|
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 |
$3,556.85
|
| 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
|
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 |
$3,205.40
|
| 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 BILAT WO CONTRAST
|
Facility
|
OP
|
$5,828.00
|
|
|
Service Code
|
CPT 77047
|
| Hospital Charge Code |
908801212
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$4,953.80 |
| Rate for Payer: Adventist Health Commercial |
$1,165.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,822.59
|
| 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 |
$3,578.97
|
| Rate for Payer: Blue Shield of California Commercial |
$3,566.74
|
| Rate for Payer: Blue Shield of California EPN |
$2,354.51
|
| Rate for Payer: Cash Price |
$3,205.40
|
| Rate for Payer: Cash Price |
$3,205.40
|
| Rate for Payer: Cigna of CA HMO |
$3,729.92
|
| Rate for Payer: Cigna of CA PPO |
$4,312.72
|
| 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 |
$4,953.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,496.80
|
| 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 |
$3,887.28
|
| 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 |
$1,398.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$4,662.40
|
| Rate for Payer: Networks By Design Commercial |
$3,788.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,953.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,496.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,496.80
|
| 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 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 |
$3,225.20
|
| 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 W/CONTRAST
|
Facility
|
OP
|
$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: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,984.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,225.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,398.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,601.08
|
| Rate for Payer: Blue Shield of California Commercial |
$3,588.77
|
| Rate for Payer: Blue Shield of California EPN |
$2,369.06
|
| Rate for Payer: Cash Price |
$3,225.20
|
| Rate for Payer: Cash Price |
$3,225.20
|
| Rate for Payer: Cigna of CA HMO |
$3,752.96
|
| Rate for Payer: Cigna of CA PPO |
$4,339.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,984.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,984.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,984.40
|
| 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: Molina Healthcare of CA Medi-Cal |
$4,104.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,104.80
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,518.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,518.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,932.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,932.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,932.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,984.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,984.40
|
| Rate for Payer: Vantage Medical Group Senior |
$4,984.40
|
|
|
HC MRI BREAST UNI WO CONTRAST
|
Facility
|
OP
|
$5,176.00
|
|
|
Service Code
|
CPT 77046
|
| Hospital Charge Code |
908801219
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$4,399.60 |
| Rate for Payer: Adventist Health Commercial |
$1,035.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,394.94
|
| 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 |
$3,178.58
|
| Rate for Payer: Blue Shield of California Commercial |
$3,167.71
|
| Rate for Payer: Blue Shield of California EPN |
$2,091.10
|
| Rate for Payer: Cash Price |
$2,846.80
|
| Rate for Payer: Cash Price |
$2,846.80
|
| Rate for Payer: Cigna of CA HMO |
$3,312.64
|
| Rate for Payer: Cigna of CA PPO |
$3,830.24
|
| 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 |
$4,399.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,105.60
|
| 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 |
$3,452.39
|
| 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 |
$1,242.24
|
| 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 |
$4,140.80
|
| Rate for Payer: Networks By Design Commercial |
$3,364.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,399.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,105.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,105.60
|
| 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 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 |
$2,846.80
|
| 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 BRST BI W WO CNTRST W CAD
|
Facility
|
OP
|
$7,101.00
|
|
|
Service Code
|
CPT 77049
|
| Hospital Charge Code |
908801210
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$567.57 |
| Max. Negotiated Rate |
$6,035.85 |
| Rate for Payer: Adventist Health Commercial |
$1,420.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,657.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,035.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,905.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,325.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,360.72
|
| Rate for Payer: Blue Shield of California Commercial |
$4,345.81
|
| Rate for Payer: Blue Shield of California EPN |
$2,868.80
|
| Rate for Payer: Cash Price |
$3,905.55
|
| Rate for Payer: Cash Price |
$3,905.55
|
| Rate for Payer: Cigna of CA HMO |
$4,544.64
|
| Rate for Payer: Cigna of CA PPO |
$5,254.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,035.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,035.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,035.85
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$567.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,736.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$641.90
|
