|
HC MRI BRAIN ASSESS WO W CONTRAST
|
Facility
|
IP
|
$2,034.00
|
|
|
Service Code
|
CPT 70559
|
| Hospital Charge Code |
908870559
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$406.80 |
| Max. Negotiated Rate |
$1,830.60 |
| Rate for Payer: Adventist Health Commercial |
$406.80
|
| Rate for Payer: Cash Price |
$915.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,627.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$813.60
|
| Rate for Payer: EPIC Health Plan Senior |
$813.60
|
| Rate for Payer: Galaxy Health WC |
$1,728.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,220.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,830.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,356.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$774.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,259.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$406.80
|
| Rate for Payer: Multiplan Commercial |
$1,525.50
|
| Rate for Payer: Networks By Design Commercial |
$1,322.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,728.90
|
|
|
HC MRI BRAIN ASSESS WO W CONTRAST
|
Facility
|
OP
|
$2,034.00
|
|
|
Service Code
|
CPT 70559
|
| Hospital Charge Code |
908870559
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$4,537.33 |
| Rate for Payer: Adventist Health Commercial |
$406.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$226.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,235.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,537.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,194.57
|
| Rate for Payer: Blue Shield of California Commercial |
$1,234.64
|
| Rate for Payer: Blue Shield of California EPN |
$807.50
|
| Rate for Payer: Cash Price |
$915.30
|
| Rate for Payer: Cash Price |
$915.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,627.20
|
| Rate for Payer: Cigna of CA HMO |
$1,301.76
|
| Rate for Payer: Cigna of CA PPO |
$1,505.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.36
|
| Rate for Payer: EPIC Health Plan Senior |
$226.19
|
| Rate for Payer: Galaxy Health WC |
$1,728.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,220.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,830.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$286.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: InnovAge PACE Commercial |
$339.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,356.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$316.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$406.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$303.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.09
|
| Rate for Payer: Multiplan Commercial |
$1,525.50
|
| Rate for Payer: Networks By Design Commercial |
$1,322.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$226.19
|
| Rate for Payer: Prime Health Services Commercial |
$1,728.90
|
| Rate for Payer: Prime Health Services Medicare |
$239.76
|
| Rate for Payer: Riverside University Health System MISP |
$248.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,220.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,220.40
|
| 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 HMO Rider |
$1,367.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,367.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$226.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC MRI BRAIN WITH CONTRAST
|
Facility
|
OP
|
$5,421.00
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
908801012
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$453.77 |
| Max. Negotiated Rate |
$4,878.90 |
| Rate for Payer: Adventist Health Commercial |
$1,084.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$453.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,292.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,759.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,183.75
|
| Rate for Payer: Blue Shield of California Commercial |
$3,290.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,152.14
|
| Rate for Payer: Cash Price |
$2,439.45
|
| Rate for Payer: Cash Price |
$2,439.45
|
| Rate for Payer: Central Health Plan Commercial |
$4,336.80
|
| Rate for Payer: Cigna of CA HMO |
$3,469.44
|
| Rate for Payer: Cigna of CA PPO |
$4,011.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.59
|
| Rate for Payer: EPIC Health Plan Senior |
$453.77
|
| Rate for Payer: Galaxy Health WC |
$4,607.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,252.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,878.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$454.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: InnovAge PACE Commercial |
$680.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,615.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$502.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,084.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$608.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$608.05
|
| Rate for Payer: Multiplan Commercial |
$4,065.75
|
| Rate for Payer: Networks By Design Commercial |
$3,523.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$453.77
|
| Rate for Payer: Prime Health Services Commercial |
$4,607.85
|
| Rate for Payer: Prime Health Services Medicare |
$481.00
|
| Rate for Payer: Riverside University Health System MISP |
$499.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,252.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,252.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,115.74
|
| Rate for Payer: United Healthcare All Other HMO |
$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: Upland Medical Group Pediatric |
$453.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
HC MRI BRAIN WITH CONTRAST
|
Facility
|
IP
|
$11,689.00
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
908801013
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$2,337.80 |
| Max. Negotiated Rate |
$10,520.10 |
| Rate for Payer: Adventist Health Commercial |
$2,337.80
|
| Rate for Payer: Cash Price |
$5,260.05
|
| Rate for Payer: Central Health Plan Commercial |
