|
HC MRI CHEST, W/O CONT
|
Facility
|
OP
|
$4,442.00
|
|
|
Service Code
|
CPT 71550
|
| Hospital Charge Code |
908801200
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$306.88 |
| Max. Negotiated Rate |
$3,997.80 |
| Rate for Payer: Adventist Health Commercial |
$888.40
|
| Rate for Payer: Adventist Health Commercial |
$1,839.00
|
| 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 |
$2,954.00
|
| 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 |
$2,305.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,305.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,583.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,348.73
|
| Rate for Payer: Blue Shield of California Commercial |
$5,792.85
|
| Rate for Payer: Blue Shield of California Commercial |
$2,798.46
|
| Rate for Payer: Blue Shield of California EPN |
$1,763.47
|
| Rate for Payer: Blue Shield of California EPN |
$3,650.41
|
| Rate for Payer: Cash Price |
$1,998.90
|
| Rate for Payer: Cash Price |
$1,998.90
|
| Rate for Payer: Cash Price |
$1,998.90
|
| Rate for Payer: Cash Price |
$4,137.75
|
| Rate for Payer: Cash Price |
$4,137.75
|
| Rate for Payer: Cash Price |
$4,137.75
|
| Rate for Payer: Central Health Plan Commercial |
$7,356.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,553.60
|
| Rate for Payer: Cigna of CA HMO |
$5,884.80
|
| Rate for Payer: Cigna of CA HMO |
$2,842.88
|
| Rate for Payer: Cigna of CA PPO |
$6,804.30
|
| Rate for Payer: Cigna of CA PPO |
$3,287.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,436.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,109.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: Galaxy Health WC |
$3,775.70
|
| Rate for Payer: Galaxy Health WC |
$7,815.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,517.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,665.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,275.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,997.80
|
| 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 |
$582.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$582.39
|
| 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 |
$5,838.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,820.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$643.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$643.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$888.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,839.00
|
| 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 |
$6,896.25
|
| Rate for Payer: Multiplan Commercial |
$3,331.50
|
| Rate for Payer: Networks By Design Commercial |
$2,887.30
|
| Rate for Payer: Networks By Design Commercial |
$5,976.75
|
| 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 |
$3,775.70
|
| Rate for Payer: Prime Health Services Commercial |
$7,815.75
|
| 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 |
$2,665.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,517.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,665.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,517.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| Rate for Payer: United Healthcare All Other HMO |
$866.34
|
| Rate for Payer: United Healthcare All Other HMO |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$306.88
|
| Rate for Payer: Upland Medical Group Pediatric |
$306.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC MRI CHEST W WO CONTRAST
|
Facility
|
IP
|
$15,210.00
|
|
|
Service Code
|
CPT 71552
|
| Hospital Charge Code |
908801202
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,042.00 |
| Max. Negotiated Rate |
$13,689.00 |
| Rate for Payer: Adventist Health Commercial |
$3,042.00
|
| Rate for Payer: Cash Price |
$6,844.50
|
| Rate for Payer: Central Health Plan Commercial |
$12,168.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,647.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,084.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,084.00
|
| Rate for Payer: Galaxy Health WC |
$12,928.50
|
| Rate for Payer: Global Benefits Group Commercial |
$9,126.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,689.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,658.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,973.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,042.00
|
| Rate for Payer: Multiplan Commercial |
$11,407.50
|
| Rate for Payer: Networks By Design Commercial |
$9,886.50
|
| Rate for Payer: Prime Health Services Commercial |
$12,928.50
|
|
|
HC MRI CHEST W WO CONTRAST
|
Facility
|
OP
|
$15,210.00
|
|
|
Service Code
|
CPT 71552
|
| Hospital Charge Code |
908801202
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$448.71 |
| Max. Negotiated Rate |
$13,689.00 |
| Rate for Payer: Adventist Health Commercial |
$3,042.00
|
| Rate for Payer: Adventist Health Commercial |
$1,229.40
|
| 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 |
$5,176.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,176.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,847.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,575.71
|
| Rate for Payer: Blue Shield of California Commercial |
$3,872.61
|
| Rate for Payer: Blue Shield of California Commercial |
$9,582.30
|
| Rate for Payer: Blue Shield of California EPN |
$6,038.37
|
| Rate for Payer: Blue Shield of California EPN |
$2,440.36
|
| Rate for Payer: Cash Price |
$6,844.50
|
| Rate for Payer: Cash Price |
$6,844.50
|
| Rate for Payer: Cash Price |
$6,844.50
|
| Rate for Payer: Cash Price |
$2,766.15
|
| Rate for Payer: Cash Price |
$2,766.15
|
| Rate for Payer: Cash Price |
$2,766.15
|
| Rate for Payer: Central Health Plan Commercial |
$4,917.60
|
| Rate for Payer: Central Health Plan Commercial |
$12,168.00
|
| Rate for Payer: Cigna of CA HMO |
$3,934.08
|
| Rate for Payer: Cigna of CA HMO |
$9,734.40
|
| Rate for Payer: Cigna of CA PPO |
$4,548.78
|
| Rate for Payer: Cigna of CA PPO |
$11,255.40
|
| 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 |
$4,302.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,647.00
|
| 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 |
$12,928.50
|
| Rate for Payer: Galaxy Health WC |
$5,224.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,688.20
|
| Rate for Payer: Global Benefits Group Commercial |
$9,126.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,532.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,689.00
|
| 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 |
$812.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$812.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,903.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,658.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$897.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$897.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,042.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,229.40
|
| 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 |
$4,610.25
