|
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 |
$2,683.80
|
| 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
|
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 |
$2,401.20
|
| 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/O CONT
|
Facility
|
OP
|
$4,442.00
|
|
|
Service Code
|
CPT 71550
|
| Hospital Charge Code |
908801200
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$3,775.70 |
| Rate for Payer: Adventist Health Commercial |
$888.40
|
| 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 |
$2,727.83
|
| Rate for Payer: Blue Shield of California Commercial |
$2,718.50
|
| Rate for Payer: Blue Shield of California EPN |
$1,794.57
|
| Rate for Payer: Cash Price |
$1,998.90
|
| Rate for Payer: Cash Price |
$1,998.90
|
| Rate for Payer: Cash Price |
$1,998.90
|
| Rate for Payer: Cigna of CA HMO |
$2,842.88
|
| Rate for Payer: Cigna of CA PPO |
$3,287.08
|
| 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 |
$3,775.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,665.20
|
| 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 |
$2,962.81
|
| 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 |
$1,066.08
|
| 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 |
$3,553.60
|
| Rate for Payer: Networks By Design Commercial |
$2,887.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,775.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,665.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,665.20
|
| 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 CHEST W WO CONTRAST
|
Facility
|
OP
|
$6,147.00
|
|
|
Service Code
|
CPT 71552
|
| Hospital Charge Code |
908801202
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$453.77 |
| Max. Negotiated Rate |
$5,224.95 |
| Rate for Payer: Adventist Health Commercial |
$1,229.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,774.87
|
| Rate for Payer: Blue Shield of California Commercial |
$3,761.96
|
| Rate for Payer: Blue Shield of California EPN |
$2,483.39
|
| Rate for Payer: Cash Price |
$2,766.15
|
| Rate for Payer: Cash Price |
$2,766.15
|
| Rate for Payer: Cash Price |
$2,766.15
|
| Rate for Payer: Cigna of CA HMO |
$3,934.08
|
| Rate for Payer: Cigna of CA PPO |
$4,548.78
|
| 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 |
$5,224.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,688.20
|
| 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 |
$4,100.05
|
| 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 |
$1,475.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$571.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$608.05
|
| Rate for Payer: Multiplan Commercial |
$4,917.60
|
| Rate for Payer: Networks By Design Commercial |
$3,995.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,224.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,688.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,688.20
|
| 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 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 |
$3,971.70
|
| 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
|
OP
|
$5,667.00
|
|
|
Service Code
|
CPT 72156
|
| Hospital Charge Code |
908801104
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$453.77 |
| Max. Negotiated Rate |
$4,816.95 |
| Rate for Payer: Adventist Health Commercial |
$1,133.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,480.10
|
| Rate for Payer: Blue Shield of California Commercial |
$3,468.20
|
| Rate for Payer: Blue Shield of California EPN |
$2,289.47
|
| Rate for Payer: Cash Price |
$2,550.15
|
| Rate for Payer: Cash Price |
$2,550.15
|
| Rate for Payer: Cash Price |
$2,550.15
|
| Rate for Payer: Cigna of CA HMO |
$3,626.88
|
| Rate for Payer: Cigna of CA PPO |
$4,193.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.59
|
| Rate for Payer: EPIC Health Plan Senior |
$453.77
|
| Rate for Payer: Galaxy Health WC |
$4,816.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,400.20
|
| 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 |
$3,779.89
|
| 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 |
$1,360.08
|
| 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 |
$4,533.60
|
| Rate for Payer: Networks By Design Commercial |
$3,683.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,816.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,400.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,400.20
|
| 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 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 |
$3,062.70
|
| 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 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 |
$387.45
|
| Rate for Payer: Cash Price |
$387.45
|
| 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
|
|
|
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 |
$387.45
|
| 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 ADD FETUS
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
CPT 74713
|
| Hospital Charge Code |
908874713
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$86.00 |
| Max. Negotiated Rate |
$365.50 |
| Rate for Payer: Adventist Health Commercial |
$86.00
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.00
|
| Rate for Payer: EPIC Health Plan Senior |
$172.00
|
| Rate for Payer: Galaxy Health WC |
$365.50
|
| Rate for Payer: Global Benefits Group Commercial |