$9,351.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,675.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,675.60
|
| Rate for Payer: Galaxy Health WC |
$9,935.65
|
| Rate for Payer: Global Benefits Group Commercial |
$7,013.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,520.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,796.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,453.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,235.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,337.80
|
| Rate for Payer: Multiplan Commercial |
$8,766.75
|
| Rate for Payer: Networks By Design Commercial |
$7,597.85
|
| Rate for Payer: Prime Health Services Commercial |
$9,935.65
|
|
|
HC MRI BRAIN WITH CONTRAST
|
Facility
|
IP
|
$11,689.00
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
908801012
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$2,337.80 |
| Max. Negotiated Rate |
$10,520.10 |
| Rate for Payer: Adventist Health Commercial |
$2,337.80
|
| Rate for Payer: Cash Price |
$5,260.05
|
| Rate for Payer: Central Health Plan Commercial |
$9,351.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,675.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,675.60
|
| Rate for Payer: Galaxy Health WC |
$9,935.65
|
| Rate for Payer: Global Benefits Group Commercial |
$7,013.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,520.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,796.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,453.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,235.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,337.80
|
| Rate for Payer: Multiplan Commercial |
$8,766.75
|
| Rate for Payer: Networks By Design Commercial |
$7,597.85
|
| Rate for Payer: Prime Health Services Commercial |
$9,935.65
|
|
|
HC MRI BRAIN WITH CONTRAST
|
Facility
|
OP
|
$5,421.00
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
908801013
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$453.77 |
| Max. Negotiated Rate |
$4,878.90 |
| Rate for Payer: Adventist Health Commercial |
$1,084.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$453.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,292.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,759.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,183.75
|
| Rate for Payer: Blue Shield of California Commercial |
$3,290.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,152.14
|
| Rate for Payer: Cash Price |
$2,439.45
|
| Rate for Payer: Cash Price |
$2,439.45
|
| Rate for Payer: Central Health Plan Commercial |
$4,336.80
|
| Rate for Payer: Cigna of CA HMO |
$3,469.44
|
| Rate for Payer: Cigna of CA PPO |
$4,011.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.59
|
| Rate for Payer: EPIC Health Plan Senior |
$453.77
|
| Rate for Payer: Galaxy Health WC |
$4,607.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,252.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,878.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$454.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: InnovAge PACE Commercial |
$680.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,615.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$502.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,084.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$608.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$608.05
|
| Rate for Payer: Multiplan Commercial |
$4,065.75
|
| Rate for Payer: Networks By Design Commercial |
$3,523.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$453.77
|
| Rate for Payer: Prime Health Services Commercial |
$4,607.85
|
| Rate for Payer: Prime Health Services Medicare |
$481.00
|
| Rate for Payer: Riverside University Health System MISP |
$499.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,252.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,252.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,115.74
|
| Rate for Payer: United Healthcare All Other HMO |
$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: Upland Medical Group Pediatric |
$453.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
HC MRI BRAIN WO CONTRAST
|
Facility
|
OP
|
$5,126.00
|
|
|
Service Code
|
CPT 70551
|
| Hospital Charge Code |
908801010
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$4,613.40 |
| Rate for Payer: Adventist Health Commercial |
$1,025.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$307.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,303.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,010.50
|
| Rate for Payer: Blue Shield of California Commercial |
$3,111.48
|
| Rate for Payer: Blue Shield of California EPN |
$2,035.02
|
| Rate for Payer: Cash Price |
$2,306.70
|
| Rate for Payer: Cash Price |
$2,306.70
|
| Rate for Payer: Cash Price |
$2,306.70
|
| Rate for Payer: Central Health Plan Commercial |
$4,100.80
|
| Rate for Payer: Cigna of CA HMO |
$3,280.64
|
| Rate for Payer: Cigna of CA PPO |
$3,793.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$4,357.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,075.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,613.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$327.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: InnovAge PACE Commercial |
$460.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,419.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$361.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,025.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$411.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$3,844.50
|
| Rate for Payer: Networks By Design Commercial |
$3,331.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$307.13
|
| Rate for Payer: Prime Health Services Commercial |
$4,357.10
|
| Rate for Payer: Prime Health Services Medicare |
$325.56
|
| Rate for Payer: Riverside University Health System MISP |
$337.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,075.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,075.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| Rate for Payer: United Healthcare All Other HMO |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC MRI BRAIN WO CONTRAST
