|
HC MRI LOWER EXTREM WO CONT
|
Facility
|
OP
|
$12,967.00
|
|
|
Service Code
|
CPT 73720
|
| Hospital Charge Code |
908801399
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$448.71 |
| Max. Negotiated Rate |
$11,670.30 |
| Rate for Payer: Adventist Health Commercial |
$2,593.40
|
| Rate for Payer: Adventist Health Commercial |
$1,002.40
|
| 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 |
$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 |
$7,542.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,915.48
|
| Rate for Payer: Blue Shield of California Commercial |
$3,157.56
|
| Rate for Payer: Blue Shield of California Commercial |
$8,169.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,147.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,989.76
|
| Rate for Payer: Cash Price |
$5,835.15
|
| Rate for Payer: Cash Price |
$5,835.15
|
| Rate for Payer: Cash Price |
$5,835.15
|
| Rate for Payer: Cash Price |
$2,255.40
|
| Rate for Payer: Cash Price |
$2,255.40
|
| Rate for Payer: Cash Price |
$2,255.40
|
| Rate for Payer: Central Health Plan Commercial |
$4,009.60
|
| Rate for Payer: Central Health Plan Commercial |
$10,373.60
|
| Rate for Payer: Cigna of CA HMO |
$3,207.68
|
| Rate for Payer: Cigna of CA HMO |
$8,298.88
|
| Rate for Payer: Cigna of CA PPO |
$3,708.88
|
| Rate for Payer: Cigna of CA PPO |
$9,595.58
|
| 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 |
$3,508.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,076.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.37
|
| Rate for Payer: EPIC Health Plan Senior |
$493.58
|
| Rate for Payer: EPIC Health Plan Senior |
$493.58
|
| Rate for Payer: Galaxy Health WC |
$11,021.95
|
| Rate for Payer: Galaxy Health WC |
$4,260.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,007.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7,780.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,510.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,670.30
|
| 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 |
$572.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$572.88
|
| 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 |
$3,182.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,234.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$632.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$632.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,593.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,002.40
|
| 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 |
$3,759.00
|
| Rate for Payer: Multiplan Commercial |
$9,725.25
|
| Rate for Payer: Networks By Design Commercial |
$8,428.55
|
| Rate for Payer: Networks By Design Commercial |
$3,257.80
|
| 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 |
$11,021.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,260.20
|
| 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 |
$7,780.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,007.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,780.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,007.20
|
| 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 LOWER EXTREM WO CONT
|
Facility
|
IP
|
$12,967.00
|
|
|
Service Code
|
CPT 73720
|
| Hospital Charge Code |
908801399
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,593.40 |
| Max. Negotiated Rate |
$11,670.30 |
| Rate for Payer: Adventist Health Commercial |
$2,593.40
|
| Rate for Payer: Cash Price |
$5,835.15
|
| Rate for Payer: Central Health Plan Commercial |
$10,373.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,076.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,186.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5,186.80
|
| Rate for Payer: Galaxy Health WC |
$11,021.95
|
| Rate for Payer: Global Benefits Group Commercial |
$7,780.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,670.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,234.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,650.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,593.40
|
| Rate for Payer: Multiplan Commercial |
$9,725.25
|
| Rate for Payer: Networks By Design Commercial |
$8,428.55
|
| Rate for Payer: Prime Health Services Commercial |
$11,021.95
|
|
|
HC MRI L-SPINE W & WO CONTRAST
|
Facility
|
OP
|
$12,346.00
|
|
|
Service Code
|
CPT 72158
|
| Hospital Charge Code |
908801124
|
|
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 |
$4,537.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,537.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,181.67
|
| 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 |
$537.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$537.14
|
| 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 |
$593.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$593.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 L-SPINE W & WO CONTRAST
|
Facility
|
IP
|
$12,346.00
|
|
|
Service Code
|
CPT 72158
|
| Hospital Charge Code |
908801124
|
|
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 LUMBAR SPINE W CONTRAST
|
Facility
|
OP
|
$11,827.00
|
|
|
Service Code
|
CPT 72149
|
| Hospital Charge Code |
908801122
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$448.71 |
| Max. Negotiated Rate |
$10,644.30 |
| Rate for Payer: Adventist Health Commercial |
$2,365.40
|
| 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 |
$2,954.00
|
| 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 |
$2,764.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,764.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,879.77
|
| 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 |
$7,451.01
|
| Rate for Payer: Blue Shield of California EPN |
$4,695.32
|
| Rate for Payer: Blue Shield of California EPN |
$2,044.55
|
| Rate for Payer: Cash Price |
$5,322.15
|
| Rate for Payer: Cash Price |
$5,322.15
|
| Rate for Payer: Cash Price |
$5,322.15
|
| Rate for Payer: Cash Price |
$2,317.50
|
| Rate for Payer: Cash Price |
$2,317.50
|
| Rate for Payer: Cash Price |
$2,317.50
|
| Rate for Payer: Central Health Plan Commercial |
$4,120.00
|
| Rate for Payer: Central Health Plan Commercial |
