|
HC MRI BREAST BILAT WO CONTRAST
|
Facility
|
OP
|
$4,853.00
|
|
|
Service Code
|
CPT 77047
|
| Hospital Charge Code |
908801212
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$306.88 |
| Max. Negotiated Rate |
$4,125.05 |
| Rate for Payer: Adventist Health Commercial |
$970.60
|
| Rate for Payer: Adventist Health Commercial |
$1,165.60
|
| 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 |
$3,739.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,114.17
|
| Rate for Payer: Blue Shield of California Commercial |
$2,043.11
|
| Rate for Payer: Blue Shield of California Commercial |
$3,718.26
|
| Rate for Payer: Blue Shield of California Commercial |
$2,453.59
|
| Rate for Payer: Blue Shield of California Commercial |
$3,096.21
|
| Rate for Payer: Cash Price |
$2,622.60
|
| Rate for Payer: Cash Price |
$2,183.85
|
| Rate for Payer: Cash Price |
$2,622.60
|
| Rate for Payer: Cash Price |
$2,183.85
|
| Rate for Payer: Cigna of CA HMO |
$3,729.92
|
| Rate for Payer: Cigna of CA HMO |
$3,105.92
|
| Rate for Payer: Cigna of CA PPO |
$3,591.22
|
| Rate for Payer: Cigna of CA PPO |
$4,312.72
|
| 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 |
$4,079.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,397.10
|
| 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 |
$4,953.80
|
| Rate for Payer: Galaxy Health WC |
$4,125.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,911.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,496.80
|
| 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) Medi-Cal |
$359.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$359.64
|
| 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 |
$3,081.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,700.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$406.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$406.73
|
| 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 |
$1,164.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,398.72
|
| 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 |
$4,662.40
|
| Rate for Payer: Multiplan Commercial |
$3,882.40
|
| Rate for Payer: Networks By Design Commercial |
$3,154.45
|
| Rate for Payer: Networks By Design Commercial |
$3,788.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,125.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,953.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,496.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,911.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,911.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,496.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$590.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$590.24
|
| Rate for Payer: United Healthcare All Other HMO |
$590.24
|
| Rate for Payer: United Healthcare All Other HMO |
$590.24
|
| Rate for Payer: United Healthcare HMO Rider |
$590.24
|
| Rate for Payer: United Healthcare HMO Rider |
$590.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$590.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$590.24
|
| 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 BREAST BILAT WO CONTRAST
|
Facility
|
IP
|
$5,828.00
|
|
|
Service Code
|
CPT 77047
|
| Hospital Charge Code |
908801212
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,165.60 |
| Max. Negotiated Rate |
$4,953.80 |
| Rate for Payer: Adventist Health Commercial |
$1,165.60
|
| Rate for Payer: Cash Price |
$2,622.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,079.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,331.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,331.20
|
| Rate for Payer: Galaxy Health WC |
$4,953.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,496.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,700.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,438.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,398.72
|
| Rate for Payer: Multiplan Commercial |
$4,662.40
|
| Rate for Payer: Networks By Design Commercial |
$3,788.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,953.80
|
|
|
HC MRI BREAST UNI W/CONTRAST
|
Facility
|
OP
|
$4,998.00
|
|
|
Service Code
|
CPT 77058
|
| Hospital Charge Code |
908801217
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$999.60 |
| Max. Negotiated Rate |
$4,248.30 |
| Rate for Payer: Galaxy Health WC |
$4,248.30
|
| Rate for Payer: Adventist Health Commercial |
$999.60
|
| Rate for Payer: Adventist Health Commercial |
$1,172.80
|
| 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 |
$4,248.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,984.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,748.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,225.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,398.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,748.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,207.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,762.93
|
| Rate for Payer: Blue Shield of California Commercial |
$2,468.74
|
| Rate for Payer: Blue Shield of California Commercial |
$2,104.16
|
| Rate for Payer: Blue Shield of California Commercial |
$3,188.72
|
| Rate for Payer: Blue Shield of California Commercial |
$3,741.23
|
| Rate for Payer: Cash Price |
$2,249.10
|
| Rate for Payer: Cash Price |
$2,249.10
|
| Rate for Payer: Cash Price |
$2,638.80
|
| Rate for Payer: Cash Price |
$2,638.80
|
| Rate for Payer: Cigna of CA HMO |
$3,198.72
|
| Rate for Payer: Cigna of CA HMO |
$3,752.96
|
| Rate for Payer: Cigna of CA PPO |
$3,698.52
|
| Rate for Payer: Cigna of CA PPO |
$4,339.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,984.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,248.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,248.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,984.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,248.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,984.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,104.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,498.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,999.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,345.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,345.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,999.20
|
| Rate for Payer: Galaxy Health WC |