|
Facility
|
IP
|
$11,051.00
|
|
|
Service Code
|
CPT 70551
|
| Hospital Charge Code |
908801010
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$2,210.20 |
| Max. Negotiated Rate |
$9,945.90 |
| Rate for Payer: Adventist Health Commercial |
$2,210.20
|
| Rate for Payer: Cash Price |
$4,972.95
|
| Rate for Payer: Central Health Plan Commercial |
$8,840.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,420.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,420.40
|
| Rate for Payer: Galaxy Health WC |
$9,393.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6,630.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,945.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,371.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,210.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,840.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,210.20
|
| Rate for Payer: Multiplan Commercial |
$8,288.25
|
| Rate for Payer: Networks By Design Commercial |
$7,183.15
|
| Rate for Payer: Prime Health Services Commercial |
$9,393.35
|
|
|
HC MRI BRAIN W WO CONTRAST
|
Facility
|
IP
|
$13,075.00
|
|
|
Service Code
|
CPT 70553
|
| Hospital Charge Code |
908801014
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$2,615.00 |
| Max. Negotiated Rate |
$11,767.50 |
| Rate for Payer: Adventist Health Commercial |
$2,615.00
|
| Rate for Payer: Cash Price |
$5,883.75
|
| Rate for Payer: Central Health Plan Commercial |
$10,460.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,230.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,230.00
|
| Rate for Payer: Galaxy Health WC |
$11,113.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7,845.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,767.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,721.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,981.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,093.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,615.00
|
| Rate for Payer: Multiplan Commercial |
$9,806.25
|
| Rate for Payer: Networks By Design Commercial |
$8,498.75
|
| Rate for Payer: Prime Health Services Commercial |
$11,113.75
|
|
|
HC MRI BRAIN W WO CONTRAST
|
Facility
|
OP
|
$6,338.00
|
|
|
Service Code
|
CPT 70553
|
| Hospital Charge Code |
908801014
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$453.77 |
| Max. Negotiated Rate |
$5,704.20 |
| Rate for Payer: Adventist Health Commercial |
$1,267.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$453.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,537.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,722.31
|
| Rate for Payer: Blue Shield of California Commercial |
$3,847.17
|
| Rate for Payer: Blue Shield of California EPN |
$2,516.19
|
| Rate for Payer: Cash Price |
$2,852.10
|
| Rate for Payer: Cash Price |
$2,852.10
|
| Rate for Payer: Cash Price |
$2,852.10
|
| Rate for Payer: Central Health Plan Commercial |
$5,070.40
|
| Rate for Payer: Cigna of CA HMO |
$4,056.32
|
| Rate for Payer: Cigna of CA PPO |
$4,690.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.59
|
| Rate for Payer: EPIC Health Plan Senior |
$453.77
|
| Rate for Payer: Galaxy Health WC |
$5,387.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,802.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,704.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$535.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: InnovAge PACE Commercial |
$680.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,227.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$591.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,267.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$608.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$608.05
|
| Rate for Payer: Multiplan Commercial |
$4,753.50
|
| Rate for Payer: Networks By Design Commercial |
$4,119.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$453.77
|
| Rate for Payer: Prime Health Services Commercial |
$5,387.30
|
| Rate for Payer: Prime Health Services Medicare |
$481.00
|
| Rate for Payer: Riverside University Health System MISP |
$499.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,802.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,802.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,367.12
|
| Rate for Payer: United Healthcare All Other HMO |
$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: Upland Medical Group Pediatric |
$453.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
HC MRI BREAST BILAT W/CONTRAST
|
Facility
|
IP
|
$11,143.00
|
|
|
Service Code
|
CPT 77059
|
| Hospital Charge Code |
908801211
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,228.60 |
| Max. Negotiated Rate |
$10,028.70 |
| Rate for Payer: Adventist Health Commercial |
$2,228.60
|
| Rate for Payer: Cash Price |
$5,014.35
|
| Rate for Payer: Central Health Plan Commercial |
$8,914.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,457.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,457.20
|
| Rate for Payer: Galaxy Health WC |
$9,471.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6,685.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,028.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,432.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,245.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,897.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,228.60
|
| Rate for Payer: Multiplan Commercial |
$8,357.25
|
| Rate for Payer: Networks By Design Commercial |
$7,242.95
|
| Rate for Payer: Prime Health Services Commercial |
$9,471.55
|
|
|
HC MRI BREAST BILAT W/CONTRAST
|
Facility
|
OP
|
$5,310.00
|
|
|
Service Code
|
CPT 77059
|
| Hospital Charge Code |
908801211
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,062.00 |
| Max. Negotiated Rate |
$4,779.00 |
| Rate for Payer: Adventist Health Commercial |
$1,062.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,513.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,920.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,571.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,118.56
