|
HC MRI FETAL PELVIC IMG 1ST FETUS
|
Facility
OP
|
$1,013.00
|
|
|
Service Code
|
CPT 74712
|
| Hospital Charge Code |
908874712
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$243.12 |
| Max. Negotiated Rate |
$5,310.96 |
| Rate for Payer: IEHP Medicare Advantage |
$306.16
|
| 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 |
$5,310.96
|
| Rate for Payer: BCBS Transplant Transplant |
$607.80
|
| Rate for Payer: Blue Shield of California Commercial |
$598.68
|
| Rate for Payer: Blue Shield of California EPN |
$475.10
|
| Rate for Payer: Cash Price |
$455.85
|
| Rate for Payer: Cash Price |
$455.85
|
| Rate for Payer: Cigna of CA HMO |
$648.32
|
| Rate for Payer: Cigna of CA PPO |
$749.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Media |
$306.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$306.16
|
| Rate for Payer: Galaxy Health WC |
$861.05
|
| Rate for Payer: Global Benefits Group Commercial |
$607.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$759.75
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$675.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$762.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410.25
|
| Rate for Payer: Multiplan Commercial |
$810.40
|
| Rate for Payer: Networks By Design Commercial |
$658.45
|
| Rate for Payer: Prime Health Services Commercial |
$861.05
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$607.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$607.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$607.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$700.26
|
| Rate for Payer: United Healthcare All Other HMO |
$700.26
|
| Rate for Payer: United Healthcare HMO Rider |
$700.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$700.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC MRI FETAL PELVIC IMG ADD FETUS
|
Facility
IP
|
$506.00
|
|
|
Service Code
|
CPT 74713
|
| Hospital Charge Code |
908874713
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$121.44 |
| Max. Negotiated Rate |
$430.10 |
| Rate for Payer: Cash Price |
$227.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.40
|
| Rate for Payer: Galaxy Health WC |
$430.10
|
| Rate for Payer: Global Benefits Group Commercial |
$303.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$337.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$192.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.44
|
| Rate for Payer: Multiplan Commercial |
$404.80
|
| Rate for Payer: Networks By Design Commercial |
$328.90
|
| Rate for Payer: Prime Health Services Commercial |
$430.10
|
|
|
HC MRI FETAL PELVIC IMG ADD FETUS
|
Facility
OP
|
$506.00
|
|
|
Service Code
|
CPT 74713
|
| Hospital Charge Code |
908874713
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$121.44 |
| Max. Negotiated Rate |
$2,328.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,328.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$430.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$278.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$278.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,275.64
|
| Rate for Payer: BCBS Transplant Transplant |
$303.60
|
| Rate for Payer: Blue Shield of California Commercial |
$299.05
|
| Rate for Payer: Blue Shield of California EPN |
$237.31
|
| Rate for Payer: Cash Price |
$227.70
|
| Rate for Payer: Cash Price |
$227.70
|
| Rate for Payer: Cigna of CA HMO |
$323.84
|
| Rate for Payer: Cigna of CA PPO |
$374.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$430.10
|
| Rate for Payer: Dignity Health Media |
$430.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$430.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$202.40
|
| Rate for Payer: Galaxy Health WC |
$430.10
|
| Rate for Payer: Global Benefits Group Commercial |
$303.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$379.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$337.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$367.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.44
|
| Rate for Payer: Multiplan Commercial |
$404.80
|
| Rate for Payer: Networks By Design Commercial |
$328.90
|
| Rate for Payer: Prime Health Services Commercial |
$430.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$303.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$303.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$303.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$253.00
|
| Rate for Payer: United Healthcare All Other HMO |
$253.00
|
| Rate for Payer: United Healthcare HMO Rider |
$253.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$253.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$430.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$430.10
|
| Rate for Payer: Vantage Medical Group Senior |
$430.10
|
|
|
HC MRI GUID BX/NEEDLE LOC/ASPIR
|
Facility
IP
|
$8,887.00
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
909002020
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,132.88 |
| Max. Negotiated Rate |
$7,553.95 |
| Rate for Payer: Cash Price |
$3,999.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,554.80
|
| Rate for Payer: Galaxy Health WC |
$7,553.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,332.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,927.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,385.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,132.88
|
| Rate for Payer: Multiplan Commercial |
$7,109.60
|
| Rate for Payer: Networks By Design Commercial |
$5,776.55
|
| Rate for Payer: Prime Health Services Commercial |
$7,553.95
|
|
|
HC MRI GUID BX/NEEDLE LOC/ASPIR
|
Facility
OP
|
$5,198.00
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
909002020
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$4,418.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,328.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,418.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,858.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,858.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,096.97
|
| Rate for Payer: BCBS Transplant Transplant |
$3,118.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,072.02
|
| Rate for Payer: Blue Shield of California EPN |
$2,437.86
|
| Rate for Payer: Cash Price |
$2,339.10
|
| Rate for Payer: Cash Price |
$2,339.10
|
| Rate for Payer: Cigna of CA HMO |
$3,326.72
|
| Rate for Payer: Cigna of CA PPO |
$3,846.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,418.30
|