$258.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$286.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$163.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$266.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.20
|
| Rate for Payer: Multiplan Commercial |
$344.00
|
| Rate for Payer: Networks By Design Commercial |
$279.50
|
| Rate for Payer: Prime Health Services Commercial |
$365.50
|
|
|
HC MRI FETAL PELVIC IMG ADD FETUS
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
CPT 74713
|
| Hospital Charge Code |
908874713
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$86.00 |
| Max. Negotiated Rate |
$2,463.58 |
| Rate for Payer: Adventist Health Commercial |
$86.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$282.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$365.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$236.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$322.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,463.58
|
| Rate for Payer: Blue Shield of California Commercial |
$263.16
|
| Rate for Payer: Blue Shield of California EPN |
$173.72
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cigna of CA HMO |
$275.20
|
| Rate for Payer: Cigna of CA PPO |
$318.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$365.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$365.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$365.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.00
|
| Rate for Payer: EPIC Health Plan Senior |
$172.00
|
| Rate for Payer: Galaxy Health WC |
$365.50
|
| Rate for Payer: Global Benefits Group Commercial |
$258.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$325.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$286.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$367.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$266.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$301.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$301.00
|
| Rate for Payer: Multiplan Commercial |
$344.00
|
| Rate for Payer: Networks By Design Commercial |
$279.50
|
| Rate for Payer: Prime Health Services Commercial |
$365.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$258.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$258.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$215.00
|
| Rate for Payer: United Healthcare All Other HMO |
$215.00
|
| Rate for Payer: United Healthcare HMO Rider |
$215.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$215.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$365.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$365.50
|
| Rate for Payer: Vantage Medical Group Senior |
$365.50
|
|
|
HC MRI GUID BX/NEEDLE LOC/ASPIR
|
Facility
|
IP
|
$7,554.00
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
909002020
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,510.80 |
| Max. Negotiated Rate |
$6,420.90 |
| Rate for Payer: Adventist Health Commercial |
$1,510.80
|
| Rate for Payer: Cash Price |
$3,399.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,021.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,021.60
|
| Rate for Payer: Galaxy Health WC |
$6,420.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,532.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,038.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,878.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,675.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,812.96
|
| Rate for Payer: Multiplan Commercial |
$6,043.20
|
| Rate for Payer: Networks By Design Commercial |
$4,910.10
|
| Rate for Payer: Prime Health Services Commercial |
$6,420.90
|
|
|
HC MRI GUID BX/NEEDLE LOC/ASPIR
|
Facility
|
OP
|
$6,290.00
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
909002020
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$616.16 |
| Max. Negotiated Rate |
$5,346.50 |
| Rate for Payer: Cash Price |
$2,830.50
|
| Rate for Payer: Adventist Health Commercial |
$1,258.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,125.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,346.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,459.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,717.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,862.69
|
| Rate for Payer: Blue Shield of California Commercial |
$3,849.48
|
| Rate for Payer: Blue Shield of California EPN |
$2,541.16
|
| Rate for Payer: Cash Price |
$2,830.50
|
| Rate for Payer: Cigna of CA HMO |
$4,025.60
|
| Rate for Payer: Cigna of CA PPO |
$4,654.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,346.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,346.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,346.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,516.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,516.00
|
| Rate for Payer: Galaxy Health WC |
$5,346.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,774.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$616.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,195.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$696.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,893.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,509.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,403.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,403.00
|
| Rate for Payer: Multiplan Commercial |
$5,032.00
|
| Rate for Payer: Networks By Design Commercial |
