|
HC MRI LOWER EXTREM WO CONT
|
Facility
|
IP
|
$7,524.00
|
|
|
Service Code
|
CPT 73720
|
| Hospital Charge Code |
908801399
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,504.80 |
| Max. Negotiated Rate |
$6,395.40 |
| Rate for Payer: Adventist Health Commercial |
$1,504.80
|
| Rate for Payer: Cash Price |
$3,385.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,009.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,009.60
|
| Rate for Payer: Galaxy Health WC |
$6,395.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,514.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,018.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,866.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,657.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,805.76
|
| Rate for Payer: Multiplan Commercial |
$6,019.20
|
| Rate for Payer: Networks By Design Commercial |
$4,890.60
|
| Rate for Payer: Prime Health Services Commercial |
$6,395.40
|
|
|
HC MRI LOWER EXTREM WO CONT
|
Facility
|
OP
|
$5,012.00
|
|
|
Service Code
|
CPT 73720
|
| Hospital Charge Code |
908801399
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$453.77 |
| Max. Negotiated Rate |
$4,260.20 |
| Rate for Payer: Adventist Health Commercial |
$1,002.40
|
| 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 |
$3,077.87
|
| Rate for Payer: Blue Shield of California Commercial |
$3,067.34
|
| Rate for Payer: Blue Shield of California EPN |
$2,024.85
|
| Rate for Payer: Cash Price |
$2,255.40
|
| Rate for Payer: Cash Price |
$2,255.40
|
| Rate for Payer: Cash Price |
$2,255.40
|
| Rate for Payer: Cigna of CA HMO |
$3,207.68
|
| Rate for Payer: Cigna of CA PPO |
$3,708.88
|
| 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 |
$4,260.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,007.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$559.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,343.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$632.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,202.88
|
| 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 |
$4,009.60
|
| Rate for Payer: Networks By Design Commercial |
$3,257.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,260.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,007.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,007.20
|
| 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 L-SPINE W & WO CONTRAST
|
Facility
|
OP
|
$5,667.00
|
|
|
Service Code
|
CPT 72158
|
| Hospital Charge Code |
908801124
|
|
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 |
$524.65
|
| 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 |
$593.35
|
| 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 L-SPINE W & WO CONTRAST
|
Facility
|
IP
|
$7,165.00
|
|
|
Service Code
|
CPT 72158
|
| Hospital Charge Code |
908801124
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,433.00 |
| Max. Negotiated Rate |
$6,090.25 |
| Rate for Payer: Adventist Health Commercial |
$1,433.00
|
| Rate for Payer: Cash Price |
$3,224.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,866.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,866.00
|
| Rate for Payer: Galaxy Health WC |
$6,090.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,299.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,779.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,729.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,435.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,719.60
|
| Rate for Payer: Multiplan Commercial |
$5,732.00
|
| Rate for Payer: Networks By Design Commercial |
$4,657.25
|
| Rate for Payer: Prime Health Services Commercial |
$6,090.25
|
|
|
HC MRI LUMBAR SPINE W CONTRAST
|
Facility
|
OP
|
$5,150.00
|
|
|
Service Code
|
CPT 72149
|
| Hospital Charge Code |
908801122
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$446.09 |
| Max. Negotiated Rate |
$4,377.50 |
| Rate for Payer: Adventist Health Commercial |
$1,030.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,162.61
|
| Rate for Payer: Blue Shield of California Commercial |
$3,151.80
|
| Rate for Payer: Blue Shield of California EPN |
$2,080.60
|
| Rate for Payer: Cash Price |
$2,317.50
|
| Rate for Payer: Cash Price |
$2,317.50
|
| Rate for Payer: Cash Price |
$2,317.50
|
| Rate for Payer: Cigna of CA HMO |
$3,296.00
|
| Rate for Payer: Cigna of CA PPO |
$3,811.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.59
|
| Rate for Payer: EPIC Health Plan Senior |
$453.77
|
| Rate for Payer: Galaxy Health WC |
$4,377.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,090.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$446.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,435.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$504.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,236.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$571.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$608.05
|
| Rate for Payer: Multiplan Commercial |
$4,120.00
|
| Rate for Payer: Networks By Design Commercial |
