|
HC MRI BRAIN WITH CONTRAST
|
Facility
|
IP
|
$11,689.00
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
908801013
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$2,337.80 |
| Max. Negotiated Rate |
$10,520.10 |
| Rate for Payer: Adventist Health Commercial |
$2,337.80
|
| Rate for Payer: Cash Price |
$5,260.05
|
| Rate for Payer: Central Health Plan Commercial |
$9,351.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,182.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,675.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,675.60
|
| Rate for Payer: Galaxy Health WC |
$9,935.65
|
| Rate for Payer: Global Benefits Group Commercial |
$7,013.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,520.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,422.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,896.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,337.80
|
| Rate for Payer: Multiplan Commercial |
$8,766.75
|
| Rate for Payer: Networks By Design Commercial |
$7,597.85
|
| Rate for Payer: Prime Health Services Commercial |
$9,935.65
|
|
|
HC MRI BRAIN WITH CONTRAST
|
Facility
|
OP
|
$11,689.00
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
908801013
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$448.71 |
| Max. Negotiated Rate |
$10,520.10 |
| Rate for Payer: Adventist Health Commercial |
$2,337.80
|
| Rate for Payer: Adventist Health Commercial |
$1,084.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$448.71
|
| Rate for Payer: Adventist Health Medi-Cal |
$448.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,055.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,055.46
|
| 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 Exchange |
$2,759.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,759.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,799.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,153.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,415.23
|
| Rate for Payer: Blue Shield of California Commercial |
$7,364.07
|
| Rate for Payer: Blue Shield of California EPN |
$2,152.14
|
| Rate for Payer: Blue Shield of California EPN |
$4,640.53
|
| Rate for Payer: Cash Price |
$5,260.05
|
| Rate for Payer: Cash Price |
$2,439.45
|
| Rate for Payer: Cash Price |
$5,260.05
|
| Rate for Payer: Cash Price |
$2,439.45
|
| Rate for Payer: Central Health Plan Commercial |
$9,351.20
|
| Rate for Payer: Central Health Plan Commercial |
$4,336.80
|
| Rate for Payer: Cigna of CA HMO |
$7,480.96
|
| Rate for Payer: Cigna of CA HMO |
$3,469.44
|
| Rate for Payer: Cigna of CA PPO |
$4,011.54
|
| Rate for Payer: Cigna of CA PPO |
$8,649.86
|
| 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 |
$8,182.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,794.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.37
|
| Rate for Payer: EPIC Health Plan Senior |
$493.58
|
| Rate for Payer: EPIC Health Plan Senior |
$493.58
|
| Rate for Payer: Galaxy Health WC |
$4,607.85
|
| Rate for Payer: Galaxy Health WC |
$9,935.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,252.60
|
| Rate for Payer: Global Benefits Group Commercial |
$7,013.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,878.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,520.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$735.88
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$735.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$454.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$454.48
|
| 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 |
$7,422.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,442.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$502.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$502.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,337.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,084.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$601.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$601.27
|
| Rate for Payer: Multiplan Commercial |
$8,766.75
|
| Rate for Payer: Multiplan Commercial |
$4,065.75
|
| Rate for Payer: Networks By Design Commercial |
$7,597.85
|
| Rate for Payer: Networks By Design Commercial |
$3,523.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$448.71
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$448.71
|
| Rate for Payer: Prime Health Services Commercial |
$9,935.65
|
| Rate for Payer: Prime Health Services Commercial |
$4,607.85
|
| Rate for Payer: Prime Health Services Medicare |
$475.63
|
| Rate for Payer: Prime Health Services Medicare |
$475.63
|
| Rate for Payer: Riverside University Health System MISP |
$493.58
|
| Rate for Payer: Riverside University Health System MISP |
$493.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,013.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,252.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,013.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,252.60
|
| 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 |
$448.71
|
| Rate for Payer: Upland Medical Group Pediatric |
$448.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
|
|
HC MRI BRAIN WO CONTRAST
|
Facility
|
IP
|
$11,051.00
|
|
|
Service Code
|
CPT 70551
|
| Hospital Charge Code |
908801010
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$2,210.20 |
| Max. Negotiated Rate |
$9,945.90 |
| Rate for Payer: Adventist Health Commercial |
$2,210.20
|
| Rate for Payer: Cash Price |
$4,972.95
|
| Rate for Payer: Central Health Plan Commercial |
$8,840.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,735.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,420.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,420.40
|
| Rate for Payer: Galaxy Health WC |
$9,393.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6,630.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,945.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,017.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,520.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,210.20
|
| Rate for Payer: Multiplan Commercial |
$8,288.25
|
| Rate for Payer: Networks By Design Commercial |
$7,183.15
|
| Rate for Payer: Prime Health Services Commercial |
$9,393.35
|
|
|
HC MRI BRAIN WO CONTRAST
|
Facility
|
OP
|
$11,051.00
|
|
|
Service Code
|
CPT 70551
|
| Hospital Charge Code |
908801010
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$306.88 |
| Max. Negotiated Rate |
$9,945.90 |
| Rate for Payer: Adventist Health Commercial |
$2,210.20
|
| Rate for Payer: Adventist Health Commercial |
$1,025.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$306.88
|
| Rate for Payer: Adventist Health Medi-Cal |
$306.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| 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 Exchange |
$2,303.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,303.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,428.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,981.79
|
| Rate for Payer: Blue Shield of California Commercial |
$3,229.38
|
| Rate for Payer: Blue Shield of California Commercial |
$6,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$4,387.25
|
| Rate for Payer: Blue Shield of California EPN |
$2,035.02
|
| Rate for Payer: Cash Price |
$4,972.95
|
| Rate for Payer: Cash Price |
$4,972.95
|
| Rate for Payer: Cash Price |
$4,972.95
|
| Rate for Payer: Cash Price |
$2,306.70
|
| Rate for Payer: Cash Price |
$2,306.70
|
| Rate for Payer: Cash Price |
$2,306.70
|
| Rate for Payer: Central Health Plan Commercial |
$4,100.80
|
| Rate for Payer: Central Health Plan Commercial |
$8,840.80
|
| Rate for Payer: Cigna of CA HMO |
$3,280.64
|
| Rate for Payer: Cigna of CA HMO |
$7,072.64
|
| Rate for Payer: Cigna of CA PPO |
$3,793.24
|
| Rate for Payer: Cigna of CA PPO |
$8,177.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,588.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,735.70
|
| 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 |
$9,393.35
|
| Rate for Payer: Galaxy Health WC |
$4,357.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,075.60
|
| Rate for Payer: Global Benefits Group Commercial |
$6,630.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,613.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,945.90
|