|
| Rate for Payer: Multiplan Commercial |
$11,407.50
|
| Rate for Payer: Networks By Design Commercial |
$9,886.50
|
| Rate for Payer: Networks By Design Commercial |
$3,995.55
|
| 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 |
$12,928.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,224.95
|
| 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 |
$9,126.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,688.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,126.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,688.20
|
| 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 C-SPINE W & WO CONTRAST
|
Facility
|
OP
|
$12,346.00
|
|
|
Service Code
|
CPT 72156
|
| Hospital Charge Code |
908801104
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$448.71 |
| Max. Negotiated Rate |
$11,111.40 |
| Rate for Payer: Adventist Health Commercial |
$2,469.20
|
| Rate for Payer: Adventist Health Commercial |
$1,133.40
|
| 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 |
$4,535.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,535.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,181.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,296.49
|
| Rate for Payer: Blue Shield of California Commercial |
$3,570.21
|
| Rate for Payer: Blue Shield of California Commercial |
$7,777.98
|
| Rate for Payer: Blue Shield of California EPN |
$4,901.36
|
| Rate for Payer: Blue Shield of California EPN |
$2,249.80
|
| Rate for Payer: Cash Price |
$5,555.70
|
| Rate for Payer: Cash Price |
$5,555.70
|
| Rate for Payer: Cash Price |
$5,555.70
|
| Rate for Payer: Cash Price |
$2,550.15
|
| Rate for Payer: Cash Price |
$2,550.15
|
| Rate for Payer: Cash Price |
$2,550.15
|
| Rate for Payer: Central Health Plan Commercial |
$4,533.60
|
| Rate for Payer: Central Health Plan Commercial |
$9,876.80
|
| Rate for Payer: Cigna of CA HMO |
$3,626.88
|
| Rate for Payer: Cigna of CA HMO |
$7,901.44
|
| Rate for Payer: Cigna of CA PPO |
$4,193.58
|
| Rate for Payer: Cigna of CA PPO |
$9,136.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,966.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,642.20
|
| 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 |
$10,494.10
|
| Rate for Payer: Galaxy Health WC |
$4,816.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,400.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7,407.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,100.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,111.40
|
| 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 |
$538.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$538.77
|
| 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 |
$7,839.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$595.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$595.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,469.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,133.40
|
| 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 |
$4,250.25
|
| Rate for Payer: Multiplan Commercial |
$9,259.50
|
| Rate for Payer: Networks By Design Commercial |
$8,024.90
|
| Rate for Payer: Networks By Design Commercial |
$3,683.55
|
| 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 |
$10,494.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,816.95
|
| 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 |
$7,407.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,400.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,407.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,400.20
|
| 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 C-SPINE W & WO CONTRAST
|
Facility
|
IP
|
$12,346.00
|
|
|
Service Code
|
CPT 72156
|
| Hospital Charge Code |
908801104
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$2,469.20 |
| Max. Negotiated Rate |
$11,111.40 |
| Rate for Payer: Adventist Health Commercial |
$2,469.20
|
| Rate for Payer: Cash Price |
$5,555.70
|
| Rate for Payer: Central Health Plan Commercial |
$9,876.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,642.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,938.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,938.40
|
| Rate for Payer: Galaxy Health WC |
$10,494.10
|
| Rate for Payer: Global Benefits Group Commercial |
$7,407.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,111.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,839.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,284.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,469.20
|
| Rate for Payer: Multiplan Commercial |
$9,259.50
|
| Rate for Payer: Networks By Design Commercial |
$8,024.90
|
| Rate for Payer: Prime Health Services Commercial |
$10,494.10
|
|
|
HC MRI FETAL PELVIC IMG 1ST FETUS
|
Facility
|
IP
|
$1,551.00
|
|
|
Service Code
|
CPT 74712
|
| Hospital Charge Code |
908874712
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$310.20 |
| Max. Negotiated Rate |
$1,395.90 |
| Rate for Payer: Adventist Health Commercial |
$310.20
|
| Rate for Payer: Cash Price |
$697.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,240.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,085.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$620.40
|
| Rate for Payer: EPIC Health Plan Senior |
$620.40
|
| Rate for Payer: Galaxy Health WC |
$1,318.35
|
| Rate for Payer: Global Benefits Group Commercial |
$930.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,395.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$984.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$915.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$310.20
|
| Rate for Payer: Multiplan Commercial |
$1,163.25
|
| Rate for Payer: Networks By Design Commercial |
$1,008.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,318.35
|
|
|
HC MRI FETAL PELVIC IMG 1ST FETUS
|
Facility
|
OP
|
$1,551.00
|
|
|
Service Code
|
CPT 74712
|
| Hospital Charge Code |
908874712
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$306.88 |
| Max. Negotiated Rate |
$5,887.33 |
| Rate for Payer: Adventist Health Commercial |
$310.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$306.88
|
| 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 Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,234.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,887.33
|
| Rate for Payer: Blue Shield of California Commercial |
$977.13
|
| Rate for Payer: Blue Shield of California EPN |
$615.75
|
| Rate for Payer: Cash Price |
$697.95
|
| Rate for Payer: Cash Price |
$697.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,240.80
|
| Rate for Payer: Cigna of CA HMO |
$992.64
|
| Rate for Payer: Cigna of CA PPO |
$1,147.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,085.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: Galaxy Health WC |
$1,318.35
|
| Rate for Payer: Global Benefits Group Commercial |
