|
HC MRI BRAIN WITH CONTRAST
|
Facility
|
IP
|
$6,444.00
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
908801012
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,288.80 |
| Max. Negotiated Rate |
$5,477.40 |
| Rate for Payer: Adventist Health Commercial |
$1,288.80
|
| Rate for Payer: Cash Price |
$2,899.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,577.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,577.60
|
| Rate for Payer: Galaxy Health WC |
$5,477.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,866.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,298.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,455.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,988.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,546.56
|
| Rate for Payer: Multiplan Commercial |
$5,155.20
|
| Rate for Payer: Networks By Design Commercial |
$4,188.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,477.40
|
|
|
HC MRI BRAIN WITH CONTRAST
|
Facility
|
OP
|
$5,421.00
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
908801012
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$443.91 |
| Max. Negotiated Rate |
$4,607.85 |
| Rate for Payer: Adventist Health Commercial |
$1,084.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,555.63
|
| 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 |
$3,329.04
|
| Rate for Payer: Blue Shield of California Commercial |
$3,317.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,190.08
|
| Rate for Payer: Cash Price |
$2,439.45
|
| Rate for Payer: Cash Price |
$2,439.45
|
| Rate for Payer: Cigna of CA HMO |
$3,469.44
|
| Rate for Payer: Cigna of CA PPO |
$4,011.54
|
| 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 |
$4,607.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,252.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$443.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,615.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$502.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,301.04
|
| 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 |
$4,336.80
|
| Rate for Payer: Networks By Design Commercial |
$3,523.65
|
| Rate for Payer: Prime Health Services Commercial |
$4,607.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,252.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,252.60
|
| 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: 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 BRAIN WITH CONTRAST
|
Facility
|
IP
|
$6,444.00
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
908801013
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,288.80 |
| Max. Negotiated Rate |
$5,477.40 |
| Rate for Payer: Adventist Health Commercial |
$1,288.80
|
| Rate for Payer: Cash Price |
$2,899.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,577.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,577.60
|
| Rate for Payer: Galaxy Health WC |
$5,477.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,866.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,298.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,455.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,988.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,546.56
|
| Rate for Payer: Multiplan Commercial |
$5,155.20
|
| Rate for Payer: Networks By Design Commercial |
$4,188.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,477.40
|
|
|
HC MRI BRAIN WITH CONTRAST
|
Facility
|
OP
|
$5,421.00
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
908801013
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$443.91 |
| Max. Negotiated Rate |
$4,607.85 |
| Rate for Payer: Adventist Health Commercial |
$1,084.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,555.63
|
| 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 |
$3,329.04
|
| Rate for Payer: Blue Shield of California Commercial |
$3,317.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,190.08
|
| Rate for Payer: Cash Price |
$2,439.45
|
| Rate for Payer: Cash Price |
$2,439.45
|
| Rate for Payer: Cigna of CA HMO |
$3,469.44
|
| Rate for Payer: Cigna of CA PPO |
$4,011.54
|
| 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 |
$4,607.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,252.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$443.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,615.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$502.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,301.04
|
| 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 |
$4,336.80
|
| Rate for Payer: Networks By Design Commercial |
$3,523.65
|
| Rate for Payer: Prime Health Services Commercial |
$4,607.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,252.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,252.60
|
| 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: 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 BRAIN WO CONTRAST
|
Facility
|
IP
|
$6,092.00
|
|
|
Service Code
|
CPT 70551
|
| Hospital Charge Code |
908801010
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,218.40 |
| Max. Negotiated Rate |
$5,178.20 |
| Rate for Payer: Adventist Health Commercial |
$1,218.40
|
| Rate for Payer: Cash Price |
$2,741.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,436.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,436.80
|
| Rate for Payer: Galaxy Health WC |
$5,178.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,655.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,063.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,321.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,770.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,462.08
|
| Rate for Payer: Multiplan Commercial |
$4,873.60
|
| Rate for Payer: Networks By Design Commercial |
$3,959.80
|
| Rate for Payer: Prime Health Services Commercial |
$5,178.20
|
|
|
HC MRI BRAIN WO CONTRAST
|
Facility
|
OP
|
$5,126.00
