|
HC MRI ANGIO HEAD WO CNTRAST
|
Facility
OP
|
$4,319.00
|
|
|
Service Code
|
CPT 70544
|
| Hospital Charge Code |
908801015
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$306.16 |
| Max. Negotiated Rate |
$3,671.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,573.26
|
| Rate for Payer: BCBS Transplant Transplant |
$2,591.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,552.53
|
| Rate for Payer: Blue Shield of California EPN |
$2,025.61
|
| Rate for Payer: Cash Price |
$1,943.55
|
| Rate for Payer: Cash Price |
$1,943.55
|
| Rate for Payer: Cigna of CA HMO |
$2,764.16
|
| Rate for Payer: Cigna of CA PPO |
$3,196.06
|
| 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 |
$3,671.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,591.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,239.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$502.10
|
| Rate for Payer: Heritage Provider Network Transplant |
$502.10
|
| Rate for Payer: IEHP Medi-Cal |
$495.98
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$495.98
|
| Rate for Payer: IEHP Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,880.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$400.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,036.56
|
| 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 |
$3,455.20
|
| Rate for Payer: Networks By Design Commercial |
$2,807.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,671.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$350.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,591.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,591.40
|
| 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 ANGIO HEAD W WO CONTRAST
|
Facility
IP
|
$9,142.00
|
|
|
Service Code
|
CPT 70546
|
| Hospital Charge Code |
908801085
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$2,194.08 |
| Max. Negotiated Rate |
$7,770.70 |
| Rate for Payer: Cash Price |
$4,113.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,656.80
|
| Rate for Payer: Galaxy Health WC |
$7,770.70
|
| Rate for Payer: Global Benefits Group Commercial |
$5,485.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,097.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,483.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,194.08
|
| Rate for Payer: Multiplan Commercial |
$7,313.60
|
| Rate for Payer: Networks By Design Commercial |
$5,942.30
|
| Rate for Payer: Prime Health Services Commercial |
$7,770.70
|
|
|
HC MRI ANGIO HEAD W WO CONTRAST
|
Facility
OP
|
$5,182.00
|
|
|
Service Code
|
CPT 70546
|
| Hospital Charge Code |
908801085
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$4,404.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,087.44
|
| Rate for Payer: BCBS Transplant Transplant |
$3,109.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,062.56
|
| Rate for Payer: Blue Shield of California EPN |
$2,430.36
|
| Rate for Payer: Cash Price |
$2,331.90
|
| Rate for Payer: Cash Price |
$2,331.90
|
| Rate for Payer: Cigna of CA HMO |
$3,316.48
|
| Rate for Payer: Cigna of CA PPO |
$3,834.68
|
| 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 |
$4,404.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,109.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,886.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$788.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$788.02
|
| Rate for Payer: IEHP Medi-Cal |
$778.41
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$778.41
|
| Rate for Payer: IEHP Medicare Advantage |
$480.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,456.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$615.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,243.68
|
| 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 |
$4,145.60
|
| Rate for Payer: Networks By Design Commercial |
$3,368.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,404.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$350.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,109.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,109.20
|
| 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 ANGIO NECK W CONTRAST
|
Facility
IP
|
$6,891.00
|
|
|
Service Code
|
CPT 70548
|
| Hospital Charge Code |
908801087
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,653.84 |
| Max. Negotiated Rate |
$5,857.35 |
| Rate for Payer: Cash Price |
$3,100.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,756.40
|
| Rate for Payer: Galaxy Health WC |
$5,857.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,134.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,596.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,625.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,653.84
|
| Rate for Payer: Multiplan Commercial |
$5,512.80
|
| Rate for Payer: Networks By Design Commercial |
$4,479.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,857.35
|
|
|
HC MRI ANGIO NECK W CONTRAST
|
Facility
OP
|
$4,837.00
|
|
|
Service Code
|
CPT 70548
|
| Hospital Charge Code |
908801087
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$4,111.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,881.88
|
| Rate for Payer: BCBS Transplant Transplant |
$2,902.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,858.67
|
| Rate for Payer: Blue Shield of California EPN |
$2,268.55
|
| Rate for Payer: Cash Price |
$2,176.65
|
| Rate for Payer: Cash Price |
$2,176.65
|
| Rate for Payer: Cigna of CA HMO |
$3,095.68
|
