|
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 |
$2,956.25
|
| 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
|
$5,375.00
|
|
|
Service Code
|
CPT 70547
|
| Hospital Charge Code |
908801086
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$4,568.75 |
| Rate for Payer: Adventist Health Commercial |
$1,075.00
|
| 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 |
$3,300.79
|
| Rate for Payer: Blue Shield of California Commercial |
$3,289.50
|
| Rate for Payer: Blue Shield of California EPN |
$2,171.50
|
| Rate for Payer: Cash Price |
$2,956.25
|
| Rate for Payer: Cash Price |
$2,956.25
|
| Rate for Payer: Cash Price |
$2,956.25
|
| Rate for Payer: Cigna of CA HMO |
$3,440.00
|
| Rate for Payer: Cigna of CA PPO |
$3,977.50
|
| 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 |
$4,568.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,225.00
|
| 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 |
$3,585.12
|
| 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 |
$1,290.00
|
| 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 |
$4,300.00
|
| Rate for Payer: Networks By Design Commercial |
$3,493.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,568.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,225.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,225.00
|
| 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 ANGIO NECK WO CONTRAST
|
Facility
|
OP
|
$5,375.00
|
|
|
Service Code
|
CPT 70547
|
| Hospital Charge Code |
908801018
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$4,568.75 |
| Rate for Payer: Galaxy Health WC |
$4,568.75
|
| Rate for Payer: Adventist Health Commercial |
$1,075.00
|
| 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 |
$3,300.79
|
| Rate for Payer: Blue Shield of California Commercial |
$3,289.50
|
| Rate for Payer: Blue Shield of California EPN |
$2,171.50
|
| Rate for Payer: Cash Price |
$2,956.25
|
| Rate for Payer: Cash Price |
$2,956.25
|
| Rate for Payer: Cash Price |
$2,956.25
|
| Rate for Payer: Cigna of CA HMO |
$3,440.00
|
| Rate for Payer: Cigna of CA PPO |
$3,977.50
|
| 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: Global Benefits Group Commercial |
$3,225.00
|
| 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 |
$3,585.12
|
| 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 |
$1,290.00
|
| 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 |
$4,300.00
|
| Rate for Payer: Networks By Design Commercial |
$3,493.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,568.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,225.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,225.00
|
| 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 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 |
$2,956.25
|
| 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 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 |
$3,630.55
|
| 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 ANGIO NECK W WO CONTRAST
|
Facility
|
OP
|
$6,601.00
|
|
|
Service Code
|
CPT 70549
|
| Hospital Charge Code |
908801088
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$453.77 |
| Max. Negotiated Rate |
$5,610.85 |
| Rate for Payer: Adventist Health Commercial |
$1,320.20
|
| 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 |
$4,053.67
|
| Rate for Payer: Blue Shield of California Commercial |
$4,039.81
|
| Rate for Payer: Blue Shield of California EPN |
$2,666.80
|
| Rate for Payer: Cash Price |
$3,630.55
|
| Rate for Payer: Cash Price |
$3,630.55
|
| Rate for Payer: Cash Price |
$3,630.55
|
| Rate for Payer: Cigna of CA HMO |
$4,224.64
|
| Rate for Payer: Cigna of CA PPO |
$4,884.74
|
| 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 |
$5,610.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,960.60
|
| 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 |
$4,402.87
|
| 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 |
$1,584.24
|
| 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 |
$5,280.80
|
| Rate for Payer: Networks By Design Commercial |
$4,290.65
|
| Rate for Payer: Prime Health Services Commercial |
$5,610.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,960.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,960.60
|
| 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 |
$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 BILATERAL TMJ
|
Facility
|
OP
|
$6,791.00
|
|
|
Service Code
|
CPT 70336
|
| Hospital Charge Code |
908801055
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$5,772.35 |
| Rate for Payer: Adventist Health Commercial |
$1,358.20
|
| 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 |
$4,170.35
|
| Rate for Payer: Blue Shield of California Commercial |
$4,156.09
|
| Rate for Payer: Blue Shield of California EPN |
$2,743.56
|
| Rate for Payer: Cash Price |
$3,735.05
|
| Rate for Payer: Cash Price |
$3,735.05
|
| Rate for Payer: Cash Price |
$3,735.05
|
| Rate for Payer: Cigna of CA HMO |
$4,346.24
|
| Rate for Payer: Cigna of CA PPO |
$5,025.34
|
| 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 |
$5,772.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,074.60
|
| 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 |
$4,529.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,587.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,629.84
|
| 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 |
$5,432.80
|
| Rate for Payer: Networks By Design Commercial |
$4,414.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,772.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,074.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,074.60
|
| 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 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 |
$3,735.05
|
| 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 BN MARROW(2 SEQ)
|
Facility
|
OP
|
$4,452.00
|
|
|
Service Code
|
CPT 77084
|
| Hospital Charge Code |
908801140
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$3,784.20 |
| Rate for Payer: Adventist Health Commercial |
$890.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,920.07
|
| 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 |
$2,733.97
|
| Rate for Payer: Blue Shield of California Commercial |
$2,724.62
|
| Rate for Payer: Blue Shield of California EPN |
$1,798.61
|
| Rate for Payer: Cash Price |
$2,448.60
|
| Rate for Payer: Cash Price |
$2,448.60
|
| Rate for Payer: Cigna of CA HMO |
$2,849.28
|
| Rate for Payer: Cigna of CA PPO |
$3,294.48
|
| 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 |
$3,784.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,671.20
|
| 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 |
$2,969.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,696.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,068.48
|
| 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 |
$3,561.60
|
| Rate for Payer: Networks By Design Commercial |
$2,893.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,784.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,671.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,671.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| Rate for Payer: United Healthcare All Other HMO |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: 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 |
$2,448.60
|
| 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 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 |
$586.85
|
| Rate for Payer: Cash Price |
$586.85
|
| 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 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 |
$586.85
|
| 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 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 |
$310.75
|