$3,347.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,377.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,090.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,090.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,115.74
|
| Rate for Payer: United Healthcare All Other HMO |
$1,115.74
|
| Rate for Payer: United Healthcare HMO Rider |
$1,115.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,115.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$453.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
HC MRI LUMBAR SPINE W CONTRAST
|
Facility
|
IP
|
$6,864.00
|
|
|
Service Code
|
CPT 72149
|
| Hospital Charge Code |
908801122
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,372.80 |
| Max. Negotiated Rate |
$5,834.40 |
| Rate for Payer: Adventist Health Commercial |
$1,372.80
|
| Rate for Payer: Cash Price |
$3,088.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,745.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,745.60
|
| Rate for Payer: Galaxy Health WC |
$5,834.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,118.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,578.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,615.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,248.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,647.36
|
| Rate for Payer: Multiplan Commercial |
$5,491.20
|
| Rate for Payer: Networks By Design Commercial |
$4,461.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,834.40
|
|
|
HC MRI LUMBAR SPINE WO CONTR
|
Facility
|
IP
|
$6,129.00
|
|
|
Service Code
|
CPT 72148
|
| Hospital Charge Code |
908801120
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,225.80 |
| Max. Negotiated Rate |
$5,209.65 |
| Rate for Payer: Adventist Health Commercial |
$1,225.80
|
| Rate for Payer: Cash Price |
$2,758.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,451.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,451.60
|
| Rate for Payer: Galaxy Health WC |
$5,209.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,677.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,088.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,335.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,793.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,470.96
|
| Rate for Payer: Multiplan Commercial |
$4,903.20
|
| Rate for Payer: Networks By Design Commercial |
$3,983.85
|
| Rate for Payer: Prime Health Services Commercial |
$5,209.65
|
|
|
HC MRI LUMBAR SPINE WO CONTR
|
Facility
|
OP
|
$4,965.00
|
|
|
Service Code
|
CPT 72148
|
| Hospital Charge Code |
908801120
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$4,220.25 |
| Rate for Payer: Adventist Health Commercial |
$993.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| 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 |
$3,049.01
|
| Rate for Payer: Blue Shield of California Commercial |
$3,038.58
|
| Rate for Payer: Blue Shield of California EPN |
$2,005.86
|
| Rate for Payer: Cash Price |
$2,234.25
|
| Rate for Payer: Cash Price |
$2,234.25
|
| Rate for Payer: Cash Price |
$2,234.25
|
| Rate for Payer: Cigna of CA HMO |
$3,177.60
|
| Rate for Payer: Cigna of CA PPO |
$3,674.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$4,220.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,979.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$312.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,311.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$353.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,191.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$3,972.00
|
| Rate for Payer: Networks By Design Commercial |
$3,227.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,220.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,979.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,979.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| Rate for Payer: United Healthcare All Other HMO |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC MRI ORBIT FACE/NECK W CON
|
Facility
|
IP
|
$5,228.00
|
|
|
Service Code
|
CPT 70542
|
| Hospital Charge Code |
908801081
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,045.60 |
| Max. Negotiated Rate |
$4,443.80 |
| Rate for Payer: Adventist Health Commercial |
$1,045.60
|
| Rate for Payer: Cash Price |
$2,352.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,091.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,091.20
|
| Rate for Payer: Galaxy Health WC |
$4,443.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,136.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,487.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,991.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,236.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,254.72
|
| Rate for Payer: Multiplan Commercial |
$4,182.40
|
| Rate for Payer: Networks By Design Commercial |
$3,398.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,443.80
|
|
|
HC MRI ORBIT FACE/NECK W CON
|
Facility
|
OP
|
$5,017.00
|
|
|
Service Code
|
CPT 70542
|
| Hospital Charge Code |
908801081
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$444.93 |
| Max. Negotiated Rate |
$4,264.45 |
| Rate for Payer: Adventist Health Commercial |
$1,003.40
|
