|
HC MRI ANGIO HEAD WITH CONTRAST
|
Facility
|
OP
|
$5,853.00
|
|
|
Service Code
|
CPT 70545
|
| Hospital Charge Code |
908801084
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$374.27 |
| Max. Negotiated Rate |
$4,975.05 |
| Rate for Payer: Adventist Health Commercial |
$1,170.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,594.33
|
| Rate for Payer: Blue Shield of California Commercial |
$3,582.04
|
| Rate for Payer: Blue Shield of California EPN |
$2,364.61
|
| Rate for Payer: Cash Price |
$2,633.85
|
| Rate for Payer: Cash Price |
$2,633.85
|
| Rate for Payer: Cash Price |
$2,633.85
|
| Rate for Payer: Cigna of CA HMO |
$3,745.92
|
| Rate for Payer: Cigna of CA PPO |
$4,331.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.59
|
| Rate for Payer: EPIC Health Plan Senior |
$453.77
|
| Rate for Payer: Galaxy Health WC |
$4,975.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,511.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$374.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,903.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$423.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,404.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$571.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$608.05
|
| Rate for Payer: Multiplan Commercial |
$4,682.40
|
| Rate for Payer: Networks By Design Commercial |
$3,804.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,975.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,511.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,511.80
|
| 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: Upland Medical Group Pediatric |
$453.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
HC MRI ANGIO HEAD WO CNTRAST
|
Facility
|
OP
|
$5,226.00
|
|
|
Service Code
|
CPT 70544
|
| Hospital Charge Code |
908801083
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$4,442.10 |
| Rate for Payer: Adventist Health Commercial |
$1,045.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,209.29
|
| Rate for Payer: Blue Shield of California Commercial |
$3,198.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,111.30
|
| Rate for Payer: Cash Price |
$2,351.70
|
| Rate for Payer: Cash Price |
$2,351.70
|
| Rate for Payer: Cash Price |
$2,351.70
|
| Rate for Payer: Cigna of CA HMO |
$3,344.64
|
| Rate for Payer: Cigna of CA PPO |
$3,867.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$4,442.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,135.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$354.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,485.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$400.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,254.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$4,180.80
|
| Rate for Payer: Networks By Design Commercial |
$3,396.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,442.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,135.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,135.60
|
| 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: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC MRI ANGIO HEAD WO CNTRAST
|
Facility
|
OP
|
$5,226.00
|
|
|
Service Code
|
CPT 70544
|
| Hospital Charge Code |
908801015
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$4,442.10 |
| Rate for Payer: Adventist Health Commercial |
$1,045.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,209.29
|
| Rate for Payer: Blue Shield of California Commercial |
$3,198.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,111.30
|
| Rate for Payer: Cash Price |
$2,351.70
|
| Rate for Payer: Cash Price |
$2,351.70
|
| Rate for Payer: Cash Price |
$2,351.70
|
| Rate for Payer: Cigna of CA HMO |
$3,344.64
|
| Rate for Payer: Cigna of CA PPO |
$3,867.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$4,442.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,135.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$354.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,485.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$400.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,254.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$4,180.80
|
| Rate for Payer: Networks By Design Commercial |
$3,396.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,442.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,135.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,135.60
|
| 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: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC MRI ANGIO HEAD WO CNTRAST
|
Facility
|
IP
|
$5,632.00
|
|
|
Service Code
|
CPT 70544
|
| Hospital Charge Code |
908801015
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,126.40 |
| Max. Negotiated Rate |
$4,787.20 |
| Rate for Payer: Adventist Health Commercial |
$1,126.40
|
| Rate for Payer: Cash Price |
$2,534.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,252.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,252.80
|
| Rate for Payer: Galaxy Health WC |
$4,787.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,379.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,756.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,145.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,486.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,351.68
|
| Rate for Payer: Multiplan Commercial |
