|
HC MRI ORBIT FACE/NECK WO CON
|
Facility
|
OP
|
$4,397.00
|
|
|
Service Code
|
CPT 70540
|
| Hospital Charge Code |
908801080
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$306.88 |
| Max. Negotiated Rate |
$3,737.45 |
| Rate for Payer: Adventist Health Commercial |
$879.40
|
| Rate for Payer: Adventist Health Commercial |
$950.60
|
| 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 |
$2,821.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,050.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,001.01
|
| Rate for Payer: Blue Shield of California Commercial |
$1,851.14
|
| Rate for Payer: Blue Shield of California Commercial |
$2,805.29
|
| Rate for Payer: Blue Shield of California Commercial |
$3,032.41
|
| Rate for Payer: Cash Price |
$1,978.65
|
| Rate for Payer: Cash Price |
$1,978.65
|
| Rate for Payer: Cash Price |
$2,138.85
|
| Rate for Payer: Cash Price |
$1,978.65
|
| Rate for Payer: Cash Price |
$2,138.85
|
| Rate for Payer: Cash Price |
$2,138.85
|
| Rate for Payer: Cigna of CA HMO |
$2,814.08
|
| Rate for Payer: Cigna of CA HMO |
$3,041.92
|
| Rate for Payer: Cigna of CA PPO |
$3,253.78
|
| Rate for Payer: Cigna of CA PPO |
$3,517.22
|
| 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 |
$3,327.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,077.90
|
| 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 |
$4,040.05
|
| Rate for Payer: Galaxy Health WC |
$3,737.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,638.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,851.80
|
| 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 |
$374.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$374.59
|
| 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 |
$3,018.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,792.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$423.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$423.64
|
| 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 |
$1,055.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,140.72
|
| 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 |
$3,517.60
|
| Rate for Payer: Multiplan Commercial |
$3,802.40
|
| Rate for Payer: Networks By Design Commercial |
$3,089.45
|
| Rate for Payer: Networks By Design Commercial |
$2,858.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,737.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,040.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,851.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,638.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,638.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,851.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| Rate for Payer: United Healthcare All Other 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 ORBIT FACE/NECK WO CON
|
Facility
|
IP
|
$4,753.00
|
|
|
Service Code
|
CPT 70540
|
| Hospital Charge Code |
908801080
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$950.60 |
| Max. Negotiated Rate |
$4,040.05 |
| Rate for Payer: Adventist Health Commercial |
$950.60
|
| Rate for Payer: Cash Price |
$2,138.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,327.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,901.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,901.20
|
| Rate for Payer: Galaxy Health WC |
$4,040.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,851.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,018.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,804.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,140.72
|
| Rate for Payer: Multiplan Commercial |
$3,802.40
|
| Rate for Payer: Networks By Design Commercial |
$3,089.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,040.05
|
|
|
HC MRI ORBIT FACE/NECK W WO CON
|
Facility
|
OP
|
$6,714.00
|
|
|
Service Code
|
CPT 70543
|
| Hospital Charge Code |
908801082
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$448.71 |
| Max. Negotiated Rate |
$5,706.90 |
| Rate for Payer: Adventist Health Commercial |
$1,342.80
|
| Rate for Payer: Adventist Health Commercial |
$1,526.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,308.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,897.45
|
| Rate for Payer: Blue Shield of California Commercial |
$3,213.07
|
| Rate for Payer: Blue Shield of California Commercial |
$2,826.59
|
| Rate for Payer: Blue Shield of California Commercial |
$4,283.53
|
| Rate for Payer: Blue Shield of California Commercial |
$4,869.22
|
| Rate for Payer: Cash Price |
$3,021.30
|
| Rate for Payer: Cash Price |
$3,021.30
|
| Rate for Payer: Cash Price |
$3,434.40
|
| Rate for Payer: Cash Price |
$3,021.30
|
| Rate for Payer: Cash Price |
$3,434.40
|
| Rate for Payer: Cash Price |
$3,434.40
|
| Rate for Payer: Cigna of CA HMO |
$4,296.96
|
| Rate for Payer: Cigna of CA HMO |
$4,884.48
|
| Rate for Payer: Cigna of CA PPO |
$4,968.36
|
| Rate for Payer: Cigna of CA PPO |
$5,647.68
|
| 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 |
$5,342.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,699.80
|
| 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 |
$6,487.20
|
| Rate for Payer: Galaxy Health WC |