| 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 |
$327.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$327.08
|
| 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 |
$3,255.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,017.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$361.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$361.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,210.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,025.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$3,844.50
|
| Rate for Payer: Multiplan Commercial |
$8,288.25
|
| Rate for Payer: Networks By Design Commercial |
$7,183.15
|
| Rate for Payer: Networks By Design Commercial |
$3,331.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$306.88
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$306.88
|
| Rate for Payer: Prime Health Services Commercial |
$9,393.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,357.10
|
| Rate for Payer: Prime Health Services Medicare |
$325.29
|
| Rate for Payer: Prime Health Services Medicare |
$325.29
|
| Rate for Payer: Riverside University Health System MISP |
$337.57
|
| Rate for Payer: Riverside University Health System MISP |
$337.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,630.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,075.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,630.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,075.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| Rate for Payer: United Healthcare All Other HMO |
$866.34
|
| Rate for Payer: United Healthcare All Other HMO |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$306.88
|
| Rate for Payer: Upland Medical Group Pediatric |
$306.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC MRI BRAIN W WO CONTRAST
|
Facility
|
OP
|
$13,075.00
|
|
|
Service Code
|
CPT 70553
|
| Hospital Charge Code |
908801014
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$448.71 |
| Max. Negotiated Rate |
$11,767.50 |
| Rate for Payer: Adventist Health Commercial |
$2,615.00
|
| Rate for Payer: Adventist Health Commercial |
$1,267.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$448.71
|
| Rate for Payer: Adventist Health Medi-Cal |
$448.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| 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 Exchange |
$4,537.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,537.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,605.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,686.81
|
| Rate for Payer: Blue Shield of California Commercial |
$3,992.94
|
| Rate for Payer: Blue Shield of California Commercial |
$8,237.25
|
| Rate for Payer: Blue Shield of California EPN |
$5,190.77
|
| Rate for Payer: Blue Shield of California EPN |
$2,516.19
|
| Rate for Payer: Cash Price |
$5,883.75
|
| Rate for Payer: Cash Price |
$5,883.75
|
| Rate for Payer: Cash Price |
$5,883.75
|
| Rate for Payer: Cash Price |
$2,852.10
|
| Rate for Payer: Cash Price |
$2,852.10
|
| Rate for Payer: Cash Price |
$2,852.10
|
| Rate for Payer: Central Health Plan Commercial |
$5,070.40
|
| Rate for Payer: Central Health Plan Commercial |
$10,460.00
|
| Rate for Payer: Cigna of CA HMO |
$4,056.32
|
| Rate for Payer: Cigna of CA HMO |
$8,368.00
|
| Rate for Payer: Cigna of CA PPO |
$4,690.12
|
| Rate for Payer: Cigna of CA PPO |
$9,675.50
|
| 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 |
$4,436.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,152.50
|
| 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 |
$11,113.75
|
| Rate for Payer: Galaxy Health WC |
$5,387.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,802.80
|
| Rate for Payer: Global Benefits Group Commercial |
$7,845.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,704.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,767.50
|
| 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 |
$535.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$535.02
|
| 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 |
$4,024.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,302.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$591.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$591.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,615.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,267.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$601.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$601.27
|
| Rate for Payer: Multiplan Commercial |
$4,753.50
|
| Rate for Payer: Multiplan Commercial |
$9,806.25
|
| Rate for Payer: Networks By Design Commercial |
$8,498.75
|
| Rate for Payer: Networks By Design Commercial |
$4,119.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$448.71
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$448.71
|
| Rate for Payer: Prime Health Services Commercial |
$11,113.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,387.30
|
| Rate for Payer: Prime Health Services Medicare |
$475.63
|
| Rate for Payer: Prime Health Services Medicare |
$475.63
|
| Rate for Payer: Riverside University Health System MISP |
$493.58
|
| Rate for Payer: Riverside University Health System MISP |
$493.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,845.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,802.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,845.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,802.80
|
| 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 BRAIN W WO CONTRAST
|
Facility
|
IP
|
$13,075.00
|
|
|
Service Code
|
CPT 70553
|
| Hospital Charge Code |
908801014
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$2,615.00 |
| Max. Negotiated Rate |
$11,767.50 |
| Rate for Payer: Adventist Health Commercial |
$2,615.00
|
| Rate for Payer: Cash Price |
$5,883.75
|
| Rate for Payer: Central Health Plan Commercial |
$10,460.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,152.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,230.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,230.00
|
| Rate for Payer: Galaxy Health WC |
$11,113.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7,845.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,767.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,302.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,714.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,615.00
|
| Rate for Payer: Multiplan Commercial |
$9,806.25
|
| Rate for Payer: Networks By Design Commercial |
$8,498.75
|
| Rate for Payer: Prime Health Services Commercial |
$11,113.75
|
|
|
HC MRI BREAST BILAT W/CONTRAST
|
Facility
|
OP
|
$5,310.00
|
|
|
Service Code
|
CPT 77059
|
| Hospital Charge Code |
908801211
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,062.00 |
| Max. Negotiated Rate |
$4,779.00 |
| Rate for Payer: Adventist Health Commercial |
$1,062.00
|
| Rate for Payer: Adventist Health Commercial |
$2,228.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,513.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,471.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,128.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,920.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,357.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,326.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,326.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,088.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,481.88
|
| Rate for Payer: Blue Shield of California Commercial |
$3,345.30
|
| Rate for Payer: Blue Shield of California Commercial |
$7,020.09
|
| Rate for Payer: Blue Shield of California EPN |
$4,423.77
|
| Rate for Payer: Blue Shield of California EPN |
$2,108.07
|
| Rate for Payer: Cash Price |
$5,014.35
|
| Rate for Payer: Cash Price |
$2,389.50
|
| Rate for Payer: Cash Price |
$2,389.50
|
| Rate for Payer: Cash Price |
$5,014.35
|
| Rate for Payer: Cash Price |
$5,014.35
|
| Rate for Payer: Cash Price |
$2,389.50
|
| Rate for Payer: Central Health Plan Commercial |
$4,248.00
|
| Rate for Payer: Central Health Plan Commercial |
$8,914.40
|
| Rate for Payer: Cigna of CA HMO |
$3,398.40
|
| Rate for Payer: Cigna of CA HMO |
$7,131.52
|
| Rate for Payer: Cigna of CA PPO |
$8,245.82
|
| Rate for Payer: Cigna of CA PPO |