$4,505.60
|
| Rate for Payer: Networks By Design Commercial |
$3,660.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,787.20
|
|
|
HC MRI ANGIO HEAD WO CNTRAST
|
Facility
|
IP
|
$5,632.00
|
|
|
Service Code
|
CPT 70544
|
| Hospital Charge Code |
908801083
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,126.40 |
| Max. Negotiated Rate |
$4,787.20 |
| Rate for Payer: Adventist Health Commercial |
$1,126.40
|
| Rate for Payer: Cash Price |
$2,534.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,252.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,252.80
|
| Rate for Payer: Galaxy Health WC |
$4,787.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,379.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,756.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,145.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,486.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,351.68
|
| Rate for Payer: Multiplan Commercial |
$4,505.60
|
| Rate for Payer: Networks By Design Commercial |
$3,660.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,787.20
|
|
|
HC MRI ANGIO HEAD W WO CONTRAST
|
Facility
|
OP
|
$6,270.00
|
|
|
Service Code
|
CPT 70546
|
| Hospital Charge Code |
908801085
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$453.77 |
| Max. Negotiated Rate |
$5,329.50 |
| Rate for Payer: Adventist Health Commercial |
$1,254.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,850.41
|
| Rate for Payer: Blue Shield of California Commercial |
$3,837.24
|
| Rate for Payer: Blue Shield of California EPN |
$2,533.08
|
| Rate for Payer: Cash Price |
$2,821.50
|
| Rate for Payer: Cash Price |
$2,821.50
|
| Rate for Payer: Cash Price |
$2,821.50
|
| Rate for Payer: Cigna of CA HMO |
$4,012.80
|
| Rate for Payer: Cigna of CA PPO |
$4,639.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.59
|
| Rate for Payer: EPIC Health Plan Senior |
$453.77
|
| Rate for Payer: Galaxy Health WC |
$5,329.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,762.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$544.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,182.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$615.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,504.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$571.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$608.05
|
| Rate for Payer: Multiplan Commercial |
$5,016.00
|
| Rate for Payer: Networks By Design Commercial |
$4,075.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,329.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,762.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,762.00
|
| 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: Upland Medical Group Pediatric |
$453.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
HC MRI ANGIO HEAD W WO CONTRAST
|
Facility
|
IP
|
$7,381.00
|
|
|
Service Code
|
CPT 70546
|
| Hospital Charge Code |
908801085
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,476.20 |
| Max. Negotiated Rate |
$6,273.85 |
| Rate for Payer: Adventist Health Commercial |
$1,476.20
|
| Rate for Payer: Cash Price |
$3,321.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,952.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,952.40
|
| Rate for Payer: Galaxy Health WC |
$6,273.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,428.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,923.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,812.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,568.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,771.44
|
| Rate for Payer: Multiplan Commercial |
$5,904.80
|
| Rate for Payer: Networks By Design Commercial |
$4,797.65
|
| Rate for Payer: Prime Health Services Commercial |
$6,273.85
|
|
|
HC MRI ANGIO NECK W CONTRAST
|
Facility
|
OP
|
$5,853.00
|
|
|
Service Code
|
CPT 70548
|
| Hospital Charge Code |
908801087
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$404.17 |
| Max. Negotiated Rate |
$4,975.05 |
| Rate for Payer: Adventist Health Commercial |
$1,170.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,594.33
|
| Rate for Payer: Blue Shield of California Commercial |
$3,582.04
|
| Rate for Payer: Blue Shield of California EPN |
$2,364.61
|
| Rate for Payer: Cash Price |
$2,633.85
|
| Rate for Payer: Cash Price |
$2,633.85
|
| Rate for Payer: Cash Price |
$2,633.85
|
| Rate for Payer: Cigna of CA HMO |
$3,745.92
|
| Rate for Payer: Cigna of CA PPO |
$4,331.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.59
|
| Rate for Payer: EPIC Health Plan Senior |
$453.77
|
| Rate for Payer: Galaxy Health WC |
$4,975.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,511.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$404.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,903.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$457.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,404.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$571.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$608.05
|
| Rate for Payer: Multiplan Commercial |
$4,682.40
|
| Rate for Payer: Networks By Design Commercial |
$3,804.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,975.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,511.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,511.80
|
