|
HC MRI ANGIO NECK WO CONTRAST
|
Facility
|
IP
|
$5,375.00
|
|
|
Service Code
|
CPT 70547
|
| Hospital Charge Code |
908801086
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,075.00 |
| Max. Negotiated Rate |
$4,568.75 |
| Rate for Payer: Adventist Health Commercial |
$1,075.00
|
| Rate for Payer: Cash Price |
$2,418.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,762.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,150.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,150.00
|
| Rate for Payer: Galaxy Health WC |
$4,568.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,225.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,413.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,171.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,290.00
|
| Rate for Payer: Multiplan Commercial |
$4,300.00
|
| Rate for Payer: Networks By Design Commercial |
$3,493.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,568.75
|
|
|
HC MRI ANGIO NECK WO CONTRAST
|
Facility
|
OP
|
$5,375.00
|
|
|
Service Code
|
CPT 70547
|
| Hospital Charge Code |
908801018
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$306.88 |
| Max. Negotiated Rate |
$4,568.75 |
| Rate for Payer: Adventist Health Commercial |
$1,075.00
|
| Rate for Payer: Adventist Health Commercial |
$1,130.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,449.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,626.25
|
| Rate for Payer: Blue Shield of California Commercial |
$2,379.07
|
| Rate for Payer: Blue Shield of California Commercial |
$2,262.88
|
| Rate for Payer: Blue Shield of California Commercial |
$3,429.25
|
| Rate for Payer: Blue Shield of California Commercial |
$3,605.34
|
| Rate for Payer: Cash Price |
$2,418.75
|
| Rate for Payer: Cash Price |
$2,418.75
|
| Rate for Payer: Cash Price |
$2,542.95
|
| Rate for Payer: Cash Price |
$2,418.75
|
| Rate for Payer: Cash Price |
$2,542.95
|
| Rate for Payer: Cash Price |
$2,542.95
|
| Rate for Payer: Cigna of CA HMO |
$3,440.00
|
| Rate for Payer: Cigna of CA HMO |
$3,616.64
|
| Rate for Payer: Cigna of CA PPO |
$3,977.50
|
| Rate for Payer: Cigna of CA PPO |
$4,181.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,955.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,762.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: Galaxy Health WC |
$4,803.35
|
| Rate for Payer: Galaxy Health WC |
$4,568.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,225.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,390.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.28
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$355.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$355.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,588.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,413.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$402.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$402.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,290.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,356.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$4,300.00
|
| Rate for Payer: Multiplan Commercial |
$4,520.80
|
| Rate for Payer: Networks By Design Commercial |
$3,673.15
|
| Rate for Payer: Networks By Design Commercial |
$3,493.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,568.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,803.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,390.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,225.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,225.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,390.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| 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 All Other HMO |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$306.88
|
| Rate for Payer: Upland Medical Group Pediatric |
$306.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC MRI ANGIO NECK WO CONTRAST
|
Facility
|
IP
|
$5,375.00
|
|
|
Service Code
|
CPT 70547
|
| Hospital Charge Code |
908801018
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,075.00 |
| Max. Negotiated Rate |
$4,568.75 |
| Rate for Payer: Adventist Health Commercial |
$1,075.00
|
| Rate for Payer: Cash Price |
$2,418.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,762.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,150.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,150.00
|
| Rate for Payer: Galaxy Health WC |
$4,568.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,225.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,413.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,171.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,290.00
|
| Rate for Payer: Multiplan Commercial |
$4,300.00
|
| Rate for Payer: Networks By Design Commercial |
$3,493.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,568.75
|
|
|
HC MRI ANGIO NECK W WO CONTRAST
|
Facility
|
OP
|
$6,472.00
|
|
|
Service Code
|
CPT 70549
|
| Hospital Charge Code |
908801088
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$448.71 |
| Max. Negotiated Rate |
$5,501.20 |
| Rate for Payer: Adventist Health Commercial |
$1,294.40
|
| Rate for Payer: Adventist Health Commercial |
$1,320.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,153.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,235.86
|
| Rate for Payer: Blue Shield of California Commercial |
$2,779.02
|
| Rate for Payer: Blue Shield of California Commercial |
$2,724.71
|
| Rate for Payer: Blue Shield of California Commercial |
$4,129.14
|
| Rate for Payer: Blue Shield of California Commercial |
$4,211.44
|
| Rate for Payer: Cash Price |
$2,912.40
|
| Rate for Payer: Cash Price |
$2,912.40
|
| Rate for Payer: Cash Price |
$2,970.45
|
| Rate for Payer: Cash Price |
$2,912.40
|
| Rate for Payer: Cash Price |
$2,970.45
|
| Rate for Payer: Cash Price |
$2,970.45
|
| Rate for Payer: Cigna of CA HMO |
$4,142.08
|
| Rate for Payer: Cigna of CA HMO |
$4,224.64
|
| Rate for Payer: Cigna of CA PPO |