| Rate for Payer: Dignity Health Media |
$4,418.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,418.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,079.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,079.20
|
| Rate for Payer: Galaxy Health WC |
$4,418.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,118.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,898.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,467.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$696.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,247.52
|
| Rate for Payer: Multiplan Commercial |
$4,158.40
|
| Rate for Payer: Networks By Design Commercial |
$3,378.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,418.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$350.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,118.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,118.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,599.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,599.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,599.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,599.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,418.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,418.30
|
| Rate for Payer: Vantage Medical Group Senior |
$4,418.30
|
|
|
HC MRI LOWER EXTREMITY W/O CON
|
Facility
IP
|
$5,774.00
|
|
|
Service Code
|
CPT 73718
|
| Hospital Charge Code |
908801402
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,385.76 |
| Max. Negotiated Rate |
$4,907.90 |
| Rate for Payer: Cash Price |
$2,598.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,309.60
|
| Rate for Payer: Galaxy Health WC |
$4,907.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,464.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,851.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,199.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,385.76
|
| Rate for Payer: Multiplan Commercial |
$4,619.20
|
| Rate for Payer: Networks By Design Commercial |
$3,753.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,907.90
|
|
|
HC MRI LOWER EXTREMITY W/O CON
|
Facility
OP
|
$3,310.00
|
|
|
Service Code
|
CPT 73718
|
| Hospital Charge Code |
908801402
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$306.16 |
| Max. Negotiated Rate |
$3,443.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: 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 |
$1,972.10
|
| Rate for Payer: BCBS Transplant Transplant |
$1,986.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,956.21
|
| Rate for Payer: Blue Shield of California EPN |
$1,552.39
|
| Rate for Payer: Cash Price |
$1,489.50
|
| Rate for Payer: Cash Price |
$1,489.50
|
| Rate for Payer: Cigna of CA HMO |
$2,118.40
|
| Rate for Payer: Cigna of CA PPO |
$2,449.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Media |
$306.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$306.16
|
| Rate for Payer: Galaxy Health WC |
$2,813.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,986.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,482.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$502.10
|
| Rate for Payer: Heritage Provider Network Transplant |
$502.10
|
| Rate for Payer: 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 |
$2,207.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$418.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$794.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410.25
|
| Rate for Payer: Multiplan Commercial |
$2,648.00
|
| Rate for Payer: Networks By Design Commercial |
$2,151.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,813.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$350.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,986.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,986.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| Rate for Payer: United Healthcare All Other HMO |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC MRI LOWER EXTREM JOINT W CONT
|
Facility
OP
|
$3,496.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
908801376
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$3,443.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,500.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: AlphaCare 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: BCBS Transplant 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 Transplant 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: IEHP Medi-Cal |
$1,620.65
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$1,620.65
|
| Rate for Payer: IEHP Medicare Advantage |
$1,000.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,331.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$594.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,000.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$839.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,260.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,340.54
|
| Rate for Payer: Multiplan Commercial |
$2,796.80
|
| Rate for Payer: Networks By Design Commercial |
$2,272.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,971.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$350.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,097.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,097.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,115.74
|
| Rate for Payer: United Healthcare All Other HMO |
$1,115.74
|
| Rate for Payer: United Healthcare HMO Rider |
$1,115.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,115.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: Vantage Medical Group Senior |
$1,000.40
|
|
|
HC MRI LOWER EXTREM JOINT W CONT
|
Facility
IP
|
$5,978.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
908801376
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,434.72 |
| Max. Negotiated Rate |
$5,081.30 |
| Rate for Payer: Cash Price |
$2,690.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,391.20
|
| Rate for Payer: Galaxy Health WC |
$5,081.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,586.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,987.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,277.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,434.72
|
| Rate for Payer: Multiplan Commercial |
$4,782.40
|
| Rate for Payer: Networks By Design Commercial |
$3,885.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,081.30
|
|
|
HC MRI LOWER EXTREM JOINT WO CONT
|
Facility
IP
|
$5,658.00
|
|