$3,929.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,471.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,513.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,471.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,513.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,471.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,513.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,717.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,800.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,124.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,457.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,124.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,457.20
|
| Rate for Payer: Galaxy Health WC |
$9,471.55
|
| Rate for Payer: Galaxy Health WC |
$4,513.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,186.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,685.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,779.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,028.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,371.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,075.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,044.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,927.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,132.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,574.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,062.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,228.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7,800.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,717.00
|
| Rate for Payer: Multiplan Commercial |
$3,982.50
|
| Rate for Payer: Multiplan Commercial |
$8,357.25
|
| Rate for Payer: Networks By Design Commercial |
$3,451.50
|
| Rate for Payer: Networks By Design Commercial |
$7,242.95
|
| Rate for Payer: Prime Health Services Commercial |
$9,471.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,513.50
|
| Rate for Payer: Riverside University Health System MISP |
$2,124.00
|
| Rate for Payer: Riverside University Health System MISP |
$4,457.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,186.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,685.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,685.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,186.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,571.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,655.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,655.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,571.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,571.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,655.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,571.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,655.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,513.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,471.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,471.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,513.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,513.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,471.55
|
|
|
HC MRI BREAST BILAT W/CONTRAST
|
Facility
|
IP
|
$11,143.00
|
|
|
Service Code
|
CPT 77059
|
| Hospital Charge Code |
908801211
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,228.60 |
| Max. Negotiated Rate |
$10,028.70 |
| Rate for Payer: Adventist Health Commercial |
$2,228.60
|
| Rate for Payer: Cash Price |
$5,014.35
|
| Rate for Payer: Central Health Plan Commercial |
$8,914.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,800.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,457.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,457.20
|
| Rate for Payer: Galaxy Health WC |
$9,471.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6,685.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,028.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,075.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,574.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,228.60
|
| Rate for Payer: Multiplan Commercial |
$8,357.25
|
| Rate for Payer: Networks By Design Commercial |
$7,242.95
|
| Rate for Payer: Prime Health Services Commercial |
$9,471.55
|
|
|
HC MRI BREAST BILAT WO CONTRAST
|
Facility
|
OP
|
$10,044.00
|
|
|
Service Code
|
CPT 77047
|
| Hospital Charge Code |
908801212
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$306.88 |
| Max. Negotiated Rate |
$9,039.60 |
| Rate for Payer: Adventist Health Commercial |
$2,008.80
|
| Rate for Payer: Adventist Health Commercial |
$970.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$306.88
|
| Rate for Payer: Adventist Health Medi-Cal |
$306.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,055.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,055.46
|
| 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 Exchange |
$1,264.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,264.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,842.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,822.99
|
| Rate for Payer: Blue Shield of California Commercial |
$3,057.39
|
| Rate for Payer: Blue Shield of California Commercial |
$6,327.72
|
| Rate for Payer: Blue Shield of California EPN |
$1,926.64
|
| Rate for Payer: Blue Shield of California EPN |
$3,987.47
|
| Rate for Payer: Cash Price |
$4,519.80
|
| Rate for Payer: Cash Price |
$2,183.85
|
| Rate for Payer: Cash Price |
$4,519.80
|
| Rate for Payer: Cash Price |
$2,183.85
|
| Rate for Payer: Central Health Plan Commercial |
$8,035.20
|
| Rate for Payer: Central Health Plan Commercial |
$3,882.40
|
| Rate for Payer: Cigna of CA HMO |
$6,428.16
|
| Rate for Payer: Cigna of CA HMO |
$3,105.92
|
| Rate for Payer: Cigna of CA PPO |
$3,591.22
|
| Rate for Payer: Cigna of CA PPO |
$7,432.56
|
| 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 |
$7,030.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,397.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: Galaxy Health WC |
$4,125.05
|
| Rate for Payer: Galaxy Health WC |
$8,537.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,911.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,026.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,367.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,039.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.28
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$368.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$368.20
|
| 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 |
$6,377.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,081.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$406.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$406.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,008.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$970.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$7,533.00
|
| Rate for Payer: Multiplan Commercial |
$3,639.75
|
| Rate for Payer: Networks By Design Commercial |
$6,528.60
|
| Rate for Payer: Networks By Design Commercial |
$3,154.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$306.88
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$306.88
|
| Rate for Payer: Prime Health Services Commercial |
$8,537.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,125.05
|
| Rate for Payer: Prime Health Services Medicare |
$325.29
|
| Rate for Payer: Prime Health Services Medicare |
$325.29
|
| Rate for Payer: Riverside University Health System MISP |
$337.57
|
| Rate for Payer: Riverside University Health System MISP |
$337.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,026.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,911.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,026.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,911.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$590.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$590.24
|
| Rate for Payer: United Healthcare All Other HMO |
$590.24
|
| Rate for Payer: United Healthcare All Other HMO |
$590.24
|
| Rate for Payer: United Healthcare HMO Rider |
$590.24
|
| Rate for Payer: United Healthcare HMO Rider |
$590.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$590.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$590.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$306.88