$4,789.28
|
| Rate for Payer: Cigna of CA PPO |
$4,884.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,620.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,530.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.37
|
| Rate for Payer: EPIC Health Plan Senior |
$493.58
|
| Rate for Payer: EPIC Health Plan Senior |
$493.58
|
| Rate for Payer: Galaxy Health WC |
$5,610.85
|
| Rate for Payer: Galaxy Health WC |
$5,501.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,883.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,960.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$735.88
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$735.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$569.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$569.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,191.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,109.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$644.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$644.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,553.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,584.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$565.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$565.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$601.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$601.27
|
| Rate for Payer: Multiplan Commercial |
$5,177.60
|
| Rate for Payer: Multiplan Commercial |
$5,280.80
|
| Rate for Payer: Networks By Design Commercial |
$4,290.65
|
| Rate for Payer: Networks By Design Commercial |
$4,206.80
|
| Rate for Payer: Prime Health Services Commercial |
$5,501.20
|
| Rate for Payer: Prime Health Services Commercial |
$5,610.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,960.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,883.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,883.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,960.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,367.12
|
| 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 All Other HMO |
$1,367.12
|
| Rate for Payer: United Healthcare HMO Rider |
$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: United Healthcare Select/Navigate/Core |
$1,367.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$448.71
|
| Rate for Payer: Upland Medical Group Pediatric |
$448.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
|
|
HC MRI ANGIO NECK W WO CONTRAST
|
Facility
|
IP
|
$6,601.00
|
|
|
Service Code
|
CPT 70549
|
| Hospital Charge Code |
908801088
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,320.20 |
| Max. Negotiated Rate |
$5,610.85 |
| Rate for Payer: Adventist Health Commercial |
$1,320.20
|
| Rate for Payer: Cash Price |
$2,970.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,620.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,640.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,640.40
|
| Rate for Payer: Galaxy Health WC |
$5,610.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,960.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,191.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,894.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,584.24
|
| Rate for Payer: Multiplan Commercial |
$5,280.80
|
| Rate for Payer: Networks By Design Commercial |
$4,290.65
|
| Rate for Payer: Prime Health Services Commercial |
$5,610.85
|
|
|
HC MRI BILATERAL TMJ
|
Facility
|
OP
|
$5,653.00
|
|
|
Service Code
|
CPT 70336
|
| Hospital Charge Code |
908801055
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$306.88 |
| Max. Negotiated Rate |
$4,805.05 |
| Rate for Payer: Adventist Health Commercial |
$1,130.60
|
| Rate for Payer: Adventist Health Commercial |
$1,358.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,627.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,357.78
|
| Rate for Payer: Blue Shield of California Commercial |
$2,859.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,379.91
|
| Rate for Payer: Blue Shield of California Commercial |
$3,606.61
|
| Rate for Payer: Blue Shield of California Commercial |
$4,332.66
|
| Rate for Payer: Cash Price |
$2,543.85
|
| Rate for Payer: Cash Price |
$3,055.95
|
| Rate for Payer: Cash Price |
$3,055.95
|
| Rate for Payer: Cash Price |
$2,543.85
|
| Rate for Payer: Cash Price |
$3,055.95
|
| Rate for Payer: Cash Price |
$2,543.85
|
| Rate for Payer: Cigna of CA HMO |
$3,617.92
|
| Rate for Payer: Cigna of CA HMO |
$4,346.24
|
| Rate for Payer: Cigna of CA PPO |
$4,183.22
|
| Rate for Payer: Cigna of CA PPO |
$5,025.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,957.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,753.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: Galaxy Health WC |
$5,772.35
|
| Rate for Payer: Galaxy Health WC |
$4,805.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,074.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,391.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.28
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,589.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,312.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,465.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,052.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,356.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,629.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$5,432.80
|
| Rate for Payer: Multiplan Commercial |
$4,522.40
|
| Rate for Payer: Networks By Design Commercial |
$3,674.45
|
| Rate for Payer: Networks By Design Commercial |
$4,414.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,772.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,805.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,391.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,074.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,391.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,074.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| 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 All Other HMO |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$306.88