|
Service Code
|
CPT 73721
|
| Hospital Charge Code |
908801441
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,357.92 |
| Max. Negotiated Rate |
$4,809.30 |
| Rate for Payer: Cash Price |
$2,546.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,263.20
|
| Rate for Payer: Galaxy Health WC |
$4,809.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,394.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,773.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,155.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,357.92
|
| Rate for Payer: Multiplan Commercial |
$4,526.40
|
| Rate for Payer: Networks By Design Commercial |
$3,677.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,809.30
|
|
|
HC MRI LOWER EXTREM JOINT WO CONT
|
Facility
OP
|
$3,310.00
|
|
|
Service Code
|
CPT 73721
|
| Hospital Charge Code |
908801441
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$306.16 |
| Max. Negotiated Rate |
$3,443.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: 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 |
$1,972.10
|
| Rate for Payer: BCBS Transplant Transplant |
$1,986.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,956.21
|
| Rate for Payer: Blue Shield of California EPN |
$1,552.39
|
| Rate for Payer: Cash Price |
$1,489.50
|
| Rate for Payer: Cash Price |
$1,489.50
|
| Rate for Payer: Cigna of CA HMO |
$2,118.40
|
| Rate for Payer: Cigna of CA PPO |
$2,449.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Media |
$306.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$306.16
|
| Rate for Payer: Galaxy Health WC |
$2,813.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,986.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,482.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$502.10
|
| Rate for Payer: Heritage Provider Network Transplant |
$502.10
|
| Rate for Payer: 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 |
$2,207.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$741.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$794.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410.25
|
| Rate for Payer: Multiplan Commercial |
$2,648.00
|
| Rate for Payer: Networks By Design Commercial |
$2,151.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,813.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$350.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,986.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,986.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| Rate for Payer: United Healthcare All Other HMO |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC MRI LOWER EXTREM JOIN W & WO CONT
|
Facility
OP
|
$5,355.00
|
|
|
Service Code
|
CPT 73723
|
| Hospital Charge Code |
908801377
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$4,551.75 |
| 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 |
$3,190.51
|
| Rate for Payer: BCBS Transplant Transplant |
$3,213.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,164.80
|
| Rate for Payer: Blue Shield of California EPN |
$2,511.50
|
| Rate for Payer: Cash Price |
$2,409.75
|
| Rate for Payer: Cash Price |
$2,409.75
|
| Rate for Payer: Cigna of CA HMO |
$3,427.20
|
| Rate for Payer: Cigna of CA PPO |
$3,962.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: Dignity Health Media |
$480.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$480.50
|
| Rate for Payer: Galaxy Health WC |
$4,551.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,213.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,016.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$788.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$788.02
|
| Rate for Payer: 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 |
$3,571.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,089.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,285.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$605.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.87
|
| Rate for Payer: Multiplan Commercial |
$4,284.00
|
| Rate for Payer: Networks By Design Commercial |
$3,480.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,551.75
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$350.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,213.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,213.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,367.12
|
| Rate for Payer: United Healthcare All Other HMO |
$1,367.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1,367.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,367.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC MRI LOWER EXTREM JOIN W & WO CONT
|
Facility
IP
|
$9,158.00
|
|
|
Service Code
|
CPT 73723
|
| Hospital Charge Code |
908801377
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,197.92 |
| Max. Negotiated Rate |
$7,784.30 |
| Rate for Payer: Cash Price |
$4,121.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,663.20
|
| Rate for Payer: Galaxy Health WC |
$7,784.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,494.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,108.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,489.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,197.92
|
| Rate for Payer: Multiplan Commercial |
$7,326.40
|
| Rate for Payer: Networks By Design Commercial |
$5,952.70
|
| Rate for Payer: Prime Health Services Commercial |
$7,784.30
|
|
|
HC MRI LOWER EXTREM W/ CON
|
Facility
OP
|
$3,687.00
|
|
|
Service Code
|
CPT 73719
|
| Hospital Charge Code |
908801403
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$3,133.95 |
| 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 |
$2,196.71
|
| Rate for Payer: BCBS Transplant Transplant |
$2,212.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,179.02
|
| Rate for Payer: Blue Shield of California EPN |
$1,729.20
|
| Rate for Payer: Cash Price |
$1,659.15
|
| Rate for Payer: Cash Price |
$1,659.15
|
| Rate for Payer: Cigna of CA HMO |
$2,359.68
|
| Rate for Payer: Cigna of CA PPO |
$2,728.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: Dignity Health Media |
$480.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$480.50
|
| Rate for Payer: Galaxy Health WC |
$3,133.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,212.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,765.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$788.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$788.02
|
| Rate for Payer: 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 |
