|
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 |
$236.50
|
| Rate for Payer: Cash Price |
$236.50
|
| 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 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 |
$236.50
|
| 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 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 |
$4,154.70
|
| 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
|
$7,554.00
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
909002020
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$616.16 |
| Max. Negotiated Rate |
$6,420.90 |
| Rate for Payer: Adventist Health Commercial |
$1,510.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,954.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,420.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,154.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,665.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,638.91
|
| Rate for Payer: Blue Shield of California Commercial |
$4,623.05
|
| Rate for Payer: Blue Shield of California EPN |
$3,051.82
|
| Rate for Payer: Cash Price |
$4,154.70
|
| Rate for Payer: Cash Price |
$4,154.70
|
| Rate for Payer: Cigna of CA HMO |
$4,834.56
|
| Rate for Payer: Cigna of CA PPO |
$5,589.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,420.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,420.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,420.90
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$616.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,038.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$696.84
|
| 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: Molina Healthcare of CA Medi-Cal |
$5,287.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,287.80
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,532.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,532.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,777.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,777.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,777.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,777.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,420.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,420.90
|
| Rate for Payer: Vantage Medical Group Senior |
$6,420.90
|
|
|
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 |
$288.75
|
| Rate for Payer: Cash Price |
$288.75
|
| 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 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 |
$288.75
|
| 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 LOWER EXTREMITY W/O CON
|
Facility
|
OP
|
$4,908.00
|
|
|
Service Code
|
CPT 73718
|
| Hospital Charge Code |
908801402
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$4,171.80 |
| Rate for Payer: Adventist Health Commercial |
$981.60
|
| 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 |
$3,014.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,003.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,982.83
|
| Rate for Payer: Cash Price |
$2,699.40
|
| Rate for Payer: Cash Price |
$2,699.40
|
| Rate for Payer: Cash Price |
$2,699.40
|
| Rate for Payer: Cigna of CA HMO |
$3,141.12
|
| Rate for Payer: Cigna of CA PPO |
$3,631.92
|
| 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 |
$4,171.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,944.80
|
| 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 |
$3,273.64
|
| 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 |
$1,177.92
|
| 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 |
$3,926.40
|
| Rate for Payer: Networks By Design Commercial |
$3,190.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,171.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,944.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,944.80
|
| 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 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 |
$2,699.40
|
| 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 EXTREM JOINT W CONT
|
Facility
|
OP
|
$5,081.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
908801376
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$525.86 |
| Max. Negotiated Rate |
$4,318.85 |
| Rate for Payer: Adventist Health Commercial |
$1,016.20
|
| 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 |
$3,120.24
|
| Rate for Payer: Blue Shield of California Commercial |
$3,109.57
|
| Rate for Payer: Blue Shield of California EPN |
$2,052.72
|
| Rate for Payer: Cash Price |
$2,794.55
|
| Rate for Payer: Cash Price |
$2,794.55
|
| Rate for Payer: Cash Price |
$2,794.55
|
| Rate for Payer: Cigna of CA HMO |
$3,251.84
|
| Rate for Payer: Cigna of CA PPO |
$3,759.94
|
| 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 |
$4,318.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,048.60
|
| 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 |
$3,389.03
|
| 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 |
$1,219.44
|
| 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 |
$4,064.80
|
| Rate for Payer: Networks By Design Commercial |
$3,302.65
|
| Rate for Payer: Prime Health Services Commercial |
$4,318.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,048.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,048.60
|
| 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 |
$2,794.55
|
| 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
|
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 |
$2,644.95
|
| 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 JOINT WO CONT
|
Facility
|
OP
|
$4,809.00
|
|
|
Service Code
|
CPT 73721
|
| Hospital Charge Code |
908801441
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$4,087.65 |
| Rate for Payer: Adventist Health Commercial |
$961.80
|