| 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: Upland Medical Group Pediatric |
$453.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
HC MRI ANGIO NECK W CONTRAST
|
Facility
|
IP
|
$5,564.00
|
|
|
Service Code
|
CPT 70548
|
| Hospital Charge Code |
908801087
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,112.80 |
| Max. Negotiated Rate |
$4,729.40 |
| Rate for Payer: Adventist Health Commercial |
$1,112.80
|
| Rate for Payer: Cash Price |
$2,503.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,225.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,225.60
|
| Rate for Payer: Galaxy Health WC |
$4,729.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,338.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,711.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,119.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,444.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,335.36
|
| Rate for Payer: Multiplan Commercial |
$4,451.20
|
| Rate for Payer: Networks By Design Commercial |
$3,616.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,729.40
|
|
|
HC MRI ANGIO NECK WO CONTRAST
|
Facility
|
IP
|
$5,375.00
|
|
|
Service Code
|
CPT 70547
|
| Hospital Charge Code |
908801086
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,075.00 |
| Max. Negotiated Rate |
$4,568.75 |
| Rate for Payer: Adventist Health Commercial |
$1,075.00
|
| Rate for Payer: Cash Price |
$2,418.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,150.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,150.00
|
| Rate for Payer: Galaxy Health WC |
$4,568.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,225.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,585.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,047.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,327.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,290.00
|
| Rate for Payer: Multiplan Commercial |
$4,300.00
|
| Rate for Payer: Networks By Design Commercial |
$3,493.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,568.75
|
|
|
HC MRI ANGIO NECK WO CONTRAST
|
Facility
|
OP
|
$5,651.00
|
|
|
Service Code
|
CPT 70547
|
| Hospital Charge Code |
908801018
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$4,803.35 |
| Rate for Payer: Adventist Health Commercial |
$1,130.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,470.28
|
| Rate for Payer: Blue Shield of California Commercial |
$3,458.41
|
| Rate for Payer: Blue Shield of California EPN |
$2,283.00
|
| Rate for Payer: Cash Price |
$2,542.95
|
| Rate for Payer: Cash Price |
$2,542.95
|
| Rate for Payer: Cash Price |
$2,542.95
|
| Rate for Payer: Cigna of CA HMO |
$3,616.64
|
| Rate for Payer: Cigna of CA PPO |
$4,181.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$4,803.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,390.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$355.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,769.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$402.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,356.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$4,520.80
|
| Rate for Payer: Networks By Design Commercial |
$3,673.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,803.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,390.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,390.60
|
| 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: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC MRI ANGIO NECK WO CONTRAST
|
Facility
|
IP
|
$5,375.00
|
|
|
Service Code
|
CPT 70547
|
| Hospital Charge Code |
908801018
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,075.00 |
| Max. Negotiated Rate |
$4,568.75 |
| Rate for Payer: Adventist Health Commercial |
$1,075.00
|
| Rate for Payer: Cash Price |
$2,418.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,150.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,150.00
|
| Rate for Payer: Galaxy Health WC |
$4,568.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,225.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,585.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,047.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,327.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,290.00
|
| Rate for Payer: Multiplan Commercial |
$4,300.00
|
| Rate for Payer: Networks By Design Commercial |
$3,493.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,568.75
|
|
|
HC MRI ANGIO NECK WO CONTRAST
|
Facility
|
OP
|
$5,651.00
|
|
|
Service Code
|
CPT 70547
|
| Hospital Charge Code |
908801086
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$4,803.35 |
| Rate for Payer: Adventist Health Commercial |
$1,130.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,470.28
|
| Rate for Payer: Blue Shield of California Commercial |
$3,458.41
|
| Rate for Payer: Blue Shield of California EPN |
$2,283.00
|
| Rate for Payer: Cash Price |
$2,542.95
|
| Rate for Payer: Cash Price |
$2,542.95
|
| Rate for Payer: Cash Price |
$2,542.95
|
| Rate for Payer: Cigna of CA HMO |
$3,616.64
|
| Rate for Payer: Cigna of CA PPO |
$4,181.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$4,803.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,390.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$355.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,769.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$402.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,356.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$4,520.80