| 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: Molina Healthcare of CA Medi-Cal |
$4,970.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,970.70
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,260.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,260.60
|
| 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 |
$6,035.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,035.85
|
| Rate for Payer: Vantage Medical Group Senior |
$6,035.85
|
|
|
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 |
$3,905.55
|
| 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 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 |
$3,602.50
|
| 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 BRST UNI W WO CTRST W CAD
|
Facility
|
OP
|
$6,550.00
|
|
|
Service Code
|
CPT 77048
|
| Hospital Charge Code |
908801215
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$556.99 |
| Max. Negotiated Rate |
$5,567.50 |
| Rate for Payer: Adventist Health Commercial |
$1,310.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,296.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,567.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,602.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,912.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,022.36
|
| Rate for Payer: Blue Shield of California Commercial |
$4,008.60
|
| Rate for Payer: Blue Shield of California EPN |
$2,646.20
|
| Rate for Payer: Cash Price |
$3,602.50
|
| Rate for Payer: Cash Price |
$3,602.50
|
| Rate for Payer: Cigna of CA HMO |
$4,192.00
|
| Rate for Payer: Cigna of CA PPO |
$4,847.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,567.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,567.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,567.50
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$556.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,368.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$629.93
|
| 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: Molina Healthcare of CA Medi-Cal |
$4,585.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,585.00
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,930.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,930.00
|
| 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 |
$5,567.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,567.50
|
| Rate for Payer: Vantage Medical Group Senior |
$5,567.50
|
|
|
HC MRI CERVICAL SPINE W CONTRA
|
Facility
|
OP
|
$5,942.00
|
|
|
Service Code
|
CPT 72142
|
| Hospital Charge Code |
908801102
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$453.77 |
| Max. Negotiated Rate |
$5,050.70 |
| Rate for Payer: Adventist Health Commercial |
$1,188.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,897.36
|
| 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 |
$3,648.98
|
| Rate for Payer: Blue Shield of California Commercial |
$3,636.50
|
| Rate for Payer: Blue Shield of California EPN |
$2,400.57
|
| Rate for Payer: Cash Price |
$3,268.10
|
| Rate for Payer: Cash Price |
$3,268.10
|
| Rate for Payer: Cigna of CA HMO |
$3,802.88
|
| Rate for Payer: Cigna of CA PPO |
$4,397.08
|
| 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 |
$5,050.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,565.20
|
| 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 |
$3,963.31
|
| 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 |
$1,426.08
|
| 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 |
$4,753.60
|
| Rate for Payer: Networks By Design Commercial |
$3,862.30
|
| Rate for Payer: Prime Health Services Commercial |
$5,050.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,565.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,565.20
|
| 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 |
$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 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 |
$3,268.10
|
| 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 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 |
$3,115.75
|
| 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 CERVICAL SPINE WO CONT
|
Facility
|
OP
|
$5,665.00
|
|
|
Service Code
|
CPT 72141
|
| Hospital Charge Code |
908801100
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$4,815.25 |
| Rate for Payer: Adventist Health Commercial |
$1,133.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,715.67
|
| 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 |
$3,478.88
|
| Rate for Payer: Blue Shield of California Commercial |
$3,466.98
|
| Rate for Payer: Blue Shield of California EPN |
$2,288.66
|
| Rate for Payer: Cash Price |
$3,115.75
|
| Rate for Payer: Cash Price |
$3,115.75
|
| Rate for Payer: Cigna of CA HMO |
$3,625.60
|
| Rate for Payer: Cigna of CA PPO |
$4,192.10
|
| 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 |
$4,815.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,399.00
|
| 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 |
$3,778.55
|
| 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 |
$1,359.60
|
| 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 |
$4,532.00
|
| Rate for Payer: Networks By Design Commercial |
$3,682.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,815.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,399.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,399.00
|
| 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 CHEST W/ CONTRAST
|
Facility
|
OP
|
$5,964.00
|
|
|
Service Code
|
CPT 71551
|
| Hospital Charge Code |
908801201
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$628.54 |
| Max. Negotiated Rate |
$5,069.40 |
| Rate for Payer: Adventist Health Commercial |
$1,192.80
|
| 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 |
$3,662.49
|
| Rate for Payer: Blue Shield of California Commercial |
$3,649.97
|
| Rate for Payer: Blue Shield of California EPN |