$5,706.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,028.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,579.20
|
| 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 |
$560.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$560.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,846.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,263.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$633.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$633.99
|
| 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 |
$1,611.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,831.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$565.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$565.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$601.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$601.27
|
| Rate for Payer: Multiplan Commercial |
$5,371.20
|
| Rate for Payer: Multiplan Commercial |
$6,105.60
|
| Rate for Payer: Networks By Design Commercial |
$4,960.80
|
| Rate for Payer: Networks By Design Commercial |
$4,364.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,706.90
|
| Rate for Payer: Prime Health Services Commercial |
$6,487.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,579.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,028.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,028.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,579.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,367.12
|
| Rate for Payer: United Healthcare All Other 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 ORBIT FACE/NECK W WO CON
|
Facility
|
IP
|
$7,632.00
|
|
|
Service Code
|
CPT 70543
|
| Hospital Charge Code |
908801082
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,526.40 |
| Max. Negotiated Rate |
$6,487.20 |
| Rate for Payer: Adventist Health Commercial |
$1,526.40
|
| Rate for Payer: Cash Price |
$3,434.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,342.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,052.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,052.80
|
| Rate for Payer: Galaxy Health WC |
$6,487.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,579.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,846.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,502.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,831.68
|
| Rate for Payer: Multiplan Commercial |
$6,105.60
|
| Rate for Payer: Networks By Design Commercial |
$4,960.80
|
| Rate for Payer: Prime Health Services Commercial |
$6,487.20
|
|
|
HC MRI PELVIS W/CONTRAST
|
Facility
|
IP
|
$7,037.00
|
|
|
Service Code
|
CPT 72196
|
| Hospital Charge Code |
908801350
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,407.40 |
| Max. Negotiated Rate |
$5,981.45 |
| Rate for Payer: Adventist Health Commercial |
$1,407.40
|
| Rate for Payer: Cash Price |
$3,166.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,925.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,814.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,814.80
|
| Rate for Payer: Galaxy Health WC |
$5,981.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,222.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,468.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,151.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,688.88
|
| Rate for Payer: Multiplan Commercial |
$5,629.60
|
| Rate for Payer: Networks By Design Commercial |
$4,574.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,981.45
|
|
|
HC MRI PELVIS W/CONTRAST
|
Facility
|
OP
|
$5,150.00
|
|
|
Service Code
|
CPT 72196
|
| Hospital Charge Code |
908801350
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$445.25 |
| Max. Negotiated Rate |
$4,377.50 |
| Rate for Payer: Adventist Health Commercial |
$1,030.00
|
| Rate for Payer: Adventist Health Commercial |
$1,407.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,304.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,515.64
|
| Rate for Payer: Blue Shield of California Commercial |
$2,962.58
|
| 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 |
$4,489.61
|
| Rate for Payer: Cash Price |
$2,317.50
|
| Rate for Payer: Cash Price |
$2,317.50
|
| Rate for Payer: Cash Price |
$3,166.65
|
| Rate for Payer: Cash Price |
$2,317.50
|
| Rate for Payer: Cash Price |
$3,166.65
|
| Rate for Payer: Cash Price |
$3,166.65
|
| Rate for Payer: Cigna of CA HMO |
$3,296.00
|
| Rate for Payer: Cigna of CA HMO |
$4,503.68
|
| Rate for Payer: Cigna of CA PPO |
$3,811.00
|
| Rate for Payer: Cigna of CA PPO |
$5,207.38
|
| 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 |
$4,925.90
|
| 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 |
$5,981.45
|
| 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 |
$4,222.20
|
| 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 |
$445.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$445.25
|
| 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 |
$4,468.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,270.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$503.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$503.56
|
| 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 |
$1,688.88