|
| Rate for Payer: Blue Shield of California Commercial |
$3,223.17
|
| Rate for Payer: Blue Shield of California EPN |
$2,108.07
|
| Rate for Payer: Cash Price |
$2,389.50
|
| Rate for Payer: Cash Price |
$2,389.50
|
| Rate for Payer: Central Health Plan Commercial |
$4,248.00
|
| Rate for Payer: Cigna of CA HMO |
$3,398.40
|
| Rate for Payer: Cigna of CA PPO |
$3,929.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,513.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,513.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,513.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,124.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,124.00
|
| Rate for Payer: Galaxy Health WC |
$4,513.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,186.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,779.00
|
| Rate for Payer: InnovAge PACE Commercial |
$2,655.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,541.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,023.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,286.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,062.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,717.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,717.00
|
| Rate for Payer: Multiplan Commercial |
$3,982.50
|
| Rate for Payer: Networks By Design Commercial |
$3,451.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,513.50
|
| Rate for Payer: Riverside University Health System MISP |
$2,124.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,186.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,186.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,655.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,655.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,655.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,655.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,513.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,513.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,513.50
|
|
|
HC MRI BREAST BILAT WO CONTRAST
|
Facility
|
OP
|
$4,853.00
|
|
|
Service Code
|
CPT 77047
|
| Hospital Charge Code |
908801212
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$4,367.70 |
| Rate for Payer: Adventist Health Commercial |
$970.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$307.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,947.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,264.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,850.17
|
| Rate for Payer: Blue Shield of California Commercial |
$2,945.77
|
| Rate for Payer: Blue Shield of California EPN |
$1,926.64
|
| Rate for Payer: Cash Price |
$2,183.85
|
| Rate for Payer: Cash Price |
$2,183.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,882.40
|
| Rate for Payer: Cigna of CA HMO |
$3,105.92
|
| Rate for Payer: Cigna of CA PPO |
$3,591.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$4,125.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,911.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,367.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$368.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: InnovAge PACE Commercial |
$460.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,236.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$406.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$970.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$411.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$3,639.75
|
| Rate for Payer: Networks By Design Commercial |
$3,154.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$307.13
|
| Rate for Payer: Prime Health Services Commercial |
$4,125.05
|
| Rate for Payer: Prime Health Services Medicare |
$325.56
|
| Rate for Payer: Riverside University Health System MISP |
$337.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,911.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,911.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$590.24
|
| Rate for Payer: United Healthcare All Other HMO |
$590.24
|
| Rate for Payer: United Healthcare HMO Rider |
$590.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$590.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC MRI BREAST BILAT WO CONTRAST
|
Facility
|
IP
|
$10,044.00
|
|
|
Service Code
|
CPT 77047
|
| Hospital Charge Code |
908801212
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,008.80 |
| Max. Negotiated Rate |
$9,039.60 |
| Rate for Payer: Adventist Health Commercial |
$2,008.80
|
| Rate for Payer: Cash Price |
$4,519.80
|
| Rate for Payer: Central Health Plan Commercial |
$8,035.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,017.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,017.60
|
| Rate for Payer: Galaxy Health WC |
$8,537.40
|
| Rate for Payer: Global Benefits Group Commercial |
$6,026.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,039.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,699.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,826.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,217.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,008.80
|
| Rate for Payer: Multiplan Commercial |
$7,533.00
|
| Rate for Payer: Networks By Design Commercial |
$6,528.60
|
| Rate for Payer: Prime Health Services Commercial |
$8,537.40
|
|
|
HC MRI BREAST UNI W/CONTRAST
|
Facility
|
IP
|
$10,105.00
|
|
|
Service Code
|
CPT 77058
|
| Hospital Charge Code |
908801217
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,021.00 |
| Max. Negotiated Rate |
$9,094.50 |
| Rate for Payer: Adventist Health Commercial |
$2,021.00
|
| Rate for Payer: Cash Price |
$4,547.25
|
| Rate for Payer: Central Health Plan Commercial |
$8,084.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,042.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,042.00
|
| Rate for Payer: Galaxy Health WC |
$8,589.25
|
| Rate for Payer: Global Benefits Group Commercial |