$9,461.60
|
| Rate for Payer: Cigna of CA HMO |
$3,296.00
|
| Rate for Payer: Cigna of CA HMO |
$7,569.28
|
| Rate for Payer: Cigna of CA PPO |
$3,811.00
|
| Rate for Payer: Cigna of CA PPO |
$8,751.98
|
| 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 |
$3,605.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,278.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.37
|
| Rate for Payer: EPIC Health Plan Senior |
$493.58
|
| Rate for Payer: EPIC Health Plan Senior |
$493.58
|
| Rate for Payer: Galaxy Health WC |
$10,052.95
|
| Rate for Payer: Galaxy Health WC |
$4,377.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,090.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,096.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,635.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,644.30
|
| 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 |
$456.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$456.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,270.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,510.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$504.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$504.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,365.40
|
| 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 |
$3,862.50
|
| Rate for Payer: Multiplan Commercial |
$8,870.25
|
| Rate for Payer: Networks By Design Commercial |
$7,687.55
|
| 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 |
$10,052.95
|
| 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 |
$7,096.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,090.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,096.20
|
| 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 LUMBAR SPINE W CONTRAST
|
Facility
|
IP
|
$11,827.00
|
|
|
Service Code
|
CPT 72149
|
| Hospital Charge Code |
908801122
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$2,365.40 |
| Max. Negotiated Rate |
$10,644.30 |
| Rate for Payer: Adventist Health Commercial |
$2,365.40
|
| Rate for Payer: Cash Price |
$5,322.15
|
| Rate for Payer: Central Health Plan Commercial |
$9,461.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,278.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,730.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,730.80
|
| Rate for Payer: Galaxy Health WC |
$10,052.95
|
| Rate for Payer: Global Benefits Group Commercial |
$7,096.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,644.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,510.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,977.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,365.40
|
| Rate for Payer: Multiplan Commercial |
$8,870.25
|
| Rate for Payer: Networks By Design Commercial |
$7,687.55
|
| Rate for Payer: Prime Health Services Commercial |
$10,052.95
|
|
|
HC MRI LUMBAR SPINE WO CONTR
|
Facility
|
OP
|
$10,563.00
|
|
|
Service Code
|
CPT 72148
|
| Hospital Charge Code |
908801120
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$306.88 |
| Max. Negotiated Rate |
$9,506.70 |
| Rate for Payer: Adventist Health Commercial |
$2,112.60
|
| 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 |
$2,954.00
|
| 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 |
$2,554.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,554.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,144.50
|
| 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 |
$6,654.69
|
| Rate for Payer: Blue Shield of California EPN |
$4,193.51
|
| Rate for Payer: Blue Shield of California EPN |
$1,971.11
|
| Rate for Payer: Cash Price |
$4,753.35
|
| Rate for Payer: Cash Price |
$4,753.35
|
| Rate for Payer: Cash Price |
$4,753.35
|
| 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 |
$8,450.40
|
| Rate for Payer: Cigna of CA HMO |
$3,177.60
|
| Rate for Payer: Cigna of CA HMO |
$6,760.32
|
| Rate for Payer: Cigna of CA PPO |
$3,674.10
|
| Rate for Payer: Cigna of CA PPO |
$7,816.62
|
| 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 |
$3,475.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,394.10
|
| 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 |
$8,978.55
|
| 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 |
$6,337.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,468.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,506.70
|
| 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 |
$319.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$319.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,152.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,707.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$353.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$353.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,112.60
|
| 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 |
$3,723.75
|
| Rate for Payer: Multiplan Commercial |
$7,922.25
|
| Rate for Payer: Networks By Design Commercial |
$6,865.95
|
| 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 |
$8,978.55
|
| 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 |
$6,337.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,979.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,337.80
|
| 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 LUMBAR SPINE WO CONTR
|
Facility
|
IP
|
$10,563.00
|
|
|
Service Code
|
CPT 72148
|
| Hospital Charge Code |
908801120
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$2,112.60 |
| Max. Negotiated Rate |
$9,506.70 |
| Rate for Payer: Adventist Health Commercial |
$2,112.60
|
| Rate for Payer: Cash Price |
$4,753.35
|
| Rate for Payer: Central Health Plan Commercial |
$8,450.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,394.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,225.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,225.20
|
| Rate for Payer: Galaxy Health WC |
$8,978.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6,337.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,506.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,707.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,232.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,112.60