|
| Rate for Payer: Upland Medical Group Pediatric |
$306.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC MRI BILATERAL TMJ
|
Facility
|
IP
|
$6,791.00
|
|
|
Service Code
|
CPT 70336
|
| Hospital Charge Code |
908801055
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,358.20 |
| Max. Negotiated Rate |
$5,772.35 |
| Rate for Payer: Adventist Health Commercial |
$1,358.20
|
| Rate for Payer: Cash Price |
$3,055.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,753.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,716.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,716.40
|
| Rate for Payer: Galaxy Health WC |
$5,772.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,074.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,312.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,006.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,629.84
|
| Rate for Payer: Multiplan Commercial |
$5,432.80
|
| Rate for Payer: Networks By Design Commercial |
$4,414.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,772.35
|
|
|
HC MRI BN MARROW(2 SEQ)
|
Facility
|
IP
|
$4,452.00
|
|
|
Service Code
|
CPT 77084
|
| Hospital Charge Code |
908801140
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$890.40 |
| Max. Negotiated Rate |
$3,784.20 |
| Rate for Payer: Adventist Health Commercial |
$890.40
|
| Rate for Payer: Cash Price |
$2,003.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,116.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,780.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,780.80
|
| Rate for Payer: Galaxy Health WC |
$3,784.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,671.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,827.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,626.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,068.48
|
| Rate for Payer: Multiplan Commercial |
$3,561.60
|
| Rate for Payer: Networks By Design Commercial |
$2,893.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,784.20
|
|
|
HC MRI BN MARROW(2 SEQ)
|
Facility
|
OP
|
$3,706.00
|
|
|
Service Code
|
CPT 77084
|
| Hospital Charge Code |
908801140
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$306.88 |
| Max. Negotiated Rate |
$3,150.10 |
| Rate for Payer: Adventist Health Commercial |
$741.20
|
| Rate for Payer: Adventist Health Commercial |
$890.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,328.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,328.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,378.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,856.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1,560.23
|
| Rate for Payer: Blue Shield of California Commercial |
$2,364.43
|
| Rate for Payer: Blue Shield of California Commercial |
$2,840.38
|
| Rate for Payer: Blue Shield of California Commercial |
$1,874.29
|
| Rate for Payer: Cash Price |
$1,667.70
|
| Rate for Payer: Cash Price |
$2,003.40
|
| Rate for Payer: Cash Price |
$1,667.70
|
| Rate for Payer: Cash Price |
$2,003.40
|
| Rate for Payer: Cigna of CA HMO |
$2,849.28
|
| Rate for Payer: Cigna of CA HMO |
$2,371.84
|
| Rate for Payer: Cigna of CA PPO |
$3,294.48
|
| Rate for Payer: Cigna of CA PPO |
$2,742.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,116.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,594.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: Galaxy Health WC |
$3,784.20
|
| Rate for Payer: Galaxy Health WC |
$3,150.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,223.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,671.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.28
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,827.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,353.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,345.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,616.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$889.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,068.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$3,561.60
|
| Rate for Payer: Multiplan Commercial |
$2,964.80
|
| Rate for Payer: Networks By Design Commercial |
$2,408.90
|
| Rate for Payer: Networks By Design Commercial |
$2,893.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,150.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,784.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,671.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,223.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,671.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,223.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| 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 All Other HMO |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$306.88
|
| Rate for Payer: Upland Medical Group Pediatric |
$306.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC MRI BRAIN ASSESS W CONTRAST
|
Facility
|
IP
|
$1,067.00
|
|
|
Service Code
|
CPT 70558
|
| Hospital Charge Code |
908870558
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$213.40 |
| Max. Negotiated Rate |
$906.95 |
| Rate for Payer: Adventist Health Commercial |
$213.40
|
| Rate for Payer: Cash Price |
$480.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$746.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$426.80
|
| Rate for Payer: EPIC Health Plan Senior |
$426.80
|
| Rate for Payer: Galaxy Health WC |
$906.95
|
| Rate for Payer: Global Benefits Group Commercial |
$640.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$677.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$629.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.08
|
| Rate for Payer: Multiplan Commercial |
$853.60
|
| Rate for Payer: Networks By Design Commercial |
$693.55
|
| Rate for Payer: Prime Health Services Commercial |
$906.95
|
|
|
HC MRI BRAIN ASSESS W CONTRAST
|
Facility
|
OP
|
$1,067.00
|
|
|
Service Code
|
CPT 70558
|
