|
HC MRI SPECTROSCOPY
|
Facility
|
OP
|
$3,452.00
|
|
|
Service Code
|
CPT 76390
|
| Hospital Charge Code |
908801255
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$113.54 |
| Max. Negotiated Rate |
$2,934.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,328.99
|
| 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 |
$2,056.70
|
| Rate for Payer: Blue Distinction Transplant |
$2,071.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,040.13
|
| Rate for Payer: Blue Shield of California EPN |
$1,618.99
|
| Rate for Payer: Cash Price |
$1,553.40
|
| Rate for Payer: Cash Price |
$1,553.40
|
| Rate for Payer: Cigna of CA HMO |
$2,209.28
|
| Rate for Payer: Cigna of CA PPO |
$2,554.48
|
| 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 |
$2,934.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,071.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,589.00
|
| 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 |
$2,302.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,315.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$828.48
|
| 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 |
$2,761.60
|
| Rate for Payer: Networks By Design Commercial |
$2,243.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,934.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,071.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,071.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,065.68
|
| Rate for Payer: United Healthcare All Other HMO |
$1,065.68
|
| Rate for Payer: United Healthcare HMO Rider |
$1,065.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,065.68
|
| Rate for Payer: 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 SPECTROSCOPY
|
Facility
|
IP
|
$5,902.00
|
|
|
Service Code
|
CPT 76390
|
| Hospital Charge Code |
908801255
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,416.48 |
| Max. Negotiated Rate |
$5,016.70 |
| Rate for Payer: Cash Price |
$2,655.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,360.80
|
| Rate for Payer: Galaxy Health WC |
$5,016.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,541.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,936.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,248.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,416.48
|
| Rate for Payer: Multiplan Commercial |
$4,721.60
|
| Rate for Payer: Networks By Design Commercial |
$3,836.30
|
| Rate for Payer: Prime Health Services Commercial |
$5,016.70
|
|
|
HC MRI THORACIC SPINE WITH CONTRA
|
Facility
|
IP
|
$7,717.00
|
|
|
Service Code
|
CPT 72147
|
| Hospital Charge Code |
908801112
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,852.08 |
| Max. Negotiated Rate |
$6,559.45 |
| Rate for Payer: Cash Price |
$3,472.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,086.80
|
| Rate for Payer: Galaxy Health WC |
$6,559.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,630.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,147.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,940.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,852.08
|
| Rate for Payer: Multiplan Commercial |
$6,173.60
|
| Rate for Payer: Networks By Design Commercial |
$5,016.05
|
| Rate for Payer: Prime Health Services Commercial |
$6,559.45
|
|
|
HC MRI THORACIC SPINE WITH CONTRA
|
Facility
|
OP
|
$4,256.00
|
|
|
Service Code
|
CPT 72147
|
| Hospital Charge Code |
908801112
|
|
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 |
$508.71
|
| 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 THORACIC SPINE WO CON
|
Facility
|
IP
|
$7,016.00
|
|
|
Service Code
|
CPT 72146
|
| Hospital Charge Code |
908801110
|
|
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 THORACIC SPINE WO CON
|
Facility
|
OP
|
$4,104.00
|
|
|
Service Code
|
CPT 72146
|
| Hospital Charge Code |
908801110
|
|
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 |
$352.16
|
| 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 T-SPINE W & WO CONTRAST
|
Facility
|
OP
|
$4,480.00
|
|
|
Service Code
|
CPT 72157
|
| Hospital Charge Code |
908801114
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$480.50 |
| Max. Negotiated Rate |
$3,808.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,328.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,669.18
|
| Rate for Payer: Blue Distinction Transplant |
$2,688.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,647.68
|
| Rate for Payer: Blue Shield of California EPN |
$2,101.12
|
| Rate for Payer: Cash Price |
$2,016.00
|
| Rate for Payer: Cash Price |
$2,016.00
|
| Rate for Payer: Cigna of CA HMO |
$2,867.20
|
| Rate for Payer: Cigna of CA PPO |
$3,315.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: Dignity Health Media |
$480.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$480.50
|
| Rate for Payer: Galaxy Health WC |
$3,808.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,688.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,360.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$788.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$788.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$778.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$778.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$480.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,988.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$595.80
|
| 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 T-SPINE W & WO CONTRAST
|
Facility
|
IP
|
$8,429.00
|
|
|
Service Code
|
CPT 72157
|
| Hospital Charge Code |
908801114
|
|
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 UPPER EXT JNT W & WO CONT
|
Facility
|
IP
|
$8,849.00
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
908801435
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,123.76 |
| Max. Negotiated Rate |
$7,521.65 |
| Rate for Payer: Cash Price |
$3,982.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,539.60
|
| Rate for Payer: Galaxy Health WC |