$6,063.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,094.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,740.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,850.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,254.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,021.00
|
| Rate for Payer: Multiplan Commercial |
$7,578.75
|
| Rate for Payer: Networks By Design Commercial |
$6,568.25
|
| Rate for Payer: Prime Health Services Commercial |
$8,589.25
|
|
|
HC MRI BREAST UNI W/CONTRAST
|
Facility
|
OP
|
$4,998.00
|
|
|
Service Code
|
CPT 77058
|
| Hospital Charge Code |
908801217
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$999.60 |
| Max. Negotiated Rate |
$4,498.20 |
| Rate for Payer: Adventist Health Commercial |
$999.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,248.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,748.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,748.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,420.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,935.33
|
| Rate for Payer: Blue Shield of California Commercial |
$3,033.79
|
| Rate for Payer: Blue Shield of California EPN |
$1,984.21
|
| Rate for Payer: Cash Price |
$2,249.10
|
| Rate for Payer: Cash Price |
$2,249.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,998.40
|
| Rate for Payer: Cigna of CA HMO |
$3,198.72
|
| Rate for Payer: Cigna of CA PPO |
$3,698.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,248.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,248.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,248.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,999.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,999.20
|
| Rate for Payer: Galaxy Health WC |
$4,248.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,998.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,498.20
|
| Rate for Payer: InnovAge PACE Commercial |
$2,499.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,333.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,904.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,093.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$999.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,498.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,498.60
|
| Rate for Payer: Multiplan Commercial |
$3,748.50
|
| Rate for Payer: Networks By Design Commercial |
$3,248.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,248.30
|
| Rate for Payer: Riverside University Health System MISP |
$1,999.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,998.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,998.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,499.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,499.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,499.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,499.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,248.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,248.30
|
| Rate for Payer: Vantage Medical Group Senior |
$4,248.30
|
|
|
HC MRI BREAST UNI WO CONTRAST
|
Facility
|
OP
|
$4,310.00
|
|
|
Service Code
|
CPT 77046
|
| Hospital Charge Code |
908801219
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$3,879.00 |
| Rate for Payer: Adventist Health Commercial |
$862.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$307.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,617.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,272.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,531.26
|
| Rate for Payer: Blue Shield of California Commercial |
$2,616.17
|
| Rate for Payer: Blue Shield of California EPN |
$1,711.07
|
| Rate for Payer: Cash Price |
$1,939.50
|
| Rate for Payer: Cash Price |
$1,939.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,448.00
|
| Rate for Payer: Cigna of CA HMO |
$2,758.40
|
| Rate for Payer: Cigna of CA PPO |
$3,189.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$3,663.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,586.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,879.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$359.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: InnovAge PACE Commercial |
$460.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,874.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$396.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$862.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$411.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$3,232.50
|
| Rate for Payer: Networks By Design Commercial |
$2,801.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$307.13
|
| Rate for Payer: Prime Health Services Commercial |
$3,663.50
|
| Rate for Payer: Prime Health Services Medicare |
$325.56
|
| Rate for Payer: Riverside University Health System MISP |
$337.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,586.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,586.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$590.24
|
| Rate for Payer: United Healthcare All Other HMO |
$590.24
|
| Rate for Payer: United Healthcare HMO Rider |
$590.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$590.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC MRI BREAST UNI WO CONTRAST
|
Facility
|
IP
|
$7,050.00
|
|
|
Service Code
|
CPT 77046
|
| Hospital Charge Code |
908801219
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,410.00 |
| Max. Negotiated Rate |
$6,345.00 |
| Rate for Payer: Adventist Health Commercial |
$1,410.00
|
| Rate for Payer: Cash Price |
$3,172.50
|
| Rate for Payer: Central Health Plan Commercial |
$5,640.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,820.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,820.00
|
| Rate for Payer: Galaxy Health WC |
$5,992.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,230.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,345.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,702.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,686.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,363.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,410.00
|
| Rate for Payer: Multiplan Commercial |