$4,088.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,346.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,774.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,774.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,145.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,145.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,145.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,145.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,346.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,346.50
|
| Rate for Payer: Vantage Medical Group Senior |
$5,346.50
|
|
|
HC MRI INSERTABLE IMAGING COIL
|
Facility
|
OP
|
$525.00
|
|
|
Service Code
|
CPT C1770
|
| Hospital Charge Code |
908801710
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$446.25 |
| Rate for Payer: Adventist Health Commercial |
$105.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$446.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$288.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$393.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$304.08
|
| Rate for Payer: Blue Shield of California Commercial |
$387.45
|
| Rate for Payer: Blue Shield of California EPN |
$255.15
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Cigna of CA HMO |
$367.50
|
| Rate for Payer: Cigna of CA PPO |
$367.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$446.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$446.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$446.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.00
|
| Rate for Payer: EPIC Health Plan Senior |
$210.00
|
| Rate for Payer: Galaxy Health WC |
$446.25
|
| Rate for Payer: Global Benefits Group Commercial |
$315.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$350.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$324.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$367.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$367.50
|
| Rate for Payer: Multiplan Commercial |
$420.00
|
| Rate for Payer: Networks By Design Commercial |
$262.50
|
| Rate for Payer: Prime Health Services Commercial |
$446.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$315.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$315.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$197.03
|
| Rate for Payer: United Healthcare All Other HMO |
$191.78
|
| Rate for Payer: United Healthcare HMO Rider |
$187.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$171.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$446.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$446.25
|
| Rate for Payer: Vantage Medical Group Senior |
$446.25
|
|
|
HC MRI INSERTABLE IMAGING COIL
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
CPT C1770
|
| Hospital Charge Code |
908801710
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$105.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Cigna of CA HMO |
$367.50
|
| Rate for Payer: Cigna of CA PPO |
$367.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.00
|
| Rate for Payer: EPIC Health Plan Senior |
$210.00
|
| Rate for Payer: Galaxy Health WC |
$446.25
|
| Rate for Payer: Global Benefits Group Commercial |
$315.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$350.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$324.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.00
|
| Rate for Payer: Multiplan Commercial |
$420.00
|
| Rate for Payer: Networks By Design Commercial |
$262.50
|
| Rate for Payer: Prime Health Services Commercial |
$446.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$197.03
|
| Rate for Payer: United Healthcare All Other HMO |
$191.78
|
| Rate for Payer: United Healthcare HMO Rider |
$187.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$171.94
|
|
|
HC MRI LOWER EXTREMITY W/O CON
|
Facility
|
IP
|
$4,908.00
|
|
|
Service Code
|
CPT 73718
|
| Hospital Charge Code |
908801402
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$981.60 |
| Max. Negotiated Rate |
$4,171.80 |
| Rate for Payer: Adventist Health Commercial |
$981.60
|
| Rate for Payer: Cash Price |
$2,208.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,963.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,963.20
|
| Rate for Payer: Galaxy Health WC |
$4,171.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,944.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,273.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,869.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,038.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,177.92
|
| Rate for Payer: Multiplan Commercial |
$3,926.40
|
| Rate for Payer: Networks By Design Commercial |
$3,190.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,171.80
|
|
|
HC MRI LOWER EXTREMITY W/O CON
|
Facility
|
OP
|
$4,005.00
|
|
|
Service Code
|
CPT 73718
|
| Hospital Charge Code |
908801402
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$3,443.00 |
| Rate for Payer: Adventist Health Commercial |
$801.00
|
| 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 |
$2,459.47
|
| Rate for Payer: Blue Shield of California Commercial |
$2,451.06
|
| Rate for Payer: Blue Shield of California EPN |
$1,618.02
|
| Rate for Payer: Cash Price |
$1,802.25
|
| Rate for Payer: Cash Price |
$1,802.25
|
| Rate for Payer: Cash Price |
$1,802.25
|
| Rate for Payer: Cigna of CA HMO |
$2,563.20
|
| Rate for Payer: Cigna of CA PPO |