|
| 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 |
$5,629.60
|
| Rate for Payer: Networks By Design Commercial |
$4,574.05
|
| 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 |
$5,981.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,222.20
|
| 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 |
$4,222.20
|
| 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 PELVIS W/O CONTRAST
|
Facility
|
OP
|
$4,687.00
|
|
|
Service Code
|
CPT 72195
|
| Hospital Charge Code |
908801351
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$306.88 |
| Max. Negotiated Rate |
$3,983.95 |
| Rate for Payer: Adventist Health Commercial |
$937.40
|
| Rate for Payer: Adventist Health Commercial |
$1,237.00
|
| 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 |
$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 |
$3,007.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,968.91
|
| Rate for Payer: Blue Shield of California Commercial |
$2,603.89
|
| Rate for Payer: Blue Shield of California Commercial |
$1,973.23
|
| Rate for Payer: Blue Shield of California Commercial |
$2,990.31
|
| Rate for Payer: Blue Shield of California Commercial |
$3,946.03
|
| Rate for Payer: Cash Price |
$2,109.15
|
| Rate for Payer: Cash Price |
$2,109.15
|
| Rate for Payer: Cash Price |
$2,783.25
|
| Rate for Payer: Cash Price |
$2,109.15
|
| Rate for Payer: Cash Price |
$2,783.25
|
| Rate for Payer: Cash Price |
$2,783.25
|
| Rate for Payer: Cigna of CA HMO |
$2,999.68
|
| Rate for Payer: Cigna of CA HMO |
$3,958.40
|
| Rate for Payer: Cigna of CA PPO |
$3,468.38
|
| Rate for Payer: Cigna of CA PPO |
$4,576.90
|
| 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 |
$4,329.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,280.90
|
| 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 |
$5,257.25
|
| Rate for Payer: Galaxy Health WC |
$3,983.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,812.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,711.00
|
| 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 |
$380.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$380.25
|
| 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 |
$3,927.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,976.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$430.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$430.05
|
| 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 |
$1,124.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,484.40
|
| 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 |
$3,749.60
|
| Rate for Payer: Multiplan Commercial |
$4,948.00
|
| Rate for Payer: Networks By Design Commercial |
$4,020.25
|
| Rate for Payer: Networks By Design Commercial |
$3,046.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,983.95
|
| Rate for Payer: Prime Health Services Commercial |
$5,257.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,711.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,812.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,812.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,711.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| Rate for Payer: United Healthcare All Other 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 PELVIS W/O CONTRAST
|
Facility
|
IP
|
$6,185.00
|
|
|
Service Code
|
CPT 72195
|
| Hospital Charge Code |
908801351
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,237.00 |
| Max. Negotiated Rate |
$5,257.25 |
| Rate for Payer: Adventist Health Commercial |
$1,237.00
|
| Rate for Payer: Cash Price |
$2,783.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,329.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,474.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,474.00
|
| Rate for Payer: Galaxy Health WC |
$5,257.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,711.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,927.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,649.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,484.40
|
| Rate for Payer: Multiplan Commercial |
$4,948.00
|
| Rate for Payer: Networks By Design Commercial |
$4,020.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,257.25
|
|
|
HC MRI PELVIS W & WO CONTRAST
|
Facility
|
OP
|
$6,180.00
|
|
|
Service Code
|
CPT 72197
|
| Hospital Charge Code |
908801352
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$448.71 |
| Max. Negotiated Rate |
$5,253.00 |
| Rate for Payer: Adventist Health Commercial |
$1,236.00
|
| Rate for Payer: Adventist Health Commercial |
$1,562.20
|
| 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 |
$3,965.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,012.32
|
| Rate for Payer: Blue Shield of California Commercial |
$3,288.43
|
| Rate for Payer: Blue Shield of California Commercial |
$2,601.78
|
| Rate for Payer: Blue Shield of California Commercial |
$3,942.84
|
| Rate for Payer: Blue Shield of California Commercial |
$4,983.42
|
| Rate for Payer: Cash Price |
$2,781.00
|
| Rate for Payer: Cash Price |
$2,781.00
|
| Rate for Payer: Cash Price |
$3,514.95
|
| Rate for Payer: Cash Price |
$2,781.00
|
| Rate for Payer: Cash Price |
$3,514.95
|
| Rate for Payer: Cash Price |