$5,287.50
|
| Rate for Payer: Networks By Design Commercial |
$4,582.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,992.50
|
|
|
HC MRI BRST BI W WO CNTRST W CAD
|
Facility
|
OP
|
$5,911.00
|
|
|
Service Code
|
CPT 77049
|
| Hospital Charge Code |
908801210
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$581.08 |
| Max. Negotiated Rate |
$5,319.90 |
| Rate for Payer: Adventist Health Commercial |
$1,182.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,589.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,024.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,251.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,433.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,084.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,471.53
|
| Rate for Payer: Blue Shield of California Commercial |
$3,587.98
|
| Rate for Payer: Blue Shield of California EPN |
$2,346.67
|
| Rate for Payer: Cash Price |
$2,659.95
|
| Rate for Payer: Cash Price |
$2,659.95
|
| Rate for Payer: Central Health Plan Commercial |
$4,728.80
|
| Rate for Payer: Cigna of CA HMO |
$3,783.04
|
| Rate for Payer: Cigna of CA PPO |
$4,374.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,024.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,024.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,024.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,364.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,364.40
|
| Rate for Payer: Galaxy Health WC |
$5,024.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,546.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,319.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$581.08
|
| Rate for Payer: InnovAge PACE Commercial |
$2,955.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,942.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$641.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,658.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,182.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,137.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,137.70
|
| Rate for Payer: Multiplan Commercial |
$4,433.25
|
| Rate for Payer: Networks By Design Commercial |
$3,842.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,024.35
|
| Rate for Payer: Riverside University Health System MISP |
$2,364.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,546.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,546.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$750.08
|
| Rate for Payer: United Healthcare All Other HMO |
$750.08
|
| Rate for Payer: United Healthcare HMO Rider |
$750.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$750.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,024.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,024.35
|
| Rate for Payer: Vantage Medical Group Senior |
$5,024.35
|
|
|
HC MRI BRST BI W WO CNTRST W CAD
|
Facility
|
IP
|
$12,236.00
|
|
|
Service Code
|
CPT 77049
|
| Hospital Charge Code |
908801210
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,447.20 |
| Max. Negotiated Rate |
$11,012.40 |
| Rate for Payer: Adventist Health Commercial |
$2,447.20
|
| Rate for Payer: Cash Price |
$5,506.20
|
| Rate for Payer: Central Health Plan Commercial |
$9,788.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,894.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,894.40
|
| Rate for Payer: Galaxy Health WC |
$10,400.60
|
| Rate for Payer: Global Benefits Group Commercial |
$7,341.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,012.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,161.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,661.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,574.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,447.20
|
| Rate for Payer: Multiplan Commercial |
$9,177.00
|
| Rate for Payer: Networks By Design Commercial |
$7,953.40
|
| Rate for Payer: Prime Health Services Commercial |
$10,400.60
|
|
|
HC MRI BRST UNI W WO CTRST W CAD
|
Facility
|
IP
|
$11,288.00
|
|
|
Service Code
|
CPT 77048
|
| Hospital Charge Code |
908801215
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,257.60 |
| Max. Negotiated Rate |
$10,159.20 |
| Rate for Payer: Adventist Health Commercial |
$2,257.60
|
| Rate for Payer: Cash Price |
$5,079.60
|
| Rate for Payer: Central Health Plan Commercial |
$9,030.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,515.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,515.20
|
| Rate for Payer: Galaxy Health WC |
$9,594.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,772.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,159.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,529.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,300.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,987.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,257.60
|
| Rate for Payer: Multiplan Commercial |
$8,466.00
|
| Rate for Payer: Networks By Design Commercial |
$7,337.20
|
| Rate for Payer: Prime Health Services Commercial |
$9,594.80
|
|
|
HC MRI BRST UNI W WO CTRST W CAD
|
Facility
|
OP
|
$5,454.00
|
|
|
Service Code
|
CPT 77048
|
| Hospital Charge Code |
908801215
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$570.25 |
| Max. Negotiated Rate |
$4,908.60 |
| Rate for Payer: Adventist Health Commercial |
$1,090.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,312.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,635.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,999.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,090.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,094.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,203.13
|
| Rate for Payer: Blue Shield of California Commercial |
$3,310.58
|
| Rate for Payer: Blue Shield of California EPN |
$2,165.24
|
| Rate for Payer: Cash Price |
$2,454.30
|
| Rate for Payer: Cash Price |
$2,454.30
|
| Rate for Payer: Central Health Plan Commercial |
$4,363.20
|
| Rate for Payer: Cigna of CA HMO |
$3,490.56
|
| Rate for Payer: Cigna of CA PPO |