|
|
|
Service Code
|
CPT 70551
|
| Hospital Charge Code |
908801010
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$4,357.10 |
| Rate for Payer: Adventist Health Commercial |
$1,025.20
|
| 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 |
$3,147.88
|
| Rate for Payer: Blue Shield of California Commercial |
$3,137.11
|
| Rate for Payer: Blue Shield of California EPN |
$2,070.90
|
| Rate for Payer: Cash Price |
$2,306.70
|
| Rate for Payer: Cash Price |
$2,306.70
|
| Rate for Payer: Cash Price |
$2,306.70
|
| Rate for Payer: Cigna of CA HMO |
$3,280.64
|
| Rate for Payer: Cigna of CA PPO |
$3,793.24
|
| 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 |
$4,357.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,075.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$319.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,419.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$361.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,230.24
|
| 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 |
$4,100.80
|
| Rate for Payer: Networks By Design Commercial |
$3,331.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,357.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,075.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,075.60
|
| 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 W WO CONTRAST
|
Facility
|
IP
|
$7,207.00
|
|
|
Service Code
|
CPT 70553
|
| Hospital Charge Code |
908801014
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,441.40 |
| Max. Negotiated Rate |
$6,125.95 |
| Rate for Payer: Adventist Health Commercial |
$1,441.40
|
| Rate for Payer: Cash Price |
$3,243.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,882.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,882.80
|
| Rate for Payer: Galaxy Health WC |
$6,125.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,324.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,807.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,745.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,461.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,729.68
|
| Rate for Payer: Multiplan Commercial |
$5,765.60
|
| Rate for Payer: Networks By Design Commercial |
$4,684.55
|
| Rate for Payer: Prime Health Services Commercial |
$6,125.95
|
|
|
HC MRI BRAIN W WO CONTRAST
|
Facility
|
OP
|
$6,338.00
|
|
|
Service Code
|
CPT 70553
|
| Hospital Charge Code |
908801014
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$453.77 |
| Max. Negotiated Rate |
$5,387.30 |
| Rate for Payer: Adventist Health Commercial |
$1,267.60
|
| 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 |
$3,892.17
|
| Rate for Payer: Blue Shield of California Commercial |
$3,878.86
|
| Rate for Payer: Blue Shield of California EPN |
$2,560.55
|
| Rate for Payer: Cash Price |
$2,852.10
|
| Rate for Payer: Cash Price |
$2,852.10
|
| Rate for Payer: Cash Price |
$2,852.10
|
| Rate for Payer: Cigna of CA HMO |
$4,056.32
|
| Rate for Payer: Cigna of CA PPO |
$4,690.12
|
| 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 |
$5,387.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,802.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$522.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,227.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$591.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,521.12
|
| 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 |
$5,070.40
|
| Rate for Payer: Networks By Design Commercial |
$4,119.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,387.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,802.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,802.80
|
| 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 BREAST BILAT W/CONTRAST
|
Facility
|
OP
|
$5,310.00
|
|
|
Service Code
|
CPT 77059
|
| Hospital Charge Code |
908801211
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,062.00 |
| Max. Negotiated Rate |
$4,513.50 |
| Rate for Payer: Adventist Health Commercial |
$1,062.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,513.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,920.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,260.87
|
| Rate for Payer: Blue Shield of California Commercial |
$3,249.72
|
| Rate for Payer: Blue Shield of California EPN |
$2,145.24
|
| Rate for Payer: Cash Price |
$2,389.50
|
| Rate for Payer: Cash Price |
$2,389.50
|
| Rate for Payer: Cigna of CA HMO |
$3,398.40
|
| Rate for Payer: Cigna of CA PPO |
$3,929.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,513.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,513.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,513.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,124.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,124.00
|
| Rate for Payer: Galaxy Health WC |
$4,513.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,186.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,541.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,023.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,286.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,274.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,717.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,717.00
|
| Rate for Payer: Multiplan Commercial |
$4,248.00
|
| Rate for Payer: Networks By Design Commercial |
$3,451.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,513.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,186.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,186.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,655.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,655.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,655.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,655.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,513.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,513.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,513.50
