|
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
|
|
|
HC MRI GUID BX/NEEDLE LOC/ASPIR
|
Facility
|
IP
|
$7,554.00
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
909002020
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,510.80 |
| Max. Negotiated Rate |
$6,420.90 |
| Rate for Payer: Adventist Health Commercial |
$1,510.80
|
| Rate for Payer: Cash Price |
$3,399.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,287.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,021.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,021.60
|
| Rate for Payer: Galaxy Health WC |
$6,420.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,532.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,796.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,456.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,812.96
|
| Rate for Payer: Multiplan Commercial |
$6,043.20
|
| Rate for Payer: Networks By Design Commercial |
$4,910.10
|
| Rate for Payer: Prime Health Services Commercial |
$6,420.90
|
|
|
HC MRI GUID BX/NEEDLE LOC/ASPIR
|
Facility
|
OP
|
$7,554.00
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
909002020
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$616.16 |
| Max. Negotiated Rate |
$6,420.90 |
| Rate for Payer: Adventist Health Commercial |
$1,510.80
|
| Rate for Payer: Adventist Health Commercial |
$1,258.00
|
| 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 |
$6,420.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,346.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,459.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,154.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,665.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,717.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,036.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,847.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4,013.02
|
| Rate for Payer: Blue Shield of California Commercial |
$2,648.09
|
| Rate for Payer: Blue Shield of California Commercial |
$4,819.45
|
| Rate for Payer: Blue Shield of California Commercial |
$3,180.23
|
| Rate for Payer: Cash Price |
$3,399.30
|
| Rate for Payer: Cash Price |
$2,830.50
|
| Rate for Payer: Cash Price |
$3,399.30
|
| Rate for Payer: Cash Price |
$2,830.50
|
| Rate for Payer: Cigna of CA HMO |
$4,834.56
|
| Rate for Payer: Cigna of CA HMO |
$4,025.60
|
| Rate for Payer: Cigna of CA PPO |
$4,654.60
|
| Rate for Payer: Cigna of CA PPO |
$5,589.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,420.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,346.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,420.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,346.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,346.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,420.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,403.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,287.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,516.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,021.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,516.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,021.60
|
| Rate for Payer: Galaxy Health WC |
$6,420.90
|
| Rate for Payer: Galaxy Health WC |
$5,346.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,774.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,532.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$616.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$616.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,994.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,796.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$696.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$696.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,456.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,711.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,509.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,812.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,403.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,287.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,403.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,287.80
|
| Rate for Payer: Multiplan Commercial |
$6,043.20
|
| Rate for Payer: Multiplan Commercial |
$5,032.00
|
| Rate for Payer: Networks By Design Commercial |
$4,088.50
|
| Rate for Payer: Networks By Design Commercial |
$4,910.10
|
| Rate for Payer: Prime Health Services Commercial |
$6,420.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,346.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,774.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,532.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,532.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,774.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,145.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,777.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,145.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,777.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,777.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,145.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,145.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,777.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,420.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,346.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,346.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,420.90
|
| Rate for Payer: Vantage Medical Group Senior |
$5,346.50
|
| Rate for Payer: Vantage Medical Group Senior |
$6,420.90
|
|
|