$4,035.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,635.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,635.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,635.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,181.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,181.60
|
| Rate for Payer: Galaxy Health WC |
$4,635.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,272.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,908.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$570.25
|
| Rate for Payer: InnovAge PACE Commercial |
$2,727.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,637.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$629.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,376.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,090.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,817.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,817.80
|
| Rate for Payer: Multiplan Commercial |
$4,090.50
|
| Rate for Payer: Networks By Design Commercial |
$3,545.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,635.90
|
| Rate for Payer: Riverside University Health System MISP |
$2,181.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,272.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,272.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$753.76
|
| Rate for Payer: United Healthcare All Other HMO |
$753.76
|
| Rate for Payer: United Healthcare HMO Rider |
$753.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$753.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,635.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,635.90
|
| Rate for Payer: Vantage Medical Group Senior |
$4,635.90
|
|
|
HC MRI CERVICAL SPINE W CONTRA
|
Facility
|
OP
|
$5,150.00
|
|
|
Service Code
|
CPT 72142
|
| Hospital Charge Code |
908801102
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$453.77 |
| Max. Negotiated Rate |
$4,635.00 |
| Rate for Payer: Adventist Health Commercial |
$1,030.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$453.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,127.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,766.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,024.59
|
| Rate for Payer: Blue Shield of California Commercial |
$3,126.05
|
| Rate for Payer: Blue Shield of California EPN |
$2,044.55
|
| 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: Cigna of CA HMO |
$3,296.00
|
| Rate for Payer: Cigna of CA PPO |
$3,811.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.59
|
| Rate for Payer: EPIC Health Plan Senior |
$453.77
|
| Rate for Payer: Galaxy Health WC |
$4,377.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,090.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,635.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$465.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: InnovAge PACE Commercial |
$680.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,435.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$514.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,030.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$608.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$608.05
|
| Rate for Payer: Multiplan Commercial |
$3,862.50
|
| Rate for Payer: Networks By Design Commercial |
$3,347.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$453.77
|
| Rate for Payer: Prime Health Services Commercial |
$4,377.50
|
| Rate for Payer: Prime Health Services Medicare |
$481.00
|
| Rate for Payer: Riverside University Health System MISP |
$499.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,090.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,090.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$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 Select/Navigate/Core |
$1,115.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$453.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
HC MRI CERVICAL SPINE W CONTRA
|
Facility
|
IP
|
$10,778.00
|
|
|
Service Code
|
CPT 72142
|
| Hospital Charge Code |
908801102
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$2,155.60 |
| Max. Negotiated Rate |
$9,700.20 |
| Rate for Payer: Adventist Health Commercial |
$2,155.60
|
| Rate for Payer: Cash Price |
$4,850.10
|
| Rate for Payer: Central Health Plan Commercial |
$8,622.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,311.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,311.20
|
| Rate for Payer: Galaxy Health WC |
$9,161.30
|
| Rate for Payer: Global Benefits Group Commercial |
$6,466.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,700.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,188.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,106.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,671.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,155.60
|
| Rate for Payer: Multiplan Commercial |
$8,083.50
|
| Rate for Payer: Networks By Design Commercial |
$7,005.70
|
| Rate for Payer: Prime Health Services Commercial |
$9,161.30
|
|
|
HC MRI CERVICAL SPINE WO CONT
|
Facility
|
IP
|
$10,276.00
|
|
|
Service Code
|
CPT 72141
|
| Hospital Charge Code |
908801100
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$2,055.20 |
| Max. Negotiated Rate |
$9,248.40 |
| Rate for Payer: Adventist Health Commercial |
$2,055.20
|
| Rate for Payer: Cash Price |
$4,624.20
|
| Rate for Payer: Central Health Plan Commercial |
$8,220.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,110.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,110.40
|
| Rate for Payer: Galaxy Health WC |
$8,734.60
|
| Rate for Payer: Global Benefits Group Commercial |
$6,165.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,248.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,854.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,915.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,360.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,055.20
|
| Rate for Payer: Multiplan Commercial |
$7,707.00
|
| Rate for Payer: Networks By Design Commercial |
$6,679.40
|
| Rate for Payer: Prime Health Services Commercial |
$8,734.60
|
|