$3,514.95
|
| Rate for Payer: Cigna of CA HMO |
$3,955.20
|
| Rate for Payer: Cigna of CA HMO |
$4,999.04
|
| Rate for Payer: Cigna of CA PPO |
$4,573.20
|
| Rate for Payer: Cigna of CA PPO |
$5,780.14
|
| 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 |
$5,467.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,326.00
|
| 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 |
$6,639.35
|
| Rate for Payer: Galaxy Health WC |
$5,253.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,708.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,686.60
|
| 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 |
$559.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$559.29
|
| 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 |
$4,959.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,924.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$632.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$632.53
|
| 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 |
$1,483.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,874.64
|
| 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 |
$4,944.00
|
| Rate for Payer: Multiplan Commercial |
$6,248.80
|
| Rate for Payer: Networks By Design Commercial |
$5,077.15
|
| Rate for Payer: Networks By Design Commercial |
$4,017.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,253.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,639.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,686.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,708.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,708.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,686.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,367.12
|
| Rate for Payer: United Healthcare All Other 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 PELVIS W & WO CONTRAST
|
Facility
|
IP
|
$7,811.00
|
|
|
Service Code
|
CPT 72197
|
| Hospital Charge Code |
908801352
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,562.20 |
| Max. Negotiated Rate |
$6,639.35 |
| Rate for Payer: Adventist Health Commercial |
$1,562.20
|
| Rate for Payer: Cash Price |
$3,514.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,467.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,124.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,124.40
|
| Rate for Payer: Galaxy Health WC |
$6,639.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,686.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,959.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,608.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,874.64
|
| Rate for Payer: Multiplan Commercial |
$6,248.80
|
| Rate for Payer: Networks By Design Commercial |
$5,077.15
|
| Rate for Payer: Prime Health Services Commercial |
$6,639.35
|
|
|
HC MRI PROCEDURE
|
Facility
|
IP
|
$3,801.00
|
|
|
Service Code
|
CPT 76498
|
| Hospital Charge Code |
908801008
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$760.20 |
| Max. Negotiated Rate |
$3,230.85 |
| Rate for Payer: Adventist Health Commercial |
$760.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,491.94
|
| Rate for Payer: Cash Price |
$1,710.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,660.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,520.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,520.40
|
| Rate for Payer: Galaxy Health WC |
$3,230.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,280.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,413.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,242.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$912.24
|
| Rate for Payer: Multiplan Commercial |
$3,040.80
|
| Rate for Payer: Networks By Design Commercial |
$2,470.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,230.85
|
|
|
HC MRI PROCEDURE
|
Facility
|
OP
|
$3,801.00
|
|
|
Service Code
|
CPT 76498
|
| Hospital Charge Code |
908801008
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$111.93 |
| Max. Negotiated Rate |
$3,230.85 |
| Rate for Payer: Adventist Health Commercial |
$760.20
|
| Rate for Payer: Adventist Health Commercial |
$632.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,491.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,074.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,439.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,030.34
|
| Rate for Payer: Blue Shield of California Commercial |
$2,018.63
|
| Rate for Payer: Blue Shield of California Commercial |
$1,332.04
|
| Rate for Payer: Blue Shield of California Commercial |
$2,425.04
|
| Rate for Payer: Blue Shield of California Commercial |
$1,600.22
|
| Rate for Payer: Cash Price |
$1,710.45
|
| Rate for Payer: Cash Price |
$1,423.80
|
| Rate for Payer: Cash Price |
$1,710.45
|
| Rate for Payer: Cash Price |
$1,423.80
|
| Rate for Payer: Cigna of CA HMO |
$2,024.96
|
| Rate for Payer: Cigna of CA HMO |
$2,432.64
|
| Rate for Payer: Cigna of CA PPO |
$2,812.74
|
| Rate for Payer: Cigna of CA PPO |
$2,341.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,660.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,214.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$2,689.40
|