$2,963.70
|
| 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 |
$3,404.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,403.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$369.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,671.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$418.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$961.20
|
| 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 |
$3,204.00
|
| Rate for Payer: Networks By Design Commercial |
$2,603.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,404.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,403.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,403.00
|
| 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 LOWER EXTREM JOINT W CONT
|
Facility
|
OP
|
$4,231.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
908801376
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$525.86 |
| Max. Negotiated Rate |
$3,596.35 |
| Rate for Payer: Adventist Health Commercial |
$846.20
|
| 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 |
$2,598.26
|
| Rate for Payer: Blue Shield of California Commercial |
$2,589.37
|
| Rate for Payer: Blue Shield of California EPN |
$1,709.32
|
| Rate for Payer: Cash Price |
$1,903.95
|
| Rate for Payer: Cash Price |
$1,903.95
|
| Rate for Payer: Cash Price |
$1,903.95
|
| Rate for Payer: Cigna of CA HMO |
$2,707.84
|
| Rate for Payer: Cigna of CA PPO |
$3,130.94
|
| 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 |
$3,596.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,538.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,646.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$525.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,003.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,822.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$594.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,003.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,015.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,264.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,345.16
|
| Rate for Payer: Multiplan Commercial |
$3,384.80
|
| Rate for Payer: Networks By Design Commercial |
$2,750.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,596.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,538.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,538.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,115.74
|
| Rate for Payer: United Healthcare All Other HMO |
$1,115.74
|
| Rate for Payer: United Healthcare HMO Rider |
$1,115.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,115.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 LOWER EXTREM JOINT W CONT
|
Facility
|
IP
|
$5,081.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
908801376
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,016.20 |
| Max. Negotiated Rate |
$4,318.85 |
| Rate for Payer: Adventist Health Commercial |
$1,016.20
|
| Rate for Payer: Cash Price |
$2,286.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,032.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,032.40
|
| Rate for Payer: Galaxy Health WC |
$4,318.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,048.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,389.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,935.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,145.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,219.44
|
| Rate for Payer: Multiplan Commercial |
$4,064.80
|
| Rate for Payer: Networks By Design Commercial |
$3,302.65
|
| Rate for Payer: Prime Health Services Commercial |
$4,318.85
|
|
|
HC MRI LOWER EXTREM JOINT WO CONT
|
Facility
|
OP
|
$3,641.00
|
|
|
Service Code
|
CPT 73721
|
| Hospital Charge Code |
908801441
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$3,443.00 |
| Rate for Payer: Adventist Health Commercial |
$728.20
|
| 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 |
$2,235.94
|
| Rate for Payer: Blue Shield of California Commercial |
$2,228.29
|
| Rate for Payer: Blue Shield of California EPN |
$1,470.96
|
| Rate for Payer: Cash Price |
$1,638.45
|
| Rate for Payer: Cash Price |
$1,638.45
|
| Rate for Payer: Cash Price |
$1,638.45
|
| Rate for Payer: Cigna of CA HMO |
$2,330.24
|
| Rate for Payer: Cigna of CA PPO |
$2,694.34
|
| 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 |
$3,094.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,184.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$656.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,428.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$741.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$873.84
|
| 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 |
$2,912.80
|
| Rate for Payer: Networks By Design Commercial |
$2,366.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,094.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,184.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,184.60
|
| 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 LOWER EXTREM JOINT WO CONT
|
Facility
|
IP
|
$4,809.00
|
|
|
Service Code
|
CPT 73721
|
| Hospital Charge Code |
908801441
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$961.80 |
| Max. Negotiated Rate |
$4,087.65 |
| Rate for Payer: Adventist Health Commercial |
$961.80
|
| Rate for Payer: Cash Price |