$930.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,395.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$690.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$984.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$762.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$310.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$1,163.25
|
| Rate for Payer: Networks By Design Commercial |
$1,008.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$306.88
|
| Rate for Payer: Prime Health Services Commercial |
$1,318.35
|
| Rate for Payer: Prime Health Services Medicare |
$325.29
|
| Rate for Payer: Riverside University Health System MISP |
$337.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$930.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$930.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$700.26
|
| Rate for Payer: United Healthcare All Other HMO |
$700.26
|
| Rate for Payer: United Healthcare HMO Rider |
$700.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$700.26
|
| Rate for Payer: Upland Medical Group Pediatric |
$306.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC MRI FETAL PELVIC IMG ADD FETUS
|
Facility
|
OP
|
$741.00
|
|
|
Service Code
|
CPT 74713
|
| Hospital Charge Code |
908874713
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$148.20 |
| Max. Negotiated Rate |
$2,522.60 |
| Rate for Payer: Adventist Health Commercial |
$148.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,055.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$629.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$407.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$555.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,814.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,522.60
|
| Rate for Payer: Blue Shield of California Commercial |
$466.83
|
| Rate for Payer: Blue Shield of California EPN |
$294.18
|
| Rate for Payer: Cash Price |
$333.45
|
| Rate for Payer: Cash Price |
$333.45
|
| Rate for Payer: Central Health Plan Commercial |
$592.80
|
| Rate for Payer: Cigna of CA HMO |
$474.24
|
| Rate for Payer: Cigna of CA PPO |
$548.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$629.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$629.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$629.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$518.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$296.40
|
| Rate for Payer: EPIC Health Plan Senior |
$296.40
|
| Rate for Payer: Galaxy Health WC |
$629.85
|
| Rate for Payer: Global Benefits Group Commercial |
$444.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$666.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$332.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$470.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$367.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$437.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$518.70
|
| Rate for Payer: Multiplan Commercial |
$555.75
|
| Rate for Payer: Networks By Design Commercial |
$481.65
|
| Rate for Payer: Prime Health Services Commercial |
$629.85
|
| Rate for Payer: Riverside University Health System MISP |
$296.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$444.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$444.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$370.50
|
| Rate for Payer: United Healthcare All Other HMO |
$370.50
|
| Rate for Payer: United Healthcare HMO Rider |
$370.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$370.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$629.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$629.85
|
| Rate for Payer: Vantage Medical Group Senior |
$629.85
|
|
|
HC MRI FETAL PELVIC IMG ADD FETUS
|
Facility
|
IP
|
$741.00
|
|
|
Service Code
|
CPT 74713
|
| Hospital Charge Code |
908874713
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$148.20 |
| Max. Negotiated Rate |
$666.90 |
| Rate for Payer: Adventist Health Commercial |
$148.20
|
| Rate for Payer: Cash Price |
$333.45
|
| Rate for Payer: Central Health Plan Commercial |
$592.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$518.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$296.40
|
| Rate for Payer: EPIC Health Plan Senior |
$296.40
|
| Rate for Payer: Galaxy Health WC |
$629.85
|
| Rate for Payer: Global Benefits Group Commercial |
$444.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$666.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$470.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$437.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.20
|
| Rate for Payer: Multiplan Commercial |
$555.75
|
| Rate for Payer: Networks By Design Commercial |
$481.65
|
| Rate for Payer: Prime Health Services Commercial |
$629.85
|
|
|
HC MRI FOR TISSUE ABLATION
|
Facility
|
OP
|
$1,263.00
|
|
|
Service Code
|
CPT 77022
|
| Hospital Charge Code |
908877022
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$252.60 |
| Max. Negotiated Rate |
$2,364.46 |
| Rate for Payer: Adventist Health Commercial |
$252.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,055.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,073.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$694.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$947.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,364.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$734.69
|
| Rate for Payer: Blue Shield of California Commercial |
$795.69
|
| Rate for Payer: Blue Shield of California EPN |
$501.41
|
| Rate for Payer: Cash Price |
$568.35
|
| Rate for Payer: Cash Price |
$568.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,010.40
|
| Rate for Payer: Cigna of CA HMO |
$808.32
|
| Rate for Payer: Cigna of CA PPO |
$934.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,073.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,073.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,073.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$884.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$505.20
|
| Rate for Payer: EPIC Health Plan Senior |
$505.20
|
| Rate for Payer: Galaxy Health WC |
$1,073.55
|
| Rate for Payer: Global Benefits Group Commercial |
$757.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,136.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$295.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$802.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$326.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$745.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$884.10
|
| Rate for Payer: Multiplan Commercial |
$947.25
|
| Rate for Payer: Networks By Design Commercial |
$820.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,073.55
|
| Rate for Payer: Riverside University Health System MISP |
$505.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$757.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$757.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$631.50
|
| Rate for Payer: United Healthcare All Other HMO |
$631.50
|
| Rate for Payer: United Healthcare HMO Rider |