HC MRI INSERTABLE IMAGING COIL
|
Facility
|
OP
|
$525.00
|
|
|
Service Code
|
CPT C1770
|
| Hospital Charge Code |
908801710
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$446.25 |
| Rate for Payer: Adventist Health Commercial |
$105.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$446.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$288.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$393.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$317.78
|
| Rate for Payer: Blue Shield of California Commercial |
$266.18
|
| Rate for Payer: Blue Shield of California Commercial |
$403.73
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Cigna of CA HMO |
$367.50
|
| Rate for Payer: Cigna of CA PPO |
$367.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$446.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$446.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$446.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$367.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.00
|
| Rate for Payer: EPIC Health Plan Senior |
$210.00
|
| Rate for Payer: Galaxy Health WC |
$446.25
|
| Rate for Payer: Global Benefits Group Commercial |
$315.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$333.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$190.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$309.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$367.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$367.50
|
| Rate for Payer: Multiplan Commercial |
$420.00
|
| Rate for Payer: Networks By Design Commercial |
$262.50
|
| Rate for Payer: Prime Health Services Commercial |
$446.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$315.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$315.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$197.03
|
| Rate for Payer: United Healthcare All Other HMO |
$191.78
|
| Rate for Payer: United Healthcare HMO Rider |
$187.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$171.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$446.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$446.25
|
| Rate for Payer: Vantage Medical Group Senior |
$446.25
|
|
|
HC MRI INSERTABLE IMAGING COIL
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
CPT C1770
|
| Hospital Charge Code |
908801710
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$105.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Cigna of CA HMO |
$367.50
|
| Rate for Payer: Cigna of CA PPO |
$367.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$367.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.00
|
| Rate for Payer: EPIC Health Plan Senior |
$210.00
|
| Rate for Payer: Galaxy Health WC |
$446.25
|
| Rate for Payer: Global Benefits Group Commercial |
$315.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$333.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$309.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.00
|
| Rate for Payer: Multiplan Commercial |
$420.00
|
| Rate for Payer: Networks By Design Commercial |
$262.50
|
| Rate for Payer: Prime Health Services Commercial |
$446.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$197.03
|
| Rate for Payer: United Healthcare All Other HMO |
$191.78
|
| Rate for Payer: United Healthcare HMO Rider |
$187.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$171.94
|
|
|
HC MRI LOWER EXTREMITY W/O CON
|
Facility
|
OP
|
$4,005.00
|
|
|
Service Code
|
CPT 73718
|
| Hospital Charge Code |
908801402
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$306.88 |
| Max. Negotiated Rate |
$3,443.00 |
| Rate for Payer: Adventist Health Commercial |
$801.00
|
| Rate for Payer: Adventist Health Commercial |
$981.60
|
| 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 |
$2,570.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,149.46
|
| Rate for Payer: Blue Shield of California Commercial |
$2,066.27
|
| Rate for Payer: Blue Shield of California Commercial |
$1,686.11
|
| Rate for Payer: Blue Shield of California Commercial |
$2,555.19
|
| Rate for Payer: Blue Shield of California Commercial |
$3,131.30
|
| Rate for Payer: Cash Price |
$1,802.25
|
| Rate for Payer: Cash Price |
$1,802.25
|
| Rate for Payer: Cash Price |
$2,208.60
|
| Rate for Payer: Cash Price |
$1,802.25
|
| Rate for Payer: Cash Price |
$2,208.60
|
| Rate for Payer: Cash Price |
$2,208.60
|
| Rate for Payer: Cigna of CA HMO |
$2,563.20
|
| Rate for Payer: Cigna of CA HMO |
$3,141.12
|
| Rate for Payer: Cigna of CA PPO |
$2,963.70
|
| Rate for Payer: Cigna of CA PPO |
$3,631.92
|
| 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 |
$3,435.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,803.50
|
| 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 |
$4,171.80
|
| Rate for Payer: Galaxy Health WC |
$3,404.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,403.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,944.80
|
| 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 |
$369.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$369.72
|
| 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 |
$3,116.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,543.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$418.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$418.13
|
| 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 |
$961.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,177.92
|
| 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 |
$3,204.00
|
| Rate for Payer: Multiplan Commercial |
$3,926.40
|
| Rate for Payer: Networks By Design Commercial |
$3,190.20
|
| Rate for Payer: Networks By Design Commercial |