$2,459.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$908.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$884.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$605.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.87
|
| Rate for Payer: Multiplan Commercial |
$2,949.60
|
| Rate for Payer: Networks By Design Commercial |
$2,396.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,133.95
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$350.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,212.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,212.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,115.74
|
| Rate for Payer: United Healthcare All Other HMO |
$1,115.74
|
| Rate for Payer: United Healthcare HMO Rider |
$1,115.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,115.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC MRI LOWER EXTREM W/ CON
|
Facility
IP
|
$6,304.00
|
|
|
Service Code
|
CPT 73719
|
| Hospital Charge Code |
908801403
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,512.96 |
| Max. Negotiated Rate |
$5,358.40 |
| Rate for Payer: Cash Price |
$2,836.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,521.60
|
| Rate for Payer: Galaxy Health WC |
$5,358.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,782.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,204.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,401.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,512.96
|
| Rate for Payer: Multiplan Commercial |
$5,043.20
|
| Rate for Payer: Networks By Design Commercial |
$4,097.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,358.40
|
|
|
HC MRI LOWER EXTREM WO CONT
|
Facility
OP
|
$4,142.00
|
|
|
Service Code
|
CPT 73720
|
| Hospital Charge Code |
908801399
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$3,520.70 |
| 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 |
$2,467.80
|
| Rate for Payer: BCBS Transplant Transplant |
$2,485.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,447.92
|
| Rate for Payer: Blue Shield of California EPN |
$1,942.60
|
| Rate for Payer: Cash Price |
$1,863.90
|
| Rate for Payer: Cash Price |
$1,863.90
|
| Rate for Payer: Cigna of CA HMO |
$2,650.88
|
| Rate for Payer: Cigna of CA PPO |
$3,065.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: Dignity Health Media |
$480.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$480.50
|
| Rate for Payer: Galaxy Health WC |
$3,520.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,485.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,106.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$788.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$788.02
|
| Rate for Payer: 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 |
$2,762.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$632.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$994.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$605.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.87
|
| Rate for Payer: Multiplan Commercial |
$3,313.60
|
| Rate for Payer: Networks By Design Commercial |
$2,692.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,520.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$350.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,485.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,485.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,367.12
|
| Rate for Payer: United Healthcare All Other HMO |
$1,367.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1,367.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,367.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC MRI LOWER EXTREM WO CONT
|
Facility
IP
|
$8,852.00
|
|
|
Service Code
|
CPT 73720
|
| Hospital Charge Code |
908801399
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,124.48 |
| Max. Negotiated Rate |
$7,524.20 |
| Rate for Payer: Cash Price |
$3,983.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,540.80
|
| Rate for Payer: Galaxy Health WC |
$7,524.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,311.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,904.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,372.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,124.48
|
| Rate for Payer: Multiplan Commercial |
$7,081.60
|
| Rate for Payer: Networks By Design Commercial |
$5,753.80
|
| Rate for Payer: Prime Health Services Commercial |
$7,524.20
|
|
|
HC MRI L-SPINE W & WO CONTRAST
|
Facility
IP
|
$8,429.00
|
|
|
Service Code
|
CPT 72158
|
| Hospital Charge Code |
908801124
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$2,022.96 |
| Max. Negotiated Rate |
$7,164.65 |
| Rate for Payer: Cash Price |
$3,793.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,371.60
|
| Rate for Payer: Galaxy Health WC |
$7,164.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,057.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,622.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,211.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,022.96
|
| Rate for Payer: Multiplan Commercial |
$6,743.20
|
| Rate for Payer: Networks By Design Commercial |
$5,478.85
|
| Rate for Payer: Prime Health Services Commercial |
$7,164.65
|
|
|
HC MRI L-SPINE W & WO CONTRAST
|
Facility
OP
|
$4,480.00
|
|
|
Service Code
|
CPT 72158
|
| Hospital Charge Code |
908801124
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$3,808.00 |
| 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 |
$2,669.18
|
| 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 |
$593.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,075.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$605.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.87
|
| Rate for Payer: Multiplan Commercial |
$3,584.00
|
| Rate for Payer: Networks By Design Commercial |
$2,912.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,808.00
|
| Rate for Payer: 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 |
$1,367.12
|
| Rate for Payer: United Healthcare All Other HMO |
$1,367.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1,367.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,367.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC MRI LUMBAR SPINE W CONTRAST
|
Facility
IP
|
$8,075.00
|
|
|
Service Code
|
CPT 72149
|
| Hospital Charge Code |
908801122
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,938.00 |
| Max. Negotiated Rate |
$6,863.75 |
| Rate for Payer: Cash Price |