|
| Rate for Payer: Networks By Design Commercial |
$3,673.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,803.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,390.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,390.60
|
| 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: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC MRI ANGIO NECK W WO CONTRAST
|
Facility
|
OP
|
$6,472.00
|
|
|
Service Code
|
CPT 70549
|
| Hospital Charge Code |
908801088
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$453.77 |
| Max. Negotiated Rate |
$5,501.20 |
| Rate for Payer: Adventist Health Commercial |
$1,294.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,974.46
|
| Rate for Payer: Blue Shield of California Commercial |
$3,960.86
|
| Rate for Payer: Blue Shield of California EPN |
$2,614.69
|
| Rate for Payer: Cash Price |
$2,912.40
|
| Rate for Payer: Cash Price |
$2,912.40
|
| Rate for Payer: Cash Price |
$2,912.40
|
| Rate for Payer: Cigna of CA HMO |
$4,142.08
|
| Rate for Payer: Cigna of CA PPO |
$4,789.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.59
|
| Rate for Payer: EPIC Health Plan Senior |
$453.77
|
| Rate for Payer: Galaxy Health WC |
$5,501.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,883.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$569.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,316.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$644.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,553.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$571.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$608.05
|
| Rate for Payer: Multiplan Commercial |
$5,177.60
|
| Rate for Payer: Networks By Design Commercial |
$4,206.80
|
| Rate for Payer: Prime Health Services Commercial |
$5,501.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,883.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,883.20
|
| 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: Upland Medical Group Pediatric |
$453.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
HC MRI ANGIO NECK W WO CONTRAST
|
Facility
|
IP
|
$6,601.00
|
|
|
Service Code
|
CPT 70549
|
| Hospital Charge Code |
908801088
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,320.20 |
| Max. Negotiated Rate |
$5,610.85 |
| Rate for Payer: Adventist Health Commercial |
$1,320.20
|
| Rate for Payer: Cash Price |
$2,970.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,640.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,640.40
|
| Rate for Payer: Galaxy Health WC |
$5,610.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,960.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,402.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,514.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,086.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,584.24
|
| Rate for Payer: Multiplan Commercial |
$5,280.80
|
| Rate for Payer: Networks By Design Commercial |
$4,290.65
|
| Rate for Payer: Prime Health Services Commercial |
$5,610.85
|
|
|
HC MRI BILATERAL TMJ
|
Facility
|
IP
|
$6,791.00
|
|
|
Service Code
|
CPT 70336
|
| Hospital Charge Code |
908801055
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,358.20 |
| Max. Negotiated Rate |
$5,772.35 |
| Rate for Payer: Adventist Health Commercial |
$1,358.20
|
| Rate for Payer: Cash Price |
$3,055.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,716.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,716.40
|
| Rate for Payer: Galaxy Health WC |
$5,772.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,074.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,529.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,587.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,203.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,629.84
|
| Rate for Payer: Multiplan Commercial |
$5,432.80
|
| Rate for Payer: Networks By Design Commercial |
$4,414.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,772.35
|
|
|
HC MRI BILATERAL TMJ
|
Facility
|
OP
|
$5,653.00
|
|
|
Service Code
|
CPT 70336
|
| Hospital Charge Code |
908801055
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$4,805.05 |
| Rate for Payer: Adventist Health Commercial |
$1,130.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,471.51
|
| Rate for Payer: Blue Shield of California Commercial |
$3,459.64
|
| Rate for Payer: Blue Shield of California EPN |
$2,283.81
|
| Rate for Payer: Cash Price |
$2,543.85
|
| Rate for Payer: Cash Price |
$2,543.85
|
| Rate for Payer: Cash Price |
$2,543.85
|
| Rate for Payer: Cigna of CA HMO |
$3,617.92
|
| Rate for Payer: Cigna of CA PPO |
$4,183.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$4,805.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,391.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,770.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,153.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,356.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$4,522.40
|
| Rate for Payer: Networks By Design Commercial |
$3,674.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,805.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,391.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,391.80