$2,603.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,404.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,171.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,944.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,403.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,403.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,944.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| Rate for Payer: United Healthcare All Other 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 LOWER EXTREMITY W/O CON
|
Facility
|
IP
|
$4,908.00
|
|
|
Service Code
|
CPT 73718
|
| Hospital Charge Code |
908801402
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$981.60 |
| Max. Negotiated Rate |
$4,171.80 |
| Rate for Payer: Adventist Health Commercial |
$981.60
|
| Rate for Payer: Cash Price |
$2,208.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,435.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,963.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,963.20
|
| Rate for Payer: Galaxy Health WC |
$4,171.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,944.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,116.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,895.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,177.92
|
| Rate for Payer: Multiplan Commercial |
$3,926.40
|
| Rate for Payer: Networks By Design Commercial |
$3,190.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,171.80
|
|
|
HC MRI LOWER EXTREM JOINT W CONT
|
Facility
|
OP
|
$4,231.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
908801376
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$525.86 |
| Max. Negotiated Rate |
$3,596.35 |
| Rate for Payer: Adventist Health Commercial |
$846.20
|
| Rate for Payer: Adventist Health Commercial |
$1,016.20
|
| 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 |
$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 |
$2,715.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,260.48
|
| Rate for Payer: Blue Shield of California Commercial |
$2,139.10
|
| Rate for Payer: Blue Shield of California Commercial |
$1,781.25
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.38
|
| Rate for Payer: Blue Shield of California Commercial |
$3,241.68
|
| Rate for Payer: Cash Price |
$1,903.95
|
| Rate for Payer: Cash Price |
$1,903.95
|
| Rate for Payer: Cash Price |
$2,286.45
|
| Rate for Payer: Cash Price |
$1,903.95
|
| Rate for Payer: Cash Price |
$2,286.45
|
| Rate for Payer: Cash Price |
$2,286.45
|
| Rate for Payer: Cigna of CA HMO |
$2,707.84
|
| Rate for Payer: Cigna of CA HMO |
$3,251.84
|
| Rate for Payer: Cigna of CA PPO |
$3,130.94
|
| Rate for Payer: Cigna of CA PPO |
$3,759.94
|
| 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 |
$3,556.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,961.70
|
| 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 |
$4,318.85
|
| Rate for Payer: Galaxy Health WC |
$3,596.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,538.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,048.60
|
| 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 |
$525.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$525.86
|
| 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 |
$3,226.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,686.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$594.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$594.72
|
| 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 |
$1,015.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,219.44
|
| 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 |
$3,384.80
|
| Rate for Payer: Multiplan Commercial |
$4,064.80
|
| Rate for Payer: Networks By Design Commercial |
$3,302.65
|
| Rate for Payer: Networks By Design Commercial |
$2,750.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,596.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,318.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,048.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,538.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,538.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,048.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,115.74
|
| Rate for Payer: United Healthcare All Other 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 LOWER EXTREM JOINT W CONT
|
Facility
|
IP
|
$5,081.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
908801376
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,016.20 |
| Max. Negotiated Rate |
$4,318.85 |
| Rate for Payer: Adventist Health Commercial |
$1,016.20
|
| Rate for Payer: Cash Price |
$2,286.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,556.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,032.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,032.40
|
| Rate for Payer: Galaxy Health WC |
$4,318.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,048.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,226.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,997.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,219.44
|
| Rate for Payer: Multiplan Commercial |
$4,064.80
|
| Rate for Payer: Networks By Design Commercial |
$3,302.65
|
| Rate for Payer: Prime Health Services Commercial |
$4,318.85
|
|
|
HC MRI LOWER EXTREM JOINT WO CONT
|
Facility
|
OP
|
$3,641.00
|
|
|
Service Code
|
CPT 73721
|
| Hospital Charge Code |
908801441
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$306.88 |
| Max. Negotiated Rate |
$3,443.00 |
| Rate for Payer: Adventist Health Commercial |
$728.20
|
| Rate for Payer: Adventist Health Commercial |