$7,521.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,309.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,902.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,371.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,123.76
|
| Rate for Payer: Multiplan Commercial |
$7,079.20
|
| Rate for Payer: Networks By Design Commercial |
$5,751.85
|
| Rate for Payer: Prime Health Services Commercial |
$7,521.65
|
|
|
HC MRI UPPER EXT JNT W & WO CONT
|
Facility
|
OP
|
$4,880.00
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
908801435
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$480.50 |
| Max. Negotiated Rate |
$4,148.00 |
| 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 |
$2,907.50
|
| Rate for Payer: Blue Distinction Transplant |
$2,928.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,884.08
|
| Rate for Payer: Blue Shield of California EPN |
$2,288.72
|
| Rate for Payer: Cash Price |
$2,196.00
|
| Rate for Payer: Cash Price |
$2,196.00
|
| Rate for Payer: Cigna of CA HMO |
$3,123.20
|
| Rate for Payer: Cigna of CA PPO |
$3,611.20
|
| 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 |
$4,148.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,928.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,660.00
|
| 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 |
$3,254.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$733.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,171.20
|
| 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 |
$3,904.00
|
| Rate for Payer: Networks By Design Commercial |
$3,172.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,148.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,928.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,928.00
|
| 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 UPPER EXTREM JOINT W/CONT
|
Facility
|
IP
|
$5,978.00
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
908801433
|
|
Hospital Revenue Code
|
614
|
| 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 UPPER EXTREM JOINT W/CONT
|
Facility
|
OP
|
$3,496.00
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
908801433
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$593.48 |
| 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 |
$593.48
|
| 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 UPPER EXTREM JOINT WO CONT
|
Facility
|
IP
|
$5,751.00
|
|
|
Service Code
|
CPT 73221
|
| Hospital Charge Code |
908801431
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,380.24 |
| Max. Negotiated Rate |
$4,888.35 |
| Rate for Payer: Cash Price |
$2,587.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,300.40
|
| Rate for Payer: Galaxy Health WC |
$4,888.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,450.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,835.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,191.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,380.24
|
| Rate for Payer: Multiplan Commercial |
$4,600.80
|
| Rate for Payer: Networks By Design Commercial |
$3,738.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,888.35
|
|
|
HC MRI UPPER EXTREM JOINT WO CONT
|
Facility
|
OP
|
$3,119.00
|
|
|
Service Code
|
CPT 73221
|
| Hospital Charge Code |
908801431
|
|
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 |
$1,858.30
|
| Rate for Payer: Blue Distinction Transplant |
$1,871.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,843.33
|
| Rate for Payer: Blue Shield of California EPN |
$1,462.81
|
| Rate for Payer: Cash Price |
$1,403.55
|
| Rate for Payer: Cash Price |
$1,403.55
|
| Rate for Payer: Cigna of CA HMO |
$1,996.16
|
| Rate for Payer: Cigna of CA PPO |
$2,308.06
|
| 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 |
$2,651.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,871.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,339.25
|
| 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 |
$2,080.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$374.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$748.56
|
| 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 |
$2,495.20
|
| Rate for Payer: Networks By Design Commercial |
$2,027.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,651.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,871.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,871.40
|
| 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 UPPER EXTREM W CONT
|
Facility
|
IP
|
$6,090.00
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
908801415
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,461.60 |
| Max. Negotiated Rate |
$5,176.50 |
| Rate for Payer: Cash Price |
$2,740.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,436.00
|
| Rate for Payer: Galaxy Health WC |
$5,176.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,654.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,062.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,320.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,461.60
|
| Rate for Payer: Multiplan Commercial |
$4,872.00
|
| Rate for Payer: Networks By Design Commercial |
$3,958.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,176.50
|
|
|
HC MRI UPPER EXTREM W CONT
|
Facility
|
OP
|
$3,562.00
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
908801415
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$480.50 |
| 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 |
$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 |
$2,122.24
|
| Rate for Payer: Blue Distinction Transplant |
$2,137.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,105.14
|
| Rate for Payer: Blue Shield of California EPN |
$1,670.58
|
| Rate for Payer: Cash Price |
$1,602.90
|
| Rate for Payer: Cash Price |
$1,602.90
|
| Rate for Payer: Cigna of CA HMO |
$2,279.68
|
| Rate for Payer: Cigna of CA PPO |
$2,635.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$3,027.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,137.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,671.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$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 |