$4,984.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,518.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,998.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,173.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,723.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,128.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,814.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,459.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,948.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,199.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,407.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,104.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,498.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,498.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,104.80
|
| Rate for Payer: Multiplan Commercial |
$4,691.20
|
| Rate for Payer: Multiplan Commercial |
$3,998.40
|
| Rate for Payer: Networks By Design Commercial |
$3,248.70
|
| Rate for Payer: Networks By Design Commercial |
$3,811.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,984.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,248.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,518.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,998.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,518.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,998.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,499.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,499.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,932.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,932.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,499.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,499.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,932.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,248.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,984.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,984.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,248.30
|
| Rate for Payer: Vantage Medical Group Senior |
$4,984.40
|
| Rate for Payer: Vantage Medical Group Senior |
$4,248.30
|
|
|
HC MRI BREAST UNI W/CONTRAST
|
Facility
|
IP
|
$5,864.00
|
|
|
Service Code
|
CPT 77058
|
| Hospital Charge Code |
908801217
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,172.80 |
| Max. Negotiated Rate |
$4,984.40 |
| Rate for Payer: Adventist Health Commercial |
$1,172.80
|
| Rate for Payer: Cash Price |
$2,638.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,104.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,345.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,345.60
|
| Rate for Payer: Galaxy Health WC |
$4,984.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,518.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,723.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,459.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,407.36
|
| Rate for Payer: Multiplan Commercial |
$4,691.20
|
| Rate for Payer: Networks By Design Commercial |
$3,811.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,984.40
|
|
|
HC MRI BREAST UNI WO CONTRAST
|
Facility
|
IP
|
$5,176.00
|
|
|
Service Code
|
CPT 77046
|
| Hospital Charge Code |
908801219
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,035.20 |
| Max. Negotiated Rate |
$4,399.60 |
| Rate for Payer: Adventist Health Commercial |
$1,035.20
|
| Rate for Payer: Cash Price |
$2,329.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,623.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,070.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,070.40
|
| Rate for Payer: Galaxy Health WC |
$4,399.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,105.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,286.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,053.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,242.24
|
| Rate for Payer: Multiplan Commercial |
$4,140.80
|
| Rate for Payer: Networks By Design Commercial |
$3,364.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,399.60
|
|
|
HC MRI BREAST UNI WO CONTRAST
|
Facility
|
OP
|
$4,310.00
|
|
|
Service Code
|
CPT 77046
|
| Hospital Charge Code |
908801219
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$306.88 |
| Max. Negotiated Rate |
$3,663.50 |
| Rate for Payer: Adventist Health Commercial |
$862.00
|
| Rate for Payer: Adventist Health Commercial |
$1,035.20
|
| 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 |
$3,321.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,765.73
|
| Rate for Payer: Blue Shield of California Commercial |
$1,814.51
|
| Rate for Payer: Blue Shield of California Commercial |
$3,302.29
|
| Rate for Payer: Blue Shield of California Commercial |
$2,179.10
|
| Rate for Payer: Blue Shield of California Commercial |
$2,749.78
|
| Rate for Payer: Cash Price |
$2,329.20
|
| Rate for Payer: Cash Price |
$1,939.50
|
| Rate for Payer: Cash Price |
$2,329.20
|
| Rate for Payer: Cash Price |
$1,939.50
|
| Rate for Payer: Cigna of CA HMO |
$3,312.64
|
| Rate for Payer: Cigna of CA HMO |
$2,758.40
|
| Rate for Payer: Cigna of CA PPO |
$3,189.40
|
| Rate for Payer: Cigna of CA PPO |
$3,830.24
|
| 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 |
$3,623.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,017.00
|
| 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 |
$4,399.60
|
| Rate for Payer: Galaxy Health WC |
$3,663.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,586.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,105.60
|
| 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 |
$350.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$350.78
|
| 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 |
$2,736.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,286.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$396.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$396.72
|
| 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 |
$1,034.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,242.24
|
| 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 |
$4,140.80
|
| Rate for Payer: Multiplan Commercial |
$3,448.00
|
| Rate for Payer: Networks By Design Commercial |
$2,801.50
|
| Rate for Payer: Networks By Design Commercial |
$3,364.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,663.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,399.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,105.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,586.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,586.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,105.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$590.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$590.24