$961.80
|
| 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 |
$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 |
$2,336.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,085.94
|
| Rate for Payer: Blue Shield of California Commercial |
$2,024.59
|
| Rate for Payer: Blue Shield of California Commercial |
$1,532.86
|
| Rate for Payer: Blue Shield of California Commercial |
$2,322.96
|
| Rate for Payer: Blue Shield of California Commercial |
$3,068.14
|
| Rate for Payer: Cash Price |
$1,638.45
|
| Rate for Payer: Cash Price |
$1,638.45
|
| Rate for Payer: Cash Price |
$2,164.05
|
| Rate for Payer: Cash Price |
$1,638.45
|
| Rate for Payer: Cash Price |
$2,164.05
|
| Rate for Payer: Cash Price |
$2,164.05
|
| Rate for Payer: Cigna of CA HMO |
$2,330.24
|
| Rate for Payer: Cigna of CA HMO |
$3,077.76
|
| Rate for Payer: Cigna of CA PPO |
$2,694.34
|
| Rate for Payer: Cigna of CA PPO |
$3,558.66
|
| 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 |
$3,366.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,548.70
|
| 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 |
$4,087.65
|
| Rate for Payer: Galaxy Health WC |
$3,094.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,184.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,885.40
|
| 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 |
$656.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$656.01
|
| 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 |
$3,053.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,312.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$741.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$741.91
|
| 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 |
$873.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,154.16
|
| 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 |
$2,912.80
|
| Rate for Payer: Multiplan Commercial |
$3,847.20
|
| Rate for Payer: Networks By Design Commercial |
$3,125.85
|
| Rate for Payer: Networks By Design Commercial |
$2,366.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,094.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,087.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,885.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,184.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,184.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,885.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| Rate for Payer: United Healthcare All Other 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 LOWER EXTREM JOINT WO CONT
|
Facility
|
IP
|
$4,809.00
|
|
|
Service Code
|
CPT 73721
|
| Hospital Charge Code |
908801441
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$961.80 |
| Max. Negotiated Rate |
$4,087.65 |
| Rate for Payer: Adventist Health Commercial |
$961.80
|
| Rate for Payer: Cash Price |
$2,164.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,366.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,923.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,923.60
|
| Rate for Payer: Galaxy Health WC |
$4,087.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,885.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,053.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,837.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,154.16
|
| Rate for Payer: Multiplan Commercial |
$3,847.20
|
| Rate for Payer: Networks By Design Commercial |
$3,125.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,087.65
|
|
|
HC MRI LOWER EXTREM JOIN W & WO CONT
|
Facility
|
OP
|
$6,774.00
|
|
|
Service Code
|
CPT 73723
|
| Hospital Charge Code |
908801377
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$448.71 |
| Max. Negotiated Rate |
$5,757.90 |
| Rate for Payer: Adventist Health Commercial |
$1,354.80
|
| Rate for Payer: Adventist Health Commercial |
$1,556.80
|
| 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 |
$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 |
$4,346.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,994.99
|
| Rate for Payer: Blue Shield of California Commercial |
$3,277.06
|
| Rate for Payer: Blue Shield of California Commercial |
$2,851.85
|
| Rate for Payer: Blue Shield of California Commercial |
$4,321.81
|
| Rate for Payer: Blue Shield of California Commercial |
$4,966.19
|
| Rate for Payer: Cash Price |
$3,048.30
|
| Rate for Payer: Cash Price |
$3,048.30
|
| Rate for Payer: Cash Price |
$3,502.80
|
| Rate for Payer: Cash Price |
$3,048.30
|
| Rate for Payer: Cash Price |
$3,502.80
|
| Rate for Payer: Cash Price |
$3,502.80
|
| Rate for Payer: Cigna of CA HMO |
$4,335.36
|
| Rate for Payer: Cigna of CA HMO |
$4,981.76
|
| Rate for Payer: Cigna of CA PPO |
$5,012.76
|
| Rate for Payer: Cigna of CA PPO |
$5,760.16
|
| 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 |
$5,448.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,741.80
|
| 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 |
$6,616.40
|
| Rate for Payer: Galaxy Health WC |
$5,757.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,064.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,670.40
|
| 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 |
$962.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$962.96
|
| 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 |
$4,942.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,301.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,089.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,089.06
|
| 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 |
$1,625.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,868.16
|