| 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 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 |
$310.75
|
| Rate for Payer: Cash Price |
$310.75
|
| 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 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 |
$616.55
|
| Rate for Payer: Cash Price |
$616.55
|
| 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 |
$616.55
|
| 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
|
|
|
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 |
$3,544.20
|
| 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
|
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 |
$3,544.20
|
| 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
|
$6,444.00
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
908801012
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$443.91 |
| Max. Negotiated Rate |
$5,477.40 |
| Rate for Payer: Adventist Health Commercial |
$1,288.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,226.62
|
| 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 |
$3,957.26
|
| Rate for Payer: Blue Shield of California Commercial |
$3,943.73
|
| Rate for Payer: Blue Shield of California EPN |
$2,603.38
|
| Rate for Payer: Cash Price |
$3,544.20
|
| Rate for Payer: Cash Price |
$3,544.20
|
| Rate for Payer: Cigna of CA HMO |
$4,124.16
|
| Rate for Payer: Cigna of CA PPO |
$4,768.56
|
| 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 |
$5,477.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,866.40
|
| 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 |
$4,298.15
|
| 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 |
$1,546.56
|
| 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 |
$5,155.20
|
| Rate for Payer: Networks By Design Commercial |
$4,188.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,477.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,866.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,866.40
|
| 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
|
OP
|
$6,444.00
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
908801013
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$443.91 |
| Max. Negotiated Rate |
$5,477.40 |
| Rate for Payer: Adventist Health Commercial |
$1,288.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,226.62
|
| 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 |
$3,957.26
|
| Rate for Payer: Blue Shield of California Commercial |
$3,943.73
|
| Rate for Payer: Blue Shield of California EPN |
$2,603.38
|
| Rate for Payer: Cash Price |
$3,544.20
|
| Rate for Payer: Cash Price |
$3,544.20
|
| Rate for Payer: Cigna of CA HMO |
$4,124.16
|
| Rate for Payer: Cigna of CA PPO |
$4,768.56
|
| 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 |
$5,477.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,866.40
|
| 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 |
$4,298.15
|
| 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 |
$1,546.56
|
| 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 |
$5,155.20
|
| Rate for Payer: Networks By Design Commercial |
$4,188.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,477.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,866.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,866.40
|
| 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
|
OP
|
$6,092.00
|
|
|
Service Code
|
CPT 70551
|
| Hospital Charge Code |
908801010
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$5,178.20 |
| Rate for Payer: Adventist Health Commercial |
$1,218.40
|
| 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 |
$3,741.10
|
| Rate for Payer: Blue Shield of California Commercial |
$3,728.30
|
| Rate for Payer: Blue Shield of California EPN |
$2,461.17
|
| Rate for Payer: Cash Price |
$3,350.60
|
| Rate for Payer: Cash Price |
$3,350.60
|
| Rate for Payer: Cash Price |
$3,350.60
|
| Rate for Payer: Cigna of CA HMO |
$3,898.88
|
| Rate for Payer: Cigna of CA PPO |
$4,508.08
|
| 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 |
$5,178.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,655.20
|
| 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 |
$4,063.36
|
| 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 |
$1,462.08
|
| 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 |
$4,873.60
|
| Rate for Payer: Networks By Design Commercial |
$3,959.80
|
| Rate for Payer: Prime Health Services Commercial |
$5,178.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,655.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,655.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| Rate for Payer: United Healthcare All Other HMO |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: 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 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 |
$3,350.60
|
| 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 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 |
$3,963.85
|
| 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
|
$7,207.00
|
|
|
Service Code
|
CPT 70553
|
| Hospital Charge Code |
908801014
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$453.77 |
| Max. Negotiated Rate |
$6,125.95 |
| Rate for Payer: Adventist Health Commercial |
$1,441.40
|
| 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 |
$4,425.82
|
| Rate for Payer: Blue Shield of California Commercial |
$4,410.68
|
| Rate for Payer: Blue Shield of California EPN |
$2,911.63
|
| Rate for Payer: Cash Price |
$3,963.85
|
| Rate for Payer: Cash Price |
$3,963.85
|
| Rate for Payer: Cash Price |
$3,963.85
|
| Rate for Payer: Cigna of CA HMO |
$4,612.48
|
| Rate for Payer: Cigna of CA PPO |
$5,333.18
|
| 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 |
$6,125.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,324.20
|
| 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 |
$4,807.07
|
| 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 |
$1,729.68
|
| 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 |
$5,765.60
|
| Rate for Payer: Networks By Design Commercial |
$4,684.55
|
| Rate for Payer: Prime Health Services Commercial |
$6,125.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,324.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,324.20
|
| 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 BREAST BILAT W/CONTRAST
|
Facility
|
OP
|
$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: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,496.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,556.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,850.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,971.38
|
| Rate for Payer: Blue Shield of California Commercial |
$3,957.80
|
| Rate for Payer: Blue Shield of California EPN |
$2,612.67
|
| Rate for Payer: Cash Price |
$3,556.85
|
| Rate for Payer: Cash Price |
$3,556.85
|
| Rate for Payer: Cigna of CA HMO |
$4,138.88
|
| Rate for Payer: Cigna of CA PPO |
$4,785.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,496.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,496.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,496.95
|
| 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: Molina Healthcare of CA Medi-Cal |
$4,526.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,526.90
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,880.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,880.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,233.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,233.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,233.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,233.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,496.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,496.95
|
| Rate for Payer: Vantage Medical Group Senior |
$5,496.95
|
|