$631.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$631.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,073.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,073.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,073.55
|
|
|
HC MRI FOR TISSUE ABLATION
|
Facility
|
IP
|
$1,263.00
|
|
|
Service Code
|
CPT 77022
|
| Hospital Charge Code |
908877022
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$252.60 |
| Max. Negotiated Rate |
$1,136.70 |
| Rate for Payer: Adventist Health Commercial |
$252.60
|
| Rate for Payer: Cash Price |
$568.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,010.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$884.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$505.20
|
| Rate for Payer: EPIC Health Plan Senior |
$505.20
|
| Rate for Payer: Galaxy Health WC |
$1,073.55
|
| Rate for Payer: Global Benefits Group Commercial |
$757.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,136.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$802.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$745.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.60
|
| Rate for Payer: Multiplan Commercial |
$947.25
|
| Rate for Payer: Networks By Design Commercial |
$820.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,073.55
|
|
|
HC MRI GUID BX/NEEDLE LOC/ASPIR
|
Facility
|
IP
|
$10,250.00
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
909002020
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,050.00 |
| Max. Negotiated Rate |
$9,225.00 |
| Rate for Payer: Adventist Health Commercial |
$2,050.00
|
| Rate for Payer: Cash Price |
$4,612.50
|
| Rate for Payer: Central Health Plan Commercial |
$8,200.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,175.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,100.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,100.00
|
| Rate for Payer: Galaxy Health WC |
$8,712.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,150.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,225.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,508.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,047.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,050.00
|
| Rate for Payer: Multiplan Commercial |
$7,687.50
|
| Rate for Payer: Networks By Design Commercial |
$6,662.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,712.50
|
|
|
HC MRI GUID BX/NEEDLE LOC/ASPIR
|
Facility
|
OP
|
$10,250.00
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
909002020
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$630.83 |
| Max. Negotiated Rate |
$9,225.00 |
| Rate for Payer: Adventist Health Commercial |
$2,050.00
|
| Rate for Payer: Adventist Health Commercial |
$1,258.00
|
| 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 |
$5,346.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,712.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,459.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,637.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,717.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,687.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,364.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,364.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,962.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,658.89
|
| Rate for Payer: Blue Shield of California Commercial |
$6,457.50
|
| Rate for Payer: Blue Shield of California Commercial |
$3,962.70
|
| Rate for Payer: Blue Shield of California EPN |
$4,069.25
|
| Rate for Payer: Blue Shield of California EPN |
$2,497.13
|
| Rate for Payer: Cash Price |
$4,612.50
|
| Rate for Payer: Cash Price |
$2,830.50
|
| Rate for Payer: Cash Price |
$4,612.50
|
| Rate for Payer: Cash Price |
$2,830.50
|
| Rate for Payer: Central Health Plan Commercial |
$8,200.00
|
| Rate for Payer: Central Health Plan Commercial |
$5,032.00
|
| Rate for Payer: Cigna of CA HMO |
$6,560.00
|
| Rate for Payer: Cigna of CA HMO |
$4,025.60
|
| Rate for Payer: Cigna of CA PPO |
$4,654.60
|
| Rate for Payer: Cigna of CA PPO |
$7,585.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,346.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,712.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,712.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,346.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,346.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,712.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,403.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,175.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,516.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,100.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,516.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,100.00
|
| Rate for Payer: Galaxy Health WC |
$8,712.50
|
| Rate for Payer: Galaxy Health WC |
$5,346.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,774.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,150.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,225.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,661.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$630.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$630.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,994.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,508.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$696.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$696.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,711.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,047.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,050.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,258.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,403.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7,175.00
|
| Rate for Payer: Multiplan Commercial |
$7,687.50
|
| Rate for Payer: Multiplan Commercial |
$4,717.50
|
| Rate for Payer: Networks By Design Commercial |
$4,088.50
|
| Rate for Payer: Networks By Design Commercial |
$6,662.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,712.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,346.50
|
| Rate for Payer: Riverside University Health System MISP |
$4,100.00
|
| Rate for Payer: Riverside University Health System MISP |
$2,516.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,150.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,774.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,150.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,774.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,145.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,125.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,125.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,145.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,125.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,145.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,125.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,145.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,346.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,712.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,712.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,346.50