| Rate for Payer: Galaxy Health WC |
$3,230.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,898.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,280.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,413.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,009.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$759.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$912.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$141.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$141.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$3,040.80
|
| Rate for Payer: Multiplan Commercial |
$2,531.20
|
| Rate for Payer: Networks By Design Commercial |
$2,056.60
|
| Rate for Payer: Networks By Design Commercial |
$2,470.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,689.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,230.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,280.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,898.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,280.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,898.40
|
| 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 |
$111.93
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC MRI SPECTROSCOPY
|
Facility
|
OP
|
$4,177.00
|
|
|
Service Code
|
CPT 76390
|
| Hospital Charge Code |
908801255
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$111.93 |
| Max. Negotiated Rate |
$3,550.45 |
| Rate for Payer: Adventist Health Commercial |
$835.40
|
| Rate for Payer: Adventist Health Commercial |
$1,003.40
|
| 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 |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,680.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,219.41
|
| Rate for Payer: Blue Shield of California Commercial |
$1,758.52
|
| Rate for Payer: Blue Shield of California Commercial |
$2,664.93
|
| Rate for Payer: Blue Shield of California Commercial |
$3,200.85
|
| Rate for Payer: Blue Shield of California Commercial |
$2,112.16
|
| Rate for Payer: Cash Price |
$1,879.65
|
| Rate for Payer: Cash Price |
$2,257.65
|
| Rate for Payer: Cash Price |
$1,879.65
|
| Rate for Payer: Cash Price |
$2,257.65
|
| Rate for Payer: Cigna of CA HMO |
$3,210.88
|
| Rate for Payer: Cigna of CA HMO |
$2,673.28
|
| Rate for Payer: Cigna of CA PPO |
$3,712.58
|
| Rate for Payer: Cigna of CA PPO |
$3,090.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,511.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,923.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$4,264.45
|
| Rate for Payer: Galaxy Health WC |
$3,550.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,506.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,010.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,185.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,652.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,516.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,821.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,002.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,204.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$141.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$141.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$4,013.60
|
| Rate for Payer: Multiplan Commercial |
$3,341.60
|
| Rate for Payer: Networks By Design Commercial |
$2,715.05
|
| Rate for Payer: Networks By Design Commercial |
$3,261.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,550.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,264.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,010.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,506.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,010.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,506.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,065.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,065.68
|
| Rate for Payer: United Healthcare All Other HMO |
$1,065.68
|
| Rate for Payer: United Healthcare All Other HMO |
$1,065.68
|
| Rate for Payer: United Healthcare HMO Rider |
$1,065.68
|
| Rate for Payer: United Healthcare HMO Rider |
$1,065.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,065.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,065.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.93
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC MRI SPECTROSCOPY
|
Facility
|
IP
|
$5,017.00
|
|
|
Service Code
|
CPT 76390
|
| Hospital Charge Code |
908801255
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,003.40 |
| Max. Negotiated Rate |
$4,264.45 |
| Rate for Payer: Adventist Health Commercial |
$1,003.40
|
| Rate for Payer: Cash Price |
$2,257.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,511.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,006.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,006.80
|
| Rate for Payer: Galaxy Health WC |
$4,264.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,010.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,185.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,960.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,204.08
|
| Rate for Payer: Multiplan Commercial |
$4,013.60
|
| Rate for Payer: Networks By Design Commercial |