|
| Rate for Payer: United Healthcare All Other HMO |
$590.24
|
| Rate for Payer: United Healthcare All Other HMO |
$590.24
|
| Rate for Payer: United Healthcare HMO Rider |
$590.24
|
| Rate for Payer: United Healthcare HMO Rider |
$590.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$590.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$590.24
|
| 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 BRST BI W WO CNTRST W CAD
|
Facility
|
OP
|
$7,101.00
|
|
|
Service Code
|
CPT 77049
|
| Hospital Charge Code |
908801210
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$567.57 |
| Max. Negotiated Rate |
$6,035.85 |
| Rate for Payer: Adventist Health Commercial |
$1,420.20
|
| Rate for Payer: Adventist Health Commercial |
$1,182.20
|
| 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 |
$6,035.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,024.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,251.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,905.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,433.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,325.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,793.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,556.71
|
| Rate for Payer: Blue Shield of California Commercial |
$4,530.44
|
| Rate for Payer: Blue Shield of California Commercial |
$3,771.22
|
| Rate for Payer: Blue Shield of California Commercial |
$2,488.53
|
| Rate for Payer: Blue Shield of California Commercial |
$2,989.52
|
| Rate for Payer: Cash Price |
$2,659.95
|
| Rate for Payer: Cash Price |
$3,195.45
|
| Rate for Payer: Cash Price |
$3,195.45
|
| Rate for Payer: Cash Price |
$2,659.95
|
| Rate for Payer: Cigna of CA HMO |
$4,544.64
|
| Rate for Payer: Cigna of CA HMO |
$3,783.04
|
| Rate for Payer: Cigna of CA PPO |
$4,374.14
|
| Rate for Payer: Cigna of CA PPO |
$5,254.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,024.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,035.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,024.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,035.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,024.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,035.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,970.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,137.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,840.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,364.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,840.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,364.40
|
| Rate for Payer: Galaxy Health WC |
$6,035.85
|
| Rate for Payer: Galaxy Health WC |
$5,024.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,546.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,260.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$567.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$567.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,509.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,753.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$641.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$641.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,487.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,189.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,418.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,704.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,970.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,137.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,970.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,137.70
|
| Rate for Payer: Multiplan Commercial |
$5,680.80
|
| Rate for Payer: Multiplan Commercial |
$4,728.80
|
| Rate for Payer: Networks By Design Commercial |
$3,842.15
|
| Rate for Payer: Networks By Design Commercial |
$4,615.65
|
| Rate for Payer: Prime Health Services Commercial |
$6,035.85
|
| Rate for Payer: Prime Health Services Commercial |
$5,024.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,546.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,260.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,260.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,546.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$750.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$750.08
|
| Rate for Payer: United Healthcare All Other HMO |
$750.08
|
| Rate for Payer: United Healthcare All Other HMO |
$750.08
|
| Rate for Payer: United Healthcare HMO Rider |
$750.08
|
| Rate for Payer: United Healthcare HMO Rider |
$750.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$750.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$750.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,035.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,024.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,024.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,035.85
|
| Rate for Payer: Vantage Medical Group Senior |
$6,035.85
|
| Rate for Payer: Vantage Medical Group Senior |
$5,024.35
|
|
|
HC MRI BRST BI W WO CNTRST W CAD
|
Facility
|
IP
|
$7,101.00
|
|
|
Service Code
|
CPT 77049
|
| Hospital Charge Code |
908801210
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,420.20 |
| Max. Negotiated Rate |
$6,035.85 |
| Rate for Payer: Adventist Health Commercial |
$1,420.20
|
| Rate for Payer: Cash Price |
$3,195.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,970.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,840.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,840.40
|
| Rate for Payer: Galaxy Health WC |
$6,035.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,260.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,509.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,189.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,704.24
|
| Rate for Payer: Multiplan Commercial |
$5,680.80
|
| Rate for Payer: Networks By Design Commercial |
$4,615.65
|
| Rate for Payer: Prime Health Services Commercial |
$6,035.85
|
|
|
HC MRI BRST UNI W WO CTRST W CAD
|
Facility
|
IP
|
$6,550.00
|
|
|
Service Code
|
CPT 77048
|
| Hospital Charge Code |
908801215
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,310.00 |
| Max. Negotiated Rate |
$5,567.50 |
| Rate for Payer: Adventist Health Commercial |
$1,310.00
|
| Rate for Payer: Cash Price |