| 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 |
$5,419.20
|
| Rate for Payer: Multiplan Commercial |
$6,227.20
|
| Rate for Payer: Networks By Design Commercial |
$5,059.60
|
| Rate for Payer: Networks By Design Commercial |
$4,403.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,757.90
|
| Rate for Payer: Prime Health Services Commercial |
$6,616.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,670.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,064.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,064.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,670.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,367.12
|
| Rate for Payer: United Healthcare All Other 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 LOWER EXTREM JOIN W & WO CONT
|
Facility
|
IP
|
$7,784.00
|
|
|
Service Code
|
CPT 73723
|
| Hospital Charge Code |
908801377
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,556.80 |
| Max. Negotiated Rate |
$6,616.40 |
| Rate for Payer: Adventist Health Commercial |
$1,556.80
|
| Rate for Payer: Cash Price |
$3,502.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,448.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,113.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,113.60
|
| Rate for Payer: Galaxy Health WC |
$6,616.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,670.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,942.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,592.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,868.16
|
| Rate for Payer: Multiplan Commercial |
$6,227.20
|
| Rate for Payer: Networks By Design Commercial |
$5,059.60
|
| Rate for Payer: Prime Health Services Commercial |
$6,616.40
|
|
|
HC MRI LOWER EXTREM W/ CON
|
Facility
|
OP
|
$4,462.00
|
|
|
Service Code
|
CPT 73719
|
| Hospital Charge Code |
908801403
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$448.71 |
| Max. Negotiated Rate |
$3,792.70 |
| Rate for Payer: Adventist Health Commercial |
$892.40
|
| Rate for Payer: Adventist Health Commercial |
$1,071.60
|
| 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 |
$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 |
$3,438.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,863.27
|
| Rate for Payer: Blue Shield of California Commercial |
$1,878.50
|
| Rate for Payer: Blue Shield of California Commercial |
$3,418.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,255.72
|
| Rate for Payer: Blue Shield of California Commercial |
$2,846.76
|
| Rate for Payer: Cash Price |
$2,411.10
|
| Rate for Payer: Cash Price |
$2,007.90
|
| Rate for Payer: Cash Price |
$2,411.10
|
| Rate for Payer: Cash Price |
$2,007.90
|
| Rate for Payer: Cigna of CA HMO |
$3,429.12
|
| Rate for Payer: Cigna of CA HMO |
$2,855.68
|
| Rate for Payer: Cigna of CA PPO |
$3,301.88
|
| Rate for Payer: Cigna of CA PPO |
$3,964.92
|
| 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 |
$3,750.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,123.40
|
| 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 |
$4,554.30
|
| Rate for Payer: Galaxy Health WC |
$3,792.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,677.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,214.80
|
| 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 |
$803.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$803.54
|
| 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 |
$2,833.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,402.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$908.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$908.77
|
| 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 |
$1,070.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,285.92
|
| 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 |
$4,286.40
|
| Rate for Payer: Multiplan Commercial |
$3,569.60
|
| Rate for Payer: Networks By Design Commercial |
$2,900.30
|
| Rate for Payer: Networks By Design Commercial |
$3,482.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,792.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,554.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,214.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,677.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,677.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,214.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,115.74
|
| Rate for Payer: United Healthcare All Other 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 LOWER EXTREM W/ CON
|
Facility
|
IP
|
$5,358.00
|
|
|
Service Code
|
CPT 73719
|
| Hospital Charge Code |
908801403
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,071.60 |
| Max. Negotiated Rate |
$4,554.30 |
| Rate for Payer: Adventist Health Commercial |
$1,071.60
|
| Rate for Payer: Cash Price |
$2,411.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,750.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,143.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,143.20
|
| Rate for Payer: Galaxy Health WC |
$4,554.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,214.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,402.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,161.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,285.92
|
| Rate for Payer: Multiplan Commercial |
$4,286.40
|
| Rate for Payer: Networks By Design Commercial |
$3,482.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,554.30
|
|
|
HC MRI LOWER EXTREM WO CONT
|
Facility
|
IP
|
$7,524.00
|
|
|
Service Code
|
CPT 73720
|
| Hospital Charge Code |
908801399
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,504.80 |