|
| Rate for Payer: Upland Medical Group Pediatric |
$306.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC MRI BREAST BILAT WO CONTRAST
|
Facility
|
IP
|
$10,044.00
|
|
|
Service Code
|
CPT 77047
|
| Hospital Charge Code |
908801212
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,008.80 |
| Max. Negotiated Rate |
$9,039.60 |
| Rate for Payer: Adventist Health Commercial |
$2,008.80
|
| Rate for Payer: Cash Price |
$4,519.80
|
| Rate for Payer: Central Health Plan Commercial |
$8,035.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,030.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,017.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,017.60
|
| Rate for Payer: Galaxy Health WC |
$8,537.40
|
| Rate for Payer: Global Benefits Group Commercial |
$6,026.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,039.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,377.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,925.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,008.80
|
| Rate for Payer: Multiplan Commercial |
$7,533.00
|
| Rate for Payer: Networks By Design Commercial |
$6,528.60
|
| Rate for Payer: Prime Health Services Commercial |
$8,537.40
|
|
|
HC MRI BREAST UNI W/CONTRAST
|
Facility
|
OP
|
$4,998.00
|
|
|
Service Code
|
CPT 77058
|
| Hospital Charge Code |
908801217
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$999.60 |
| Max. Negotiated Rate |
$4,498.20 |
| Rate for Payer: Adventist Health Commercial |
$999.60
|
| Rate for Payer: Adventist Health Commercial |
$2,021.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,248.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,589.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,557.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,748.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,748.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,578.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,994.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,994.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,907.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,878.08
|
| Rate for Payer: Blue Shield of California Commercial |
$3,148.74
|
| Rate for Payer: Blue Shield of California Commercial |
$6,366.15
|
| Rate for Payer: Blue Shield of California EPN |
$4,011.68
|
| Rate for Payer: Blue Shield of California EPN |
$1,984.21
|
| Rate for Payer: Cash Price |
$4,547.25
|
| Rate for Payer: Cash Price |
$2,249.10
|
| Rate for Payer: Cash Price |
$2,249.10
|
| Rate for Payer: Cash Price |
$4,547.25
|
| Rate for Payer: Cash Price |
$4,547.25
|
| Rate for Payer: Cash Price |
$2,249.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,998.40
|
| Rate for Payer: Central Health Plan Commercial |
$8,084.00
|
| Rate for Payer: Cigna of CA HMO |
$3,198.72
|
| Rate for Payer: Cigna of CA HMO |
$6,467.20
|
| Rate for Payer: Cigna of CA PPO |
$7,477.70
|
| Rate for Payer: Cigna of CA PPO |
$3,698.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,589.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,248.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,589.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,248.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,589.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,248.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,498.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,073.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,999.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,042.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,999.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,042.00
|
| Rate for Payer: Galaxy Health WC |
$8,589.25
|
| Rate for Payer: Galaxy Health WC |
$4,248.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,998.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,063.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,498.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,094.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,173.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,416.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,668.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,814.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,948.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,961.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$999.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,021.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7,073.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,498.60
|
| Rate for Payer: Multiplan Commercial |
$3,748.50
|
| Rate for Payer: Multiplan Commercial |
$7,578.75
|
| Rate for Payer: Networks By Design Commercial |
$3,248.70
|
| Rate for Payer: Networks By Design Commercial |
$6,568.25
|
| Rate for Payer: Prime Health Services Commercial |
$8,589.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,248.30
|
| Rate for Payer: Riverside University Health System MISP |
$1,999.20
|
| Rate for Payer: Riverside University Health System MISP |
$4,042.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,998.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,063.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,063.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,998.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,052.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,499.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,499.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,052.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,052.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,499.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,052.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,499.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,248.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,589.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,589.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,248.30
|
| Rate for Payer: Vantage Medical Group Senior |
$4,248.30
|
| Rate for Payer: Vantage Medical Group Senior |
$8,589.25
|
|
|
HC MRI BREAST UNI W/CONTRAST
|
Facility
|
IP
|
$10,105.00
|
|
|
Service Code
|
CPT 77058
|
| Hospital Charge Code |
908801217
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,021.00 |
| Max. Negotiated Rate |
$9,094.50 |
| Rate for Payer: Adventist Health Commercial |
$2,021.00
|
| Rate for Payer: Cash Price |
$4,547.25
|
| Rate for Payer: Central Health Plan Commercial |
$8,084.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,073.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,042.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,042.00
|
| Rate for Payer: Galaxy Health WC |
$8,589.25
|
| Rate for Payer: Global Benefits Group Commercial |
$6,063.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,094.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,416.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,961.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,021.00
|
| Rate for Payer: Multiplan Commercial |
$7,578.75
|
| Rate for Payer: Networks By Design Commercial |
$6,568.25
|
| Rate for Payer: Prime Health Services Commercial |
$8,589.25
|
|
|
HC MRI BREAST UNI WO CONTRAST
|
Facility
|
OP
|
$4,310.00
|
|
|
Service Code
|
CPT 77046
|
| Hospital Charge Code |
908801219
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$306.88 |
| Max. Negotiated Rate |
$3,879.00 |
| Rate for Payer: Adventist Health Commercial |
$862.00
|
| Rate for Payer: Adventist Health Commercial |
$1,410.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$306.88
|
| Rate for Payer: Adventist Health Medi-Cal |
$306.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,055.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,055.46
|
| 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 Exchange |
$1,272.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,272.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,507.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,100.98
|
| Rate for Payer: Blue Shield of California Commercial |
$4,441.50
|
| Rate for Payer: Blue Shield of California Commercial |
$2,715.30
|
| Rate for Payer: Blue Shield of California EPN |
$2,798.85
|
| Rate for Payer: Blue Shield of California EPN |
$1,711.07
|