| Hospital Charge Code |
908870558
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$213.40 |
| Max. Negotiated Rate |
$2,328.99 |
| Rate for Payer: Adventist Health Commercial |
$213.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,328.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$684.69
|
| Rate for Payer: Blue Shield of California Commercial |
$680.75
|
| Rate for Payer: Blue Shield of California Commercial |
$449.21
|
| Rate for Payer: Cash Price |
$480.15
|
| Rate for Payer: Cash Price |
$480.15
|
| Rate for Payer: Cigna of CA HMO |
$682.88
|
| Rate for Payer: Cigna of CA PPO |
$789.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$746.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: Galaxy Health WC |
$906.95
|
| Rate for Payer: Global Benefits Group Commercial |
$640.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$297.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$677.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$336.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$284.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$853.60
|
| Rate for Payer: Networks By Design Commercial |
$693.55
|
| Rate for Payer: Prime Health Services Commercial |
$906.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$640.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$640.20
|
| 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 |
$225.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
|
HC MRI BRAIN ASSESS WO CONTRAST
|
Facility
|
OP
|
$565.00
|
|
|
Service Code
|
CPT 70557
|
| Hospital Charge Code |
908870557
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$113.00 |
| Max. Negotiated Rate |
$2,328.99 |
| Rate for Payer: Adventist Health Commercial |
$113.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,328.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$773.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$702.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$362.56
|
| Rate for Payer: Blue Shield of California Commercial |
$360.47
|
| Rate for Payer: Blue Shield of California Commercial |
$237.87
|
| Rate for Payer: Cash Price |
$254.25
|
| Rate for Payer: Cash Price |
$254.25
|
| Rate for Payer: Cigna of CA HMO |
$361.60
|
| Rate for Payer: Cigna of CA PPO |
$418.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$773.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$702.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$395.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,159.59
|
| Rate for Payer: EPIC Health Plan Senior |
$773.06
|
| Rate for Payer: Galaxy Health WC |
$480.25
|
| Rate for Payer: Global Benefits Group Commercial |
$339.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,152.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$288.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$702.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$358.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$326.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$983.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$885.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$941.73
|
| Rate for Payer: Multiplan Commercial |
$452.00
|
| Rate for Payer: Networks By Design Commercial |
$367.25
|
| Rate for Payer: Prime Health Services Commercial |
$480.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$339.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$339.00
|
| 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 |
$702.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$773.06
|
| Rate for Payer: Vantage Medical Group Senior |
$702.78
|
|
|
HC MRI BRAIN ASSESS WO CONTRAST
|
Facility
|
IP
|
$565.00
|
|
|
Service Code
|
CPT 70557
|
| Hospital Charge Code |
908870557
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$113.00 |
| Max. Negotiated Rate |
$480.25 |
| Rate for Payer: Adventist Health Commercial |
$113.00
|
| Rate for Payer: Cash Price |
$254.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$395.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$226.00
|
| Rate for Payer: EPIC Health Plan Senior |
$226.00
|
| Rate for Payer: Galaxy Health WC |
$480.25
|
| Rate for Payer: Global Benefits Group Commercial |
$339.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$358.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$333.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.60
|
| Rate for Payer: Multiplan Commercial |
$452.00
|
| Rate for Payer: Networks By Design Commercial |
$367.25
|
| Rate for Payer: Prime Health Services Commercial |
$480.25
|
|
|
HC MRI BRAIN ASSESS WO W CONTRAST
|
Facility
|
OP
|
$1,121.00
|
|
|
Service Code
|
CPT 70559
|
| Hospital Charge Code |
908870559
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$224.20 |
| Max. Negotiated Rate |
$2,328.99 |
| Rate for Payer: Adventist Health Commercial |
$224.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,328.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$719.35
|
| Rate for Payer: Blue Shield of California Commercial |
$715.20
|
| Rate for Payer: Blue Shield of California Commercial |
$471.94
|
| Rate for Payer: Cash Price |
$504.45
|
| Rate for Payer: Cash Price |
$504.45
|
| Rate for Payer: Cigna of CA HMO |
$717.44
|
| Rate for Payer: Cigna of CA PPO |
$829.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$784.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: Galaxy Health WC |
$952.85
|
| Rate for Payer: Global Benefits Group Commercial |
$672.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$280.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$711.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$316.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$269.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$284.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$896.80
|
| Rate for Payer: Networks By Design Commercial |
$728.65
|
| Rate for Payer: Prime Health Services Commercial |