|
| 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: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC MRI BN MARROW(2 SEQ)
|
Facility
|
IP
|
$4,452.00
|
|
|
Service Code
|
CPT 77084
|
| Hospital Charge Code |
908801140
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$890.40 |
| Max. Negotiated Rate |
$3,784.20 |
| Rate for Payer: Adventist Health Commercial |
$890.40
|
| Rate for Payer: Cash Price |
$2,003.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,780.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,780.80
|
| Rate for Payer: Galaxy Health WC |
$3,784.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,671.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,969.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,696.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,755.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,068.48
|
| Rate for Payer: Multiplan Commercial |
$3,561.60
|
| Rate for Payer: Networks By Design Commercial |
$2,893.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,784.20
|
|
|
HC MRI BN MARROW(2 SEQ)
|
Facility
|
OP
|
$3,706.00
|
|
|
Service Code
|
CPT 77084
|
| Hospital Charge Code |
908801140
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$3,150.10 |
| Rate for Payer: Adventist Health Commercial |
$741.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,430.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,275.85
|
| Rate for Payer: Blue Shield of California Commercial |
$2,268.07
|
| Rate for Payer: Blue Shield of California EPN |
$1,497.22
|
| Rate for Payer: Cash Price |
$1,667.70
|
| Rate for Payer: Cash Price |
$1,667.70
|
| Rate for Payer: Cigna of CA HMO |
$2,371.84
|
| Rate for Payer: Cigna of CA PPO |
$2,742.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$3,150.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,223.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,471.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,411.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$889.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$2,964.80
|
| Rate for Payer: Networks By Design Commercial |
$2,408.90
|
| Rate for Payer: Prime Health Services Commercial |
$3,150.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,223.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,223.60
|
| 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: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC MRI BRAIN ASSESS W CONTRAST
|
Facility
|
IP
|
$1,067.00
|
|
|
Service Code
|
CPT 70558
|
| Hospital Charge Code |
908870558
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$213.40 |
| Max. Negotiated Rate |
$906.95 |
| Rate for Payer: Adventist Health Commercial |
$213.40
|
| Rate for Payer: Cash Price |
$480.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$426.80
|
| Rate for Payer: EPIC Health Plan Senior |
$426.80
|
| Rate for Payer: Galaxy Health WC |
$906.95
|
| Rate for Payer: Global Benefits Group Commercial |
$640.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$711.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$406.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$660.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.08
|
| Rate for Payer: Multiplan Commercial |
$853.60
|
| Rate for Payer: Networks By Design Commercial |
$693.55
|
| Rate for Payer: Prime Health Services Commercial |
$906.95
|
|
|
HC MRI BRAIN ASSESS W CONTRAST
|
Facility
|
OP
|
$1,067.00
|
|
|
Service Code
|
CPT 70558
|
| Hospital Charge Code |
908870558
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$213.40 |
| Max. Negotiated Rate |
$1,115.74 |
| Rate for Payer: Adventist Health Commercial |
$213.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$699.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$655.24
|
| Rate for Payer: Blue Shield of California Commercial |
$653.00
|
| Rate for Payer: Blue Shield of California EPN |
$431.07
|
| Rate for Payer: Cash Price |
$480.15
|
| Rate for Payer: Cash Price |
$480.15
|
| Rate for Payer: Cigna of CA HMO |
$682.88
|
| Rate for Payer: Cigna of CA PPO |
$789.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.36
|
| Rate for Payer: EPIC Health Plan Senior |
$226.19
|
| Rate for Payer: Galaxy Health WC |
$906.95
|
| Rate for Payer: Global Benefits Group Commercial |
$640.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$297.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$711.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$336.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.09
|
| Rate for Payer: Multiplan Commercial |
$853.60
|
| Rate for Payer: Networks By Design Commercial |
$693.55
|
| Rate for Payer: Prime Health Services Commercial |
$906.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$640.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$640.20
|
| 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: Upland Medical Group Pediatric |
$226.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC MRI BRAIN ASSESS WO CONTRAST
|
Facility
|
OP
|
$565.00
|
|
|
Service Code
|
CPT 70557
|
| Hospital Charge Code |
908870557
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$113.00 |
| Max. Negotiated Rate |
$1,142.54 |
| Rate for Payer: Adventist Health Commercial |