$2,409.46
|
| Rate for Payer: Cash Price |
$3,280.20
|
| Rate for Payer: Cash Price |
$3,280.20
|
| Rate for Payer: Cash Price |
$3,280.20
|
| Rate for Payer: Cigna of CA HMO |
$3,816.96
|
| Rate for Payer: Cigna of CA PPO |
$4,413.36
|
| 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 |
$5,069.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,578.40
|
| 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 |
$3,977.99
|
| 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 |
$1,431.36
|
| 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 |
$4,771.20
|
| Rate for Payer: Networks By Design Commercial |
$3,876.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,069.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,578.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,578.40
|
| 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 |
$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
|
|
|
HC MRI CHEST W/ CONTRAST
|
Facility
|
IP
|
$5,964.00
|
|
|
Service Code
|
CPT 71551
|
| Hospital Charge Code |
908801201
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,192.80 |
| Max. Negotiated Rate |
$5,069.40 |
| Rate for Payer: Adventist Health Commercial |
$1,192.80
|
| Rate for Payer: Cash Price |
$3,280.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,385.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,385.60
|
| Rate for Payer: Galaxy Health WC |
$5,069.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,578.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,977.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,272.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,691.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,431.36
|
| Rate for Payer: Multiplan Commercial |
$4,771.20
|
| Rate for Payer: Networks By Design Commercial |
$3,876.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,069.40
|
|
|
HC MRI CHEST, W/O CONT
|
Facility
|
OP
|
$5,336.00
|
|
|
Service Code
|
CPT 71550
|
| Hospital Charge Code |
908801200
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$4,535.60 |
| Rate for Payer: Adventist Health Commercial |
$1,067.20
|
| 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 |
$3,276.84
|
| Rate for Payer: Blue Shield of California Commercial |
$3,265.63
|
| Rate for Payer: Blue Shield of California EPN |
$2,155.74
|
| Rate for Payer: Cash Price |
$2,934.80
|
| Rate for Payer: Cash Price |
$2,934.80
|
| Rate for Payer: Cash Price |
$2,934.80
|
| Rate for Payer: Cigna of CA HMO |
$3,415.04
|
| Rate for Payer: Cigna of CA PPO |
$3,948.64
|
| 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 |
$4,535.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,201.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$568.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,559.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$643.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,280.64
|
| 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 |
$4,268.80
|
| Rate for Payer: Networks By Design Commercial |
$3,468.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,535.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,201.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,201.60
|
| 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 CHEST, W/O CONT
|
Facility
|
IP
|
$5,336.00
|
|
|
Service Code
|
CPT 71550
|
| Hospital Charge Code |
908801200
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,067.20 |
| Max. Negotiated Rate |
$4,535.60 |
| Rate for Payer: Adventist Health Commercial |
$1,067.20
|
| Rate for Payer: Cash Price |
$2,934.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,134.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,134.40
|
| Rate for Payer: Galaxy Health WC |
$4,535.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,201.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,559.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,033.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,302.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,280.64
|
| Rate for Payer: Multiplan Commercial |
$4,268.80
|
| Rate for Payer: Networks By Design Commercial |
$3,468.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,535.60
|
|
|
HC MRI CHEST W WO CONTRAST
|
Facility
|
OP
|
$8,826.00
|
|
|
Service Code
|
CPT 71552
|
| Hospital Charge Code |
908801202
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$453.77 |
| Max. Negotiated Rate |
$7,502.10 |
| Rate for Payer: Adventist Health Commercial |
$1,765.20
|
| 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 |
$5,420.05
|
| Rate for Payer: Blue Shield of California Commercial |
$5,401.51
|
| Rate for Payer: Blue Shield of California EPN |
$3,565.70
|
| Rate for Payer: Cash Price |
$4,854.30
|
| Rate for Payer: Cash Price |
$4,854.30
|
| Rate for Payer: Cash Price |
$4,854.30
|
| Rate for Payer: Cigna of CA HMO |
$5,648.64
|
| Rate for Payer: Cigna of CA PPO |
$6,531.24
|
| 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 |
$7,502.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,295.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$793.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,886.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$897.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,118.24
|
| 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 |
$7,060.80
|
| Rate for Payer: Networks By Design Commercial |
$5,736.90
|
| Rate for Payer: Prime Health Services Commercial |
$7,502.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,295.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,295.60
|
| 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 CHEST W WO CONTRAST
|
Facility
|
IP
|
$8,826.00
|
|
|
Service Code
|
CPT 71552
|
| Hospital Charge Code |
908801202
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,765.20 |