$2,947.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,585.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,620.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,620.00
|
| Rate for Payer: Galaxy Health WC |
$5,567.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,930.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,159.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,864.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,572.00
|
| Rate for Payer: Multiplan Commercial |
$5,240.00
|
| Rate for Payer: Networks By Design Commercial |
$4,257.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,567.50
|
|
|
HC MRI BRST UNI W WO CTRST W CAD
|
Facility
|
OP
|
$6,550.00
|
|
|
Service Code
|
CPT 77048
|
| Hospital Charge Code |
908801215
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$556.99 |
| Max. Negotiated Rate |
$5,567.50 |
| Rate for Payer: Adventist Health Commercial |
$1,310.00
|
| Rate for Payer: Adventist Health Commercial |
$1,090.80
|
| 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 |
$5,567.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,635.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,999.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,602.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,090.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,912.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,499.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,203.14
|
| Rate for Payer: Blue Shield of California Commercial |
$4,178.90
|
| Rate for Payer: Blue Shield of California Commercial |
$3,479.65
|
| Rate for Payer: Blue Shield of California Commercial |
$2,296.13
|
| Rate for Payer: Blue Shield of California Commercial |
$2,757.55
|
| Rate for Payer: Cash Price |
$2,454.30
|
| Rate for Payer: Cash Price |
$2,947.50
|
| Rate for Payer: Cash Price |
$2,947.50
|
| Rate for Payer: Cash Price |
$2,454.30
|
| Rate for Payer: Cigna of CA HMO |
$4,192.00
|
| Rate for Payer: Cigna of CA HMO |
$3,490.56
|
| Rate for Payer: Cigna of CA PPO |
$4,035.96
|
| Rate for Payer: Cigna of CA PPO |
$4,847.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,635.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,567.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,635.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,567.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,635.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,567.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,585.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,817.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,620.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,181.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,620.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,181.60
|
| Rate for Payer: Galaxy Health WC |
$5,567.50
|
| Rate for Payer: Galaxy Health WC |
$4,635.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,272.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,930.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$556.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$556.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,159.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,463.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$629.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$629.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,217.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,864.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,308.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,572.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,585.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,817.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,585.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,817.80
|
| Rate for Payer: Multiplan Commercial |
$5,240.00
|
| Rate for Payer: Multiplan Commercial |
$4,363.20
|
| Rate for Payer: Networks By Design Commercial |
$3,545.10
|
| Rate for Payer: Networks By Design Commercial |
$4,257.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,567.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,635.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,272.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,930.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,930.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,272.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$753.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$753.76
|
| Rate for Payer: United Healthcare All Other HMO |
$753.76
|
| Rate for Payer: United Healthcare All Other HMO |
$753.76
|
| Rate for Payer: United Healthcare HMO Rider |
$753.76
|
| Rate for Payer: United Healthcare HMO Rider |
$753.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$753.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$753.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,567.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,635.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,635.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,567.50
|
| Rate for Payer: Vantage Medical Group Senior |
$5,567.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,635.90
|
|
|
HC MRI CERVICAL SPINE W CONTRA
|
Facility
|
IP
|
$5,942.00
|
|
|
Service Code
|
CPT 72142
|
| Hospital Charge Code |
908801102
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,188.40 |
| Max. Negotiated Rate |
$5,050.70 |
| Rate for Payer: Adventist Health Commercial |
$1,188.40
|
| Rate for Payer: Cash Price |
$2,673.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,159.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,376.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,376.80
|
| Rate for Payer: Galaxy Health WC |
$5,050.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,565.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,773.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,505.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,426.08
|
| Rate for Payer: Multiplan Commercial |
$4,753.60
|
| Rate for Payer: Networks By Design Commercial |
$3,862.30
|
| Rate for Payer: Prime Health Services Commercial |
$5,050.70
|
|
|
HC MRI CERVICAL SPINE W CONTRA
|
Facility
|
OP
|
$5,150.00
|
|
|
Service Code
|
CPT 72142
|
| Hospital Charge Code |
908801102
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$448.71 |
| Max. Negotiated Rate |
$4,377.50 |
| Rate for Payer: Adventist Health Commercial |
$1,030.00
|
| Rate for Payer: Adventist Health Commercial |
$1,188.40
|