|
|
|
HC MRI BREAST BILAT W/CONTRAST
|
Facility
|
IP
|
$6,467.00
|
|
|
Service Code
|
CPT 77059
|
| Hospital Charge Code |
908801211
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,293.40 |
| Max. Negotiated Rate |
$5,496.95 |
| Rate for Payer: Adventist Health Commercial |
$1,293.40
|
| Rate for Payer: Cash Price |
$2,910.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,586.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,586.80
|
| Rate for Payer: Galaxy Health WC |
$5,496.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,880.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,313.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,463.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,003.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,552.08
|
| Rate for Payer: Multiplan Commercial |
$5,173.60
|
| Rate for Payer: Networks By Design Commercial |
$4,203.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,496.95
|
|
|
HC MRI BREAST BILAT WO CONTRAST
|
Facility
|
OP
|
$4,853.00
|
|
|
Service Code
|
CPT 77047
|
| Hospital Charge Code |
908801212
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$4,125.05 |
| Rate for Payer: Adventist Health Commercial |
$970.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,183.08
|
| 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 |
$2,980.23
|
| Rate for Payer: Blue Shield of California Commercial |
$2,970.04
|
| Rate for Payer: Blue Shield of California EPN |
$1,960.61
|
| Rate for Payer: Cash Price |
$2,183.85
|
| Rate for Payer: Cash Price |
$2,183.85
|
| Rate for Payer: Cigna of CA HMO |
$3,105.92
|
| Rate for Payer: Cigna of CA PPO |
$3,591.22
|
| 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 |
$4,125.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,911.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$359.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,236.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$406.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,164.72
|
| 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 |
$3,882.40
|
| Rate for Payer: Networks By Design Commercial |
$3,154.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,125.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,911.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,911.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$590.24
|
| Rate for Payer: United Healthcare All Other HMO |
$590.24
|
| Rate for Payer: United Healthcare HMO Rider |
$590.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$590.24
|
| 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 BREAST BILAT WO CONTRAST
|
Facility
|
IP
|
$5,828.00
|
|
|
Service Code
|
CPT 77047
|
| Hospital Charge Code |
908801212
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,165.60 |
| Max. Negotiated Rate |
$4,953.80 |
| Rate for Payer: Adventist Health Commercial |
$1,165.60
|
| Rate for Payer: Cash Price |
$2,622.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,331.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,331.20
|
| Rate for Payer: Galaxy Health WC |
$4,953.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,496.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,887.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,220.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,607.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,398.72
|
| Rate for Payer: Multiplan Commercial |
$4,662.40
|
| Rate for Payer: Networks By Design Commercial |
$3,788.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,953.80
|
|
|
HC MRI BREAST UNI W/CONTRAST
|
Facility
|
OP
|
$4,998.00
|
|
|
Service Code
|
CPT 77058
|
| Hospital Charge Code |
908801217
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$999.60 |
| Max. Negotiated Rate |
$4,248.30 |
| Rate for Payer: Adventist Health Commercial |
$999.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,248.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,748.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,748.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,069.27
|
| Rate for Payer: Blue Shield of California Commercial |
$3,058.78
|
| Rate for Payer: Blue Shield of California EPN |
$2,019.19
|
| Rate for Payer: Cash Price |
$2,249.10
|
| Rate for Payer: Cash Price |
$2,249.10
|
| Rate for Payer: Cigna of CA HMO |
$3,198.72
|
| Rate for Payer: Cigna of CA PPO |
$3,698.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,248.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,248.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,248.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,999.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,999.20
|
| Rate for Payer: Galaxy Health WC |
$4,248.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,998.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,333.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,904.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,093.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,199.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,498.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,498.60
|
| Rate for Payer: Multiplan Commercial |
$3,998.40
|
| Rate for Payer: Networks By Design Commercial |
$3,248.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,248.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,998.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,998.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,499.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,499.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,499.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,499.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,248.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,248.30
|
| Rate for Payer: Vantage Medical Group Senior |
$4,248.30
|
|
|
HC MRI BREAST UNI W/CONTRAST
|
Facility