$3,261.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,264.45
|
|
|
HC MRI THORACIC SPINE WITH CONTRA
|
Facility
|
IP
|
$6,559.00
|
|
|
Service Code
|
CPT 72147
|
| Hospital Charge Code |
908801112
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,311.80 |
| Max. Negotiated Rate |
$5,575.15 |
| Rate for Payer: Adventist Health Commercial |
$1,311.80
|
| Rate for Payer: Cash Price |
$2,951.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,591.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,623.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,623.60
|
| Rate for Payer: Galaxy Health WC |
$5,575.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,935.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,164.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,869.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,574.16
|
| Rate for Payer: Multiplan Commercial |
$5,247.20
|
| Rate for Payer: Networks By Design Commercial |
$4,263.35
|
| Rate for Payer: Prime Health Services Commercial |
$5,575.15
|
|
|
HC MRI THORACIC SPINE WITH CONTRA
|
Facility
|
OP
|
$5,150.00
|
|
|
Service Code
|
CPT 72147
|
| Hospital Charge Code |
908801112
|
|
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 |
$1,311.80
|
| 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 |
$4,208.91
|
| Rate for Payer: Blue Shield of California Commercial |
$2,761.34
|
| 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 |
$4,184.64
|
| Rate for Payer: Cash Price |
$2,317.50
|
| Rate for Payer: Cash Price |
$2,317.50
|
| Rate for Payer: Cash Price |
$2,951.55
|
| Rate for Payer: Cash Price |
$2,317.50
|
| Rate for Payer: Cash Price |
$2,951.55
|
| Rate for Payer: Cash Price |
$2,951.55
|
| Rate for Payer: Cigna of CA HMO |
$3,296.00
|
| Rate for Payer: Cigna of CA HMO |
$4,197.76
|
| Rate for Payer: Cigna of CA PPO |
$3,811.00
|
| Rate for Payer: Cigna of CA PPO |
$4,853.66
|
| 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 |
$4,591.30
|
| 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 |
$5,575.15
|
| 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 |
$3,935.40
|
| 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 |
$449.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$449.80
|
| 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 |
$4,164.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,270.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$508.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$508.71
|
| 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 |
$1,574.16
|
| 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 |
$4,120.00
|
| Rate for Payer: Multiplan Commercial |
$5,247.20
|
| Rate for Payer: Networks By Design Commercial |
$4,263.35
|
| 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 |
$5,575.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,935.40
|
| 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 |
$3,935.40
|
| 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 THORACIC SPINE WO CON
|
Facility
|
IP
|
$5,964.00
|
|
|
Service Code
|
CPT 72146
|
| Hospital Charge Code |
908801110
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,192.80 |
| Max. Negotiated Rate |
$5,069.40 |
| Rate for Payer: Adventist Health Commercial |
$1,192.80
|
| Rate for Payer: Cash Price |
$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 THORACIC SPINE WO CON
|
Facility
|
OP
|
$4,965.00
|
|
|
Service Code
|
CPT 72146
|
| Hospital Charge Code |
908801110
|
|
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 |
$1,192.80
|
| 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 |
$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 |
$3,827.10
|
| 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 |
$3,805.03
|
| Rate for Payer: Blue Shield of California Commercial |
$2,510.84
|
| Rate for Payer: Blue Shield of California Commercial |
$3,167.67
|
| 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 |
$2,234.25
|
| Rate for Payer: Cigna of CA HMO |
$3,816.96
|
| 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 |
$4,413.36
|
| 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 |
$4,174.80
|
| 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 |
$5,069.40
|
| 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 |
$503.28
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$311.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$311.39
|
| 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 |
$3,787.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$352.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$352.17
|
| 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 |
$1,431.36
|
| 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 |
$4,771.20
|
| 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 |
$3,876.60
|
| 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 |
$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 T-SPINE W & WO CONTRAST
|
Facility
|
IP
|
$7,165.00
|
|
|
Service Code
|
CPT 72157
|
| Hospital Charge Code |
908801114
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,433.00 |
| Max. Negotiated Rate |
$6,090.25 |
| Rate for Payer: Adventist Health Commercial |