$2,164.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,923.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,923.60
|
| Rate for Payer: Galaxy Health WC |
$4,087.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,885.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,207.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,832.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,976.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,154.16
|
| Rate for Payer: Multiplan Commercial |
$3,847.20
|
| Rate for Payer: Networks By Design Commercial |
$3,125.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,087.65
|
|
|
HC MRI LOWER EXTREM JOIN W & WO CONT
|
Facility
|
IP
|
$7,784.00
|
|
|
Service Code
|
CPT 73723
|
| Hospital Charge Code |
908801377
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,556.80 |
| Max. Negotiated Rate |
$6,616.40 |
| Rate for Payer: Adventist Health Commercial |
$1,556.80
|
| Rate for Payer: Cash Price |
$3,502.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,113.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,113.60
|
| Rate for Payer: Galaxy Health WC |
$6,616.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,670.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,191.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,965.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,818.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,868.16
|
| Rate for Payer: Multiplan Commercial |
$6,227.20
|
| Rate for Payer: Networks By Design Commercial |
$5,059.60
|
| Rate for Payer: Prime Health Services Commercial |
$6,616.40
|
|
|
HC MRI LOWER EXTREM JOIN W & WO CONT
|
Facility
|
OP
|
$6,774.00
|
|
|
Service Code
|
CPT 73723
|
| Hospital Charge Code |
908801377
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$453.77 |
| Max. Negotiated Rate |
$5,757.90 |
| Rate for Payer: Adventist Health Commercial |
$1,354.80
|
| 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 |
$4,159.91
|
| Rate for Payer: Blue Shield of California Commercial |
$4,145.69
|
| Rate for Payer: Blue Shield of California EPN |
$2,736.70
|
| Rate for Payer: Cash Price |
$3,048.30
|
| Rate for Payer: Cash Price |
$3,048.30
|
| Rate for Payer: Cash Price |
$3,048.30
|
| Rate for Payer: Cigna of CA HMO |
$4,335.36
|
| Rate for Payer: Cigna of CA PPO |
$5,012.76
|
| 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 |
$5,757.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,064.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$962.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,518.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,089.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,625.76
|
| 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 |
$5,419.20
|
| Rate for Payer: Networks By Design Commercial |
$4,403.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,757.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,064.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,064.40
|
| 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 LOWER EXTREM W/ CON
|
Facility
|
IP
|
$5,358.00
|
|
|
Service Code
|
CPT 73719
|
| Hospital Charge Code |
908801403
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,071.60 |
| Max. Negotiated Rate |
$4,554.30 |
| Rate for Payer: Adventist Health Commercial |
$1,071.60
|
| Rate for Payer: Cash Price |
$2,411.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,143.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,143.20
|
| Rate for Payer: Galaxy Health WC |
$4,554.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,214.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,573.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,041.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,316.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,285.92
|
| Rate for Payer: Multiplan Commercial |
$4,286.40
|
| Rate for Payer: Networks By Design Commercial |
$3,482.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,554.30
|
|
|
HC MRI LOWER EXTREM W/ CON
|
Facility
|
OP
|
$4,462.00
|
|
|
Service Code
|
CPT 73719
|
| Hospital Charge Code |
908801403
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$453.77 |
| Max. Negotiated Rate |
$3,792.70 |
| Rate for Payer: Adventist Health Commercial |
$892.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,926.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,740.11
|
| Rate for Payer: Blue Shield of California Commercial |
$2,730.74
|
| Rate for Payer: Blue Shield of California EPN |
$1,802.65
|
| Rate for Payer: Cash Price |
$2,007.90
|
| Rate for Payer: Cash Price |
$2,007.90
|
| Rate for Payer: Cigna of CA HMO |
$2,855.68
|
| Rate for Payer: Cigna of CA PPO |
$3,301.88
|
| 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 |
$3,792.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,677.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$803.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,976.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$908.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,070.88
|
| 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 |
$3,569.60
|
| Rate for Payer: Networks By Design Commercial |
$2,900.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,792.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,677.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,677.20
|
| 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
|
|