| Max. Negotiated Rate |
$6,395.40 |
| Rate for Payer: Adventist Health Commercial |
$1,504.80
|
| Rate for Payer: Cash Price |
$3,385.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,266.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,009.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,009.60
|
| Rate for Payer: Galaxy Health WC |
$6,395.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,514.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,777.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,439.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,805.76
|
| Rate for Payer: Multiplan Commercial |
$6,019.20
|
| Rate for Payer: Networks By Design Commercial |
$4,890.60
|
| Rate for Payer: Prime Health Services Commercial |
$6,395.40
|
|
|
HC MRI LOWER EXTREM WO CONT
|
Facility
|
OP
|
$5,012.00
|
|
|
Service Code
|
CPT 73720
|
| Hospital Charge Code |
908801399
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$448.71 |
| Max. Negotiated Rate |
$4,260.20 |
| Rate for Payer: Adventist Health Commercial |
$1,002.40
|
| Rate for Payer: Adventist Health Commercial |
$1,504.80
|
| 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 |
$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 |
$3,216.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,828.15
|
| Rate for Payer: Blue Shield of California Commercial |
$3,167.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,110.05
|
| Rate for Payer: Blue Shield of California Commercial |
$3,197.66
|
| Rate for Payer: Blue Shield of California Commercial |
$4,800.31
|
| Rate for Payer: Cash Price |
$2,255.40
|
| Rate for Payer: Cash Price |
$2,255.40
|
| Rate for Payer: Cash Price |
$3,385.80
|
| Rate for Payer: Cash Price |
$2,255.40
|
| Rate for Payer: Cash Price |
$3,385.80
|
| Rate for Payer: Cash Price |
$3,385.80
|
| Rate for Payer: Cigna of CA HMO |
$3,207.68
|
| Rate for Payer: Cigna of CA HMO |
$4,815.36
|
| Rate for Payer: Cigna of CA PPO |
$3,708.88
|
| Rate for Payer: Cigna of CA PPO |
$5,567.76
|
| 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 |
$5,266.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,508.40
|
| 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 |
$6,395.40
|
| Rate for Payer: Galaxy Health WC |
$4,260.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,007.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,514.40
|
| 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 |
$559.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$559.56
|
| 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 |
$4,777.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,182.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$632.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$632.83
|
| 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 |
$1,202.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,805.76
|
| 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 |
$4,009.60
|
| Rate for Payer: Multiplan Commercial |
$6,019.20
|
| Rate for Payer: Networks By Design Commercial |
$4,890.60
|
| Rate for Payer: Networks By Design Commercial |
$3,257.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,260.20
|
| Rate for Payer: Prime Health Services Commercial |
$6,395.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,514.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,007.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,007.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,514.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,367.12
|
| Rate for Payer: United Healthcare All Other 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 L-SPINE W & WO CONTRAST
|
Facility
|
OP
|
$5,667.00
|
|
|
Service Code
|
CPT 72158
|
| Hospital Charge Code |
908801124
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$448.71 |
| Max. Negotiated Rate |
$4,816.95 |
| Rate for Payer: Adventist Health Commercial |
$1,133.40
|
| Rate for Payer: Adventist Health Commercial |
$1,433.00
|
| 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 |
$4,597.78
|
| Rate for Payer: Blue Shield of California Commercial |
$3,016.47
|
| 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 |
$4,571.27
|
| Rate for Payer: Cash Price |
$2,550.15
|
| Rate for Payer: Cash Price |
$2,550.15
|
| Rate for Payer: Cash Price |
$3,224.25
|
| Rate for Payer: Cash Price |
$2,550.15
|
| Rate for Payer: Cash Price |
$3,224.25
|
| Rate for Payer: Cash Price |
$3,224.25
|
| Rate for Payer: Cigna of CA HMO |
$3,626.88
|
| Rate for Payer: Cigna of CA HMO |
$4,585.60
|
| Rate for Payer: Cigna of CA PPO |
$4,193.58
|
| Rate for Payer: Cigna of CA PPO |
$5,302.10
|
| 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 |
$5,015.50
|
| 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 |
$6,090.25
|
| 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 |
$4,299.00
|
| 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 |
$524.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$524.65
|
| 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 |
$4,549.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,598.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$593.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$593.35
|
| 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 |
$1,719.60
|
| 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 |
$5,732.00
|
| Rate for Payer: Networks By Design Commercial |
$4,657.25
|
| 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 |
$6,090.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,299.00
|
| 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 |