|
| Rate for Payer: Vantage Medical Group Senior |
$5,346.50
|
| Rate for Payer: Vantage Medical Group Senior |
$8,712.50
|
|
|
HC MRI INSERTABLE IMAGING COIL
|
Facility
|
OP
|
$525.00
|
|
|
Service Code
|
CPT C1770
|
| Hospital Charge Code |
908801710
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$472.50 |
| Rate for Payer: Adventist Health Commercial |
$105.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$446.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$288.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$393.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$239.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$287.91
|
| Rate for Payer: Blue Shield of California Commercial |
$421.05
|
| Rate for Payer: Blue Shield of California EPN |
$264.60
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Central Health Plan Commercial |
$420.00
|
| Rate for Payer: Cigna of CA HMO |
$367.50
|
| Rate for Payer: Cigna of CA PPO |
$367.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$446.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$446.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$446.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$367.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.00
|
| Rate for Payer: EPIC Health Plan Senior |
$210.00
|
| Rate for Payer: Galaxy Health WC |
$446.25
|
| Rate for Payer: Global Benefits Group Commercial |
$315.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$472.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$333.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$190.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$309.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$367.50
|
| Rate for Payer: Multiplan Commercial |
$393.75
|
| Rate for Payer: Networks By Design Commercial |
$262.50
|
| Rate for Payer: Prime Health Services Commercial |
$446.25
|
| Rate for Payer: Riverside University Health System MISP |
$210.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$315.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$315.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$197.03
|
| Rate for Payer: United Healthcare All Other HMO |
$191.78
|
| Rate for Payer: United Healthcare HMO Rider |
$187.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$171.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$446.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$446.25
|
| Rate for Payer: Vantage Medical Group Senior |
$446.25
|
|
|
HC MRI INSERTABLE IMAGING COIL
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
CPT C1770
|
| Hospital Charge Code |
908801710
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$472.50 |
| Rate for Payer: Adventist Health Commercial |
$105.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.05
|
| Rate for Payer: Blue Shield of California EPN |
$264.60
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Central Health Plan Commercial |
$420.00
|
| Rate for Payer: Cigna of CA HMO |
$367.50
|
| Rate for Payer: Cigna of CA PPO |
$367.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$367.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.00
|
| Rate for Payer: EPIC Health Plan Senior |
$210.00
|
| Rate for Payer: Galaxy Health WC |
$446.25
|
| Rate for Payer: Global Benefits Group Commercial |
$315.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$472.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$333.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$309.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.00
|
| Rate for Payer: Multiplan Commercial |
$393.75
|
| Rate for Payer: Networks By Design Commercial |
$262.50
|
| Rate for Payer: Prime Health Services Commercial |
$446.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$197.03
|
| Rate for Payer: United Healthcare All Other HMO |
$191.78
|
| Rate for Payer: United Healthcare HMO Rider |
$187.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$171.94
|
|
|
HC MRI LOWER EXTREMITY W/O CON
|
Facility
|
IP
|
$8,458.00
|
|
|
Service Code
|
CPT 73718
|
| Hospital Charge Code |
908801402
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,691.60 |
| Max. Negotiated Rate |
$7,612.20 |
| Rate for Payer: Adventist Health Commercial |
$1,691.60
|
| Rate for Payer: Cash Price |
$3,806.10
|
| Rate for Payer: Central Health Plan Commercial |
$6,766.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,920.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,383.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,383.20
|
| Rate for Payer: Galaxy Health WC |
$7,189.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,074.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,612.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,370.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,990.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,691.60
|
| Rate for Payer: Multiplan Commercial |
$6,343.50
|
| Rate for Payer: Networks By Design Commercial |
$5,497.70
|
| Rate for Payer: Prime Health Services Commercial |
$7,189.30
|
|
|
HC MRI LOWER EXTREMITY W/O CON
|
Facility
|
OP
|
$4,005.00
|
|
|
Service Code
|
CPT 73718
|
| Hospital Charge Code |
908801402
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$306.88 |
| Max. Negotiated Rate |
$3,604.50 |
| Rate for Payer: Adventist Health Commercial |
$801.00
|
| Rate for Payer: Adventist Health Commercial |
$1,691.60
|
| 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 |
$2,954.00
|
| 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 |
$2,342.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,342.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,329.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,920.02
|
| Rate for Payer: Blue Shield of California Commercial |
$5,328.54
|
| Rate for Payer: Blue Shield of California Commercial |
$2,523.15
|
| Rate for Payer: Blue Shield of California EPN |
$1,589.98
|
| Rate for Payer: Blue Shield of California EPN |
$3,357.83
|
| Rate for Payer: Cash Price |
$1,802.25
|
| Rate for Payer: Cash Price |
$1,802.25
|
| Rate for Payer: Cash Price |
$1,802.25
|
| Rate for Payer: Cash Price |
$3,806.10
|
| Rate for Payer: Cash Price |
$3,806.10
|
| Rate for Payer: Cash Price |
$3,806.10
|
| Rate for Payer: Central Health Plan Commercial |
$6,766.40
|
| Rate for Payer: Central Health Plan Commercial |
$3,204.00
|
| Rate for Payer: Cigna of CA HMO |
$5,413.12
|
| Rate for Payer: Cigna of CA HMO |
$2,563.20
|
| Rate for Payer: Cigna of CA PPO |
$6,258.92
|
| Rate for Payer: Cigna of CA PPO |
$2,963.70
|
| 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 |
$5,920.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,803.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: Galaxy Health WC |