| Rate for Payer: Cash Price |
$1,939.50
|
| Rate for Payer: Cash Price |
$3,172.50
|
| Rate for Payer: Cash Price |
$1,939.50
|
| Rate for Payer: Cash Price |
$3,172.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,448.00
|
| Rate for Payer: Central Health Plan Commercial |
$5,640.00
|
| Rate for Payer: Cigna of CA HMO |
$2,758.40
|
| Rate for Payer: Cigna of CA HMO |
$4,512.00
|
| Rate for Payer: Cigna of CA PPO |
$5,217.00
|
| Rate for Payer: Cigna of CA PPO |
$3,189.40
|
| 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 |
$3,017.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,935.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: Galaxy Health WC |
$5,992.50
|
| Rate for Payer: Galaxy Health WC |
$3,663.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,230.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,586.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,345.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,879.00
|
| 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 |
$359.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$359.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,736.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,476.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$396.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$396.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$862.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,410.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$3,232.50
|
| Rate for Payer: Multiplan Commercial |
$5,287.50
|
| Rate for Payer: Networks By Design Commercial |
$2,801.50
|
| Rate for Payer: Networks By Design Commercial |
$4,582.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$306.88
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$306.88
|
| Rate for Payer: Prime Health Services Commercial |
$3,663.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,992.50
|
| Rate for Payer: Prime Health Services Medicare |
$325.29
|
| Rate for Payer: Prime Health Services Medicare |
$325.29
|
| Rate for Payer: Riverside University Health System MISP |
$337.57
|
| Rate for Payer: Riverside University Health System MISP |
$337.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,586.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,230.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,586.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,230.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$590.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$590.24
|
| Rate for Payer: United Healthcare All Other HMO |
$590.24
|
| Rate for Payer: United Healthcare All Other HMO |
$590.24
|
| Rate for Payer: United Healthcare HMO Rider |
$590.24
|
| Rate for Payer: United Healthcare HMO Rider |
$590.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$590.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$590.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$306.88
|
| Rate for Payer: Upland Medical Group Pediatric |
$306.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC MRI BREAST UNI WO CONTRAST
|
Facility
|
IP
|
$7,050.00
|
|
|
Service Code
|
CPT 77046
|
| Hospital Charge Code |
908801219
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,410.00 |
| Max. Negotiated Rate |
$6,345.00 |
| Rate for Payer: Adventist Health Commercial |
$1,410.00
|
| Rate for Payer: Cash Price |
$3,172.50
|
| Rate for Payer: Central Health Plan Commercial |
$5,640.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,935.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,820.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,820.00
|
| Rate for Payer: Galaxy Health WC |
$5,992.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,230.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,345.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,476.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,159.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,410.00
|
| Rate for Payer: Multiplan Commercial |
$5,287.50
|
| Rate for Payer: Networks By Design Commercial |
$4,582.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,992.50
|
|
|
HC MRI BRST BI W WO CNTRST W CAD
|
Facility
|
IP
|
$12,236.00
|
|
|
Service Code
|
CPT 77049
|
| Hospital Charge Code |
908801210
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,447.20 |
| Max. Negotiated Rate |
$11,012.40 |
| Rate for Payer: Adventist Health Commercial |
$2,447.20
|
| Rate for Payer: Cash Price |
$5,506.20
|
| Rate for Payer: Central Health Plan Commercial |
$9,788.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,565.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,894.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,894.40
|
| Rate for Payer: Galaxy Health WC |
$10,400.60
|
| Rate for Payer: Global Benefits Group Commercial |
$7,341.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,012.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,769.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,219.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,447.20
|
| Rate for Payer: Multiplan Commercial |
$9,177.00
|
| Rate for Payer: Networks By Design Commercial |
$7,953.40
|
| Rate for Payer: Prime Health Services Commercial |
$10,400.60
|
|
|
HC MRI BRST BI W WO CNTRST W CAD
|
Facility
|
OP
|
$12,236.00
|
|
|
Service Code
|
CPT 77049
|
| Hospital Charge Code |
908801210
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$581.08 |
| Max. Negotiated Rate |
$11,012.40 |
| Rate for Payer: Adventist Health Commercial |
$2,447.20
|
| Rate for Payer: Adventist Health Commercial |
$1,182.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,055.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,055.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,024.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,400.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,729.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,251.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,433.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,177.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,084.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,084.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,117.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,438.43
|
| Rate for Payer: Blue Shield of California Commercial |
$3,723.93
|
| Rate for Payer: Blue Shield of California Commercial |
$7,708.68
|
| Rate for Payer: Blue Shield of California EPN |
$2,346.67
|
| Rate for Payer: Blue Shield of California EPN |
$4,857.69
|
| Rate for Payer: Cash Price |
$5,506.20
|
| Rate for Payer: Cash Price |
$2,659.95
|
| Rate for Payer: Cash Price |
$2,659.95
|
| Rate for Payer: Cash Price |
$5,506.20
|
| Rate for Payer: Central Health Plan Commercial |
$4,728.80
|
| Rate for Payer: Central Health Plan Commercial |
$9,788.80
|
| Rate for Payer: Cigna of CA HMO |
$7,831.04
|
| Rate for Payer: Cigna of CA HMO |
$3,783.04
|
| Rate for Payer: Cigna of CA PPO |
$4,374.14
|
| Rate for Payer: Cigna of CA PPO |
$9,054.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,400.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,024.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,400.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,024.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,400.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,024.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,137.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,565.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,894.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,364.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,364.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,894.40
|
| Rate for Payer: Galaxy Health WC |
$10,400.60
|
| Rate for Payer: Galaxy Health WC |
$5,024.35
|
| Rate for Payer: Global Benefits Group Commercial |
