for Payer: Cash Price |
$1,743.30
|
| Rate for Payer: Cash Price |
$1,743.30
|
| Rate for Payer: Cigna of CA HMO |
$2,479.36
|
| Rate for Payer: Cigna of CA PPO |
$2,866.76
|
| 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 |
$3,292.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,324.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,905.50
|
| 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 |
$2,583.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$430.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$929.76
|
| 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 |
$3,099.20
|
| Rate for Payer: Networks By Design Commercial |
$2,518.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,292.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,324.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,324.40
|
| 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 PELVIS W/O CONTRAST
|
Facility
|
IP
|
$7,277.00
|
|
|
Service Code
|
CPT 72195
|
| Hospital Charge Code |
908801351
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,746.48 |
| Max. Negotiated Rate |
$6,185.45 |
| Rate for Payer: Cash Price |
$3,274.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,910.80
|
| Rate for Payer: Galaxy Health WC |
$6,185.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,366.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,853.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,772.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,746.48
|
| Rate for Payer: Multiplan Commercial |
$5,821.60
|
| Rate for Payer: Networks By Design Commercial |
$4,730.05
|
| Rate for Payer: Prime Health Services Commercial |
$6,185.45
|
|
|
HC MRI PELVIS W & WO CONTRAST
|
Facility
|
IP
|
$9,189.00
|
|
|
Service Code
|
CPT 72197
|
| Hospital Charge Code |
908801352
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$2,205.36 |
| Max. Negotiated Rate |
$7,810.65 |
| Rate for Payer: Cash Price |
$4,135.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,675.60
|
| Rate for Payer: Galaxy Health WC |
$7,810.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,513.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,129.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,501.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,205.36
|
| Rate for Payer: Multiplan Commercial |
$7,351.20
|
| Rate for Payer: Networks By Design Commercial |
$5,972.85
|
| Rate for Payer: Prime Health Services Commercial |
$7,810.65
|
|
|
HC MRI PELVIS W & WO CONTRAST
|
Facility
|
OP
|
$4,885.00
|
|
|
Service Code
|
CPT 72197
|
| Hospital Charge Code |
908801352
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$480.50 |
| Max. Negotiated Rate |
$4,152.25 |
| 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 |
$2,910.48
|
| 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 |
$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 |
$4,152.25
|
| 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: 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 |
$3,258.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$632.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,172.40
|
| 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 |
$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 |
$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 PROCEDURE
|
Facility
|
OP
|
$2,615.00
|
|
|
Service Code
|
CPT 76498
|
| Hospital Charge Code |
908801008
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$113.54 |
| Max. Negotiated Rate |
$2,222.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,714.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,558.02
|
| Rate for Payer: Blue Distinction Transplant |
$1,569.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,545.46
|
| Rate for Payer: Blue Shield of California EPN |
$1,226.44
|
| Rate for Payer: Cash Price |
$1,176.75
|
| Rate for Payer: Cash Price |
$1,176.75
|
| Rate for Payer: Cigna of CA HMO |
$1,673.60
|
| Rate for Payer: Cigna of CA PPO |
$1,935.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$2,222.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,569.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,961.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$186.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$186.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$183.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$183.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,744.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$627.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$2,092.00
|
| Rate for Payer: Networks By Design Commercial |
$1,699.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,222.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,569.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,569.00
|
| 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 |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC MRI PROCEDURE
|
Facility
|
IP
|
$4,472.00
|
|
|
Service Code
|
CPT 76498
|
| Hospital Charge Code |
908801008
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,073.28 |
| Max. Negotiated Rate |
$3,801.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,931.84
|
| Rate for Payer: Cash Price |
$2,012.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,788.80
|
| Rate for Payer: Galaxy Health WC |
$3,801.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,683.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,982.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,703.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,073.28
|
| Rate for Payer: Multiplan Commercial |
$3,577.60
|
| Rate for Payer: Networks By Design Commercial |
$2,906.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,801.20
|
|