$3,404.25
|
| Rate for Payer: Galaxy Health WC |
$7,189.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,074.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,403.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,612.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,604.50
|
| 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 |
$378.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$378.52
|
| 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 |
$5,370.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,543.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$418.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$418.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$801.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,691.60
|
| 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 |
$6,343.50
|
| Rate for Payer: Multiplan Commercial |
$3,003.75
|
| Rate for Payer: Networks By Design Commercial |
$2,603.25
|
| Rate for Payer: Networks By Design Commercial |
$5,497.70
|
| 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 |
$3,404.25
|
| Rate for Payer: Prime Health Services Commercial |
$7,189.30
|
| 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 |
$2,403.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,074.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,403.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,074.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| Rate for Payer: United Healthcare All Other HMO |
$866.34
|
| Rate for Payer: United Healthcare All Other HMO |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$306.88
|
| Rate for Payer: Upland Medical Group Pediatric |
$306.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC MRI LOWER EXTREM JOINT W CONT
|
Facility
|
OP
|
$4,231.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
908801376
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$538.38 |
| Max. Negotiated Rate |
$3,807.90 |
| Rate for Payer: Adventist Health Commercial |
$846.20
|
| Rate for Payer: Adventist Health Commercial |
$1,751.40
|
| 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 |
$2,808.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,808.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,461.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,093.95
|
| Rate for Payer: Blue Shield of California Commercial |
$5,516.91
|
| Rate for Payer: Blue Shield of California Commercial |
$2,665.53
|
| Rate for Payer: Blue Shield of California EPN |
$1,679.71
|
| Rate for Payer: Blue Shield of California EPN |
$3,476.53
|
| Rate for Payer: Cash Price |
$1,903.95
|
| Rate for Payer: Cash Price |
$1,903.95
|
| Rate for Payer: Cash Price |
$1,903.95
|
| Rate for Payer: Cash Price |
$3,940.65
|
| Rate for Payer: Cash Price |
$3,940.65
|
| Rate for Payer: Cash Price |
$3,940.65
|
| Rate for Payer: Central Health Plan Commercial |
$7,005.60
|
| Rate for Payer: Central Health Plan Commercial |
$3,384.80
|
| Rate for Payer: Cigna of CA HMO |
$5,604.48
|
| Rate for Payer: Cigna of CA HMO |
$2,707.84
|
| Rate for Payer: Cigna of CA PPO |
$6,480.18
|
| Rate for Payer: Cigna of CA PPO |
$3,130.94
|
| 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 |
$6,129.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,961.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,663.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,663.61
|
| Rate for Payer: EPIC Health Plan Senior |
$1,109.08
|
| Rate for Payer: EPIC Health Plan Senior |
$1,109.08
|
| Rate for Payer: Galaxy Health WC |
$3,596.35
|
| Rate for Payer: Galaxy Health WC |
$7,443.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,254.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,538.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,881.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,807.90
|
| 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 |
$538.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$538.38
|
| 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 |
$5,560.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,686.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$594.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$594.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,411.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,411.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$846.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,751.40
|
| 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 |
$6,567.75
|
| Rate for Payer: Multiplan Commercial |
$3,173.25
|
| Rate for Payer: Networks By Design Commercial |
$2,750.15
|
| Rate for Payer: Networks By Design Commercial |
$5,692.05
|
| 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 |
$3,596.35
|
| Rate for Payer: Prime Health Services Commercial |
$7,443.45
|
| 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 |
$2,538.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,254.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,538.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,254.20
|
| 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 |
$1,008.25
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,008.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,512.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,512.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,109.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,109.08
|
| Rate for Payer: Vantage Medical Group Senior |
$1,008.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,008.25
|
|
|
HC MRI LOWER EXTREM JOINT W CONT
|
Facility
|
IP
|
$8,757.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
908801376
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,751.40 |
| Max. Negotiated Rate |
$7,881.30 |
| Rate for Payer: Adventist Health Commercial |
$1,751.40
|
| Rate for Payer: Cash Price |
$3,940.65
|
| Rate for Payer: Central Health Plan Commercial |
$7,005.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,129.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,502.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,502.80
|
| Rate for Payer: Galaxy Health WC |
$7,443.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,254.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,881.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,560.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,166.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,751.40
|
| Rate for Payer: Multiplan Commercial |
$6,567.75
|
| Rate for Payer: Networks By Design Commercial |
$5,692.05
|
| Rate for Payer: Prime Health Services Commercial |
$7,443.45
|
|
|
HC MRI LOWER EXTREM JOINT WO CONT
|
Facility
|
OP
|
$3,641.00
|
|
|
Service Code
|
CPT 73721
|
| Hospital Charge Code |
908801441
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$306.88 |
| Max. Negotiated Rate |
$3,276.90 |
| Rate for Payer: Adventist Health Commercial |