|
| Rate for Payer: Multiplan Commercial |
$7,922.25
|
| Rate for Payer: Networks By Design Commercial |
$6,865.95
|
| Rate for Payer: Prime Health Services Commercial |
$8,978.55
|
|
|
HC MRI ORBIT FACE/NECK W CON
|
Facility
|
OP
|
$5,017.00
|
|
|
Service Code
|
CPT 70542
|
| Hospital Charge Code |
908801081
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$448.71 |
| Max. Negotiated Rate |
$4,515.30 |
| Rate for Payer: Adventist Health Commercial |
$1,003.40
|
| Rate for Payer: Adventist Health Commercial |
$1,896.60
|
| 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 |
$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 |
$2,918.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,516.26
|
| Rate for Payer: Blue Shield of California Commercial |
$5,974.29
|
| Rate for Payer: Blue Shield of California Commercial |
$3,160.71
|
| Rate for Payer: Blue Shield of California EPN |
$1,991.75
|
| Rate for Payer: Blue Shield of California EPN |
$3,764.75
|
| Rate for Payer: Cash Price |
$2,257.65
|
| Rate for Payer: Cash Price |
$2,257.65
|
| Rate for Payer: Cash Price |
$2,257.65
|
| Rate for Payer: Cash Price |
$4,267.35
|
| Rate for Payer: Cash Price |
$4,267.35
|
| Rate for Payer: Cash Price |
$4,267.35
|
| Rate for Payer: Central Health Plan Commercial |
$7,586.40
|
| Rate for Payer: Central Health Plan Commercial |
$4,013.60
|
| Rate for Payer: Cigna of CA HMO |
$6,069.12
|
| Rate for Payer: Cigna of CA HMO |
$3,210.88
|
| Rate for Payer: Cigna of CA PPO |
$7,017.42
|
| Rate for Payer: Cigna of CA PPO |
$3,712.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,638.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,511.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.37
|
| Rate for Payer: EPIC Health Plan Senior |
$493.58
|
| Rate for Payer: EPIC Health Plan Senior |
$493.58
|
| Rate for Payer: Galaxy Health WC |
$4,264.45
|
| Rate for Payer: Galaxy Health WC |
$8,060.55
|
| Rate for Payer: Global Benefits Group Commercial |
$5,689.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,010.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,534.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,515.30
|
| 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 |
$455.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$455.52
|
| 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 |
$6,021.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,185.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$503.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$503.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,003.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,896.60
|
| 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 |
$7,112.25
|
| Rate for Payer: Multiplan Commercial |
$3,762.75
|
| Rate for Payer: Networks By Design Commercial |
$3,261.05
|
| Rate for Payer: Networks By Design Commercial |
$6,163.95
|
| 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 |
$4,264.45
|
| Rate for Payer: Prime Health Services Commercial |
$8,060.55
|
| 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 |
$3,010.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,689.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,010.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,689.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,115.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,115.74
|
| Rate for Payer: United Healthcare All Other HMO |
$1,115.74
|
| Rate for Payer: United Healthcare All Other HMO |
$1,115.74
|
| Rate for Payer: United Healthcare HMO Rider |
$1,115.74
|
| Rate for Payer: United Healthcare HMO Rider |
$1,115.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,115.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,115.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$448.71
|
| Rate for Payer: Upland Medical Group Pediatric |
$448.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
|
|
HC MRI ORBIT FACE/NECK W CON
|
Facility
|
IP
|
$9,483.00
|
|
|
Service Code
|
CPT 70542
|
| Hospital Charge Code |
908801081
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,896.60 |
| Max. Negotiated Rate |
$8,534.70 |
| Rate for Payer: Adventist Health Commercial |
$1,896.60
|
| Rate for Payer: Cash Price |
$4,267.35
|
| Rate for Payer: Central Health Plan Commercial |
$7,586.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,638.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,793.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,793.20
|
| Rate for Payer: Galaxy Health WC |
$8,060.55
|
| Rate for Payer: Global Benefits Group Commercial |
$5,689.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,534.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,021.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,594.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,896.60
|
| Rate for Payer: Multiplan Commercial |
$7,112.25
|
| Rate for Payer: Networks By Design Commercial |
$6,163.95
|
| Rate for Payer: Prime Health Services Commercial |
$8,060.55
|
|
|
HC MRI ORBIT FACE/NECK WO CON
|
Facility
|
OP
|
$4,397.00
|
|
|
Service Code
|
CPT 70540
|
| Hospital Charge Code |
908801080
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$306.88 |
| Max. Negotiated Rate |
$3,957.30 |
| Rate for Payer: Adventist Health Commercial |
$879.40
|
| Rate for Payer: Adventist Health Commercial |
$1,724.80
|
| 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 |
$2,557.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,016.58
|
| Rate for Payer: Blue Shield of California Commercial |
$5,433.12
|
| Rate for Payer: Blue Shield of California Commercial |
$2,770.11
|
| Rate for Payer: Blue Shield of California EPN |
$1,745.61
|
| Rate for Payer: Blue Shield of California EPN |
$3,423.73
|
| Rate for Payer: Cash Price |
$1,978.65
|
| Rate for Payer: Cash Price |
$1,978.65
|
| Rate for Payer: Cash Price |
$1,978.65
|
| Rate for Payer: Cash Price |
$3,880.80
|
| Rate for Payer: Cash Price |
$3,880.80
|
| Rate for Payer: Cash Price |
$3,880.80
|
| Rate for Payer: Central Health Plan Commercial |