| 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 |
$3,080.94
|
| Rate for Payer: Blue Shield of California Commercial |
$3,070.40
|
| Rate for Payer: Blue Shield of California EPN |
$2,026.87
|
| Rate for Payer: Cash Price |
$2,257.65
|
| Rate for Payer: Cash Price |
$2,257.65
|
| Rate for Payer: Cash Price |
$2,257.65
|
| Rate for Payer: Cigna of CA HMO |
$3,210.88
|
| Rate for Payer: Cigna of CA PPO |
$3,712.58
|
| 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 |
$4,264.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,010.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$444.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,346.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$503.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,204.08
|
| 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 |
$4,013.60
|
| Rate for Payer: Networks By Design Commercial |
$3,261.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,264.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,010.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,010.20
|
| 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 ORBIT FACE/NECK WO CON
|
Facility
|
IP
|
$4,753.00
|
|
|
Service Code
|
CPT 70540
|
| Hospital Charge Code |
908801080
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$950.60 |
| Max. Negotiated Rate |
$4,040.05 |
| Rate for Payer: Adventist Health Commercial |
$950.60
|
| Rate for Payer: Cash Price |
$2,138.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,901.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,901.20
|
| Rate for Payer: Galaxy Health WC |
$4,040.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,851.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,170.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,810.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,942.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,140.72
|
| Rate for Payer: Multiplan Commercial |
$3,802.40
|
| Rate for Payer: Networks By Design Commercial |
$3,089.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,040.05
|
|
|
HC MRI ORBIT FACE/NECK WO CON
|
Facility
|
OP
|
$4,397.00
|
|
|
Service Code
|
CPT 70540
|
| Hospital Charge Code |
908801080
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$3,737.45 |
| Rate for Payer: Adventist Health Commercial |
$879.40
|
| 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 |
$2,700.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,690.96
|
| Rate for Payer: Blue Shield of California EPN |
$1,776.39
|
| Rate for Payer: Cash Price |
$1,978.65
|
| Rate for Payer: Cash Price |
$1,978.65
|
| Rate for Payer: Cash Price |
$1,978.65
|
| Rate for Payer: Cigna of CA HMO |
$2,814.08
|
| Rate for Payer: Cigna of CA PPO |
$3,253.78
|
| 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 |
$3,737.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,638.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$374.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,932.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$423.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,055.28
|
| 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 |
$3,517.60
|
| Rate for Payer: Networks By Design Commercial |
$2,858.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,737.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,638.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,638.20
|
| 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 ORBIT FACE/NECK W WO CON
|
Facility
|
IP
|
$7,632.00
|
|
|
Service Code
|
CPT 70543
|
| Hospital Charge Code |
908801082
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,526.40 |
| Max. Negotiated Rate |
$6,487.20 |
| Rate for Payer: Adventist Health Commercial |
$1,526.40
|
| Rate for Payer: Cash Price |
$3,434.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,052.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,052.80
|
| Rate for Payer: Galaxy Health WC |
$6,487.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,579.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,090.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,907.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,724.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,831.68
|
| Rate for Payer: Multiplan Commercial |
$6,105.60
|
| Rate for Payer: Networks By Design Commercial |
$4,960.80
|
| Rate for Payer: Prime Health Services Commercial |
$6,487.20
|
|
|
HC MRI ORBIT FACE/NECK W WO CON
|
Facility
|
OP
|
$6,714.00
|
|
|
Service Code
|
CPT 70543
|
| Hospital Charge Code |
908801082
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$453.77 |
| Max. Negotiated Rate |
$5,706.90 |
| Rate for Payer: Adventist Health Commercial |
$1,342.80
|
| 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 |
$4,123.07
|
| Rate for Payer: Blue Shield of California Commercial |
$4,108.97
|
| Rate for Payer: Blue Shield of California EPN |
$2,712.46
|
| Rate for Payer: Cash Price |
$3,021.30
|
| Rate for Payer: Cash Price |
$3,021.30
|
| Rate for Payer: Cash Price |
$3,021.30
|
| Rate for Payer: Cigna of CA HMO |
$4,296.96
|
| Rate for Payer: Cigna of CA PPO |
$4,968.36