|
IP
|
$5,864.00
|
|
|
Service Code
|
CPT 77058
|
| Hospital Charge Code |
908801217
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,172.80 |
| Max. Negotiated Rate |
$4,984.40 |
| Rate for Payer: Adventist Health Commercial |
$1,172.80
|
| Rate for Payer: Cash Price |
$2,638.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,345.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,345.60
|
| Rate for Payer: Galaxy Health WC |
$4,984.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,518.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,911.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,234.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,629.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,407.36
|
| Rate for Payer: Multiplan Commercial |
$4,691.20
|
| Rate for Payer: Networks By Design Commercial |
$3,811.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,984.40
|
|
|
HC MRI BREAST UNI WO CONTRAST
|
Facility
|
IP
|
$5,176.00
|
|
|
Service Code
|
CPT 77046
|
| Hospital Charge Code |
908801219
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,035.20 |
| Max. Negotiated Rate |
$4,399.60 |
| Rate for Payer: Adventist Health Commercial |
$1,035.20
|
| Rate for Payer: Cash Price |
$2,329.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,070.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,070.40
|
| Rate for Payer: Galaxy Health WC |
$4,399.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,105.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,452.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,972.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,203.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,242.24
|
| Rate for Payer: Multiplan Commercial |
$4,140.80
|
| Rate for Payer: Networks By Design Commercial |
$3,364.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,399.60
|
|
|
HC MRI BREAST UNI WO CONTRAST
|
Facility
|
OP
|
$4,310.00
|
|
|
Service Code
|
CPT 77046
|
| Hospital Charge Code |
908801219
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$3,663.50 |
| Rate for Payer: Adventist Health Commercial |
$862.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,826.93
|
| 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 |
$2,646.77
|
| Rate for Payer: Blue Shield of California Commercial |
$2,637.72
|
| Rate for Payer: Blue Shield of California EPN |
$1,741.24
|
| Rate for Payer: Cash Price |
$1,939.50
|
| Rate for Payer: Cash Price |
$1,939.50
|
| Rate for Payer: Cigna of CA HMO |
$2,758.40
|
| Rate for Payer: Cigna of CA PPO |
$3,189.40
|
| 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 |
$3,663.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,586.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$350.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,874.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$396.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,034.40
|
| 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 |
$3,448.00
|
| Rate for Payer: Networks By Design Commercial |
$2,801.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,663.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,586.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,586.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$590.24
|
| Rate for Payer: United Healthcare All Other HMO |
$590.24
|
| Rate for Payer: United Healthcare HMO Rider |
$590.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$590.24
|
| 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 BRST BI W WO CNTRST W CAD
|
Facility
|
IP
|
$7,101.00
|
|
|
Service Code
|
CPT 77049
|
| Hospital Charge Code |
908801210
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,420.20 |
| Max. Negotiated Rate |
$6,035.85 |
| Rate for Payer: Adventist Health Commercial |
$1,420.20
|
| Rate for Payer: Cash Price |
$3,195.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,840.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,840.40
|
| Rate for Payer: Galaxy Health WC |
$6,035.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,260.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,736.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,705.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,395.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,704.24
|
| Rate for Payer: Multiplan Commercial |
$5,680.80
|
| Rate for Payer: Networks By Design Commercial |
$4,615.65
|
| Rate for Payer: Prime Health Services Commercial |
$6,035.85
|
|
|
HC MRI BRST BI W WO CNTRST W CAD
|
Facility
|
OP
|
$5,911.00
|
|
|
Service Code
|
CPT 77049
|
| Hospital Charge Code |
908801210
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$567.57 |
| Max. Negotiated Rate |
$5,024.35 |
| Rate for Payer: Adventist Health Commercial |
$1,182.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,877.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,024.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,251.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,433.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,629.95
|
| Rate for Payer: Blue Shield of California Commercial |
$3,617.53
|
| Rate for Payer: Blue Shield of California EPN |
$2,388.04
|
| Rate for Payer: Cash Price |
$2,659.95
|
| Rate for Payer: Cash Price |
$2,659.95
|
| Rate for Payer: Cigna of CA HMO |
$3,783.04
|
| Rate for Payer: Cigna of CA PPO |
$4,374.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,024.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,024.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,024.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,364.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,364.40
|
| Rate for Payer: Galaxy Health WC |