$6,899.20
|
| Rate for Payer: Central Health Plan Commercial |
$3,517.60
|
| Rate for Payer: Cigna of CA HMO |
$5,519.36
|
| Rate for Payer: Cigna of CA HMO |
$2,814.08
|
| Rate for Payer: Cigna of CA PPO |
$6,381.76
|
| Rate for Payer: Cigna of CA PPO |
$3,253.78
|
| 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 |
$6,036.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,077.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: Galaxy Health WC |
$3,737.45
|
| Rate for Payer: Galaxy Health WC |
$7,330.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,174.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,638.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,761.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,957.30
|
| 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 |
$383.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$383.51
|
| 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 |
$5,476.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,792.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$423.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$423.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$879.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,724.80
|
| 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 |
$6,468.00
|
| Rate for Payer: Multiplan Commercial |
$3,297.75
|
| Rate for Payer: Networks By Design Commercial |
$2,858.05
|
| Rate for Payer: Networks By Design Commercial |
$5,605.60
|
| 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 |
$3,737.45
|
| Rate for Payer: Prime Health Services Commercial |
$7,330.40
|
| 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 |
$2,638.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,174.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,638.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,174.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| Rate for Payer: United Healthcare All Other HMO |
$866.34
|
| Rate for Payer: United Healthcare All Other HMO |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$306.88
|
| Rate for Payer: Upland Medical Group Pediatric |
$306.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC MRI ORBIT FACE/NECK WO CON
|
Facility
|
IP
|
$8,624.00
|
|
|
Service Code
|
CPT 70540
|
| Hospital Charge Code |
908801080
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,724.80 |
| Max. Negotiated Rate |
$7,761.60 |
| Rate for Payer: Adventist Health Commercial |
$1,724.80
|
| Rate for Payer: Cash Price |
$3,880.80
|
| Rate for Payer: Central Health Plan Commercial |
$6,899.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,036.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,449.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,449.60
|
| Rate for Payer: Galaxy Health WC |
$7,330.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,174.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,761.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,476.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,088.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,724.80
|
| Rate for Payer: Multiplan Commercial |
$6,468.00
|
| Rate for Payer: Networks By Design Commercial |
$5,605.60
|
| Rate for Payer: Prime Health Services Commercial |
$7,330.40
|
|
|
HC MRI ORBIT FACE/NECK W WO CON
|
Facility
|
OP
|
$13,845.00
|
|
|
Service Code
|
CPT 70543
|
| Hospital Charge Code |
908801082
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$448.71 |
| Max. Negotiated Rate |
$12,460.50 |
| Rate for Payer: Adventist Health Commercial |
$2,769.00
|
| Rate for Payer: Adventist Health Commercial |
$1,342.80
|
| 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 |
$8,053.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,905.53
|
| Rate for Payer: Blue Shield of California Commercial |
$4,229.82
|
| Rate for Payer: Blue Shield of California Commercial |
$8,722.35
|
| Rate for Payer: Blue Shield of California EPN |
$5,496.47
|
| Rate for Payer: Blue Shield of California EPN |
$2,665.46
|
| Rate for Payer: Cash Price |
$6,230.25
|
| Rate for Payer: Cash Price |
$6,230.25
|
| Rate for Payer: Cash Price |
$6,230.25
|
| Rate for Payer: Cash Price |
$3,021.30
|
| Rate for Payer: Cash Price |
$3,021.30
|
| Rate for Payer: Cash Price |
$3,021.30
|
| Rate for Payer: Central Health Plan Commercial |
$5,371.20
|
| Rate for Payer: Central Health Plan Commercial |
$11,076.00
|
| Rate for Payer: Cigna of CA HMO |
$4,296.96
|
| Rate for Payer: Cigna of CA HMO |
$8,860.80
|
| Rate for Payer: Cigna of CA PPO |
$4,968.36
|
| Rate for Payer: Cigna of CA PPO |
$10,245.30
|
| 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 |
$4,699.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,691.50
|
| 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 |
$11,768.25
|
| Rate for Payer: Galaxy Health WC |
$5,706.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,028.40
|
| Rate for Payer: Global Benefits Group Commercial |
$8,307.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,042.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,460.50
|
| 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 |
$573.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$573.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,263.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,791.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$633.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$633.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,769.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,342.80
|
| 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 |
$5,035.50
|
| Rate for Payer: Multiplan Commercial |
$10,383.75
|
| Rate for Payer: Networks By Design Commercial |
$8,999.25
|
| Rate for Payer: Networks By Design Commercial |
$4,364.10
|
| 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 |
$11,768.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,706.90
|
| 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 |
$8,307.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,028.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,307.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,028.40