$2,375.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$626.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$854.88
|
| 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 |
$2,849.60
|
| Rate for Payer: Networks By Design Commercial |
$2,315.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,027.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,137.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,137.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$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 UPPER EXTREM W/O CONT
|
Facility
|
OP
|
$3,184.00
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
908801413
|
|
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 |
$1,897.03
|
| Rate for Payer: Blue Distinction Transplant |
$1,910.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,881.74
|
| Rate for Payer: Blue Shield of California EPN |
$1,493.30
|
| Rate for Payer: Cash Price |
$1,432.80
|
| Rate for Payer: Cash Price |
$1,432.80
|
| Rate for Payer: Cigna of CA HMO |
$2,037.76
|
| Rate for Payer: Cigna of CA PPO |
$2,356.16
|
| 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 |
$2,706.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,910.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,388.00
|
| 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 |
$2,123.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$576.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$764.16
|
| 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 |
$2,547.20
|
| Rate for Payer: Networks By Design Commercial |
$2,069.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,706.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,910.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,910.40
|
| 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 UPPER EXTREM W/O CONT
|
Facility
|
IP
|
$5,828.00
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
908801413
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,398.72 |
| Max. Negotiated Rate |
$4,953.80 |
| Rate for Payer: Cash Price |
$2,622.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,331.20
|
| Rate for Payer: Galaxy Health WC |
$4,953.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,496.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,887.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,220.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,398.72
|
| Rate for Payer: Multiplan Commercial |
$4,662.40
|
| Rate for Payer: Networks By Design Commercial |
$3,788.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,953.80
|
|
|
HC MRI UPPER EXTREM W & WO CONT
|
Facility
|
IP
|
$7,797.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
908801411
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,871.28 |
| Max. Negotiated Rate |
$6,627.45 |
| Rate for Payer: Cash Price |
$3,508.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,118.80
|
| Rate for Payer: Galaxy Health WC |
$6,627.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,678.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,200.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,970.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,871.28
|
| Rate for Payer: Multiplan Commercial |
$6,237.60
|
| Rate for Payer: Networks By Design Commercial |
$5,068.05
|
| Rate for Payer: Prime Health Services Commercial |
$6,627.45
|
|
|
HC MRI UPPER EXTREM W & WO CONT
|
Facility
|
OP
|
$3,746.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
908801411
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$480.50 |
| 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 |
$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 |
$2,231.87
|
| Rate for Payer: Blue Distinction Transplant |
$2,247.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,213.89
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.87
|
| Rate for Payer: Cash Price |
$1,685.70
|
| Rate for Payer: Cash Price |
$1,685.70
|
| Rate for Payer: Cigna of CA HMO |
$2,397.44
|
| Rate for Payer: Cigna of CA PPO |
$2,772.04
|
| 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 |
$3,184.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,247.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,809.50
|
| 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 |
$2,498.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$741.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$899.04
|
| 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 |
$2,996.80
|
| Rate for Payer: Networks By Design Commercial |
$2,434.90
|
| Rate for Payer: Prime Health Services Commercial |
$3,184.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,247.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,247.60
|
| 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 MRSA DNA
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
CPT 87641
|
| Hospital Charge Code |
900912328
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.72 |
| Max. Negotiated Rate |
$313.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$291.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$313.26
|
| Rate for Payer: Blue Distinction Transplant |
$61.80
|
| Rate for Payer: Blue Shield of California Commercial |
$66.54
|
| Rate for Payer: Blue Shield of California EPN |
$52.74
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cigna of CA HMO |
$65.92
|
| Rate for Payer: Cigna of CA PPO |
$76.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.64
|
| Rate for Payer: Dignity Health Media |
$35.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.37
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$35.09
|
| Rate for Payer: Galaxy Health WC |
$87.55
|
| Rate for Payer: Global Benefits Group Commercial |
$61.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$77.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.55
|