$1,433.00
|
| Rate for Payer: Cash Price |
$3,224.25
|
| 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 T-SPINE W & WO CONTRAST
|
Facility
|
OP
|
$5,667.00
|
|
|
Service Code
|
CPT 72157
|
| Hospital Charge Code |
908801114
|
|
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 |
$2,328.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,328.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,597.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,636.51
|
| Rate for Payer: Blue Shield of California Commercial |
$2,385.81
|
| Rate for Payer: Blue Shield of California Commercial |
$4,571.27
|
| Rate for Payer: Blue Shield of California Commercial |
$3,016.47
|
| Rate for Payer: Blue Shield of California Commercial |
$3,615.55
|
| 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 |
$2,550.15
|
| Rate for Payer: Cigna of CA HMO |
$4,585.60
|
| Rate for Payer: Cigna of CA HMO |
$3,626.88
|
| 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 |
$526.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$526.81
|
| 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 |
$3,598.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,549.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$595.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$595.80
|
| 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 |
$5,732.00
|
| Rate for Payer: Multiplan Commercial |
$4,533.60
|
| Rate for Payer: Networks By Design Commercial |
$3,683.55
|
| Rate for Payer: Networks By Design Commercial |
$4,657.25
|
| 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 UPPER EXT JNT W & WO CONT
|
Facility
|
IP
|
$7,522.00
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
908801435
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,504.40 |
| Max. Negotiated Rate |
$6,393.70 |
| Rate for Payer: Adventist Health Commercial |
$1,504.40
|
| Rate for Payer: Cash Price |
$3,384.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,265.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,008.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,008.80
|
| Rate for Payer: Galaxy Health WC |
$6,393.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,513.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,776.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,437.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,805.28
|
| Rate for Payer: Multiplan Commercial |
$6,017.60
|
| Rate for Payer: Networks By Design Commercial |
$4,889.30
|
| Rate for Payer: Prime Health Services Commercial |
$6,393.70
|
|
|
HC MRI UPPER EXT JNT W & WO CONT
|
Facility
|
OP
|
$5,612.00
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
908801435
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$448.71 |
| Max. Negotiated Rate |
$4,770.20 |
| Rate for Payer: Adventist Health Commercial |
$1,122.40
|
| Rate for Payer: Adventist Health Commercial |
$1,504.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,601.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,826.87
|
| Rate for Payer: Blue Shield of California Commercial |
$3,166.76
|
| Rate for Payer: Blue Shield of California Commercial |
$2,362.65
|
| Rate for Payer: Blue Shield of California Commercial |
$3,580.46
|
| Rate for Payer: Blue Shield of California Commercial |
$4,799.04
|
| Rate for Payer: Cash Price |
$2,525.40
|
| Rate for Payer: Cash Price |
$2,525.40
|
| Rate for Payer: Cash Price |
$3,384.90
|
| Rate for Payer: Cash Price |
$2,525.40
|
| Rate for Payer: Cash Price |
$3,384.90
|
| Rate for Payer: Cash Price |
$3,384.90
|
| Rate for Payer: Cigna of CA HMO |
$3,591.68
|
| Rate for Payer: Cigna of CA HMO |
$4,814.08
|
| Rate for Payer: Cigna of CA PPO |
$4,152.88
|
| Rate for Payer: Cigna of CA PPO |
$5,566.28
|
| 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 |
$5,265.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,928.40
|
| 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 |
$6,393.70
|
| Rate for Payer: Galaxy Health WC |
$4,770.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,367.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,513.20
|
| 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 |
$648.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$648.70
|
| 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 |
$4,776.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,563.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$733.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$733.65
|
| 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 |
$1,346.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,805.28
|
| 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 |
$4,489.60
|
| Rate for Payer: Multiplan Commercial |
$6,017.60
|
| Rate for Payer: Networks By Design Commercial |
$4,889.30
|
| Rate for Payer: Networks By Design Commercial |
$3,647.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,770.20
|
| Rate for Payer: Prime Health Services Commercial |
$6,393.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,513.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,367.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,367.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,513.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,367.12