$952.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$672.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$672.60
|
| 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 |
$225.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
|
HC MRI BRAIN ASSESS WO W CONTRAST
|
Facility
|
IP
|
$1,121.00
|
|
|
Service Code
|
CPT 70559
|
| Hospital Charge Code |
908870559
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$224.20 |
| Max. Negotiated Rate |
$952.85 |
| Rate for Payer: Adventist Health Commercial |
$224.20
|
| Rate for Payer: Cash Price |
$504.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$784.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$448.40
|
| Rate for Payer: EPIC Health Plan Senior |
$448.40
|
| Rate for Payer: Galaxy Health WC |
$952.85
|
| Rate for Payer: Global Benefits Group Commercial |
$672.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$711.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$661.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$269.04
|
| Rate for Payer: Multiplan Commercial |
$896.80
|
| Rate for Payer: Networks By Design Commercial |
$728.65
|
| Rate for Payer: Prime Health Services Commercial |
$952.85
|
|
|
HC MRI BRAIN WITH CONTRAST
|
Facility
|
OP
|
$5,421.00
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
908801013
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$443.91 |
| Max. Negotiated Rate |
$4,607.85 |
| Rate for Payer: Adventist Health Commercial |
$1,084.20
|
| Rate for Payer: Adventist Health Commercial |
$1,288.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,328.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,328.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,135.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,478.66
|
| Rate for Payer: Blue Shield of California Commercial |
$2,282.24
|
| Rate for Payer: Blue Shield of California Commercial |
$4,111.27
|
| Rate for Payer: Blue Shield of California Commercial |
$2,712.92
|
| Rate for Payer: Blue Shield of California Commercial |
$3,458.60
|
| Rate for Payer: Cash Price |
$2,899.80
|
| Rate for Payer: Cash Price |
$2,439.45
|
| Rate for Payer: Cash Price |
$2,899.80
|
| Rate for Payer: Cash Price |
$2,439.45
|
| Rate for Payer: Cigna of CA HMO |
$4,124.16
|
| Rate for Payer: Cigna of CA HMO |
$3,469.44
|
| Rate for Payer: Cigna of CA PPO |
$4,011.54
|
| Rate for Payer: Cigna of CA PPO |
$4,768.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,510.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,794.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.37
|
| Rate for Payer: EPIC Health Plan Senior |
$493.58
|
| Rate for Payer: EPIC Health Plan Senior |
$493.58
|
| Rate for Payer: Galaxy Health WC |
$5,477.40
|
| Rate for Payer: Galaxy Health WC |
$4,607.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,252.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,866.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$735.88
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$735.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$443.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$443.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,442.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,091.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$502.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$502.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,301.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,546.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$565.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$565.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$601.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$601.27
|
| Rate for Payer: Multiplan Commercial |
$5,155.20
|
| Rate for Payer: Multiplan Commercial |
$4,336.80
|
| Rate for Payer: Networks By Design Commercial |
$3,523.65
|
| Rate for Payer: Networks By Design Commercial |
$4,188.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,607.85
|
| Rate for Payer: Prime Health Services Commercial |
$5,477.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,866.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,252.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,252.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,866.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,115.74
|
| 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 All Other HMO |
$1,115.74
|
| Rate for Payer: United Healthcare HMO Rider |
$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: United Healthcare Select/Navigate/Core |
$1,115.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$448.71
|
| Rate for Payer: Upland Medical Group Pediatric |
$448.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
|
|
HC MRI BRAIN WITH CONTRAST
|
Facility
|
OP
|
$5,421.00
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
908801012
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$443.91 |
| Max. Negotiated Rate |
$4,607.85 |
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Adventist Health Commercial |
$1,084.20
|
| Rate for Payer: Adventist Health Commercial |
$1,288.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,328.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,328.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,135.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,478.66
|
| Rate for Payer: Blue Shield of California Commercial |
$2,282.24
|
| Rate for Payer: Blue Shield of California Commercial |
$4,111.27
|
| Rate for Payer: Blue Shield of California Commercial |
$2,712.92
|
| Rate for Payer: Blue Shield of California Commercial |
$3,458.60
|
| Rate for Payer: Cash Price |
$2,899.80
|
| Rate for Payer: Cash Price |
$2,439.45
|
| Rate for Payer: Cash Price |
$2,899.80
|
| Rate for Payer: Cash Price |
$2,439.45
|
| Rate for Payer: Cigna of CA HMO |
$4,124.16
|
| Rate for Payer: Cigna of CA HMO |
$3,469.44
|
| Rate for Payer: Cigna of CA PPO |
$4,011.54
|
| Rate for Payer: Cigna of CA PPO |