|
| 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 ORBIT FACE/NECK W WO CON
|
Facility
|
IP
|
$13,845.00
|
|
|
Service Code
|
CPT 70543
|
| Hospital Charge Code |
908801082
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$2,769.00 |
| Max. Negotiated Rate |
$12,460.50 |
| Rate for Payer: Adventist Health Commercial |
$2,769.00
|
| Rate for Payer: Cash Price |
$6,230.25
|
| Rate for Payer: Central Health Plan Commercial |
$11,076.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,691.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,538.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,538.00
|
| Rate for Payer: Galaxy Health WC |
$11,768.25
|
| Rate for Payer: Global Benefits Group Commercial |
$8,307.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,460.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,791.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,168.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,769.00
|
| Rate for Payer: Multiplan Commercial |
$10,383.75
|
| Rate for Payer: Networks By Design Commercial |
$8,999.25
|
| Rate for Payer: Prime Health Services Commercial |
$11,768.25
|
|
|
HC MRI PELVIS W/CONTRAST
|
Facility
|
IP
|
$12,126.00
|
|
|
Service Code
|
CPT 72196
|
| Hospital Charge Code |
908801350
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$2,425.20 |
| Max. Negotiated Rate |
$10,913.40 |
| Rate for Payer: Adventist Health Commercial |
$2,425.20
|
| Rate for Payer: Cash Price |
$5,456.70
|
| Rate for Payer: Central Health Plan Commercial |
$9,700.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,488.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,850.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,850.40
|
| Rate for Payer: Galaxy Health WC |
$10,307.10
|
| Rate for Payer: Global Benefits Group Commercial |
$7,275.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,913.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,700.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,154.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,425.20
|
| Rate for Payer: Multiplan Commercial |
$9,094.50
|
| Rate for Payer: Networks By Design Commercial |
$7,881.90
|
| Rate for Payer: Prime Health Services Commercial |
$10,307.10
|
|
|
HC MRI PELVIS W/CONTRAST
|
Facility
|
OP
|
$12,126.00
|
|
|
Service Code
|
CPT 72196
|
| Hospital Charge Code |
908801350
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$448.71 |
| Max. Negotiated Rate |
$10,913.40 |
| Rate for Payer: Adventist Health Commercial |
$2,425.20
|
| 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 |
$2,954.00
|
| 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 |
$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 |
$7,053.69
|
| 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 |
$7,639.38
|
| Rate for Payer: Blue Shield of California EPN |
$4,814.02
|
| Rate for Payer: Blue Shield of California EPN |
$2,044.55
|
| Rate for Payer: Cash Price |
$5,456.70
|
| Rate for Payer: Cash Price |
$5,456.70
|
| Rate for Payer: Cash Price |
$5,456.70
|
| Rate for Payer: Cash Price |
$2,317.50
|
| Rate for Payer: Cash Price |
$2,317.50
|
| Rate for Payer: Cash Price |
$2,317.50
|
| Rate for Payer: Central Health Plan Commercial |
$4,120.00
|
| Rate for Payer: Central Health Plan Commercial |
$9,700.80
|
| Rate for Payer: Cigna of CA HMO |
$3,296.00
|
| Rate for Payer: Cigna of CA HMO |
$7,760.64
|
| Rate for Payer: Cigna of CA PPO |
$3,811.00
|
| Rate for Payer: Cigna of CA PPO |
$8,973.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,605.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,488.20
|
| 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 |
$10,307.10
|
| Rate for Payer: Galaxy Health WC |
$4,377.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,090.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,275.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,635.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,913.40
|
| 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 |
$455.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$455.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,270.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,700.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$503.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$503.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,425.20
|
| 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 |
$3,862.50
|
| Rate for Payer: Multiplan Commercial |
$9,094.50
|
| Rate for Payer: Networks By Design Commercial |
$7,881.90
|
| 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 |
$10,307.10
|
| 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 |
$7,275.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,090.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,275.60
|
| 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 PELVIS W/O CONTRAST
|
Facility
|
OP
|
$10,659.00
|
|
|
Service Code
|
CPT 72195
|
| Hospital Charge Code |
908801351
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$306.88 |
| Max. Negotiated Rate |
$9,593.10 |
| Rate for Payer: Adventist Health Commercial |
$2,131.80
|
| Rate for Payer: Adventist Health Commercial |
$937.40
|
| 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 |
$2,350.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,350.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,200.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,726.43
|
| Rate for Payer: Blue Shield of California Commercial |
$2,952.81
|
| Rate for Payer: Blue Shield of California Commercial |
$6,715.17
|
| Rate for Payer: Blue Shield of California EPN |
$4,231.62
|
| Rate for Payer: Blue Shield of California EPN |
$1,860.74
|
| Rate for Payer: Cash Price |
$4,796.55
|
| Rate for Payer: Cash Price |
$4,796.55
|
| Rate for Payer: Cash Price |
$4,796.55
|
| Rate for Payer: Cash Price |
$2,109.15
|
| Rate for Payer: Cash Price |
$2,109.15
|
| Rate for Payer: Cash Price |
$2,109.15
|
| Rate for Payer: Central Health Plan Commercial |
$3,749.60
|