$5,024.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,546.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$567.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,942.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$641.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,658.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,418.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,137.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,137.70
|
| Rate for Payer: Multiplan Commercial |
$4,728.80
|
| Rate for Payer: Networks By Design Commercial |
$3,842.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,024.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,546.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,546.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$750.08
|
| Rate for Payer: United Healthcare All Other HMO |
$750.08
|
| Rate for Payer: United Healthcare HMO Rider |
$750.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$750.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,024.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,024.35
|
| Rate for Payer: Vantage Medical Group Senior |
$5,024.35
|
|
|
HC MRI BRST UNI W WO CTRST W CAD
|
Facility
|
OP
|
$5,454.00
|
|
|
Service Code
|
CPT 77048
|
| Hospital Charge Code |
908801215
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$556.99 |
| Max. Negotiated Rate |
$4,635.90 |
| Rate for Payer: Adventist Health Commercial |
$1,090.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,577.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,635.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,999.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,090.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,349.30
|
| Rate for Payer: Blue Shield of California Commercial |
$3,337.85
|
| Rate for Payer: Blue Shield of California EPN |
$2,203.42
|
| Rate for Payer: Cash Price |
$2,454.30
|
| Rate for Payer: Cash Price |
$2,454.30
|
| Rate for Payer: Cigna of CA HMO |
$3,490.56
|
| Rate for Payer: Cigna of CA PPO |
$4,035.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,635.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,635.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,635.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,181.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,181.60
|
| Rate for Payer: Galaxy Health WC |
$4,635.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,272.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$556.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,637.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$629.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,376.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,308.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,817.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,817.80
|
| Rate for Payer: Multiplan Commercial |
$4,363.20
|
| Rate for Payer: Networks By Design Commercial |
$3,545.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,635.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,272.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,272.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$753.76
|
| Rate for Payer: United Healthcare All Other HMO |
$753.76
|
| Rate for Payer: United Healthcare HMO Rider |
$753.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$753.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,635.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,635.90
|
| Rate for Payer: Vantage Medical Group Senior |
$4,635.90
|
|
|
HC MRI BRST UNI W WO CTRST W CAD
|
Facility
|
IP
|
$6,550.00
|
|
|
Service Code
|
CPT 77048
|
| Hospital Charge Code |
908801215
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,310.00 |
| Max. Negotiated Rate |
$5,567.50 |
| Rate for Payer: Adventist Health Commercial |
$1,310.00
|
| Rate for Payer: Cash Price |
$2,947.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,620.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,620.00
|
| Rate for Payer: Galaxy Health WC |
$5,567.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,930.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,368.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,495.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,054.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,572.00
|
| Rate for Payer: Multiplan Commercial |
$5,240.00
|
| Rate for Payer: Networks By Design Commercial |
$4,257.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,567.50
|
|
|
HC MRI CERVICAL SPINE W CONTRA
|
Facility
|
IP
|
$5,942.00
|
|
|
Service Code
|
CPT 72142
|
| Hospital Charge Code |
908801102
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,188.40 |
| Max. Negotiated Rate |
$5,050.70 |
| Rate for Payer: Adventist Health Commercial |
$1,188.40
|
| Rate for Payer: Cash Price |
$2,673.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,376.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,376.80
|
| Rate for Payer: Galaxy Health WC |
$5,050.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,565.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,963.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,263.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,678.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,426.08
|
| Rate for Payer: Multiplan Commercial |
$4,753.60
|
| Rate for Payer: Networks By Design Commercial |
$3,862.30
|
| Rate for Payer: Prime Health Services Commercial |
$5,050.70
|
|
|
HC MRI CERVICAL SPINE W CONTRA
|
Facility
|
OP
|
$5,150.00
|
|
|
Service Code
|
CPT 72142
|
| Hospital Charge Code |
908801102
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$453.77 |
| Max. Negotiated Rate |
$4,377.50 |
| Rate for Payer: Adventist Health Commercial |
$1,030.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,377.89
|
| 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 |
$3,162.61
|
| Rate for Payer: Blue Shield of California Commercial |
$3,151.80
|
| Rate for Payer: Blue Shield of California EPN |
$2,080.60
|
| Rate for Payer: Cash Price |
$2,317.50
|