$4,768.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,510.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,794.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.37
|
| Rate for Payer: EPIC Health Plan Senior |
$493.58
|
| Rate for Payer: EPIC Health Plan Senior |
$493.58
|
| Rate for Payer: Galaxy Health WC |
$5,477.40
|
| Rate for Payer: Galaxy Health WC |
$4,607.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,252.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,866.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$735.88
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$735.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$443.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$443.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,442.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,091.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$502.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$502.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,301.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,546.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$565.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$565.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$601.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$601.27
|
| Rate for Payer: Multiplan Commercial |
$5,155.20
|
| Rate for Payer: Multiplan Commercial |
$4,336.80
|
| Rate for Payer: Networks By Design Commercial |
$3,523.65
|
| Rate for Payer: Networks By Design Commercial |
$4,188.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,607.85
|
| Rate for Payer: Prime Health Services Commercial |
$5,477.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,866.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,252.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,252.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,866.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,115.74
|
| 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 All Other HMO |
$1,115.74
|
| Rate for Payer: United Healthcare HMO Rider |
$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: United Healthcare Select/Navigate/Core |
$1,115.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$448.71
|
| Rate for Payer: Upland Medical Group Pediatric |
$448.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
|
|
HC MRI BRAIN WITH CONTRAST
|
Facility
|
IP
|
$6,444.00
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
908801013
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,288.80 |
| Max. Negotiated Rate |
$5,477.40 |
| Rate for Payer: Adventist Health Commercial |
$1,288.80
|
| Rate for Payer: Cash Price |
$2,899.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,510.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,577.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,577.60
|
| Rate for Payer: Galaxy Health WC |
$5,477.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,866.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,091.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,801.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,546.56
|
| Rate for Payer: Multiplan Commercial |
$5,155.20
|
| Rate for Payer: Networks By Design Commercial |
$4,188.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,477.40
|
|
|
HC MRI BRAIN WITH CONTRAST
|
Facility
|
IP
|
$6,444.00
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
908801012
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,288.80 |
| Max. Negotiated Rate |
$5,477.40 |
| Rate for Payer: Adventist Health Commercial |
$1,288.80
|
| Rate for Payer: Cash Price |
$2,899.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,510.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,577.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,577.60
|
| Rate for Payer: Galaxy Health WC |
$5,477.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,866.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,091.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,801.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,546.56
|
| Rate for Payer: Multiplan Commercial |
$5,155.20
|
| Rate for Payer: Networks By Design Commercial |
$4,188.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,477.40
|
|
|
HC MRI BRAIN WO CONTRAST
|
Facility
|
OP
|
$5,126.00
|
|
|
Service Code
|
CPT 70551
|
| Hospital Charge Code |
908801010
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$306.88 |
| Max. Negotiated Rate |
$4,357.10 |
| Rate for Payer: Adventist Health Commercial |
$1,025.20
|
| Rate for Payer: Adventist Health Commercial |
$1,218.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,289.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,909.24
|
| Rate for Payer: Blue Shield of California Commercial |
$2,564.73
|
| Rate for Payer: Blue Shield of California Commercial |
$2,158.05
|
| Rate for Payer: Blue Shield of California Commercial |
$3,270.39
|
| Rate for Payer: Blue Shield of California Commercial |
$3,886.70
|
| Rate for Payer: Cash Price |
$2,306.70
|
| Rate for Payer: Cash Price |
$2,306.70
|
| Rate for Payer: Cash Price |
$2,741.40
|
| Rate for Payer: Cash Price |
$2,306.70
|
| Rate for Payer: Cash Price |
$2,741.40
|
| Rate for Payer: Cash Price |
$2,741.40
|
| Rate for Payer: Cigna of CA HMO |
$3,280.64
|
| Rate for Payer: Cigna of CA HMO |
$3,898.88
|
| Rate for Payer: Cigna of CA PPO |
$3,793.24
|
| Rate for Payer: Cigna of CA PPO |
$4,508.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,264.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,588.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: Galaxy Health WC |
$5,178.20
|
| Rate for Payer: Galaxy Health WC |
$4,357.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,075.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,655.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.28