$7,341.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,546.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,012.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,319.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$581.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$581.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,753.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,769.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$641.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$641.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,487.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,219.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,182.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,447.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,137.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8,565.20
|
| Rate for Payer: Multiplan Commercial |
$9,177.00
|
| Rate for Payer: Multiplan Commercial |
$4,433.25
|
| Rate for Payer: Networks By Design Commercial |
$3,842.15
|
| Rate for Payer: Networks By Design Commercial |
$7,953.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,024.35
|
| Rate for Payer: Prime Health Services Commercial |
$10,400.60
|
| Rate for Payer: Riverside University Health System MISP |
$4,894.40
|
| Rate for Payer: Riverside University Health System MISP |
$2,364.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,341.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,546.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,546.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,341.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$750.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$750.08
|
| Rate for Payer: United Healthcare All Other HMO |
$750.08
|
| Rate for Payer: United Healthcare All Other HMO |
$750.08
|
| Rate for Payer: United Healthcare HMO Rider |
$750.08
|
| Rate for Payer: United Healthcare HMO Rider |
$750.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$750.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$750.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,400.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,024.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,400.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,024.35
|
| Rate for Payer: Vantage Medical Group Senior |
$10,400.60
|
| Rate for Payer: Vantage Medical Group Senior |
$5,024.35
|
|
|
HC MRI BRST UNI W WO CTRST W CAD
|
Facility
|
IP
|
$11,288.00
|
|
|
Service Code
|
CPT 77048
|
| Hospital Charge Code |
908801215
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,257.60 |
| Max. Negotiated Rate |
$10,159.20 |
| Rate for Payer: Adventist Health Commercial |
$2,257.60
|
| Rate for Payer: Cash Price |
$5,079.60
|
| Rate for Payer: Central Health Plan Commercial |
$9,030.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,901.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,515.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,515.20
|
| Rate for Payer: Galaxy Health WC |
$9,594.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,772.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,159.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,167.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,659.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,257.60
|
| Rate for Payer: Multiplan Commercial |
$8,466.00
|
| Rate for Payer: Networks By Design Commercial |
$7,337.20
|
| Rate for Payer: Prime Health Services Commercial |
$9,594.80
|
|
|
HC MRI BRST UNI W WO CTRST W CAD
|
Facility
|
OP
|
$11,288.00
|
|
|
Service Code
|
CPT 77048
|
| Hospital Charge Code |
908801215
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$570.25 |
| Max. Negotiated Rate |
$10,159.20 |
| Rate for Payer: Adventist Health Commercial |
$2,257.60
|
| Rate for Payer: Adventist Health Commercial |
$1,090.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,055.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,055.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,635.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,594.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,208.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,999.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,090.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,466.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,094.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,094.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,566.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,172.59
|
| Rate for Payer: Blue Shield of California Commercial |
$3,436.02
|
| Rate for Payer: Blue Shield of California Commercial |
$7,111.44
|
| Rate for Payer: Blue Shield of California EPN |
$2,165.24
|
| Rate for Payer: Blue Shield of California EPN |
$4,481.34
|
| Rate for Payer: Cash Price |
$5,079.60
|
| Rate for Payer: Cash Price |
$2,454.30
|
| Rate for Payer: Cash Price |
$2,454.30
|
| Rate for Payer: Cash Price |
$5,079.60
|
| Rate for Payer: Central Health Plan Commercial |
$4,363.20
|
| Rate for Payer: Central Health Plan Commercial |
$9,030.40
|
| Rate for Payer: Cigna of CA HMO |
$7,224.32
|
| Rate for Payer: Cigna of CA HMO |
$3,490.56
|
| Rate for Payer: Cigna of CA PPO |
$4,035.96
|
| Rate for Payer: Cigna of CA PPO |
$8,353.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,594.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,635.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,594.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,635.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,594.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,635.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,817.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,901.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,515.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,181.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,181.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,515.20
|
| Rate for Payer: Galaxy Health WC |
$9,594.80
|
| Rate for Payer: Galaxy Health WC |
$4,635.90
|
| Rate for Payer: Global Benefits Group Commercial |
$6,772.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,272.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,159.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,908.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$570.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$570.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,463.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,167.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$629.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$629.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,217.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,659.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,090.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,257.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,817.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7,901.60
|
| Rate for Payer: Multiplan Commercial |
$8,466.00
|
| Rate for Payer: Multiplan Commercial |
$4,090.50
|
| Rate for Payer: Networks By Design Commercial |
$3,545.10
|
| Rate for Payer: Networks By Design Commercial |
$7,337.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,635.90
|
| Rate for Payer: Prime Health Services Commercial |
$9,594.80
|
| Rate for Payer: Riverside University Health System MISP |
$4,515.20
|
| Rate for Payer: Riverside University Health System MISP |
$2,181.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,772.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,272.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,272.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,772.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$753.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$753.76
|
| Rate for Payer: United Healthcare All Other HMO |
$753.76
|
| Rate for Payer: United Healthcare All Other HMO |
$753.76
|
| Rate for Payer: United Healthcare HMO Rider |
$753.76
|
| Rate for Payer: United Healthcare HMO Rider |
$753.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$753.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$753.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,594.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,635.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,594.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,635.90
|
| Rate for Payer: Vantage Medical Group Senior |
$9,594.80
|
| Rate for Payer: Vantage Medical Group Senior |
$4,635.90
|
|
|
HC MRI CERVICAL SPINE W CONTRA
|
Facility
|
IP
|
$10,778.00
|
|
|
Service Code
|
CPT 72142
|
| Hospital Charge Code |