| Rate for Payer: Cash Price |
$2,317.50
|
| Rate for Payer: Cigna of CA HMO |
$3,296.00
|
| Rate for Payer: Cigna of CA PPO |
$3,811.00
|
| 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 |
$4,377.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,090.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$454.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,435.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$514.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,236.00
|
| 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 |
$4,120.00
|
| Rate for Payer: Networks By Design Commercial |
$3,347.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,377.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,090.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,090.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,115.74
|
| Rate for Payer: United Healthcare All Other HMO |
$1,115.74
|
| Rate for Payer: United Healthcare HMO Rider |
$1,115.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,115.74
|
| Rate for Payer: 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 CERVICAL SPINE WO CONT
|
Facility
|
OP
|
$4,965.00
|
|
|
Service Code
|
CPT 72141
|
| Hospital Charge Code |
908801100
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$4,220.25 |
| Rate for Payer: Adventist Health Commercial |
$993.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,256.54
|
| 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 |
$3,049.01
|
| Rate for Payer: Blue Shield of California Commercial |
$3,038.58
|
| Rate for Payer: Blue Shield of California EPN |
$2,005.86
|
| Rate for Payer: Cash Price |
$2,234.25
|
| Rate for Payer: Cash Price |
$2,234.25
|
| Rate for Payer: Cigna of CA HMO |
$3,177.60
|
| Rate for Payer: Cigna of CA PPO |
$3,674.10
|
| 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 |
$4,220.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,979.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$311.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,311.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$352.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,191.60
|
| 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 |
$3,972.00
|
| Rate for Payer: Networks By Design Commercial |
$3,227.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,220.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,979.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,979.00
|
| 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 |
$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 CERVICAL SPINE WO CONT
|
Facility
|
IP
|
$5,665.00
|
|
|
Service Code
|
CPT 72141
|
| Hospital Charge Code |
908801100
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,133.00 |
| Max. Negotiated Rate |
$4,815.25 |
| Rate for Payer: Adventist Health Commercial |
$1,133.00
|
| Rate for Payer: Cash Price |
$2,549.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,266.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,266.00
|
| Rate for Payer: Galaxy Health WC |
$4,815.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,399.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,778.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,158.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,506.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,359.60
|
| Rate for Payer: Multiplan Commercial |
$4,532.00
|
| Rate for Payer: Networks By Design Commercial |
$3,682.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,815.25
|
|
|
HC MRI CHEST W/ CONTRAST
|
Facility
|
OP
|
$4,965.00
|
|
|
Service Code
|
CPT 71551
|
| Hospital Charge Code |
908801201
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$628.54 |
| Max. Negotiated Rate |
$4,220.25 |
| Rate for Payer: Adventist Health Commercial |
$993.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,104.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,003.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,049.01
|
| Rate for Payer: Blue Shield of California Commercial |
$3,038.58
|
| Rate for Payer: Blue Shield of California EPN |
$2,005.86
|
| Rate for Payer: Cash Price |
$2,234.25
|
| Rate for Payer: Cash Price |
$2,234.25
|
| Rate for Payer: Cash Price |
$2,234.25
|
| Rate for Payer: Cigna of CA HMO |
$3,177.60
|
| Rate for Payer: Cigna of CA PPO |
$3,674.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,104.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,003.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,355.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,003.85
|
| Rate for Payer: Galaxy Health WC |
$4,220.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,979.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,646.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$628.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,003.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,311.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$710.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,003.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,191.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,264.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,345.16
|
| Rate for Payer: Multiplan Commercial |
$3,972.00
|
| Rate for Payer: Networks By Design Commercial |
$3,227.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,220.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,979.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,979.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,115.74
|
| Rate for Payer: United Healthcare All Other HMO |
$1,115.74
|
| Rate for Payer: United Healthcare HMO Rider |
$1,115.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,115.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,003.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,104.23
|
| Rate for Payer: Vantage Medical Group Senior |
$1,003.85
|
|