| Rate for Payer: Central Health Plan Commercial |
$8,527.20
|
| Rate for Payer: Cigna of CA HMO |
$2,999.68
|
| Rate for Payer: Cigna of CA HMO |
$6,821.76
|
| Rate for Payer: Cigna of CA PPO |
$3,468.38
|
| Rate for Payer: Cigna of CA PPO |
$7,887.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,280.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,461.30
|
| 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 |
$9,060.15
|
| Rate for Payer: Galaxy Health WC |
$3,983.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,812.20
|
| Rate for Payer: Global Benefits Group Commercial |
$6,395.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,218.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,593.10
|
| 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 |
$389.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$389.30
|
| 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 |
$2,976.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,768.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$430.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$430.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,131.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$937.40
|
| 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 |
$3,515.25
|
| Rate for Payer: Multiplan Commercial |
$7,994.25
|
| Rate for Payer: Networks By Design Commercial |
$6,928.35
|
| Rate for Payer: Networks By Design Commercial |
$3,046.55
|
| 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 |
$9,060.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,983.95
|
| 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 |
$6,395.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,812.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,395.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,812.20
|
| 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 PELVIS W/O CONTRAST
|
Facility
|
IP
|
$10,659.00
|
|
|
Service Code
|
CPT 72195
|
| Hospital Charge Code |
908801351
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,131.80 |
| Max. Negotiated Rate |
$9,593.10 |
| Rate for Payer: Adventist Health Commercial |
$2,131.80
|
| Rate for Payer: Cash Price |
$4,796.55
|
| Rate for Payer: Central Health Plan Commercial |
$8,527.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,461.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,263.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,263.60
|
| Rate for Payer: Galaxy Health WC |
$9,060.15
|
| Rate for Payer: Global Benefits Group Commercial |
$6,395.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,593.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,768.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,288.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,131.80
|
| Rate for Payer: Multiplan Commercial |
$7,994.25
|
| Rate for Payer: Networks By Design Commercial |
$6,928.35
|
| Rate for Payer: Prime Health Services Commercial |
$9,060.15
|
|
|
HC MRI PELVIS W & WO CONTRAST
|
Facility
|
OP
|
$13,460.00
|
|
|
Service Code
|
CPT 72197
|
| Hospital Charge Code |
908801352
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$448.71 |
| Max. Negotiated Rate |
$12,114.00 |
| Rate for Payer: Adventist Health Commercial |
$2,692.00
|
| Rate for Payer: Adventist Health Commercial |
$1,236.00
|
| 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 |
$2,954.00
|
| 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 |
$5,208.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,208.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,829.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,594.91
|
| Rate for Payer: Blue Shield of California Commercial |
$3,893.40
|
| Rate for Payer: Blue Shield of California Commercial |
$8,479.80
|
| Rate for Payer: Blue Shield of California EPN |
$5,343.62
|
| Rate for Payer: Blue Shield of California EPN |
$2,453.46
|
| Rate for Payer: Cash Price |
$6,057.00
|
| Rate for Payer: Cash Price |
$6,057.00
|
| Rate for Payer: Cash Price |
$6,057.00
|
| Rate for Payer: Cash Price |
$2,781.00
|
| Rate for Payer: Cash Price |
$2,781.00
|
| Rate for Payer: Cash Price |
$2,781.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,944.00
|
| Rate for Payer: Central Health Plan Commercial |
$10,768.00
|
| Rate for Payer: Cigna of CA HMO |
$3,955.20
|
| Rate for Payer: Cigna of CA HMO |
$8,614.40
|
| Rate for Payer: Cigna of CA PPO |
$4,573.20
|
| Rate for Payer: Cigna of CA PPO |
$9,960.40
|
| 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 |
$4,326.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,422.00
|
| 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 |
$11,441.00
|
| Rate for Payer: Galaxy Health WC |
$5,253.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,708.00
|
| Rate for Payer: Global Benefits Group Commercial |
$8,076.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,562.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,114.00
|
| 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 |
$572.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$572.61
|
| 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 |
$3,924.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,547.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$632.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$632.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,692.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,236.00
|
| 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 |
$4,635.00
|
| Rate for Payer: Multiplan Commercial |
$10,095.00
|
| Rate for Payer: Networks By Design Commercial |
$8,749.00
|
| Rate for Payer: Networks By Design Commercial |
$4,017.00
|
| 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 |
$11,441.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,253.00
|
| 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 |
$8,076.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,708.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,076.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,708.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,367.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,367.12