| Max. Negotiated Rate |
$7,502.10 |
| Rate for Payer: Adventist Health Commercial |
$1,765.20
|
| Rate for Payer: Cash Price |
$4,854.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,530.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,530.40
|
| Rate for Payer: Galaxy Health WC |
$7,502.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,295.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,886.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,362.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,463.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,118.24
|
| Rate for Payer: Multiplan Commercial |
$7,060.80
|
| Rate for Payer: Networks By Design Commercial |
$5,736.90
|
| Rate for Payer: Prime Health Services Commercial |
$7,502.10
|
|
|
HC MRI C-SPINE W & WO CONTRAST
|
Facility
|
IP
|
$6,806.00
|
|
|
Service Code
|
CPT 72156
|
| Hospital Charge Code |
908801104
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,361.20 |
| Max. Negotiated Rate |
$5,785.10 |
| Rate for Payer: Adventist Health Commercial |
$1,361.20
|
| Rate for Payer: Cash Price |
$3,743.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,722.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,722.40
|
| Rate for Payer: Galaxy Health WC |
$5,785.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,083.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,539.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,593.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,212.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,633.44
|
| Rate for Payer: Multiplan Commercial |
$5,444.80
|
| Rate for Payer: Networks By Design Commercial |
$4,423.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,785.10
|
|
|
HC MRI C-SPINE W & WO CONTRAST
|
Facility
|
OP
|
$6,806.00
|
|
|
Service Code
|
CPT 72156
|
| Hospital Charge Code |
908801104
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$453.77 |
| Max. Negotiated Rate |
$5,785.10 |
| Rate for Payer: Adventist Health Commercial |
$1,361.20
|
| 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 |
$4,179.56
|
| Rate for Payer: Blue Shield of California Commercial |
$4,165.27
|
| Rate for Payer: Blue Shield of California EPN |
$2,749.62
|
| Rate for Payer: Cash Price |
$3,743.30
|
| Rate for Payer: Cash Price |
$3,743.30
|
| Rate for Payer: Cash Price |
$3,743.30
|
| Rate for Payer: Cigna of CA HMO |
$4,355.84
|
| Rate for Payer: Cigna of CA PPO |
$5,036.44
|
| 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 |
$5,785.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,083.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$526.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,539.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$595.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,633.44
|
| 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 |
$5,444.80
|
| Rate for Payer: Networks By Design Commercial |
$4,423.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,785.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,083.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,083.60
|
| 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 FETAL PELVIC IMG 1ST FETUS
|
Facility
|
IP
|
$861.00
|
|
|
Service Code
|
CPT 74712
|
| Hospital Charge Code |
908874712
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$172.20 |
| Max. Negotiated Rate |
$731.85 |
| Rate for Payer: Adventist Health Commercial |
$172.20
|
| Rate for Payer: Cash Price |
$473.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$344.40
|
| Rate for Payer: EPIC Health Plan Senior |
$344.40
|
| Rate for Payer: Galaxy Health WC |
$731.85
|
| Rate for Payer: Global Benefits Group Commercial |
$516.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$574.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$328.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$532.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.64
|
| Rate for Payer: Multiplan Commercial |
$688.80
|
| Rate for Payer: Networks By Design Commercial |
$559.65
|
| Rate for Payer: Prime Health Services Commercial |
$731.85
|
|
|
HC MRI FETAL PELVIC IMG 1ST FETUS
|
Facility
|
OP
|
$861.00
|
|
|
Service Code
|
CPT 74712
|
| Hospital Charge Code |
908874712
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$172.20 |
| Max. Negotiated Rate |
$5,749.60 |
| Rate for Payer: Adventist Health Commercial |
$172.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$564.73
|
| 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 |
$5,749.60
|
| Rate for Payer: Blue Shield of California Commercial |
$526.93
|
| Rate for Payer: Blue Shield of California EPN |
$347.84
|
| Rate for Payer: Cash Price |
$473.55
|
| Rate for Payer: Cash Price |
$473.55
|
| Rate for Payer: Cigna of CA HMO |
$551.04
|
| Rate for Payer: Cigna of CA PPO |
$637.14
|
| 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 |
$731.85
|
| Rate for Payer: Global Benefits Group Commercial |
$516.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$673.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$574.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$762.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.64
|
| 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 |
$688.80
|
| Rate for Payer: Networks By Design Commercial |
$559.65
|
| Rate for Payer: Prime Health Services Commercial |
$731.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$516.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$516.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$700.26
|
| Rate for Payer: United Healthcare All Other HMO |
$700.26
|
| Rate for Payer: United Healthcare HMO Rider |
$700.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$700.26
|
| Rate for Payer: 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
|
|