|
| 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 |
$5,706.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,028.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$560.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,478.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$633.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,611.36
|
| 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 |
$5,371.20
|
| Rate for Payer: Networks By Design Commercial |
$4,364.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,706.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,028.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,028.40
|
| 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 PELVIS W/CONTRAST
|
Facility
|
OP
|
$5,150.00
|
|
|
Service Code
|
CPT 72196
|
| Hospital Charge Code |
908801350
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$445.25 |
| Max. Negotiated Rate |
$4,377.50 |
| Rate for Payer: Adventist Health Commercial |
$1,030.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,162.61
|
| Rate for Payer: Blue Shield of California Commercial |
$3,151.80
|
| Rate for Payer: Blue Shield of California EPN |
$2,080.60
|
| Rate for Payer: Cash Price |
$2,317.50
|
| Rate for Payer: Cash Price |
$2,317.50
|
| Rate for Payer: Cash Price |
$2,317.50
|
| Rate for Payer: Cigna of CA HMO |
$3,296.00
|
| Rate for Payer: Cigna of CA PPO |
$3,811.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.59
|
| Rate for Payer: EPIC Health Plan Senior |
$453.77
|
| Rate for Payer: Galaxy Health WC |
$4,377.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,090.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$445.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,435.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$503.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,236.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$571.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$608.05
|
| Rate for Payer: Multiplan Commercial |
$4,120.00
|
| Rate for Payer: Networks By Design Commercial |
$3,347.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,377.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,090.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,090.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,115.74
|
| Rate for Payer: United Healthcare All Other HMO |
$1,115.74
|
| Rate for Payer: United Healthcare HMO Rider |
$1,115.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,115.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$453.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
HC MRI PELVIS W/CONTRAST
|
Facility
|
IP
|
$7,037.00
|
|
|
Service Code
|
CPT 72196
|
| Hospital Charge Code |
908801350
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,407.40 |
| Max. Negotiated Rate |
$5,981.45 |
| Rate for Payer: Adventist Health Commercial |
$1,407.40
|
| Rate for Payer: Cash Price |
$3,166.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,814.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,814.80
|
| Rate for Payer: Galaxy Health WC |
$5,981.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,222.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,693.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,681.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,355.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,688.88
|
| Rate for Payer: Multiplan Commercial |
$5,629.60
|
| Rate for Payer: Networks By Design Commercial |
$4,574.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,981.45
|
|
|
HC MRI PELVIS W/O CONTRAST
|
Facility
|
IP
|
$6,185.00
|
|
|
Service Code
|
CPT 72195
|
| Hospital Charge Code |
908801351
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,237.00 |
| Max. Negotiated Rate |
$5,257.25 |
| Rate for Payer: Adventist Health Commercial |
$1,237.00
|
| Rate for Payer: Cash Price |
$2,783.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,474.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,474.00
|
| Rate for Payer: Galaxy Health WC |
$5,257.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,711.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,125.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,356.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,828.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,484.40
|
| Rate for Payer: Multiplan Commercial |
$4,948.00
|
| Rate for Payer: Networks By Design Commercial |
$4,020.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,257.25
|
|
|
HC MRI PELVIS W/O CONTRAST
|
Facility
|
OP
|
$4,687.00
|
|
|
Service Code
|
CPT 72195
|
| Hospital Charge Code |
908801351
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$3,983.95 |
| Rate for Payer: Adventist Health Commercial |
$937.40
|
| 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 |
$2,878.29
|
| Rate for Payer: Blue Shield of California Commercial |
$2,868.44
|
| Rate for Payer: Blue Shield of California EPN |
$1,893.55
|
| Rate for Payer: Cash Price |
$2,109.15
|
| Rate for Payer: Cash Price |
$2,109.15
|
| Rate for Payer: Cash Price |
$2,109.15
|
| Rate for Payer: Cigna of CA HMO |