|
| Rate for Payer: United Healthcare All Other HMO |
$1,367.12
|
| Rate for Payer: United Healthcare All Other HMO |
$1,367.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1,367.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1,367.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,367.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,367.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$448.71
|
| Rate for Payer: Upland Medical Group Pediatric |
$448.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
|
|
HC MRI PELVIS W & WO CONTRAST
|
Facility
|
IP
|
$13,460.00
|
|
|
Service Code
|
CPT 72197
|
| Hospital Charge Code |
908801352
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$2,692.00 |
| Max. Negotiated Rate |
$12,114.00 |
| Rate for Payer: Adventist Health Commercial |
$2,692.00
|
| Rate for Payer: Cash Price |
$6,057.00
|
| Rate for Payer: Central Health Plan Commercial |
$10,768.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,422.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,384.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,384.00
|
| Rate for Payer: Galaxy Health WC |
$11,441.00
|
| Rate for Payer: Global Benefits Group Commercial |
$8,076.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,114.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,547.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,941.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,692.00
|
| Rate for Payer: Multiplan Commercial |
$10,095.00
|
| Rate for Payer: Networks By Design Commercial |
$8,749.00
|
| Rate for Payer: Prime Health Services Commercial |
$11,441.00
|
|
|
HC MRI PROCEDURE
|
Facility
|
IP
|
$6,549.00
|
|
|
Service Code
|
CPT 76498
|
| Hospital Charge Code |
908801008
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,309.80 |
| Max. Negotiated Rate |
$5,894.10 |
| Rate for Payer: Adventist Health Commercial |
$1,309.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,977.21
|
| Rate for Payer: Cash Price |
$2,947.05
|
| Rate for Payer: Central Health Plan Commercial |
$5,239.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,584.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,619.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,619.60
|
| Rate for Payer: Galaxy Health WC |
$5,566.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,929.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,894.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,158.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,863.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,309.80
|
| Rate for Payer: Multiplan Commercial |
$4,911.75
|
| Rate for Payer: Networks By Design Commercial |
$4,256.85
|
| Rate for Payer: Prime Health Services Commercial |
$5,566.65
|
|
|
HC MRI PROCEDURE
|
Facility
|
OP
|
$3,164.00
|
|
|
Service Code
|
CPT 76498
|
| Hospital Charge Code |
908801008
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$111.93 |
| Max. Negotiated Rate |
$2,847.60 |
| Rate for Payer: Adventist Health Commercial |
$632.80
|
| Rate for Payer: Adventist Health Commercial |
$1,309.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.93
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,921.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,977.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,532.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,171.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,840.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,809.55
|
| Rate for Payer: Blue Shield of California Commercial |
$4,125.87
|
| Rate for Payer: Blue Shield of California Commercial |
$1,993.32
|
| Rate for Payer: Blue Shield of California EPN |
$2,599.95
|
| Rate for Payer: Blue Shield of California EPN |
$1,256.11
|
| Rate for Payer: Cash Price |
$2,947.05
|
| Rate for Payer: Cash Price |
$1,423.80
|
| Rate for Payer: Cash Price |
$1,423.80
|
| Rate for Payer: Cash Price |
$2,947.05
|
| Rate for Payer: Central Health Plan Commercial |
$5,239.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,531.20
|
| Rate for Payer: Cigna of CA HMO |
$2,024.96
|
| Rate for Payer: Cigna of CA HMO |
$4,191.36
|
| Rate for Payer: Cigna of CA PPO |
$4,846.26
|
| Rate for Payer: Cigna of CA PPO |
$2,341.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,584.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,214.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$2,689.40
|
| Rate for Payer: Galaxy Health WC |
$5,566.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,929.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,898.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,847.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,894.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,009.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,158.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,309.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$632.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$2,373.00
|
| Rate for Payer: Multiplan Commercial |
$4,911.75
|
| Rate for Payer: Networks By Design Commercial |
$2,056.60
|
| Rate for Payer: Networks By Design Commercial |
$4,256.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.93
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.93
|
| Rate for Payer: Prime Health Services Commercial |
$5,566.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,689.40
|
| Rate for Payer: Prime Health Services Medicare |
$118.65
|
| Rate for Payer: Prime Health Services Medicare |
$118.65
|
| Rate for Payer: Riverside University Health System MISP |
$123.12
|
| Rate for Payer: Riverside University Health System MISP |
$123.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,898.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,929.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,929.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,898.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| Rate for Payer: United Healthcare All Other HMO |
$866.34
|
| Rate for Payer: United Healthcare All Other HMO |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.93