| Rate for Payer: Cigna of CA PPO |
$3,579.38
|
| 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 |
$4,111.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,902.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,627.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$788.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$788.02
|
| Rate for Payer: IEHP Medi-Cal |
$778.41
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$778.41
|
| Rate for Payer: IEHP Medicare Advantage |
$480.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,226.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$457.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,160.88
|
| 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 |
$3,869.60
|
| Rate for Payer: Networks By Design Commercial |
$3,144.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,111.45
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$350.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,902.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,902.20
|
| 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 ANGIO NECK WO CONTRAST
|
Facility
OP
|
$4,670.00
|
|
|
Service Code
|
CPT 70547
|
| Hospital Charge Code |
908801086
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$306.16 |
| Max. Negotiated Rate |
$3,969.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,782.39
|
| Rate for Payer: BCBS Transplant Transplant |
$2,802.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,759.97
|
| Rate for Payer: Blue Shield of California EPN |
$2,190.23
|
| Rate for Payer: Cash Price |
$2,101.50
|
| Rate for Payer: Cash Price |
$2,101.50
|
| Rate for Payer: Cigna of CA HMO |
$2,988.80
|
| Rate for Payer: Cigna of CA PPO |
$3,455.80
|
| 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 |
$3,969.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,802.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,502.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$502.10
|
| Rate for Payer: Heritage Provider Network Transplant |
$502.10
|
| Rate for Payer: IEHP Medi-Cal |
$495.98
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$495.98
|
| Rate for Payer: IEHP Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,114.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$402.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,120.80
|
| 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 |
$3,736.00
|
| Rate for Payer: Networks By Design Commercial |
$3,035.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,969.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$350.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,802.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,802.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| Rate for Payer: United Healthcare All Other HMO |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC MRI ANGIO NECK WO CONTRAST
|
Facility
IP
|
$6,656.00
|
|
|
Service Code
|
CPT 70547
|
| Hospital Charge Code |
908801018
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,597.44 |
| Max. Negotiated Rate |
$5,657.60 |
| Rate for Payer: Cash Price |
$2,995.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,662.40
|
| Rate for Payer: Galaxy Health WC |
$5,657.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,993.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,439.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,535.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,597.44
|
| Rate for Payer: Multiplan Commercial |
$5,324.80
|
| Rate for Payer: Networks By Design Commercial |
$4,326.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,657.60
|
|
|
HC MRI ANGIO NECK WO CONTRAST
|
Facility
OP
|
$4,670.00
|
|
|
Service Code
|
CPT 70547
|
| Hospital Charge Code |
908801018
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$306.16 |
| Max. Negotiated Rate |
$3,969.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,782.39
|
| Rate for Payer: BCBS Transplant Transplant |
$2,802.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,759.97
|
| Rate for Payer: Blue Shield of California EPN |
$2,190.23
|
| Rate for Payer: Cash Price |
$2,101.50
|
| Rate for Payer: Cash Price |
$2,101.50
|
| Rate for Payer: Cigna of CA HMO |
$2,988.80
|
| Rate for Payer: Cigna of CA PPO |
$3,455.80
|
| 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 |
$3,969.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,802.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,502.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$502.10
|
| Rate for Payer: Heritage Provider Network Transplant |
$502.10
|
| Rate for Payer: IEHP Medi-Cal |
$495.98
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$495.98
|
| Rate for Payer: IEHP Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,114.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$402.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,120.80
|
| 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 |
$3,736.00
|
| Rate for Payer: Networks By Design Commercial |
$3,035.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,969.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$350.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,802.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,802.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| Rate for Payer: United Healthcare All Other HMO |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC MRI ANGIO NECK WO CONTRAST
|
Facility
IP