| 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 |
$2,953.21
|
| Rate for Payer: Blue Shield of California Commercial |
$2,943.11
|
| Rate for Payer: Blue Shield of California EPN |
$1,942.84
|
| Rate for Payer: Cash Price |
$2,644.95
|
| Rate for Payer: Cash Price |
$2,644.95
|
| Rate for Payer: Cash Price |
$2,644.95
|
| Rate for Payer: Cigna of CA HMO |
$3,077.76
|
| Rate for Payer: Cigna of CA PPO |
$3,558.66
|
| 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 |
$4,087.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,885.40
|
| 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 |
$3,207.60
|
| 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 |
$1,154.16
|
| 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 |
$3,847.20
|
| Rate for Payer: Networks By Design Commercial |
$3,125.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,087.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,885.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,885.40
|
| 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 |
$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 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 |
$4,281.20
|
| 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
|
$7,784.00
|
|
|
Service Code
|
CPT 73723
|
| Hospital Charge Code |
908801377
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$453.77 |
| Max. Negotiated Rate |
$6,616.40 |
| Rate for Payer: Adventist Health Commercial |
$1,556.80
|
| 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 |
$4,780.15
|
| Rate for Payer: Blue Shield of California Commercial |
$4,763.81
|
| Rate for Payer: Blue Shield of California EPN |
$3,144.74
|
| Rate for Payer: Cash Price |
$4,281.20
|
| Rate for Payer: Cash Price |
$4,281.20
|
| Rate for Payer: Cash Price |
$4,281.20
|
| Rate for Payer: Cigna of CA HMO |
$4,981.76
|
| Rate for Payer: Cigna of CA PPO |
$5,760.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.59
|
| Rate for Payer: EPIC Health Plan Senior |
$453.77
|
| Rate for Payer: Galaxy Health WC |
$6,616.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,670.40
|
| 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 |
$5,191.93
|
| 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 |
$1,868.16
|
| 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 |
$6,227.20
|
| Rate for Payer: Networks By Design Commercial |
$5,059.60
|
| Rate for Payer: Prime Health Services Commercial |
$6,616.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,670.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,670.40
|
| 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 |
$2,946.90
|
| 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
|
$5,358.00
|
|
|
Service Code
|
CPT 73719
|
| Hospital Charge Code |
908801403
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$453.77 |
| Max. Negotiated Rate |
$4,554.30 |
| Rate for Payer: Adventist Health Commercial |
$1,071.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,514.31
|
| 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 |
$3,290.35
|
| Rate for Payer: Blue Shield of California Commercial |
$3,279.10
|
| Rate for Payer: Blue Shield of California EPN |
$2,164.63
|
| Rate for Payer: Cash Price |
$2,946.90
|
| Rate for Payer: Cash Price |
$2,946.90
|
| Rate for Payer: Cigna of CA HMO |
$3,429.12
|
| Rate for Payer: Cigna of CA PPO |
$3,964.92
|
| 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 |
$4,554.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,214.80
|
| 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 |
$3,573.79
|
| 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 |
$1,285.92
|
| 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 |
$4,286.40
|
| Rate for Payer: Networks By Design Commercial |
$3,482.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,554.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,214.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,214.80
|
| 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 LOWER EXTREM WO CONT
|
Facility
|
OP
|
$7,524.00
|
|
|
Service Code
|
CPT 73720
|
| Hospital Charge Code |
908801399
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$453.77 |
| Max. Negotiated Rate |
$6,395.40 |
| Rate for Payer: Adventist Health Commercial |
$1,504.80
|
| 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 |
$4,620.49
|
| Rate for Payer: Blue Shield of California Commercial |
$4,604.69
|
| Rate for Payer: Blue Shield of California EPN |
$3,039.70
|
| Rate for Payer: Cash Price |
$4,138.20
|
| Rate for Payer: Cash Price |
$4,138.20
|
| Rate for Payer: Cash Price |
$4,138.20
|
| Rate for Payer: Cigna of CA HMO |
$4,815.36
|
| Rate for Payer: Cigna of CA PPO |
$5,567.76
|
| 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 |
$6,395.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,514.40
|
| 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 |
$5,018.51
|
| 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 |
$1,805.76
|
| 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 |
$6,019.20
|
| Rate for Payer: Networks By Design Commercial |
$4,890.60
|
| Rate for Payer: Prime Health Services Commercial |
$6,395.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,514.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,514.40
|
| 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 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 |
$4,138.20
|
| 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 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 |
$3,940.75
|
| 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 L-SPINE W & WO CONTRAST
|
Facility
|
OP
|
$7,165.00
|
|
|
Service Code
|
CPT 72158
|
| Hospital Charge Code |
908801124
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$453.77 |