| 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 |
$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 |
$3,812.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,304.76
|
| Rate for Payer: Blue Shield of California Commercial |
$2,168.15
|
| Rate for Payer: Blue Shield of California Commercial |
$3,791.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,501.58
|
| Rate for Payer: Blue Shield of California Commercial |
$3,285.70
|
| Rate for Payer: Cash Price |
$2,673.90
|
| Rate for Payer: Cash Price |
$2,317.50
|
| Rate for Payer: Cash Price |
$2,673.90
|
| Rate for Payer: Cash Price |
$2,317.50
|
| Rate for Payer: Cigna of CA HMO |
$3,802.88
|
| Rate for Payer: Cigna of CA HMO |
$3,296.00
|
| Rate for Payer: Cigna of CA PPO |
$3,811.00
|
| Rate for Payer: Cigna of CA PPO |
$4,397.08
|
| 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 |
$4,159.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,605.00
|
| 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 |
$5,050.70
|
| Rate for Payer: Galaxy Health WC |
$4,377.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,090.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,565.20
|
| 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 |
$454.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$454.69
|
| 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 |
$3,270.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,773.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$514.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$514.24
|
| 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 |
$1,236.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,426.08
|
| 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 |
$4,753.60
|
| Rate for Payer: Multiplan Commercial |
$4,120.00
|
| Rate for Payer: Networks By Design Commercial |
$3,347.50
|
| Rate for Payer: Networks By Design Commercial |
$3,862.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,377.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,050.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,565.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,090.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,090.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,565.20
|
| 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 CERVICAL SPINE WO CONT
|
Facility
|
IP
|
$5,665.00
|
|
|
Service Code
|
CPT 72141
|
| Hospital Charge Code |
908801100
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,133.00 |
| Max. Negotiated Rate |
$4,815.25 |
| Rate for Payer: Adventist Health Commercial |
$1,133.00
|
| Rate for Payer: Cash Price |
$2,549.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,965.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,266.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,266.00
|
| Rate for Payer: Galaxy Health WC |
$4,815.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,399.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,597.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,342.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,359.60
|
| Rate for Payer: Multiplan Commercial |
$4,532.00
|
| Rate for Payer: Networks By Design Commercial |
$3,682.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,815.25
|
|
|
HC MRI CERVICAL SPINE WO CONT
|
Facility
|
OP
|
$4,965.00
|
|
|
Service Code
|
CPT 72141
|
| Hospital Charge Code |
908801100
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$306.88 |
| Max. Negotiated Rate |
$4,220.25 |
| Rate for Payer: Adventist Health Commercial |
$993.00
|
| Rate for Payer: Adventist Health Commercial |
$1,133.00
|
| 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 |
$3,635.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,186.04
|
| Rate for Payer: Blue Shield of California Commercial |
$2,090.26
|
| Rate for Payer: Blue Shield of California Commercial |
$3,614.27
|
| Rate for Payer: Blue Shield of California Commercial |
$2,384.97
|
| Rate for Payer: Blue Shield of California Commercial |
$3,167.67
|
| Rate for Payer: Cash Price |
$2,549.25
|
| Rate for Payer: Cash Price |
$2,234.25
|
| Rate for Payer: Cash Price |
$2,549.25
|
| Rate for Payer: Cash Price |
$2,234.25
|
| Rate for Payer: Cigna of CA HMO |
$3,625.60
|
| Rate for Payer: Cigna of CA HMO |
$3,177.60
|
| Rate for Payer: Cigna of CA PPO |
$3,674.10
|
| Rate for Payer: Cigna of CA PPO |
$4,192.10
|
| 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 |
$3,965.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,475.50
|
| 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 |
$4,815.25
|
| Rate for Payer: Galaxy Health WC |
$4,220.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,979.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,399.00
|
| 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 |
$311.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$311.89
|
| 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 |
$3,152.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,597.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$352.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$352.74
|
| 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 |
$1,191.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,359.60
|
| 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 |
$4,532.00
|
| Rate for Payer: Multiplan Commercial |
$3,972.00
|
| Rate for Payer: Networks By Design Commercial |
$3,227.25
|
| Rate for Payer: Networks By Design Commercial |
$3,682.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,220.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,815.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,399.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,979.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,979.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,399.00
|
| 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 CHEST W/ CONTRAST
|
Facility
|
IP
|
$5,964.00
|
|
|
Service Code
|
CPT 71551
|
| Hospital Charge Code |
908801201
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,192.80 |
| Max. Negotiated Rate |
$5,069.40 |
| Rate for Payer: Adventist Health Commercial |
$1,192.80
|
| Rate for Payer: Cash Price |
$2,683.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,174.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,385.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,385.60
|
| Rate for Payer: Galaxy Health WC |