$2,999.68
|
| Rate for Payer: Cigna of CA PPO |
$3,468.38
|
| 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 |
$3,983.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,812.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$380.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,126.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$430.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,124.88
|
| 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 |
$3,749.60
|
| Rate for Payer: Networks By Design Commercial |
$3,046.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,983.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,812.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,812.20
|
| 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 PELVIS W & WO CONTRAST
|
Facility
|
OP
|
$6,180.00
|
|
|
Service Code
|
CPT 72197
|
| Hospital Charge Code |
908801352
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$453.77 |
| Max. Negotiated Rate |
$5,253.00 |
| Rate for Payer: Adventist Health Commercial |
$1,236.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,795.14
|
| Rate for Payer: Blue Shield of California Commercial |
$3,782.16
|
| Rate for Payer: Blue Shield of California EPN |
$2,496.72
|
| Rate for Payer: Cash Price |
$2,781.00
|
| Rate for Payer: Cash Price |
$2,781.00
|
| Rate for Payer: Cash Price |
$2,781.00
|
| Rate for Payer: Cigna of CA HMO |
$3,955.20
|
| Rate for Payer: Cigna of CA PPO |
$4,573.20
|
| 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 |
$5,253.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,708.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$559.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,122.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$632.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,483.20
|
| 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 |
$4,944.00
|
| Rate for Payer: Networks By Design Commercial |
$4,017.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,253.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,708.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,708.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,367.12
|
| Rate for Payer: United Healthcare All Other HMO |
$1,367.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1,367.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,367.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$453.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
HC MRI PELVIS W & WO CONTRAST
|
Facility
|
IP
|
$7,811.00
|
|
|
Service Code
|
CPT 72197
|
| Hospital Charge Code |
908801352
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,562.20 |
| Max. Negotiated Rate |
$6,639.35 |
| Rate for Payer: Adventist Health Commercial |
$1,562.20
|
| Rate for Payer: Cash Price |
$3,514.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,124.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,124.40
|
| Rate for Payer: Galaxy Health WC |
$6,639.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,686.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,209.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,975.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,835.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,874.64
|
| Rate for Payer: Multiplan Commercial |
$6,248.80
|
| Rate for Payer: Networks By Design Commercial |
$5,077.15
|
| Rate for Payer: Prime Health Services Commercial |
$6,639.35
|
|
|
HC MRI PROCEDURE
|
Facility
|
IP
|
$3,801.00
|
|
|
Service Code
|
CPT 76498
|
| Hospital Charge Code |
908801008
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$760.20 |
| Max. Negotiated Rate |
$3,230.85 |
| Rate for Payer: Adventist Health Commercial |
$760.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,491.94
|
| Rate for Payer: Cash Price |
$1,710.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,520.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,520.40
|
| Rate for Payer: Galaxy Health WC |
$3,230.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,280.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,535.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,448.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,352.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$912.24
|
| Rate for Payer: Multiplan Commercial |
$3,040.80
|
| Rate for Payer: Networks By Design Commercial |
$2,470.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,230.85
|
|
|
HC MRI PROCEDURE
|
Facility
|
OP
|
$3,164.00
|
|
|
Service Code
|
CPT 76498
|
| Hospital Charge Code |
908801008
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$111.88 |
| Max. Negotiated Rate |
$2,689.40 |
| Rate for Payer: Adventist Health Commercial |
$632.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,074.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,943.01
|
| Rate for Payer: Blue Shield of California Commercial |
$1,936.37
|
| Rate for Payer: Blue Shield of California EPN |
$1,278.26
|
| Rate for Payer: Cash Price |
$1,423.80
|
| Rate for Payer: Cash Price |
$1,423.80
|
| Rate for Payer: Cigna of CA HMO |
$2,024.96
|
| Rate for Payer: Cigna of CA PPO |