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$319.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$319.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,868.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,255.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$361.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$361.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,230.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,462.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$4,100.80
|
| Rate for Payer: Multiplan Commercial |
$4,873.60
|
| Rate for Payer: Networks By Design Commercial |
$3,959.80
|
| Rate for Payer: Networks By Design Commercial |
$3,331.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,357.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,178.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,655.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,075.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,075.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,655.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| 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 All Other HMO |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$306.88
|
| Rate for Payer: Upland Medical Group Pediatric |
$306.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC MRI BRAIN WO CONTRAST
|
Facility
|
IP
|
$6,092.00
|
|
|
Service Code
|
CPT 70551
|
| Hospital Charge Code |
908801010
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,218.40 |
| Max. Negotiated Rate |
$5,178.20 |
| Rate for Payer: Adventist Health Commercial |
$1,218.40
|
| Rate for Payer: Cash Price |
$2,741.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,264.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,436.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,436.80
|
| Rate for Payer: Galaxy Health WC |
$5,178.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,655.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,868.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,594.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,462.08
|
| Rate for Payer: Multiplan Commercial |
$4,873.60
|
| Rate for Payer: Networks By Design Commercial |
$3,959.80
|
| Rate for Payer: Prime Health Services Commercial |
$5,178.20
|
|
|
HC MRI BRAIN W WO CONTRAST
|
Facility
|
IP
|
$7,207.00
|
|
|
Service Code
|
CPT 70553
|
| Hospital Charge Code |
908801014
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,441.40 |
| Max. Negotiated Rate |
$6,125.95 |
| Rate for Payer: Adventist Health Commercial |
$1,441.40
|
| Rate for Payer: Cash Price |
$3,243.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,044.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,882.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,882.80
|
| Rate for Payer: Galaxy Health WC |
$6,125.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,324.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,576.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,252.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,729.68
|
| Rate for Payer: Multiplan Commercial |
$5,765.60
|
| Rate for Payer: Networks By Design Commercial |
$4,684.55
|
| Rate for Payer: Prime Health Services Commercial |
$6,125.95
|
|
|
HC MRI BRAIN W WO CONTRAST
|
Facility
|
OP
|
$6,338.00
|
|
|
Service Code
|
CPT 70553
|
| Hospital Charge Code |
908801014
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$448.71 |
| Max. Negotiated Rate |
$5,387.30 |
| Rate for Payer: Adventist Health Commercial |
$1,267.60
|
| Rate for Payer: Adventist Health Commercial |
$1,441.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,067.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,624.73
|
| Rate for Payer: Blue Shield of California Commercial |
$3,034.15
|
| Rate for Payer: Blue Shield of California Commercial |
$2,668.30
|
| Rate for Payer: Blue Shield of California Commercial |
$4,043.64
|
| Rate for Payer: Blue Shield of California Commercial |
$4,598.07
|
| Rate for Payer: Cash Price |
$2,852.10
|
| Rate for Payer: Cash Price |
$2,852.10
|
| Rate for Payer: Cash Price |
$3,243.15
|
| Rate for Payer: Cash Price |
$2,852.10
|
| Rate for Payer: Cash Price |
$3,243.15
|
| Rate for Payer: Cash Price |
$3,243.15
|
| Rate for Payer: Cigna of CA HMO |
$4,056.32
|
| Rate for Payer: Cigna of CA HMO |
$4,612.48
|
| Rate for Payer: Cigna of CA PPO |
$4,690.12
|
| Rate for Payer: Cigna of CA PPO |
$5,333.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,044.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,436.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.37
|
| Rate for Payer: EPIC Health Plan Senior |
$493.58
|
| Rate for Payer: EPIC Health Plan Senior |
$493.58
|
| Rate for Payer: Galaxy Health WC |
$6,125.95
|
| Rate for Payer: Galaxy Health WC |
$5,387.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,802.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4,324.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$735.88
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$735.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$522.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$522.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,576.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,024.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$591.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$591.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,521.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,729.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$565.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$565.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$601.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$601.27
|
| Rate for Payer: Multiplan Commercial |
$5,070.40
|
| Rate for Payer: Multiplan Commercial |
$5,765.60
|
| Rate for Payer: Networks By Design Commercial |
$4,684.55
|
| Rate for Payer: Networks By Design Commercial |
$4,119.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,387.30
|
| Rate for Payer: Prime Health Services Commercial |