908801102
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$2,155.60 |
| Max. Negotiated Rate |
$9,700.20 |
| Rate for Payer: Adventist Health Commercial |
$2,155.60
|
| Rate for Payer: Cash Price |
$4,850.10
|
| Rate for Payer: Central Health Plan Commercial |
$8,622.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,544.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,311.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,311.20
|
| Rate for Payer: Galaxy Health WC |
$9,161.30
|
| Rate for Payer: Global Benefits Group Commercial |
$6,466.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,700.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,844.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,155.60
|
| Rate for Payer: Multiplan Commercial |
$8,083.50
|
| Rate for Payer: Networks By Design Commercial |
$7,005.70
|
| Rate for Payer: Prime Health Services Commercial |
$9,161.30
|
|
|
HC MRI CERVICAL SPINE W CONTRA
|
Facility
|
OP
|
$10,778.00
|
|
|
Service Code
|
CPT 72142
|
| Hospital Charge Code |
908801102
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$448.71 |
| Max. Negotiated Rate |
$9,700.20 |
| Rate for Payer: Adventist Health Commercial |
$2,155.60
|
| Rate for Payer: Adventist Health Commercial |
$1,030.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$448.71
|
| Rate for Payer: Adventist Health Medi-Cal |
$448.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,055.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,055.46
|
| 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 Exchange |
$2,766.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,766.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,269.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,995.76
|
| Rate for Payer: Blue Shield of California Commercial |
$3,244.50
|
| Rate for Payer: Blue Shield of California Commercial |
$6,790.14
|
| Rate for Payer: Blue Shield of California EPN |
$2,044.55
|
| Rate for Payer: Blue Shield of California EPN |
$4,278.87
|
| Rate for Payer: Cash Price |
$4,850.10
|
| Rate for Payer: Cash Price |
$2,317.50
|
| Rate for Payer: Cash Price |
$4,850.10
|
| Rate for Payer: Cash Price |
$2,317.50
|
| Rate for Payer: Central Health Plan Commercial |
$8,622.40
|
| Rate for Payer: Central Health Plan Commercial |
$4,120.00
|
| Rate for Payer: Cigna of CA HMO |
$6,897.92
|
| Rate for Payer: Cigna of CA HMO |
$3,296.00
|
| Rate for Payer: Cigna of CA PPO |
$3,811.00
|
| Rate for Payer: Cigna of CA PPO |
$7,975.72
|
| 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 |
$7,544.60
|
| 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 |
$4,377.50
|
| Rate for Payer: Galaxy Health WC |
$9,161.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,090.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,466.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,635.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,700.20
|
| 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 |
$465.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$465.52
|
| 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 |
$6,844.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,270.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$514.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$514.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,155.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,030.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$601.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$601.27
|
| Rate for Payer: Multiplan Commercial |
$8,083.50
|
| Rate for Payer: Multiplan Commercial |
$3,862.50
|
| Rate for Payer: Networks By Design Commercial |
$7,005.70
|
| Rate for Payer: Networks By Design Commercial |
$3,347.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$448.71
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$448.71
|
| Rate for Payer: Prime Health Services Commercial |
$9,161.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,377.50
|
| Rate for Payer: Prime Health Services Medicare |
$475.63
|
| Rate for Payer: Prime Health Services Medicare |
$475.63
|
| Rate for Payer: Riverside University Health System MISP |
$493.58
|
| Rate for Payer: Riverside University Health System MISP |
$493.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,466.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,090.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,466.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,090.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,115.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,115.74
|
| Rate for Payer: United Healthcare All Other HMO |
$1,115.74
|
| Rate for Payer: United Healthcare All Other HMO |
$1,115.74
|
| Rate for Payer: United Healthcare HMO Rider |
$1,115.74
|
| Rate for Payer: United Healthcare HMO Rider |
$1,115.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,115.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,115.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$448.71
|
| Rate for Payer: Upland Medical Group Pediatric |
$448.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
|
|
HC MRI CERVICAL SPINE WO CONT
|
Facility
|
OP
|
$10,276.00
|
|
|
Service Code
|
CPT 72141
|
| Hospital Charge Code |
908801100
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$306.88 |
| Max. Negotiated Rate |
$9,248.40 |
| Rate for Payer: Adventist Health Commercial |
$2,055.20
|
| Rate for Payer: Adventist Health Commercial |
$993.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$306.88
|
| Rate for Payer: Adventist Health Medi-Cal |
$306.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,055.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,055.46
|
| 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 Exchange |
$2,305.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,305.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,977.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,888.14
|
| Rate for Payer: Blue Shield of California Commercial |
$3,127.95
|
| Rate for Payer: Blue Shield of California Commercial |
$6,473.88
|
| Rate for Payer: Blue Shield of California EPN |
$1,971.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,079.57
|
| Rate for Payer: Cash Price |
$4,624.20
|
| Rate for Payer: Cash Price |
$2,234.25
|
| Rate for Payer: Cash Price |
$4,624.20
|
| Rate for Payer: Cash Price |
$2,234.25
|
| Rate for Payer: Central Health Plan Commercial |
$8,220.80
|
| Rate for Payer: Central Health Plan Commercial |
$3,972.00
|
| Rate for Payer: Cigna of CA HMO |
$6,576.64
|
| 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 |
$7,604.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,193.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,475.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: Galaxy Health WC |
$4,220.25
|
| Rate for Payer: Galaxy Health WC |
$8,734.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,979.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,165.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,468.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,248.40
|
| 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 |
$319.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$319.32
|
| 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 |
$6,525.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,152.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$352.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$352.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,055.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$993.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$7,707.00
|
| Rate for Payer: Multiplan Commercial |
$3,723.75
|
| Rate for Payer: Networks By Design Commercial |
$6,679.40
|
| Rate for Payer: Networks By Design Commercial |
$3,227.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$306.88
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$306.88
|
| Rate for Payer: Prime Health Services Commercial |
$8,734.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,220.25
|
| Rate for Payer: Prime Health Services Medicare |
$325.29
|
| Rate for Payer: Prime Health Services Medicare |
$325.29
|
| Rate for Payer: Riverside University Health System MISP |
$337.57
|
| Rate for Payer: Riverside University Health System MISP |