$4,299.00
|
| 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 L-SPINE W & WO CONTRAST
|
Facility
|
IP
|
$7,165.00
|
|
|
Service Code
|
CPT 72158
|
| Hospital Charge Code |
908801124
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,433.00 |
| Max. Negotiated Rate |
$6,090.25 |
| Rate for Payer: Adventist Health Commercial |
$1,433.00
|
| Rate for Payer: Cash Price |
$3,224.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,015.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,866.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,866.00
|
| Rate for Payer: Galaxy Health WC |
$6,090.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,299.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,549.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,227.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,719.60
|
| Rate for Payer: Multiplan Commercial |
$5,732.00
|
| Rate for Payer: Networks By Design Commercial |
$4,657.25
|
| Rate for Payer: Prime Health Services Commercial |
$6,090.25
|
|
|
HC MRI LUMBAR SPINE W CONTRAST
|
Facility
|
IP
|
$6,864.00
|
|
|
Service Code
|
CPT 72149
|
| Hospital Charge Code |
908801122
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,372.80 |
| Max. Negotiated Rate |
$5,834.40 |
| Rate for Payer: Adventist Health Commercial |
$1,372.80
|
| Rate for Payer: Cash Price |
$3,088.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,804.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,745.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,745.60
|
| Rate for Payer: Galaxy Health WC |
$5,834.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,118.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,358.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,049.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,647.36
|
| Rate for Payer: Multiplan Commercial |
$5,491.20
|
| Rate for Payer: Networks By Design Commercial |
$4,461.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,834.40
|
|
|
HC MRI LUMBAR SPINE W CONTRAST
|
Facility
|
OP
|
$5,150.00
|
|
|
Service Code
|
CPT 72149
|
| Hospital Charge Code |
908801122
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$446.09 |
| Max. Negotiated Rate |
$4,377.50 |
| Rate for Payer: Adventist Health Commercial |
$1,030.00
|
| Rate for Payer: Adventist Health Commercial |
$1,372.80
|
| 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 |
$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 |
$3,304.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,404.63
|
| Rate for Payer: Blue Shield of California Commercial |
$2,889.74
|
| Rate for Payer: Blue Shield of California Commercial |
$2,168.15
|
| Rate for Payer: Blue Shield of California Commercial |
$3,285.70
|
| Rate for Payer: Blue Shield of California Commercial |
$4,379.23
|
| Rate for Payer: Cash Price |
$2,317.50
|
| Rate for Payer: Cash Price |
$2,317.50
|
| Rate for Payer: Cash Price |
$3,088.80
|
| Rate for Payer: Cash Price |
$2,317.50
|
| Rate for Payer: Cash Price |
$3,088.80
|
| Rate for Payer: Cash Price |
$3,088.80
|
| Rate for Payer: Cigna of CA HMO |
$3,296.00
|
| Rate for Payer: Cigna of CA HMO |
$4,392.96
|
| Rate for Payer: Cigna of CA PPO |
$3,811.00
|
| Rate for Payer: Cigna of CA PPO |
$5,079.36
|
| 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 |
$4,804.80
|
| 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 |
$5,834.40
|
| 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 |
$4,118.40
|
| 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 |
$446.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$446.09
|
| 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 |
$4,358.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,270.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$504.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$504.51
|
| 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 |
$1,647.36
|
| 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 |
$4,120.00
|
| Rate for Payer: Multiplan Commercial |
$5,491.20
|
| Rate for Payer: Networks By Design Commercial |
$4,461.60
|
| Rate for Payer: Networks By Design Commercial |
$3,347.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,377.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,834.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,118.40
|
| Rate for Payer: 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 |
$4,118.40
|
| 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 LUMBAR SPINE WO CONTR
|
Facility
|
OP
|
$4,965.00
|
|
|
Service Code
|
CPT 72148
|
| Hospital Charge Code |
908801120
|
|
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 |
$1,225.80
|
| 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 |
$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 |
$3,186.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,932.98
|
| Rate for Payer: Blue Shield of California Commercial |
$2,580.31
|
| 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 |
$3,910.30
|
| Rate for Payer: Cash Price |
$2,234.25
|
| Rate for Payer: Cash Price |
$2,234.25
|
| Rate for Payer: Cash Price |
$2,758.05
|
| Rate for Payer: Cash Price |
$2,234.25
|
| Rate for Payer: Cash Price |
$2,758.05
|
| Rate for Payer: Cash Price |
$2,758.05
|
| Rate for Payer: Cigna of CA HMO |
$3,177.60
|
| Rate for Payer: Cigna of CA HMO |
$3,922.56
|
| Rate for Payer: Cigna of CA PPO |
$3,674.10
|
| Rate for Payer: Cigna of CA PPO |
$4,535.46
|
| 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 |
$4,290.30
|
| 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 |
$5,209.65
|
| 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 |
