|
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 |
$2,875.40
|
| 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 WO CON
|
Facility
|
OP
|
$4,753.00
|
|
|
Service Code
|
CPT 70540
|
| Hospital Charge Code |
908801080
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$4,040.05 |
| Rate for Payer: Adventist Health Commercial |
$950.60
|
| 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 |
$2,918.82
|
| Rate for Payer: Blue Shield of California Commercial |
$2,908.84
|
| Rate for Payer: Blue Shield of California EPN |
$1,920.21
|
| Rate for Payer: Cash Price |
$2,614.15
|
| Rate for Payer: Cash Price |
$2,614.15
|
| Rate for Payer: Cash Price |
$2,614.15
|
| Rate for Payer: Cigna of CA HMO |
$3,041.92
|
| Rate for Payer: Cigna of CA PPO |
$3,517.22
|
| 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 |
$4,040.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,851.80
|
| 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 |
$3,170.25
|
| 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 |
$1,140.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$3,802.40
|
| Rate for Payer: Networks By Design Commercial |
$3,089.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,040.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,851.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,851.80
|
| 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 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 |
$2,614.15
|
| 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 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 |
$4,197.60
|
| 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
|
$7,632.00
|
|
|
Service Code
|
CPT 70543
|
| Hospital Charge Code |
908801082
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$453.77 |
| Max. Negotiated Rate |
$6,487.20 |
| Rate for Payer: Adventist Health Commercial |
$1,526.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,686.81
|
| Rate for Payer: Blue Shield of California Commercial |
$4,670.78
|
| Rate for Payer: Blue Shield of California EPN |
$3,083.33
|
| Rate for Payer: Cash Price |
$4,197.60
|
| Rate for Payer: Cash Price |
$4,197.60
|
| Rate for Payer: Cash Price |
$4,197.60
|
| Rate for Payer: Cigna of CA HMO |
$4,884.48
|
| Rate for Payer: Cigna of CA PPO |
$5,647.68
|
| 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 |
$6,487.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,579.20
|
| 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 |
$5,090.54
|
| 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 |
$1,831.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$571.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$608.05
|
| Rate for Payer: Multiplan Commercial |
$6,105.60
|
| Rate for Payer: Networks By Design Commercial |
$4,960.80
|
| Rate for Payer: Prime Health Services Commercial |
$6,487.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,579.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,579.20
|
| 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 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 |
$3,870.35
|
| 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/CONTRAST
|
Facility
|
OP
|
$7,037.00
|
|
|
Service Code
|
CPT 72196
|
| Hospital Charge Code |
908801350
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$445.25 |
| Max. Negotiated Rate |
$5,981.45 |
| Rate for Payer: Adventist Health Commercial |
$1,407.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,321.42
|
| Rate for Payer: Blue Shield of California Commercial |
$4,306.64
|
| Rate for Payer: Blue Shield of California EPN |
$2,842.95
|
| Rate for Payer: Cash Price |
$3,870.35
|
| Rate for Payer: Cash Price |
$3,870.35
|
| Rate for Payer: Cash Price |
$3,870.35
|
| Rate for Payer: Cigna of CA HMO |
$4,503.68
|
| Rate for Payer: Cigna of CA PPO |
$5,207.38
|
| 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 |
$5,981.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,222.20
|
| 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 |
$4,693.68
|
| 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 |
$1,688.88
|
| 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 |
$5,629.60
|
| Rate for Payer: Networks By Design Commercial |
$4,574.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,981.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,222.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,222.20
|
| 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 PELVIS W/O CONTRAST
|
Facility
|
OP
|
$6,185.00
|
|
|
Service Code
|
CPT 72195
|
| Hospital Charge Code |
908801351
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$5,257.25 |
| Rate for Payer: Adventist Health Commercial |
$1,237.00
|
| 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 |
$3,798.21
|
| Rate for Payer: Blue Shield of California Commercial |
$3,785.22
|
| Rate for Payer: Blue Shield of California EPN |
$2,498.74
|
| Rate for Payer: Cash Price |
$3,401.75
|
| Rate for Payer: Cash Price |
$3,401.75
|
| Rate for Payer: Cash Price |
$3,401.75
|
| Rate for Payer: Cigna of CA HMO |
$3,958.40
|
| Rate for Payer: Cigna of CA PPO |
$4,576.90
|
| 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 |
$5,257.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,711.00
|
| 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 |
$4,125.40
|
| 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 |
$1,484.40
|
| 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 |
$4,948.00
|
| Rate for Payer: Networks By Design Commercial |
$4,020.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,257.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,711.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,711.00
|
| 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 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 |
$3,401.75
|
| 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 & 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 |
$4,296.05
|
| 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 PELVIS W & WO CONTRAST
|
Facility
|
OP
|
$7,811.00
|
|
|
Service Code
|
CPT 72197
|
| Hospital Charge Code |
908801352
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$453.77 |