|
| Rate for Payer: United Healthcare All Other 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 UPPER EXTREM JOINT W/CONT
|
Facility
|
OP
|
$3,846.00
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
908801433
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$524.76 |
| Max. Negotiated Rate |
$3,443.00 |
| Rate for Payer: Adventist Health Commercial |
$769.20
|
| 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 |
$2,467.98
|
| 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 |
$1,619.17
|
| Rate for Payer: Blue Shield of California Commercial |
$2,453.75
|
| Rate for Payer: Blue Shield of California Commercial |
$3,241.68
|
| Rate for Payer: Cash Price |
$1,730.70
|
| Rate for Payer: Cash Price |
$1,730.70
|
| Rate for Payer: Cash Price |
$2,286.45
|
| Rate for Payer: Cash Price |
$1,730.70
|
| Rate for Payer: Cash Price |
$2,286.45
|
| Rate for Payer: Cash Price |
$2,286.45
|
| Rate for Payer: Cigna of CA HMO |
$2,461.44
|
| Rate for Payer: Cigna of CA HMO |
$3,251.84
|
| Rate for Payer: Cigna of CA PPO |
$2,846.04
|
| 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 |
$2,692.20
|
| 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 |
$3,269.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,307.60
|
| 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 |
$524.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$524.76
|
| 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 |
$2,442.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$593.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$593.48
|
| 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 |
$923.04
|
| 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 |
$3,076.80
|
| 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 |
$2,499.90
|
| Rate for Payer: Prime Health Services Commercial |
$3,269.10
|
| 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 |
$2,307.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,307.60
|
| 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 UPPER EXTREM JOINT W/CONT
|
Facility
|
IP
|
$5,081.00
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
908801433
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,016.20 |
| Max. Negotiated Rate |
$4,318.85 |
| Rate for Payer: Adventist Health Commercial |
$1,016.20
|
| Rate for Payer: Cash Price |
$2,286.45
|
| 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 UPPER EXTREM JOINT WO CONT
|
Facility
|
OP
|
$3,431.00
|
|
|
Service Code
|
CPT 73221
|
| Hospital Charge Code |
908801431
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$306.88 |
| Max. Negotiated Rate |
$3,443.00 |
| Rate for Payer: Adventist Health Commercial |
$686.20
|
| Rate for Payer: Adventist Health Commercial |
$977.60
|
| 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 |
$2,201.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,136.63
|
| Rate for Payer: Blue Shield of California Commercial |
$2,057.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1,444.45
|
| Rate for Payer: Blue Shield of California Commercial |
$2,188.98
|
| Rate for Payer: Blue Shield of California Commercial |
$3,118.54
|
| Rate for Payer: Cash Price |
$1,543.95
|
| Rate for Payer: Cash Price |
$1,543.95
|
| Rate for Payer: Cash Price |
$2,199.60
|
| Rate for Payer: Cash Price |
$1,543.95
|
| Rate for Payer: Cash Price |
$2,199.60
|
| Rate for Payer: Cash Price |
$2,199.60
|
| Rate for Payer: Cigna of CA HMO |
$2,195.84
|
| Rate for Payer: Cigna of CA HMO |
$3,128.32
|
| Rate for Payer: Cigna of CA PPO |
$2,538.94
|
| Rate for Payer: Cigna of CA PPO |
$3,617.12
|
| 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 |
$3,421.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,401.70
|
| 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 |
$4,154.80
|
| Rate for Payer: Galaxy Health WC |
$2,916.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,058.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,932.80
|
| 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 |
$331.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$331.40
|
| 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 |
$3,103.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,178.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$374.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$374.79
|
| 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 |
$823.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,173.12
|
| 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 |
$2,744.80
|
| Rate for Payer: Multiplan Commercial |
$3,910.40
|
| Rate for Payer: Networks By Design Commercial |
$3,177.20
|
| Rate for Payer: Networks By Design Commercial |
$2,230.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,916.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,154.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,932.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,058.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,058.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,932.80
|
| 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
|
|