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC MRI SPECTROSCOPY
|
Facility
|
OP
|
$4,177.00
|
|
|
Service Code
|
CPT 76390
|
| Hospital Charge Code |
908801255
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$111.93 |
| Max. Negotiated Rate |
$3,759.30 |
| Rate for Payer: Adventist Health Commercial |
$835.40
|
| Rate for Payer: Adventist Health Commercial |
$1,097.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.93
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.93
|
| 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 |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,332.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,332.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,192.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,429.76
|
| Rate for Payer: Blue Shield of California Commercial |
$3,458.07
|
| Rate for Payer: Blue Shield of California Commercial |
$2,631.51
|
| Rate for Payer: Blue Shield of California EPN |
$2,179.13
|
| Rate for Payer: Blue Shield of California EPN |
$1,658.27
|
| Rate for Payer: Cash Price |
$2,470.05
|
| Rate for Payer: Cash Price |
$1,879.65
|
| Rate for Payer: Cash Price |
$1,879.65
|
| Rate for Payer: Cash Price |
$2,470.05
|
| Rate for Payer: Central Health Plan Commercial |
$3,341.60
|
| Rate for Payer: Central Health Plan Commercial |
$4,391.20
|
| Rate for Payer: Cigna of CA HMO |
$2,673.28
|
| Rate for Payer: Cigna of CA HMO |
$3,512.96
|
| Rate for Payer: Cigna of CA PPO |
$3,090.98
|
| Rate for Payer: Cigna of CA PPO |
$4,061.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,842.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,923.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$3,550.45
|
| Rate for Payer: Galaxy Health WC |
$4,665.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,293.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,506.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,940.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,759.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,485.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,652.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,516.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,992.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$835.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,097.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$3,132.75
|
| Rate for Payer: Multiplan Commercial |
$4,116.75
|
| Rate for Payer: Networks By Design Commercial |
$2,715.05
|
| Rate for Payer: Networks By Design Commercial |
$3,567.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.93
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.93
|
| Rate for Payer: Prime Health Services Commercial |
$4,665.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,550.45
|
| Rate for Payer: Prime Health Services Medicare |
$118.65
|
| Rate for Payer: Prime Health Services Medicare |
$118.65
|
| Rate for Payer: Riverside University Health System MISP |
$123.12
|
| Rate for Payer: Riverside University Health System MISP |
$123.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,506.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,293.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,506.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,293.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,065.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,065.68
|
| Rate for Payer: United Healthcare All Other HMO |
$1,065.68
|
| Rate for Payer: United Healthcare All Other HMO |
$1,065.68
|
| Rate for Payer: United Healthcare HMO Rider |
$1,065.68
|
| Rate for Payer: United Healthcare HMO Rider |
$1,065.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,065.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,065.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.93
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC MRI SPECTROSCOPY
|
Facility
|
IP
|
$5,489.00
|
|
|
Service Code
|
CPT 76390
|
| Hospital Charge Code |
908801255
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,097.80 |
| Max. Negotiated Rate |
$4,940.10 |
| Rate for Payer: Adventist Health Commercial |
$1,097.80
|
| Rate for Payer: Cash Price |
$2,470.05
|
| Rate for Payer: Central Health Plan Commercial |
$4,391.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,842.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,195.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,195.60
|
| Rate for Payer: Galaxy Health WC |
$4,665.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,293.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,940.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,485.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,238.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,097.80
|
| Rate for Payer: Multiplan Commercial |
$4,116.75
|
| Rate for Payer: Networks By Design Commercial |
$3,567.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,665.65
|
|
|
HC MRI THORACIC SPINE WITH CONTRA
|
Facility
|
IP
|
$11,302.00
|
|
|
Service Code
|
CPT 72147
|
| Hospital Charge Code |
908801112
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$2,260.40 |
| Max. Negotiated Rate |
$10,171.80 |
| Rate for Payer: Adventist Health Commercial |
$2,260.40
|
| Rate for Payer: Cash Price |
$5,085.90
|
| Rate for Payer: Central Health Plan Commercial |
$9,041.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,911.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,520.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,520.80
|
| Rate for Payer: Galaxy Health WC |
$9,606.70
|
| Rate for Payer: Global Benefits Group Commercial |
$6,781.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,171.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,176.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,668.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,260.40
|
| Rate for Payer: Multiplan Commercial |
$8,476.50
|
| Rate for Payer: Networks By Design Commercial |
$7,346.30
|
| Rate for Payer: Prime Health Services Commercial |
$9,606.70
|
|