$6,125.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,324.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,802.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,802.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,324.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,367.12
|
| 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 All Other HMO |
$1,367.12
|
| Rate for Payer: United Healthcare HMO Rider |
$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: United Healthcare Select/Navigate/Core |
$1,367.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$448.71
|
| Rate for Payer: Upland Medical Group Pediatric |
$448.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
|
|
HC MRI BREAST BILAT W/CONTRAST
|
Facility
|
IP
|
$6,467.00
|
|
|
Service Code
|
CPT 77059
|
| Hospital Charge Code |
908801211
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,293.40 |
| Max. Negotiated Rate |
$5,496.95 |
| Rate for Payer: Adventist Health Commercial |
$1,293.40
|
| Rate for Payer: Cash Price |
$2,910.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,526.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,586.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,586.80
|
| Rate for Payer: Galaxy Health WC |
$5,496.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,880.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,106.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,815.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,552.08
|
| Rate for Payer: Multiplan Commercial |
$5,173.60
|
| Rate for Payer: Networks By Design Commercial |
$4,203.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,496.95
|
|
|
HC MRI BREAST BILAT W/CONTRAST
|
Facility
|
OP
|
$5,310.00
|
|
|
Service Code
|
CPT 77059
|
| Hospital Charge Code |
908801211
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,062.00 |
| Max. Negotiated Rate |
$4,513.50 |
| Rate for Payer: Adventist Health Commercial |
$1,062.00
|
| Rate for Payer: Adventist Health Commercial |
$1,293.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,513.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,496.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,920.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,556.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,850.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,407.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,149.87
|
| Rate for Payer: Blue Shield of California Commercial |
$2,722.61
|
| Rate for Payer: Blue Shield of California Commercial |
$2,235.51
|
| Rate for Payer: Blue Shield of California Commercial |
$3,387.78
|
| Rate for Payer: Blue Shield of California Commercial |
$4,125.95
|
| Rate for Payer: Cash Price |
$2,389.50
|
| Rate for Payer: Cash Price |
$2,389.50
|
| Rate for Payer: Cash Price |
$2,910.15
|
| Rate for Payer: Cash Price |
$2,910.15
|
| Rate for Payer: Cigna of CA HMO |
$3,398.40
|
| Rate for Payer: Cigna of CA HMO |
$4,138.88
|
| Rate for Payer: Cigna of CA PPO |
$3,929.40
|
| Rate for Payer: Cigna of CA PPO |
$4,785.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,496.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,513.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,513.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,496.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,513.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,496.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,526.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,717.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,124.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,586.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,586.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,124.00
|
| Rate for Payer: Galaxy Health WC |
$5,496.95
|
| Rate for Payer: Galaxy Health WC |
$4,513.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,880.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,186.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,371.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,106.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,347.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,927.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,815.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,132.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,274.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,552.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,526.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,717.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,717.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,526.90
|
| Rate for Payer: Multiplan Commercial |
$5,173.60
|
| Rate for Payer: Multiplan Commercial |
$4,248.00
|
| Rate for Payer: Networks By Design Commercial |
$3,451.50
|
| Rate for Payer: Networks By Design Commercial |
$4,203.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,496.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,513.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,880.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,186.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,880.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,186.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,655.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,233.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,655.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,233.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,233.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,655.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,655.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,233.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,513.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,496.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,496.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,513.50
|
| Rate for Payer: Vantage Medical Group Senior |
$5,496.95
|
| Rate for Payer: Vantage Medical Group Senior |
$4,513.50
|
|