$5,069.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,578.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,787.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,518.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,431.36
|
| Rate for Payer: Multiplan Commercial |
$4,771.20
|
| Rate for Payer: Networks By Design Commercial |
$3,876.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,069.40
|
|
|
HC MRI CHEST W/ CONTRAST
|
Facility
|
OP
|
$4,965.00
|
|
|
Service Code
|
CPT 71551
|
| Hospital Charge Code |
908801201
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$628.54 |
| Max. Negotiated Rate |
$4,220.25 |
| Rate for Payer: Adventist Health Commercial |
$993.00
|
| Rate for Payer: Adventist Health Commercial |
$1,192.80
|
| 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 |
$1,512.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,512.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,109.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,109.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,008.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,008.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,186.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,827.10
|
| Rate for Payer: Blue Shield of California Commercial |
$2,510.84
|
| Rate for Payer: Blue Shield of California Commercial |
$2,090.26
|
| Rate for Payer: Blue Shield of California Commercial |
$3,167.67
|
| Rate for Payer: Blue Shield of California Commercial |
$3,805.03
|
| Rate for Payer: Cash Price |
$2,234.25
|
| Rate for Payer: Cash Price |
$2,234.25
|
| Rate for Payer: Cash Price |
$2,683.80
|
| Rate for Payer: Cash Price |
$2,234.25
|
| Rate for Payer: Cash Price |
$2,683.80
|
| Rate for Payer: Cash Price |
$2,683.80
|
| Rate for Payer: Cigna of CA HMO |
$3,177.60
|
| Rate for Payer: Cigna of CA HMO |
$3,816.96
|
| Rate for Payer: Cigna of CA PPO |
$3,674.10
|
| Rate for Payer: Cigna of CA PPO |
$4,413.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,512.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,512.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,109.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,109.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,008.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,008.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,174.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,475.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,663.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,663.61
|
| Rate for Payer: EPIC Health Plan Senior |
$1,109.08
|
| Rate for Payer: EPIC Health Plan Senior |
$1,109.08
|
| Rate for Payer: Galaxy Health WC |
$5,069.40
|
| Rate for Payer: Galaxy Health WC |
$4,220.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,979.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,578.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,653.53
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,653.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$628.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$628.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,008.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,008.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,787.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,152.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$710.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$710.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,411.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,411.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,191.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,431.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,270.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,270.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,351.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,351.06
|
| Rate for Payer: Multiplan Commercial |
$3,972.00
|
| Rate for Payer: Multiplan Commercial |
$4,771.20
|
| Rate for Payer: Networks By Design Commercial |
$3,876.60
|
| Rate for Payer: Networks By Design Commercial |
$3,227.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,220.25
|
| 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: Temecula Valley Physicians Medical Group Commercial |
$2,979.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,979.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,578.40
|
| 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 |
$1,008.25
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,008.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,512.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,512.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,109.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,109.08
|
| Rate for Payer: Vantage Medical Group Senior |
$1,008.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,008.25
|
|
|
HC MRI CHEST, W/O CONT
|
Facility
|
IP
|
$5,336.00
|
|
|
Service Code
|
CPT 71550
|
| Hospital Charge Code |
908801200
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,067.20 |
| Max. Negotiated Rate |
$4,535.60 |
| Rate for Payer: Adventist Health Commercial |
$1,067.20
|
| Rate for Payer: Cash Price |
$2,401.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,735.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,134.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,134.40
|
| Rate for Payer: Galaxy Health WC |
$4,535.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,201.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,388.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,148.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,280.64
|
| Rate for Payer: Multiplan Commercial |
$4,268.80
|
| Rate for Payer: Networks By Design Commercial |
$3,468.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,535.60
|
|
|
HC MRI CHEST, W/O CONT
|
Facility
|
OP
|
$4,442.00
|
|
|
Service Code
|
CPT 71550
|
| Hospital Charge Code |
908801200
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$306.88 |
| Max. Negotiated Rate |
$3,775.70 |
| Rate for Payer: Adventist Health Commercial |
$888.40
|
| Rate for Payer: Adventist Health Commercial |
$1,067.20
|
| 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 |
$2,850.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,424.11
|
| Rate for Payer: Blue Shield of California Commercial |
$2,246.46
|
| Rate for Payer: Blue Shield of California Commercial |
$1,870.08
|
| Rate for Payer: Blue Shield of California Commercial |