$3,677.40
|
| 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 |
$312.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$312.48
|
| 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 |
$3,891.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,152.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$353.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$353.40
|
| 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 |
$1,470.96
|
| 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 |
$3,972.00
|
| Rate for Payer: Multiplan Commercial |
$4,903.20
|
| Rate for Payer: Networks By Design Commercial |
$3,983.85
|
| 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 |
$5,209.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,677.40
|
| 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 |
$3,677.40
|
| 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 LUMBAR SPINE WO CONTR
|
Facility
|
IP
|
$6,129.00
|
|
|
Service Code
|
CPT 72148
|
| Hospital Charge Code |
908801120
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,225.80 |
| Max. Negotiated Rate |
$5,209.65 |
| Rate for Payer: Adventist Health Commercial |
$1,225.80
|
| Rate for Payer: Cash Price |
$2,758.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,290.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,451.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,451.60
|
| Rate for Payer: Galaxy Health WC |
$5,209.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,677.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,891.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,616.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,470.96
|
| Rate for Payer: Multiplan Commercial |
$4,903.20
|
| Rate for Payer: Networks By Design Commercial |
$3,983.85
|
| Rate for Payer: Prime Health Services Commercial |
$5,209.65
|
|
|
HC MRI ORBIT FACE/NECK W CON
|
Facility
|
OP
|
$5,017.00
|
|
|
Service Code
|
CPT 70542
|
| Hospital Charge Code |
908801081
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$444.93 |
| Max. Negotiated Rate |
$4,264.45 |
| Rate for Payer: Adventist Health Commercial |
$1,003.40
|
| Rate for Payer: Adventist Health Commercial |
$1,045.60
|
| 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 |
$3,219.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,354.81
|
| Rate for Payer: Blue Shield of California Commercial |
$2,200.99
|
| Rate for Payer: Blue Shield of California Commercial |
$2,112.16
|
| Rate for Payer: Blue Shield of California Commercial |
$3,200.85
|
| Rate for Payer: Blue Shield of California Commercial |
$3,335.46
|
| Rate for Payer: Cash Price |
$2,257.65
|
| Rate for Payer: Cash Price |
$2,257.65
|
| Rate for Payer: Cash Price |
$2,352.60
|
| Rate for Payer: Cash Price |
$2,257.65
|
| Rate for Payer: Cash Price |
$2,352.60
|
| Rate for Payer: Cash Price |
$2,352.60
|
| Rate for Payer: Cigna of CA HMO |
$3,210.88
|
| Rate for Payer: Cigna of CA HMO |
$3,345.92
|
| Rate for Payer: Cigna of CA PPO |
$3,712.58
|
| Rate for Payer: Cigna of CA PPO |
$3,868.72
|
| 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 |
$3,659.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,511.90
|
| 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 |
$4,443.80
|
| Rate for Payer: Galaxy Health WC |
$4,264.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,010.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,136.80
|
| 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 |
$444.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$444.93
|
| 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 |
$3,319.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,185.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$503.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$503.20
|
| 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 |
$1,204.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,254.72
|
| 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 |
$4,013.60
|
| Rate for Payer: Multiplan Commercial |
$4,182.40
|
| Rate for Payer: Networks By Design Commercial |
$3,398.20
|
| Rate for Payer: Networks By Design Commercial |
$3,261.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,264.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,443.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,136.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,010.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,010.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,136.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,115.74
|
| Rate for Payer: United Healthcare All Other 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 ORBIT FACE/NECK W CON
|
Facility
|
IP
|
$5,228.00
|
|
|
Service Code
|
CPT 70542
|
| Hospital Charge Code |
908801081
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,045.60 |
| Max. Negotiated Rate |
$4,443.80 |
| Rate for Payer: Adventist Health Commercial |
$1,045.60
|
| Rate for Payer: Cash Price |
$2,352.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,659.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,091.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,091.20
|
| Rate for Payer: Galaxy Health WC |
$4,443.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,136.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,319.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,084.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,254.72
|
| Rate for Payer: Multiplan Commercial |
$4,182.40
|
| Rate for Payer: Networks By Design Commercial |
$3,398.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,443.80
|
|