| Max. Negotiated Rate |
$6,090.25 |
| Rate for Payer: Adventist Health Commercial |
$1,433.00
|
| 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 |
$4,400.03
|
| Rate for Payer: Blue Shield of California Commercial |
$4,384.98
|
| Rate for Payer: Blue Shield of California EPN |
$2,894.66
|
| Rate for Payer: Cash Price |
$3,940.75
|
| Rate for Payer: Cash Price |
$3,940.75
|
| Rate for Payer: Cash Price |
$3,940.75
|
| Rate for Payer: Cigna of CA HMO |
$4,585.60
|
| Rate for Payer: Cigna of CA PPO |
$5,302.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.59
|
| Rate for Payer: EPIC Health Plan Senior |
$453.77
|
| Rate for Payer: Galaxy Health WC |
$6,090.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,299.00
|
| 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 |
$4,779.06
|
| 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 |
$1,719.60
|
| 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 |
$5,732.00
|
| Rate for Payer: Networks By Design Commercial |
$4,657.25
|
| Rate for Payer: Prime Health Services Commercial |
$6,090.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,299.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,299.00
|
| 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 LUMBAR SPINE W CONTRAST
|
Facility
|
OP
|
$6,864.00
|
|
|
Service Code
|
CPT 72149
|
| Hospital Charge Code |
908801122
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$446.09 |
| Max. Negotiated Rate |
$5,834.40 |
| Rate for Payer: Adventist Health Commercial |
$1,372.80
|
| 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 |
$4,215.18
|
| Rate for Payer: Blue Shield of California Commercial |
$4,200.77
|
| Rate for Payer: Blue Shield of California EPN |
$2,773.06
|
| Rate for Payer: Cash Price |
$3,775.20
|
| Rate for Payer: Cash Price |
$3,775.20
|
| Rate for Payer: Cash Price |
$3,775.20
|
| Rate for Payer: Cigna of CA HMO |
$4,392.96
|
| Rate for Payer: Cigna of CA PPO |
$5,079.36
|
| 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 |
$5,834.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,118.40
|
| 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 |
$4,578.29
|
| 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 |
$1,647.36
|
| 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 |
$5,491.20
|
| Rate for Payer: Networks By Design Commercial |
$4,461.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,834.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,118.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,118.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,115.74
|
| Rate for Payer: United Healthcare All Other HMO |
$1,115.74
|
| Rate for Payer: United Healthcare HMO Rider |
$1,115.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,115.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$453.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
HC MRI 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 |
$3,775.20
|
| 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
|
OP
|
$6,129.00
|
|
|
Service Code
|
CPT 72148
|
| Hospital Charge Code |
908801120
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$5,209.65 |
| Rate for Payer: Adventist Health Commercial |
$1,225.80
|
| 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 |
$3,763.82
|
| Rate for Payer: Blue Shield of California Commercial |
$3,750.95
|
| Rate for Payer: Blue Shield of California EPN |
$2,476.12
|
| Rate for Payer: Cash Price |
$3,370.95
|
| Rate for Payer: Cash Price |
$3,370.95
|
| Rate for Payer: Cash Price |
$3,370.95
|
| Rate for Payer: Cigna of CA HMO |
$3,922.56
|
| Rate for Payer: Cigna of CA PPO |
$4,535.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$5,209.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,677.40
|
| 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 |
$4,088.04
|
| 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 |
$1,470.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$4,903.20
|
| Rate for Payer: Networks By Design Commercial |
$3,983.85
|
| Rate for Payer: Prime Health Services Commercial |
$5,209.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,677.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,677.40
|
| 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 |
$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 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 |
$3,370.95
|
| 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 ORBIT FACE/NECK W CON
|
Facility
|
OP
|
$5,228.00
|
|
|
Service Code
|
CPT 70542
|
| Hospital Charge Code |
908801081
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$444.93 |
| Max. Negotiated Rate |
$4,443.80 |
| Rate for Payer: Adventist Health Commercial |
$1,045.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,210.51
|
| Rate for Payer: Blue Shield of California Commercial |
$3,199.54
|
| Rate for Payer: Blue Shield of California EPN |
$2,112.11
|
| Rate for Payer: Cash Price |
$2,875.40
|
| Rate for Payer: Cash Price |
$2,875.40
|
| Rate for Payer: Cash Price |
$2,875.40
|
| Rate for Payer: Cigna of CA HMO |
$3,345.92
|
| Rate for Payer: Cigna of CA PPO |
$3,868.72
|
| 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 |
$4,443.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,136.80
|
| 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 |
$3,487.08
|
| 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 |
$1,254.72
|
| 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 |
$4,182.40
|
| Rate for Payer: Networks By Design Commercial |
$3,398.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,443.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,136.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,136.80
|
| 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
|
|