|
$6,656.00
|
|
|
Service Code
|
CPT 70547
|
| Hospital Charge Code |
908801086
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,597.44 |
| Max. Negotiated Rate |
$5,657.60 |
| Rate for Payer: Cash Price |
$2,995.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,662.40
|
| Rate for Payer: Galaxy Health WC |
$5,657.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,993.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,439.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,535.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,597.44
|
| Rate for Payer: Multiplan Commercial |
$5,324.80
|
| Rate for Payer: Networks By Design Commercial |
$4,326.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,657.60
|
|
|
HC MRI ANGIO NECK W WO CONTRAST
|
Facility
OP
|
$5,116.00
|
|
|
Service Code
|
CPT 70549
|
| Hospital Charge Code |
908801088
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$4,348.60 |
| Rate for Payer: Cigna of CA HMO |
$3,274.24
|
| Rate for Payer: Cigna of CA PPO |
$3,785.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,048.11
|
| Rate for Payer: BCBS Transplant Transplant |
$3,069.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,023.56
|
| Rate for Payer: Blue Shield of California EPN |
$2,399.40
|
| Rate for Payer: Cash Price |
$2,302.20
|
| Rate for Payer: Cash Price |
$2,302.20
|
| 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 |
$4,348.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,069.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,837.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$788.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$788.02
|
| Rate for Payer: IEHP Medi-Cal |
$778.41
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$778.41
|
| Rate for Payer: IEHP Medicare Advantage |
$480.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,412.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$644.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,227.84
|
| 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 |
$4,092.80
|
| Rate for Payer: Networks By Design Commercial |
$3,325.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,348.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$350.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,069.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,069.60
|
| 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 MRI ANGIO NECK W WO CONTRAST
|
Facility
IP
|
$8,175.00
|
|
|
Service Code
|
CPT 70549
|
| Hospital Charge Code |
908801088
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,962.00 |
| Max. Negotiated Rate |
$6,948.75 |
| Rate for Payer: Cash Price |
$3,678.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,270.00
|
| Rate for Payer: Galaxy Health WC |
$6,948.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,905.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,452.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,114.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,962.00
|
| Rate for Payer: Multiplan Commercial |
$6,540.00
|
| Rate for Payer: Networks By Design Commercial |
$5,313.75
|
| Rate for Payer: Prime Health Services Commercial |
$6,948.75
|
|
|
HC MRI BILATERAL TMJ
|
Facility
OP
|
$4,672.00
|
|
|
Service Code
|
CPT 70336
|
| Hospital Charge Code |
908801055
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$306.16 |
| Max. Negotiated Rate |
$3,971.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,783.58
|
| Rate for Payer: BCBS Transplant Transplant |
$2,803.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,761.15
|
| Rate for Payer: Blue Shield of California EPN |
$2,191.17
|
| Rate for Payer: Cash Price |
$2,102.40
|
| Rate for Payer: Cash Price |
$2,102.40
|
| Rate for Payer: Cigna of CA HMO |
$2,990.08
|
| Rate for Payer: Cigna of CA PPO |
$3,457.28
|
| 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 |
$3,971.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,803.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,504.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$502.10
|
| Rate for Payer: Heritage Provider Network Transplant |
$502.10
|
| Rate for Payer: IEHP Medi-Cal |
$495.98
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$495.98
|
| Rate for Payer: IEHP Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,116.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,780.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,121.28
|
| 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 |
$3,737.60
|
| Rate for Payer: Networks By Design Commercial |
$3,036.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,971.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$350.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,803.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,803.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| Rate for Payer: United Healthcare All Other HMO |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: 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 BILATERAL TMJ
|
Facility
IP
|
$7,989.00
|
|
|
Service Code
|
CPT 70336
|
| Hospital Charge Code |
908801055
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,917.36 |
| Max. Negotiated Rate |
$6,790.65 |
| Rate for Payer: Cash Price |
$3,595.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,195.60
|
| Rate for Payer: Galaxy Health WC |