$728.20
|
| Rate for Payer: Adventist Health Commercial |
$1,657.40
|
| 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 |
$2,295.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,295.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,117.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,820.55
|
| Rate for Payer: Blue Shield of California Commercial |
$5,220.81
|
| Rate for Payer: Blue Shield of California Commercial |
$2,293.83
|
| Rate for Payer: Blue Shield of California EPN |
$1,445.48
|
| Rate for Payer: Blue Shield of California EPN |
$3,289.94
|
| Rate for Payer: Cash Price |
$1,638.45
|
| Rate for Payer: Cash Price |
$1,638.45
|
| Rate for Payer: Cash Price |
$1,638.45
|
| Rate for Payer: Cash Price |
$3,729.15
|
| Rate for Payer: Cash Price |
$3,729.15
|
| Rate for Payer: Cash Price |
$3,729.15
|
| Rate for Payer: Central Health Plan Commercial |
$6,629.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,912.80
|
| Rate for Payer: Cigna of CA HMO |
$5,303.68
|
| Rate for Payer: Cigna of CA HMO |
$2,330.24
|
| Rate for Payer: Cigna of CA PPO |
$6,132.38
|
| Rate for Payer: Cigna of CA PPO |
$2,694.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,800.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,548.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: Galaxy Health WC |
$3,094.85
|
| Rate for Payer: Galaxy Health WC |
$7,043.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,972.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,184.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,458.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,276.90
|
| 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 |
$671.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$671.63
|
| 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 |
$5,262.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,312.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$741.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$741.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$728.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,657.40
|
| 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 |
$6,215.25
|
| Rate for Payer: Multiplan Commercial |
$2,730.75
|
| Rate for Payer: Networks By Design Commercial |
$2,366.65
|
| Rate for Payer: Networks By Design Commercial |
$5,386.55
|
| 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 |
$3,094.85
|
| Rate for Payer: Prime Health Services Commercial |
$7,043.95
|
| 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 |
$2,184.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,972.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,184.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,972.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| Rate for Payer: United Healthcare All Other HMO |
$866.34
|
| Rate for Payer: United Healthcare All Other HMO |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$306.88
|
| Rate for Payer: Upland Medical Group Pediatric |
$306.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC MRI LOWER EXTREM JOINT WO CONT
|
Facility
|
IP
|
$8,287.00
|
|
|
Service Code
|
CPT 73721
|
| Hospital Charge Code |
908801441
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,657.40 |
| Max. Negotiated Rate |
$7,458.30 |
| Rate for Payer: Adventist Health Commercial |
$1,657.40
|
| Rate for Payer: Cash Price |
$3,729.15
|
| Rate for Payer: Central Health Plan Commercial |
$6,629.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,800.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,314.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,314.80
|
| Rate for Payer: Galaxy Health WC |
$7,043.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,972.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,458.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,262.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,889.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,657.40
|
| Rate for Payer: Multiplan Commercial |
$6,215.25
|
| Rate for Payer: Networks By Design Commercial |
$5,386.55
|
| Rate for Payer: Prime Health Services Commercial |
$7,043.95
|
|
|
HC MRI LOWER EXTREM JOIN W & WO CONT
|
Facility
|
IP
|
$13,414.00
|
|
|
Service Code
|
CPT 73723
|
| Hospital Charge Code |
908801377
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,682.80 |
| Max. Negotiated Rate |
$12,072.60 |
| Rate for Payer: Adventist Health Commercial |
$2,682.80
|
| Rate for Payer: Cash Price |
$6,036.30
|
| Rate for Payer: Central Health Plan Commercial |
$10,731.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,389.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,365.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5,365.60
|
| Rate for Payer: Galaxy Health WC |
$11,401.90
|
| Rate for Payer: Global Benefits Group Commercial |
$8,048.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,072.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,517.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,914.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,682.80
|
| Rate for Payer: Multiplan Commercial |
$10,060.50
|
| Rate for Payer: Networks By Design Commercial |
$8,719.10
|
| Rate for Payer: Prime Health Services Commercial |
$11,401.90
|
|
|
HC MRI LOWER EXTREM JOIN W & WO CONT
|
Facility
|
OP
|
$13,414.00
|
|
|
Service Code
|
CPT 73723
|
| Hospital Charge Code |
908801377
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$448.71 |
| Max. Negotiated Rate |
$12,072.60 |
| Rate for Payer: Adventist Health Commercial |
$2,682.80
|
| Rate for Payer: Adventist Health Commercial |
$1,354.80
|
| 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 |
$5,198.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,198.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,802.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,940.44
|
| Rate for Payer: Blue Shield of California Commercial |
$4,267.62
|
| Rate for Payer: Blue Shield of California Commercial |
$8,450.82
|
| Rate for Payer: Blue Shield of California EPN |
$5,325.36
|
| Rate for Payer: Blue Shield of California EPN |
$2,689.28
|
| Rate for Payer: Cash Price |
$6,036.30
|
| Rate for Payer: Cash Price |
$6,036.30
|
| Rate for Payer: Cash Price |
$6,036.30
|
| Rate for Payer: Cash Price |
$3,048.30
|
| Rate for Payer: Cash Price |
$3,048.30
|
| Rate for Payer: Cash Price |
$3,048.30
|
| Rate for Payer: Central Health Plan Commercial |
$5,419.20
|
| Rate for Payer: Central Health Plan Commercial |
$10,731.20
|
| Rate for Payer: Cigna of CA HMO |
$4,335.36
|
| Rate for Payer: Cigna of CA HMO |
$8,584.96
|
| Rate for Payer: Cigna of CA PPO |
$5,012.76
|
| Rate for Payer: Cigna of CA PPO |
$9,926.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,741.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,389.80
|
| 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 |
$11,401.90
|
| Rate for Payer: Galaxy Health WC |