$2,834.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,404.37
|
| Rate for Payer: Cash Price |
$1,998.90
|
| Rate for Payer: Cash Price |
$1,998.90
|
| Rate for Payer: Cash Price |
$2,401.20
|
| Rate for Payer: Cash Price |
$1,998.90
|
| Rate for Payer: Cash Price |
$2,401.20
|
| Rate for Payer: Cash Price |
$2,401.20
|
| Rate for Payer: Cigna of CA HMO |
$2,842.88
|
| Rate for Payer: Cigna of CA HMO |
$3,415.04
|
| Rate for Payer: Cigna of CA PPO |
$3,287.08
|
| Rate for Payer: Cigna of CA PPO |
$3,948.64
|
| 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 |
$3,735.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,109.40
|
| 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 |
$4,535.60
|
| Rate for Payer: Galaxy Health WC |
$3,775.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,665.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,201.60
|
| 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 |
$568.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$568.85
|
| 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 |
$3,388.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,820.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$643.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$643.34
|
| 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 |
$1,066.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,280.64
|
| 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 |
$3,553.60
|
| Rate for Payer: Multiplan Commercial |
$4,268.80
|
| Rate for Payer: Networks By Design Commercial |
$3,468.40
|
| Rate for Payer: Networks By Design Commercial |
$2,887.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,775.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,535.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,201.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,665.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,665.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,201.60
|
| 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 CHEST W WO CONTRAST
|
Facility
|
IP
|
$8,826.00
|
|
|
Service Code
|
CPT 71552
|
| Hospital Charge Code |
908801202
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,765.20 |
| Max. Negotiated Rate |
$7,502.10 |
| Rate for Payer: Adventist Health Commercial |
$1,765.20
|
| Rate for Payer: Cash Price |
$3,971.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,178.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,530.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,530.40
|
| Rate for Payer: Galaxy Health WC |
$7,502.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,295.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,604.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,207.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,118.24
|
| Rate for Payer: Multiplan Commercial |
$7,060.80
|
| Rate for Payer: Networks By Design Commercial |
$5,736.90
|
| Rate for Payer: Prime Health Services Commercial |
$7,502.10
|
|
|
HC MRI CHEST W WO CONTRAST
|
Facility
|
OP
|
$6,147.00
|
|
|
Service Code
|
CPT 71552
|
| Hospital Charge Code |
908801202
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$448.71 |
| Max. Negotiated Rate |
$5,224.95 |
| Rate for Payer: Adventist Health Commercial |
$1,229.40
|
| Rate for Payer: Adventist Health Commercial |
$1,765.20
|
| 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 |
$3,944.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,663.64
|
| Rate for Payer: Blue Shield of California Commercial |
$3,715.75
|
| Rate for Payer: Blue Shield of California Commercial |
$2,587.89
|
| Rate for Payer: Blue Shield of California Commercial |
$3,921.79
|
| Rate for Payer: Blue Shield of California Commercial |
$5,630.99
|
| Rate for Payer: Cash Price |
$2,766.15
|
| Rate for Payer: Cash Price |
$2,766.15
|
| Rate for Payer: Cash Price |
$3,971.70
|
| Rate for Payer: Cash Price |
$2,766.15
|
| Rate for Payer: Cash Price |
$3,971.70
|
| Rate for Payer: Cash Price |
$3,971.70
|
| Rate for Payer: Cigna of CA HMO |
$3,934.08
|
| Rate for Payer: Cigna of CA HMO |
$5,648.64
|
| Rate for Payer: Cigna of CA PPO |
$4,548.78
|
| Rate for Payer: Cigna of CA PPO |
$6,531.24
|
| 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 |
$6,178.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,302.90
|
| 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 |
$7,502.10
|
| Rate for Payer: Galaxy Health WC |
$5,224.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,688.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,295.60
|
| 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 |
$793.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$793.67
|
| 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 |
$5,604.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,903.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$897.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$897.60
|
| 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 |
$1,475.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,118.24
|
| 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 |
$4,917.60
|
| Rate for Payer: Multiplan Commercial |
$7,060.80
|
| Rate for Payer: Networks By Design Commercial |
$5,736.90
|
| Rate for Payer: Networks By Design Commercial |
$3,995.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,224.95
|
| Rate for Payer: Prime Health Services Commercial |
$7,502.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,295.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,688.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,688.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,295.60
|
| 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 C-SPINE W & WO CONTRAST
|
Facility
|
OP
|
$5,667.00
|
|
|
Service Code
|
CPT 72156
|
| Hospital Charge Code |
908801104
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$448.71 |
| Max. Negotiated Rate |
$4,816.95 |
| Rate for Payer: Adventist Health Commercial |
$1,133.40
|
| Rate for Payer: Adventist Health Commercial |
$1,361.20
|
| 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 |
$3,636.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,367.41
|
| Rate for Payer: Blue Shield of California Commercial |
$2,865.33
|
| Rate for Payer: Blue Shield of California Commercial |
$2,385.81
|
| Rate for Payer: Blue Shield of California Commercial |
$3,615.55
|
| Rate for Payer: Blue Shield of California Commercial |
$4,342.23
|
| Rate for Payer: Cash Price |
$2,550.15
|
| Rate for Payer: Cash Price |