$2,341.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$2,689.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,898.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,110.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$759.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$2,531.20
|
| Rate for Payer: Networks By Design Commercial |
$2,056.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,689.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,898.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,898.40
|
| 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 |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC MRI SPECTROSCOPY
|
Facility
|
OP
|
$4,177.00
|
|
|
Service Code
|
CPT 76390
|
| Hospital Charge Code |
908801255
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$111.88 |
| Max. Negotiated Rate |
$3,550.45 |
| Rate for Payer: Adventist Health Commercial |
$835.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,739.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,565.10
|
| Rate for Payer: Blue Shield of California Commercial |
$2,556.32
|
| Rate for Payer: Blue Shield of California EPN |
$1,687.51
|
| Rate for Payer: Cash Price |
$1,879.65
|
| Rate for Payer: Cash Price |
$1,879.65
|
| Rate for Payer: Cigna of CA HMO |
$2,673.28
|
| Rate for Payer: Cigna of CA PPO |
$3,090.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$3,550.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,506.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,786.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,591.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,002.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$3,341.60
|
| Rate for Payer: Networks By Design Commercial |
$2,715.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,550.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,506.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,506.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,065.68
|
| Rate for Payer: United Healthcare All Other HMO |
$1,065.68
|
| Rate for Payer: United Healthcare HMO Rider |
$1,065.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,065.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC MRI SPECTROSCOPY
|
Facility
|
IP
|
$5,017.00
|
|
|
Service Code
|
CPT 76390
|
| Hospital Charge Code |
908801255
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,003.40 |
| Max. Negotiated Rate |
$4,264.45 |
| Rate for Payer: Adventist Health Commercial |
$1,003.40
|
| Rate for Payer: Cash Price |
$2,257.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,006.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,006.80
|
| Rate for Payer: Galaxy Health WC |
$4,264.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,010.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,346.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,911.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,105.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,204.08
|
| Rate for Payer: Multiplan Commercial |
$4,013.60
|
| Rate for Payer: Networks By Design Commercial |
$3,261.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,264.45
|
|
|
HC MRI THORACIC SPINE WITH CONTRA
|
Facility
|
OP
|
$5,150.00
|
|
|
Service Code
|
CPT 72147
|
| Hospital Charge Code |
908801112
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$449.80 |
| Max. Negotiated Rate |
$4,377.50 |
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
| Rate for Payer: Adventist Health Commercial |
$1,030.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,162.61
|
| Rate for Payer: Blue Shield of California Commercial |
$3,151.80
|
| Rate for Payer: Blue Shield of California EPN |
$2,080.60
|
| Rate for Payer: Cash Price |
$2,317.50
|
| Rate for Payer: Cash Price |
$2,317.50
|
| Rate for Payer: Cash Price |
$2,317.50
|
| Rate for Payer: Cigna of CA HMO |
$3,296.00
|
| Rate for Payer: Cigna of CA PPO |
$3,811.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.59
|
| Rate for Payer: EPIC Health Plan Senior |
$453.77
|
| Rate for Payer: Galaxy Health WC |
$4,377.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,090.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$449.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,435.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$508.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,236.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$571.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$608.05
|
| Rate for Payer: Multiplan Commercial |
$4,120.00
|
| Rate for Payer: Networks By Design Commercial |
$3,347.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,377.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,090.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,090.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,115.74
|
| Rate for Payer: United Healthcare All Other HMO |
$1,115.74
|
| Rate for Payer: United Healthcare HMO Rider |
$1,115.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,115.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$453.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
|