$6,790.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,793.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,328.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,043.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,917.36
|
| Rate for Payer: Multiplan Commercial |
$6,391.20
|
| Rate for Payer: Networks By Design Commercial |
$5,192.85
|
| Rate for Payer: Prime Health Services Commercial |
$6,790.65
|
|
|
HC MRI BN MARROW(2 SEQ)
|
Facility
OP
|
$3,063.00
|
|
|
Service Code
|
CPT 77084
|
| Hospital Charge Code |
908801140
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$306.16 |
| Max. Negotiated Rate |
$2,603.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,328.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,824.94
|
| Rate for Payer: BCBS Transplant Transplant |
$1,837.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,810.23
|
| Rate for Payer: Blue Shield of California EPN |
$1,436.55
|
| Rate for Payer: Cash Price |
$1,378.35
|
| Rate for Payer: Cash Price |
$1,378.35
|
| Rate for Payer: Cigna of CA HMO |
$1,960.32
|
| Rate for Payer: Cigna of CA PPO |
$2,266.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Media |
$306.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$306.16
|
| Rate for Payer: Galaxy Health WC |
$2,603.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,837.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,297.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$502.10
|
| Rate for Payer: Heritage Provider Network Transplant |
$502.10
|
| Rate for Payer: IEHP Medi-Cal |
$495.98
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$495.98
|
| Rate for Payer: IEHP Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,043.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,167.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$735.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410.25
|
| Rate for Payer: Multiplan Commercial |
$2,450.40
|
| Rate for Payer: Networks By Design Commercial |
$1,990.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,603.55
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$350.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,837.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,837.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| Rate for Payer: United Healthcare All Other HMO |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC MRI BN MARROW(2 SEQ)
|
Facility
IP
|
$5,238.00
|
|
|
Service Code
|
CPT 77084
|
| Hospital Charge Code |
908801140
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,257.12 |
| Max. Negotiated Rate |
$4,452.30 |
| Rate for Payer: Cash Price |
$2,357.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,095.20
|
| Rate for Payer: Galaxy Health WC |
$4,452.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,142.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,493.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,995.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,257.12
|
| Rate for Payer: Multiplan Commercial |
$4,190.40
|
| Rate for Payer: Networks By Design Commercial |
$3,404.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,452.30
|
|
|
HC MRI BRAIN ASSESS W CONTRAST
|
Facility
IP
|
$1,322.00
|
|
|
Service Code
|
CPT 70558
|
| Hospital Charge Code |
908870558
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$317.28 |
| Max. Negotiated Rate |
$1,123.70 |
| Rate for Payer: Cash Price |
$594.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$528.80
|
| Rate for Payer: Galaxy Health WC |
$1,123.70
|
| Rate for Payer: Global Benefits Group Commercial |
$793.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$881.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$503.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$317.28
|
| Rate for Payer: Multiplan Commercial |
$1,057.60
|
| Rate for Payer: Networks By Design Commercial |
$859.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,123.70
|
|
|
HC MRI BRAIN ASSESS W CONTRAST
|
Facility
OP
|
$1,322.00
|
|
|
Service Code
|
CPT 70558
|
| Hospital Charge Code |
908870558
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$229.56 |
| Max. Negotiated Rate |
$2,328.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,328.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$787.65
|
| Rate for Payer: BCBS Transplant Transplant |
$793.20
|
| Rate for Payer: Blue Shield of California Commercial |
$781.30
|
| Rate for Payer: Blue Shield of California EPN |
$620.02
|
| Rate for Payer: Cash Price |
$594.90
|
| Rate for Payer: Cash Price |
$594.90
|
| Rate for Payer: Cigna of CA HMO |
$846.08
|
| Rate for Payer: Cigna of CA PPO |
$978.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Media |
$229.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$229.56
|
| Rate for Payer: Galaxy Health WC |
$1,123.70
|
| Rate for Payer: Global Benefits Group Commercial |
$793.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$991.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$376.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$376.48
|
| Rate for Payer: IEHP Medi-Cal |
$371.89
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$371.89
|
| Rate for Payer: IEHP Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$881.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$336.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$317.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$307.61
|
| Rate for Payer: Multiplan Commercial |
$1,057.60
|
| Rate for Payer: Networks By Design Commercial |