$5,757.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,064.40
|
| Rate for Payer: Global Benefits Group Commercial |
$8,048.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,096.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,072.60
|
| 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 |
$985.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$985.89
|
| 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 |
$4,301.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,517.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,089.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,089.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,682.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,354.80
|
| 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 |
$5,080.50
|
| Rate for Payer: Multiplan Commercial |
$10,060.50
|
| Rate for Payer: Networks By Design Commercial |
$8,719.10
|
| Rate for Payer: Networks By Design Commercial |
$4,403.10
|
| 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 |
$11,401.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,757.90
|
| 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 |
$8,048.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,064.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,048.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,064.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,367.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,367.12
|
| Rate for Payer: United Healthcare All Other HMO |
$1,367.12
|
| Rate for Payer: United Healthcare All Other HMO |
$1,367.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1,367.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1,367.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,367.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,367.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$448.71
|
| Rate for Payer: Upland Medical Group Pediatric |
$448.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
|
|
HC MRI LOWER EXTREM W/ CON
|
Facility
|
OP
|
$4,462.00
|
|
|
Service Code
|
CPT 73719
|
| Hospital Charge Code |
908801403
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$448.71 |
| Max. Negotiated Rate |
$4,015.80 |
| Rate for Payer: Adventist Health Commercial |
$892.40
|
| Rate for Payer: Adventist Health Commercial |
$1,846.60
|
| 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 |
$2,055.46
|
| 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 |
$2,808.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,808.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,595.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,370.84
|
| Rate for Payer: Blue Shield of California Commercial |
$5,816.79
|
| Rate for Payer: Blue Shield of California Commercial |
$2,811.06
|
| Rate for Payer: Blue Shield of California EPN |
$3,665.50
|
| Rate for Payer: Blue Shield of California EPN |
$1,771.41
|
| Rate for Payer: Cash Price |
$2,007.90
|
| Rate for Payer: Cash Price |
$4,154.85
|
| Rate for Payer: Cash Price |
$2,007.90
|
| Rate for Payer: Cash Price |
$4,154.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,569.60
|
| Rate for Payer: Central Health Plan Commercial |
$7,386.40
|
| Rate for Payer: Cigna of CA HMO |
$2,855.68
|
| Rate for Payer: Cigna of CA HMO |
$5,909.12
|
| Rate for Payer: Cigna of CA PPO |
$6,832.42
|
| Rate for Payer: Cigna of CA PPO |
$3,301.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,123.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,463.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.37
|
| Rate for Payer: EPIC Health Plan Senior |
$493.58
|
| Rate for Payer: EPIC Health Plan Senior |
$493.58
|
| Rate for Payer: Galaxy Health WC |
$7,848.05
|
| Rate for Payer: Galaxy Health WC |
$3,792.70
|
| Rate for Payer: Global Benefits Group Commercial |
$5,539.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,677.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,309.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,015.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$735.88
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$735.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$822.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$822.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,833.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,862.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$908.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$908.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$892.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,846.60
|
| 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 |
$3,346.50
|
| Rate for Payer: Multiplan Commercial |
$6,924.75
|
| Rate for Payer: Networks By Design Commercial |
$2,900.30
|
| Rate for Payer: Networks By Design Commercial |
$6,001.45
|
| 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 |
$3,792.70
|
| Rate for Payer: Prime Health Services Commercial |
$7,848.05
|
| 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 |
$2,677.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,539.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,677.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,539.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,115.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,115.74
|
| Rate for Payer: United Healthcare All Other HMO |
$1,115.74
|
| Rate for Payer: United Healthcare All Other HMO |
$1,115.74
|
| Rate for Payer: United Healthcare HMO Rider |
$1,115.74
|
| Rate for Payer: United Healthcare HMO Rider |
$1,115.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,115.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,115.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$448.71
|
| Rate for Payer: Upland Medical Group Pediatric |
$448.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
|
|
HC MRI LOWER EXTREM W/ CON
|
Facility
|
IP
|
$9,233.00
|
|
|
Service Code
|
CPT 73719
|
| Hospital Charge Code |
908801403
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,846.60 |
| Max. Negotiated Rate |
$8,309.70 |
| Rate for Payer: Adventist Health Commercial |
$1,846.60
|
| Rate for Payer: Cash Price |
$4,154.85
|
| Rate for Payer: Central Health Plan Commercial |
$7,386.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,463.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,693.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,693.20
|
| Rate for Payer: Galaxy Health WC |
$7,848.05
|
| Rate for Payer: Global Benefits Group Commercial |
$5,539.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,309.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,862.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,447.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,846.60
|
| Rate for Payer: Multiplan Commercial |
$6,924.75
|
| Rate for Payer: Networks By Design Commercial |
$6,001.45
|
| Rate for Payer: Prime Health Services Commercial |
$7,848.05
|
|