| Max. Negotiated Rate |
$6,639.35 |
| Rate for Payer: Adventist Health Commercial |
$1,562.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,796.74
|
| Rate for Payer: Blue Shield of California Commercial |
$4,780.33
|
| Rate for Payer: Blue Shield of California EPN |
$3,155.64
|
| Rate for Payer: Cash Price |
$4,296.05
|
| Rate for Payer: Cash Price |
$4,296.05
|
| Rate for Payer: Cash Price |
$4,296.05
|
| Rate for Payer: Cigna of CA HMO |
$4,999.04
|
| Rate for Payer: Cigna of CA PPO |
$5,780.14
|
| 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 |
$6,639.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,686.60
|
| 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 |
$5,209.94
|
| 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 |
$1,874.64
|
| 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 |
$6,248.80
|
| Rate for Payer: Networks By Design Commercial |
$5,077.15
|
| Rate for Payer: Prime Health Services Commercial |
$6,639.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,686.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,686.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,367.12
|
| Rate for Payer: United Healthcare All Other HMO |
$1,367.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1,367.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,367.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$453.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
HC MRI 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 |
$2,090.55
|
| 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
|
$3,801.00
|
|
|
Service Code
|
CPT 76498
|
| Hospital Charge Code |
908801008
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$111.88 |
| 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: 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 |
$2,334.19
|
| Rate for Payer: Blue Shield of California Commercial |
$2,326.21
|
| Rate for Payer: Blue Shield of California EPN |
$1,535.60
|
| Rate for Payer: Cash Price |
$2,090.55
|
| Rate for Payer: Cash Price |
$2,090.55
|
| Rate for Payer: Cigna of CA HMO |
$2,432.64
|
| Rate for Payer: Cigna of CA PPO |
$2,812.74
|
| 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 |
$3,230.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,280.60
|
| 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 |
$2,535.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$912.24
|
| 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 |
$3,040.80
|
| Rate for Payer: Networks By Design Commercial |
$2,470.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,230.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,280.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,280.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| Rate for Payer: United Healthcare All Other HMO |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 |
$2,759.35
|
| 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 SPECTROSCOPY
|
Facility
|
OP
|
$5,017.00
|
|
|
Service Code
|
CPT 76390
|
| Hospital Charge Code |
908801255
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$111.88 |
| Max. Negotiated Rate |
$4,264.45 |
| Rate for Payer: Adventist Health Commercial |
$1,003.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,290.65
|
| 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 |
$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 |
$2,759.35
|
| Rate for Payer: Cash Price |
$2,759.35
|
| 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 |
$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 |
$4,264.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,010.20
|
| 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 |
$3,346.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,911.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,204.08
|
| 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 |
$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 |
$1,065.68
|
| 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 THORACIC SPINE WITH CONTRA
|
Facility
|
IP
|
$6,559.00
|
|
|
Service Code
|
CPT 72147
|
| Hospital Charge Code |
908801112
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,311.80 |
| Max. Negotiated Rate |
$5,575.15 |
| Rate for Payer: Adventist Health Commercial |
$1,311.80
|
| Rate for Payer: Cash Price |
$3,607.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,623.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,623.60
|
| Rate for Payer: Galaxy Health WC |
$5,575.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,935.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,374.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,498.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,060.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,574.16
|
| Rate for Payer: Multiplan Commercial |
$5,247.20
|
| Rate for Payer: Networks By Design Commercial |
$4,263.35
|
| Rate for Payer: Prime Health Services Commercial |
$5,575.15
|
|
|
HC MRI THORACIC SPINE WITH CONTRA
|
Facility
|
OP
|
$6,559.00
|
|
|
Service Code
|
CPT 72147
|
| Hospital Charge Code |
908801112
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$449.80 |
| Max. Negotiated Rate |
$5,575.15 |
| Rate for Payer: Adventist Health Commercial |
$1,311.80
|
| 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 |
$4,027.88
|
| Rate for Payer: Blue Shield of California Commercial |
$4,014.11
|
| Rate for Payer: Blue Shield of California EPN |
$2,649.84
|
| Rate for Payer: Cash Price |
$3,607.45
|
| Rate for Payer: Cash Price |
$3,607.45
|
| Rate for Payer: Cash Price |
$3,607.45
|
| Rate for Payer: Cigna of CA HMO |
$4,197.76
|
| Rate for Payer: Cigna of CA PPO |
$4,853.66
|
| 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 |
$5,575.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,935.40
|
| 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 |
$4,374.85
|
| 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 |
$1,574.16
|
| 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 |
$5,247.20
|
| Rate for Payer: Networks By Design Commercial |
$4,263.35
|
| Rate for Payer: Prime Health Services Commercial |
$5,575.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,935.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,935.40