| Rate for Payer: Heritage Provider Network Transplant |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$56.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$56.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$68.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$82.40
|
| Rate for Payer: Networks By Design Commercial |
$66.95
|
| Rate for Payer: Prime Health Services Commercial |
$87.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$61.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$61.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC MULTI-PLANAR RECON
|
Facility
|
IP
|
$2,175.00
|
|
|
Service Code
|
CPT 76376
|
| Hospital Charge Code |
909201350
|
|
Hospital Revenue Code
|
359
|
| Min. Negotiated Rate |
$522.00 |
| Max. Negotiated Rate |
$1,848.75 |
| Rate for Payer: Cash Price |
$978.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$870.00
|
| Rate for Payer: Galaxy Health WC |
$1,848.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,305.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,450.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$828.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$522.00
|
| Rate for Payer: Multiplan Commercial |
$1,740.00
|
| Rate for Payer: Networks By Design Commercial |
$1,413.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,848.75
|
|
|
HC MULTI-PLANAR RECON
|
Facility
|
OP
|
$2,175.00
|
|
|
Service Code
|
CPT 76376
|
| Hospital Charge Code |
909201350
|
|
Hospital Revenue Code
|
359
|
| Min. Negotiated Rate |
$522.00 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,848.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,196.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,196.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,295.86
|
| Rate for Payer: Blue Distinction Transplant |
$1,305.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,602.98
|
| Rate for Payer: Blue Shield of California EPN |
$1,270.20
|
| Rate for Payer: Cash Price |
$978.75
|
| Rate for Payer: Cash Price |
$978.75
|
| Rate for Payer: Cigna of CA HMO |
$1,392.00
|
| Rate for Payer: Cigna of CA PPO |
$1,609.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,848.75
|
| Rate for Payer: Dignity Health Media |
$1,848.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,848.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$870.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$870.00
|
| Rate for Payer: Galaxy Health WC |
$1,848.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,305.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,631.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,450.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$828.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$522.00
|
| Rate for Payer: Multiplan Commercial |
$1,740.00
|
| Rate for Payer: Networks By Design Commercial |
$1,413.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,848.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,305.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,305.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,087.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,087.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,087.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,087.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,848.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,848.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,848.75
|
|
|
HC MUMPS AB
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
900913533
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.48 |
| Max. Negotiated Rate |
$120.33 |
| Rate for Payer: Aetna of CA HMO/PPO |
$108.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.33
|
| Rate for Payer: Blue Distinction Transplant |
$16.20
|
| Rate for Payer: Blue Shield of California Commercial |
$17.44
|
| Rate for Payer: Blue Shield of California EPN |
$13.82
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cigna of CA HMO |
$17.28
|
| Rate for Payer: Cigna of CA PPO |
$19.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.58
|
| Rate for Payer: Dignity Health Media |
$13.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.05
|
| Rate for Payer: Galaxy Health WC |
$22.95
|
| Rate for Payer: Global Benefits Group Commercial |
$16.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$20.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.40
|
| Rate for Payer: Heritage Provider Network Transplant |
$21.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$21.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.49
|
| Rate for Payer: Multiplan Commercial |
$21.60
|
| Rate for Payer: Networks By Design Commercial |
$17.55
|
| Rate for Payer: Prime Health Services Commercial |
$22.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.58
|
| Rate for Payer: United Healthcare All Other HMO |
$10.58
|
| Rate for Payer: United Healthcare HMO Rider |
$10.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.36
|
| Rate for Payer: Vantage Medical Group Senior |
$13.05
|
|
|
HC MUMPS ANTIBODY
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
900913663
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$120.33 |
| Rate for Payer: Aetna of CA HMO/PPO |
$108.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.33
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$25.19
|
| Rate for Payer: Blue Shield of California EPN |
$19.97
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.58
|
| Rate for Payer: Dignity Health Media |
$13.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.05
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.40
|
| Rate for Payer: Heritage Provider Network Transplant |
$21.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$21.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.49
|
| Rate for Payer: Multiplan Commercial |
$31.20
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.58
|
| Rate for Payer: United Healthcare All Other HMO |
$10.58
|
| Rate for Payer: United Healthcare HMO Rider |
$10.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.36
|
| Rate for Payer: Vantage Medical Group Senior |
$13.05
|
|