$113.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$370.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$766.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$696.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$346.97
|
| Rate for Payer: Blue Shield of California Commercial |
$345.78
|
| Rate for Payer: Blue Shield of California EPN |
$228.26
|
| Rate for Payer: Cash Price |
$254.25
|
| Rate for Payer: Cash Price |
$254.25
|
| Rate for Payer: Cigna of CA HMO |
$361.60
|
| Rate for Payer: Cigna of CA PPO |
$418.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$766.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$696.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$940.50
|
| Rate for Payer: EPIC Health Plan Senior |
$696.67
|
| Rate for Payer: Galaxy Health WC |
$480.25
|
| Rate for Payer: Global Benefits Group Commercial |
$339.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,142.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$288.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$696.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$376.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$326.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$696.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$877.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$933.54
|
| Rate for Payer: Multiplan Commercial |
$452.00
|
| Rate for Payer: Networks By Design Commercial |
$367.25
|
| Rate for Payer: Prime Health Services Commercial |
$480.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$339.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$339.00
|
| 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: Upland Medical Group Pediatric |
$696.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$766.34
|
| Rate for Payer: Vantage Medical Group Senior |
$696.67
|
|
|
HC MRI BRAIN ASSESS WO CONTRAST
|
Facility
|
IP
|
$565.00
|
|
|
Service Code
|
CPT 70557
|
| Hospital Charge Code |
908870557
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$113.00 |
| Max. Negotiated Rate |
$480.25 |
| Rate for Payer: Adventist Health Commercial |
$113.00
|
| Rate for Payer: Cash Price |
$254.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$226.00
|
| Rate for Payer: EPIC Health Plan Senior |
$226.00
|
| Rate for Payer: Galaxy Health WC |
$480.25
|
| Rate for Payer: Global Benefits Group Commercial |
$339.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$376.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$215.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$349.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.60
|
| Rate for Payer: Multiplan Commercial |
$452.00
|
| Rate for Payer: Networks By Design Commercial |
$367.25
|
| Rate for Payer: Prime Health Services Commercial |
$480.25
|
|
|
HC MRI BRAIN ASSESS WO W CONTRAST
|
Facility
|
OP
|
$1,121.00
|
|
|
Service Code
|
CPT 70559
|
| Hospital Charge Code |
908870559
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$224.20 |
| Max. Negotiated Rate |
$1,367.12 |
| Rate for Payer: Adventist Health Commercial |
$224.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$735.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$688.41
|
| Rate for Payer: Blue Shield of California Commercial |
$686.05
|
| Rate for Payer: Blue Shield of California EPN |
$452.88
|
| Rate for Payer: Cash Price |
$504.45
|
| Rate for Payer: Cash Price |
$504.45
|
| Rate for Payer: Cigna of CA HMO |
$717.44
|
| Rate for Payer: Cigna of CA PPO |
$829.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.36
|
| Rate for Payer: EPIC Health Plan Senior |
$226.19
|
| Rate for Payer: Galaxy Health WC |
$952.85
|
| Rate for Payer: Global Benefits Group Commercial |
$672.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$280.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$747.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$316.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$269.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.09
|
| Rate for Payer: Multiplan Commercial |
$896.80
|
| Rate for Payer: Networks By Design Commercial |
$728.65
|
| Rate for Payer: Prime Health Services Commercial |
$952.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$672.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$672.60
|
| 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: Upland Medical Group Pediatric |
$226.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC MRI BRAIN ASSESS WO W CONTRAST
|
Facility
|
IP
|
$1,121.00
|
|
|
Service Code
|
CPT 70559
|
| Hospital Charge Code |
908870559
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$224.20 |
| Max. Negotiated Rate |
$952.85 |
| Rate for Payer: Adventist Health Commercial |
$224.20
|
| Rate for Payer: Cash Price |
$504.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$448.40
|
| Rate for Payer: EPIC Health Plan Senior |
$448.40
|
| Rate for Payer: Galaxy Health WC |
$952.85
|
| Rate for Payer: Global Benefits Group Commercial |
$672.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$747.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$427.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$693.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$269.04
|
| Rate for Payer: Multiplan Commercial |
$896.80
|
| Rate for Payer: Networks By Design Commercial |
$728.65
|
| Rate for Payer: Prime Health Services Commercial |
$952.85
|
|