$859.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,123.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$350.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$793.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$793.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,115.74
|
| Rate for Payer: United Healthcare All Other HMO |
$1,115.74
|
| Rate for Payer: United Healthcare HMO Rider |
$1,115.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,115.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC MRI BRAIN ASSESS WO CONTRAST
|
Facility
IP
|
$701.00
|
|
|
Service Code
|
CPT 70557
|
| Hospital Charge Code |
908870557
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$168.24 |
| Max. Negotiated Rate |
$595.85 |
| Rate for Payer: Cash Price |
$315.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.40
|
| Rate for Payer: Galaxy Health WC |
$595.85
|
| Rate for Payer: Global Benefits Group Commercial |
$420.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$467.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$267.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.24
|
| Rate for Payer: Multiplan Commercial |
$560.80
|
| Rate for Payer: Networks By Design Commercial |
$455.65
|
| Rate for Payer: Prime Health Services Commercial |
$595.85
|
|
|
HC MRI BRAIN ASSESS WO CONTRAST
|
Facility
OP
|
$701.00
|
|
|
Service Code
|
CPT 70557
|
| Hospital Charge Code |
908870557
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$168.24 |
| Max. Negotiated Rate |
$2,328.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,328.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,033.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$689.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$417.66
|
| Rate for Payer: BCBS Transplant Transplant |
$420.60
|
| Rate for Payer: Blue Shield of California Commercial |
$414.29
|
| Rate for Payer: Blue Shield of California EPN |
$328.77
|
| Rate for Payer: Cash Price |
$315.45
|
| Rate for Payer: Cash Price |
$315.45
|
| Rate for Payer: Cigna of CA HMO |
$448.64
|
| Rate for Payer: Cigna of CA PPO |
$518.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Dignity Health Media |
$689.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$758.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$930.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$689.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$689.28
|
| Rate for Payer: Galaxy Health WC |
$595.85
|
| Rate for Payer: Global Benefits Group Commercial |
$420.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$525.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,130.42
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,130.42
|
| Rate for Payer: IEHP Medi-Cal |
$1,116.63
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$1,116.63
|
| Rate for Payer: IEHP Medicare Advantage |
$689.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$467.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$326.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$689.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$868.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$923.64
|
| Rate for Payer: Multiplan Commercial |
$560.80
|
| Rate for Payer: Networks By Design Commercial |
$455.65
|
| Rate for Payer: Prime Health Services Commercial |
$595.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$350.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$420.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$420.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| Rate for Payer: United Healthcare All Other HMO |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: Vantage Medical Group Senior |
$689.28
|
|
|
HC MRI BRAIN ASSESS WO W CONTRAST
|
Facility
IP
|
$1,389.00
|
|
|
Service Code
|
CPT 70559
|
| Hospital Charge Code |
908870559
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$333.36 |
| Max. Negotiated Rate |
$1,180.65 |
| Rate for Payer: Cash Price |
$625.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$555.60
|
| Rate for Payer: Galaxy Health WC |
$1,180.65
|
| Rate for Payer: Global Benefits Group Commercial |
$833.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$926.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$529.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$333.36
|
| Rate for Payer: Multiplan Commercial |
$1,111.20
|
| Rate for Payer: Networks By Design Commercial |
$902.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,180.65
|
|
|
HC MRI BRAIN ASSESS WO W CONTRAST
|
Facility
OP
|
$1,389.00
|
|
|
Service Code
|
CPT 70559
|
| Hospital Charge Code |
908870559
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$229.56 |
| Max. Negotiated Rate |
$2,328.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,328.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$827.57
|
| Rate for Payer: BCBS Transplant Transplant |
$833.40
|
| Rate for Payer: Blue Shield of California Commercial |
$820.90
|
| Rate for Payer: Blue Shield of California EPN |
$651.44
|
| Rate for Payer: Cash Price |
$625.05
|
| Rate for Payer: Cash Price |
$625.05
|
| Rate for Payer: Cigna of CA HMO |
$888.96
|
| Rate for Payer: Cigna of CA PPO |
$1,027.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Media |
$229.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$229.56
|
| Rate for Payer: Galaxy Health WC |
$1,180.65
|
| Rate for Payer: Global Benefits Group Commercial |