$3,633.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,230.00
|
| Rate for Payer: Galaxy Health WC |
$6,863.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,845.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,386.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,076.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,938.00
|
| Rate for Payer: Multiplan Commercial |
$6,460.00
|
| Rate for Payer: Networks By Design Commercial |
$5,248.75
|
| Rate for Payer: Prime Health Services Commercial |
$6,863.75
|
|
|
HC MRI LUMBAR SPINE W CONTRAST
|
Facility
OP
|
$4,256.00
|
|
|
Service Code
|
CPT 72149
|
| Hospital Charge Code |
908801122
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$3,617.60 |
| 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 |
$2,535.72
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: 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 |
$2,838.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$504.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,021.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$605.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.87
|
| Rate for Payer: Multiplan Commercial |
$3,404.80
|
| Rate for Payer: Networks By Design Commercial |
$2,766.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,617.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$350.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,553.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,553.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,115.74
|
| Rate for Payer: United Healthcare All Other HMO |
$1,115.74
|
| Rate for Payer: United Healthcare HMO Rider |
$1,115.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,115.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC MRI LUMBAR SPINE WO CONTR
|
Facility
OP
|
$4,104.00
|
|
|
Service Code
|
CPT 72148
|
| Hospital Charge Code |
908801120
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$306.16 |
| Max. Negotiated Rate |
$3,488.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: 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 |
$2,445.16
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: 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 |
$2,737.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$353.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$984.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410.25
|
| Rate for Payer: Multiplan Commercial |
$3,283.20
|
| Rate for Payer: Networks By Design Commercial |
$2,667.60
|
| Rate for Payer: Prime Health Services Commercial |
$3,488.40
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$350.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,462.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,462.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| Rate for Payer: United Healthcare All Other HMO |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC MRI LUMBAR SPINE WO CONTR
|
Facility
IP
|
$7,211.00
|
|
|
Service Code
|
CPT 72148
|
| Hospital Charge Code |
908801120
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,730.64 |
| Max. Negotiated Rate |
$6,129.35 |
| Rate for Payer: Cash Price |
$3,244.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,884.40
|
| Rate for Payer: Galaxy Health WC |
$6,129.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,326.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,809.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,747.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,730.64
|
| Rate for Payer: Multiplan Commercial |
$5,768.80
|
| Rate for Payer: Networks By Design Commercial |
$4,687.15
|
| Rate for Payer: Prime Health Services Commercial |
$6,129.35
|
|
|
HC MRI ORBIT FACE/NECK W CON
|
Facility
OP
|
$4,146.00
|
|
|
Service Code
|
CPT 70542
|
| Hospital Charge Code |
908801081
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$3,524.10 |
| 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 |
$2,470.19
|
| Rate for Payer: BCBS Transplant Transplant |
$2,487.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,450.29
|
| Rate for Payer: Blue Shield of California EPN |
$1,944.47
|
| Rate for Payer: Cash Price |
$1,865.70
|
| Rate for Payer: Cash Price |
$1,865.70
|
| Rate for Payer: Cigna of CA HMO |
$2,653.44
|
| Rate for Payer: Cigna of CA PPO |
$3,068.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: Dignity Health Media |
$480.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$480.50
|
| Rate for Payer: Galaxy Health WC |
$3,524.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,487.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,109.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$788.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$788.02
|
| Rate for Payer: 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 |
$2,765.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$503.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$995.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$605.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.87
|
| Rate for Payer: Multiplan Commercial |
$3,316.80
|
| Rate for Payer: Networks By Design Commercial |
$2,694.90
|
| Rate for Payer: Prime Health Services Commercial |
$3,524.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$350.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,487.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,487.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,115.74
|
| Rate for Payer: United Healthcare All Other HMO |
$1,115.74
|
| Rate for Payer: United Healthcare HMO Rider |
$1,115.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,115.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC MRI ORBIT FACE/NECK W CON
|
Facility
IP
|
$6,474.00
|
|
|
Service Code
|
CPT 70542
|
| Hospital Charge Code |
908801081
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,553.76 |
| Max. Negotiated Rate |
$5,502.90 |
| Rate for Payer: Cash Price |
$2,913.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,589.60
|
| Rate for Payer: Galaxy Health WC |
$5,502.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,884.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,318.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,466.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,553.76
|
| Rate for Payer: Multiplan Commercial |
$5,179.20
|
| Rate for Payer: Networks By Design Commercial |
$4,208.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,502.90
|
|