$2,550.15
|
| Rate for Payer: Cash Price |
$3,062.70
|
| Rate for Payer: Cash Price |
$2,550.15
|
| Rate for Payer: Cash Price |
$3,062.70
|
| Rate for Payer: Cash Price |
$3,062.70
|
| Rate for Payer: Cigna of CA HMO |
$3,626.88
|
| Rate for Payer: Cigna of CA HMO |
$4,355.84
|
| Rate for Payer: Cigna of CA PPO |
$4,193.58
|
| Rate for Payer: Cigna of CA PPO |
$5,036.44
|
| 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 |
$4,764.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,966.90
|
| 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 |
$5,785.10
|
| Rate for Payer: Galaxy Health WC |
$4,816.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,400.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,083.60
|
| 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 |
$526.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$526.24
|
| 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 |
$4,321.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,598.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$595.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$595.16
|
| 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 |
$1,360.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,633.44
|
| 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 |
$4,533.60
|
| Rate for Payer: Multiplan Commercial |
$5,444.80
|
| Rate for Payer: Networks By Design Commercial |
$4,423.90
|
| Rate for Payer: Networks By Design Commercial |
$3,683.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,816.95
|
| Rate for Payer: Prime Health Services Commercial |
$5,785.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,083.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,400.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,400.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,083.60
|
| 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 C-SPINE W & WO CONTRAST
|
Facility
|
IP
|
$6,806.00
|
|
|
Service Code
|
CPT 72156
|
| Hospital Charge Code |
908801104
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,361.20 |
| Max. Negotiated Rate |
$5,785.10 |
| Rate for Payer: Adventist Health Commercial |
$1,361.20
|
| Rate for Payer: Cash Price |
$3,062.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,764.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,722.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,722.40
|
| Rate for Payer: Galaxy Health WC |
$5,785.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,083.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,321.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,015.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,633.44
|
| Rate for Payer: Multiplan Commercial |
$5,444.80
|
| Rate for Payer: Networks By Design Commercial |
$4,423.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,785.10
|
|
|
HC MRI FETAL PELVIC IMG 1ST FETUS
|
Facility
|
IP
|
$861.00
|
|
|
Service Code
|
CPT 74712
|
| Hospital Charge Code |
908874712
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$172.20 |
| Max. Negotiated Rate |
$731.85 |
| Rate for Payer: Adventist Health Commercial |
$172.20
|
| Rate for Payer: Cash Price |
$387.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$602.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$344.40
|
| Rate for Payer: EPIC Health Plan Senior |
$344.40
|
| Rate for Payer: Galaxy Health WC |
$731.85
|
| Rate for Payer: Global Benefits Group Commercial |
$516.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$546.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$507.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.64
|
| Rate for Payer: Multiplan Commercial |
$688.80
|
| Rate for Payer: Networks By Design Commercial |
$559.65
|
| Rate for Payer: Prime Health Services Commercial |
$731.85
|
|
|
HC MRI FETAL PELVIC IMG 1ST FETUS
|
Facility
|
OP
|
$861.00
|
|
|
Service Code
|
CPT 74712
|
| Hospital Charge Code |
908874712
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$172.20 |
| Max. Negotiated Rate |
$6,008.30 |
| Rate for Payer: Adventist Health Commercial |
$172.20
|
| 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 Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,008.30
|
| Rate for Payer: Blue Shield of California Commercial |
$362.48
|
| Rate for Payer: Blue Shield of California Commercial |
$549.32
|
| Rate for Payer: Cash Price |
$387.45
|
| Rate for Payer: Cash Price |
$387.45
|
| Rate for Payer: Cigna of CA HMO |
$551.04
|
| Rate for Payer: Cigna of CA PPO |
$637.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$602.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: Galaxy Health WC |
$731.85
|
| Rate for Payer: Global Benefits Group Commercial |
$516.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$673.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$546.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$762.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$688.80
|
| Rate for Payer: Networks By Design Commercial |
$559.65
|
| Rate for Payer: Prime Health Services Commercial |
$731.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$516.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$516.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$700.26
|
| Rate for Payer: United Healthcare All Other HMO |
$700.26
|
| Rate for Payer: United Healthcare HMO Rider |
$700.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$700.26
|
| Rate for Payer: Upland Medical Group Pediatric |
$306.88
|
| 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 Senior |
$306.88
|
|
|
HC MRI FETAL PELVIC IMG ADD FETUS
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
CPT 74713
|
| Hospital Charge Code |
908874713
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$86.00 |
| Max. Negotiated Rate |
$365.50 |
| Rate for Payer: Adventist Health Commercial |
$86.00
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$301.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.00
|
| Rate for Payer: EPIC Health Plan Senior |
$172.00
|
| Rate for Payer: Galaxy Health WC |
$365.50
|
| Rate for Payer: Global Benefits Group Commercial |
$258.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$273.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$253.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.20
|
| Rate for Payer: Multiplan Commercial |
$344.00
|
| Rate for Payer: Networks By Design Commercial |
$279.50
|
| Rate for Payer: Prime Health Services Commercial |
$365.50
|
|