$337.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,165.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,979.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,165.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,979.00
|
| 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 CERVICAL SPINE WO CONT
|
Facility
|
IP
|
$10,276.00
|
|
|
Service Code
|
CPT 72141
|
| Hospital Charge Code |
908801100
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$2,055.20 |
| Max. Negotiated Rate |
$9,248.40 |
| Rate for Payer: Adventist Health Commercial |
$2,055.20
|
| Rate for Payer: Cash Price |
$4,624.20
|
| Rate for Payer: Central Health Plan Commercial |
$8,220.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,193.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,110.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,110.40
|
| Rate for Payer: Galaxy Health WC |
$8,734.60
|
| Rate for Payer: Global Benefits Group Commercial |
$6,165.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,248.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,525.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,062.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,055.20
|
| Rate for Payer: Multiplan Commercial |
$7,707.00
|
| Rate for Payer: Networks By Design Commercial |
$6,679.40
|
| Rate for Payer: Prime Health Services Commercial |
$8,734.60
|
|
|
HC MRI CHEST W/ CONTRAST
|
Facility
|
OP
|
$10,276.00
|
|
|
Service Code
|
CPT 71551
|
| Hospital Charge Code |
908801201
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$643.50 |
| Max. Negotiated Rate |
$9,248.40 |
| Rate for Payer: Adventist Health Commercial |
$2,055.20
|
| Rate for Payer: Adventist Health Commercial |
$993.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,008.25
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,008.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| 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 Exchange |
$2,814.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,814.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,977.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,888.14
|
| Rate for Payer: Blue Shield of California Commercial |
$3,127.95
|
| Rate for Payer: Blue Shield of California Commercial |
$6,473.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,079.57
|
| Rate for Payer: Blue Shield of California EPN |
$1,971.11
|
| Rate for Payer: Cash Price |
$4,624.20
|
| Rate for Payer: Cash Price |
$4,624.20
|
| Rate for Payer: Cash Price |
$4,624.20
|
| Rate for Payer: Cash Price |
$2,234.25
|
| Rate for Payer: Cash Price |
$2,234.25
|
| Rate for Payer: Cash Price |
$2,234.25
|
| Rate for Payer: Central Health Plan Commercial |
$3,972.00
|
| Rate for Payer: Central Health Plan Commercial |
$8,220.80
|
| Rate for Payer: Cigna of CA HMO |
$3,177.60
|
| Rate for Payer: Cigna of CA HMO |
$6,576.64
|
| Rate for Payer: Cigna of CA PPO |
$3,674.10
|
| Rate for Payer: Cigna of CA PPO |
$7,604.24
|
| 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 |
$3,475.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,193.20
|
| 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 |
$8,734.60
|
| 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 |
$6,165.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,468.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,248.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,653.53
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,653.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$643.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$643.50
|
| 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 |
$3,152.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,525.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$710.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$710.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,411.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,411.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,055.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$993.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,351.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,351.06
|
| Rate for Payer: Multiplan Commercial |
$3,723.75
|
| Rate for Payer: Multiplan Commercial |
$7,707.00
|
| Rate for Payer: Networks By Design Commercial |
$6,679.40
|
| Rate for Payer: Networks By Design Commercial |
$3,227.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,008.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,008.25
|
| Rate for Payer: Prime Health Services Commercial |
$8,734.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,220.25
|
| Rate for Payer: Prime Health Services Medicare |
$1,068.74
|
| Rate for Payer: Prime Health Services Medicare |
$1,068.74
|
| Rate for Payer: Riverside University Health System MISP |
$1,109.08
|
| Rate for Payer: Riverside University Health System MISP |
$1,109.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,165.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,979.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,165.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,979.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,115.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,115.74
|
| Rate for Payer: United Healthcare All Other HMO |
$1,115.74
|
| Rate for Payer: United Healthcare All Other HMO |
$1,115.74
|
| Rate for Payer: United Healthcare HMO Rider |
$1,115.74
|
| Rate for Payer: United Healthcare HMO Rider |
$1,115.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,115.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,115.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,008.25
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,008.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,512.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,512.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,109.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,109.08
|
| Rate for Payer: Vantage Medical Group Senior |
$1,008.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,008.25
|
|
|
HC MRI CHEST W/ CONTRAST
|
Facility
|
IP
|
$10,276.00
|
|
|
Service Code
|
CPT 71551
|
| Hospital Charge Code |
908801201
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,055.20 |
| Max. Negotiated Rate |
$9,248.40 |
| Rate for Payer: Adventist Health Commercial |
$2,055.20
|
| Rate for Payer: Cash Price |
$4,624.20
|
| Rate for Payer: Central Health Plan Commercial |
$8,220.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,193.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,110.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,110.40
|
| Rate for Payer: Galaxy Health WC |
$8,734.60
|
| Rate for Payer: Global Benefits Group Commercial |
$6,165.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,248.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,525.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,062.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,055.20
|
| Rate for Payer: Multiplan Commercial |
$7,707.00
|
| Rate for Payer: Networks By Design Commercial |
$6,679.40
|
| Rate for Payer: Prime Health Services Commercial |
$8,734.60
|
|
|
HC MRI CHEST, W/O CONT
|
Facility
|
IP
|
$9,195.00
|
|
|
Service Code
|
CPT 71550
|
| Hospital Charge Code |
908801200
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,839.00 |
| Max. Negotiated Rate |
$8,275.50 |
| Rate for Payer: Adventist Health Commercial |
$1,839.00
|
| Rate for Payer: Cash Price |
$4,137.75
|
| Rate for Payer: Central Health Plan Commercial |
$7,356.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,436.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,678.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,678.00
|
| Rate for Payer: Galaxy Health WC |
$7,815.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,517.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,275.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,838.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,425.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,839.00
|
| Rate for Payer: Multiplan Commercial |
$6,896.25
|
| Rate for Payer: Networks By Design Commercial |
$5,976.75
|
| Rate for Payer: Prime Health Services Commercial |
$7,815.75
|
|