$833.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,041.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$376.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$376.48
|
| Rate for Payer: IEHP Medi-Cal |
$371.89
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$371.89
|
| Rate for Payer: IEHP Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$926.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$316.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$333.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$307.61
|
| Rate for Payer: Multiplan Commercial |
$1,111.20
|
| Rate for Payer: Networks By Design Commercial |
$902.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,180.65
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$350.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$833.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$833.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,367.12
|
| Rate for Payer: United Healthcare All Other HMO |
$1,367.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1,367.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,367.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC MRI BRAIN WITH CONTRAST
|
Facility
IP
|
$7,980.00
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
908801012
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,915.20 |
| Max. Negotiated Rate |
$6,783.00 |
| Rate for Payer: Cash Price |
$3,591.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,192.00
|
| Rate for Payer: Galaxy Health WC |
$6,783.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,788.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,322.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,040.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,915.20
|
| Rate for Payer: Multiplan Commercial |
$6,384.00
|
| Rate for Payer: Networks By Design Commercial |
$5,187.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,783.00
|
|
|
HC MRI BRAIN WITH CONTRAST
|
Facility
IP
|
$7,980.00
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
908801013
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,915.20 |
| Max. Negotiated Rate |
$6,783.00 |
| Rate for Payer: Cash Price |
$3,591.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,192.00
|
| Rate for Payer: Galaxy Health WC |
$6,783.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,788.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,322.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,040.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,915.20
|
| Rate for Payer: Multiplan Commercial |
$6,384.00
|
| Rate for Payer: Networks By Design Commercial |
$5,187.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,783.00
|
|
|
HC MRI BRAIN WITH CONTRAST
|
Facility
OP
|
$4,480.00
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
908801013
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$3,808.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,328.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,669.18
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: IEHP Medi-Cal |
$778.41
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$778.41
|
| Rate for Payer: IEHP Medicare Advantage |
$480.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,988.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$502.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,075.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$605.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.87
|
| Rate for Payer: Multiplan Commercial |
$3,584.00
|
| Rate for Payer: Networks By Design Commercial |
$2,912.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,808.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$350.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,688.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,688.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,115.74
|
| Rate for Payer: United Healthcare All Other HMO |
$1,115.74
|
| Rate for Payer: United Healthcare HMO Rider |
$1,115.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,115.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC MRI BRAIN WITH CONTRAST
|
Facility
OP
|
$4,480.00
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
908801012
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$3,808.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,328.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,669.18
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: IEHP Medi-Cal |
$778.41
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$778.41
|
| Rate for Payer: IEHP Medicare Advantage |
$480.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,988.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$502.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,075.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$605.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.87
|
| Rate for Payer: Multiplan Commercial |
$3,584.00
|
| Rate for Payer: Networks By Design Commercial |
$2,912.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,808.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$350.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,688.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,688.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,115.74
|
| Rate for Payer: United Healthcare All Other HMO |
$1,115.74
|
| Rate for Payer: United Healthcare HMO Rider |
$1,115.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,115.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