|
| 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 THORACIC SPINE WO CON
|
Facility
|
OP
|
$5,964.00
|
|
|
Service Code
|
CPT 72146
|
| Hospital Charge Code |
908801110
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$5,069.40 |
| Rate for Payer: Adventist Health Commercial |
$1,192.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,911.79
|
| 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 |
$3,662.49
|
| Rate for Payer: Blue Shield of California Commercial |
$3,649.97
|
| Rate for Payer: Blue Shield of California EPN |
$2,409.46
|
| Rate for Payer: Cash Price |
$3,280.20
|
| Rate for Payer: Cash Price |
$3,280.20
|
| Rate for Payer: Cigna of CA HMO |
$3,816.96
|
| Rate for Payer: Cigna of CA PPO |
$4,413.36
|
| 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 |
$5,069.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,578.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$311.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,977.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$352.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,431.36
|
| 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 |
$4,771.20
|
| Rate for Payer: Networks By Design Commercial |
$3,876.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,069.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,578.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,578.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$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 THORACIC SPINE WO CON
|
Facility
|
IP
|
$5,964.00
|
|
|
Service Code
|
CPT 72146
|
| Hospital Charge Code |
908801110
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,192.80 |
| Max. Negotiated Rate |
$5,069.40 |
| Rate for Payer: Adventist Health Commercial |
$1,192.80
|
| Rate for Payer: Cash Price |
$3,280.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,385.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,385.60
|
| Rate for Payer: Galaxy Health WC |
$5,069.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,578.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,977.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,272.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,691.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,431.36
|
| Rate for Payer: Multiplan Commercial |
$4,771.20
|
| Rate for Payer: Networks By Design Commercial |
$3,876.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,069.40
|
|
|
HC MRI T-SPINE W & WO CONTRAST
|
Facility
|
IP
|
$7,165.00
|
|
|
Service Code
|
CPT 72157
|
| Hospital Charge Code |
908801114
|
|
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 T-SPINE W & WO CONTRAST
|
Facility
|
OP
|
$7,165.00
|
|
|
Service Code
|
CPT 72157
|
| Hospital Charge Code |
908801114
|
|
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 |
$4,699.52
|
| 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: 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 |
$526.81
|
| 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 |
$595.80
|
| 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 UPPER EXT JNT W & WO CONT
|
Facility
|
IP
|
$7,522.00
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
908801435
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,504.40 |
| Max. Negotiated Rate |
$6,393.70 |
| Rate for Payer: Adventist Health Commercial |
$1,504.40
|
| Rate for Payer: Cash Price |
$4,137.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,008.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,008.80
|
| Rate for Payer: Galaxy Health WC |
$6,393.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,513.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,017.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,865.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,656.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,805.28
|
| Rate for Payer: Multiplan Commercial |
$6,017.60
|
| Rate for Payer: Networks By Design Commercial |
$4,889.30
|
| Rate for Payer: Prime Health Services Commercial |
$6,393.70
|
|
|
HC MRI UPPER EXT JNT W & WO CONT
|
Facility
|
OP
|
$7,522.00
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
908801435
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$453.77 |
| Max. Negotiated Rate |
$6,393.70 |
| Rate for Payer: Adventist Health Commercial |
$1,504.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,619.26
|
| Rate for Payer: Blue Shield of California Commercial |
$4,603.46
|
| Rate for Payer: Blue Shield of California EPN |
$3,038.89
|
| Rate for Payer: Cash Price |
$4,137.10
|
| Rate for Payer: Cash Price |
$4,137.10
|
| Rate for Payer: Cash Price |
$4,137.10
|
| Rate for Payer: Cigna of CA HMO |
$4,814.08
|
| Rate for Payer: Cigna of CA PPO |
$5,566.28
|
| 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 |
$6,393.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,513.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$648.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,017.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$733.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,805.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$571.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$608.05
|
| Rate for Payer: Multiplan Commercial |
$6,017.60
|
| Rate for Payer: Networks By Design Commercial |
$4,889.30
|
| Rate for Payer: Prime Health Services Commercial |
$6,393.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,513.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,513.20
|
| 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 UPPER EXTREM JOINT W/CONT
|
Facility
|
IP
|
$5,081.00
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
908801433
|
|
Hospital Revenue Code
|
614
|
| 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 UPPER EXTREM JOINT W/CONT
|
Facility
|
OP
|
$5,081.00
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
908801433
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$524.76 |
| 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 |
$524.76
|
| 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 |
$593.48
|
| 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
|
|
