|
HC MRI ANGIO HEAD WO CNTRAST
|
Facility
|
IP
|
$5,226.00
|
|
|
Service Code
|
CPT 70544
|
| Hospital Charge Code |
908801083
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,045.20 |
| Max. Negotiated Rate |
$4,703.40 |
| Rate for Payer: Adventist Health Commercial |
$1,045.20
|
| Rate for Payer: Cash Price |
$2,874.30
|
| Rate for Payer: Central Health Plan Commercial |
$4,180.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,090.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,090.40
|
| Rate for Payer: Galaxy Health WC |
$4,442.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,135.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,703.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,485.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,991.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,234.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,045.20
|
| Rate for Payer: Multiplan Commercial |
$3,919.50
|
| Rate for Payer: Networks By Design Commercial |
$3,396.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,442.10
|
|
|
HC MRI ANGIO HEAD WO CNTRAST
|
Facility
|
OP
|
$5,226.00
|
|
|
Service Code
|
CPT 70544
|
| Hospital Charge Code |
908801083
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$4,703.40 |
| Rate for Payer: Adventist Health Commercial |
$1,045.20
|
| 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 |
$2,369.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,069.23
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.18
|
| Rate for Payer: Blue Shield of California EPN |
$2,074.72
|
| Rate for Payer: Cash Price |
$2,874.30
|
| Rate for Payer: Cash Price |
$2,874.30
|
| Rate for Payer: Cash Price |
$2,874.30
|
| Rate for Payer: Central Health Plan Commercial |
$4,180.80
|
| Rate for Payer: Cigna of CA HMO |
$3,344.64
|
| Rate for Payer: Cigna of CA PPO |
$3,867.24
|
| 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 |
$4,442.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,135.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,703.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$362.82
|
| 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 |
$3,485.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$400.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,045.20
|
| 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 |
$3,919.50
|
| Rate for Payer: Networks By Design Commercial |
$3,396.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$307.13
|
| Rate for Payer: Prime Health Services Commercial |
$4,442.10
|
| 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 |
$3,135.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,135.60
|
| 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 ANGIO HEAD W WO CONTRAST
|
Facility
|
IP
|
$6,270.00
|
|
|
Service Code
|
CPT 70546
|
| Hospital Charge Code |
908801085
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,254.00 |
| Max. Negotiated Rate |
$5,643.00 |
| Rate for Payer: Adventist Health Commercial |
$1,254.00
|
| Rate for Payer: Cash Price |
$3,448.50
|
| Rate for Payer: Central Health Plan Commercial |
$5,016.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,508.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,508.00
|
| Rate for Payer: Galaxy Health WC |
$5,329.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,762.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,643.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,182.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,388.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,881.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,254.00
|
| Rate for Payer: Multiplan Commercial |
$4,702.50
|
| Rate for Payer: Networks By Design Commercial |
$4,075.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,329.50
|
|
|
HC MRI ANGIO HEAD W WO CONTRAST
|
Facility
|
OP
|
$6,270.00
|
|
|
Service Code
|
CPT 70546
|
| Hospital Charge Code |
908801085
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$453.77 |
| Max. Negotiated Rate |
$5,643.00 |
| Rate for Payer: Adventist Health Commercial |
$1,254.00
|
| 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 |
$4,659.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,682.37
|
| Rate for Payer: Blue Shield of California Commercial |
$3,805.89
|
| Rate for Payer: Blue Shield of California EPN |
$2,489.19
|
| Rate for Payer: Cash Price |
$3,448.50
|
| Rate for Payer: Cash Price |
$3,448.50
|
| Rate for Payer: Cash Price |
$3,448.50
|
| Rate for Payer: Central Health Plan Commercial |
$5,016.00
|
| Rate for Payer: Cigna of CA HMO |
$4,012.80
|
| Rate for Payer: Cigna of CA PPO |
$4,639.80
|
| 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 |
$5,329.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,762.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,643.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$557.57
|
| 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 |
$4,182.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$615.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,254.00
|
| 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 |
$4,702.50
|
| Rate for Payer: Networks By Design Commercial |
$4,075.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$453.77
|
| Rate for Payer: Prime Health Services Commercial |
$5,329.50
|
| 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 |
$3,762.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,762.00
|
| 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 ANGIO NECK W CONTRAST
|
Facility
|
IP
|
$5,853.00
|
|
|
Service Code
|
CPT 70548
|
| Hospital Charge Code |
908801087
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,170.60 |
| Max. Negotiated Rate |
$5,267.70 |
| Rate for Payer: Adventist Health Commercial |
$1,170.60
|
| Rate for Payer: Cash Price |
$3,219.15
|
| Rate for Payer: Central Health Plan Commercial |
$4,682.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,341.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,341.20
|
| Rate for Payer: Galaxy Health WC |
$4,975.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,511.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,267.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,903.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,229.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,623.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,170.60
|
| Rate for Payer: Multiplan Commercial |
$4,389.75
|
| Rate for Payer: Networks By Design Commercial |
$3,804.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,975.05
|
|
|
HC MRI ANGIO NECK W CONTRAST
|
Facility
|
OP
|
$5,853.00
|
|
|
Service Code
|
CPT 70548
|
| Hospital Charge Code |
908801087
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$413.80 |
| Max. Negotiated Rate |
$5,267.70 |
| Rate for Payer: Adventist Health Commercial |
$1,170.60
|
| 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 |
$2,369.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,437.47
|
| Rate for Payer: Blue Shield of California Commercial |
$3,552.77
|
| Rate for Payer: Blue Shield of California EPN |
$2,323.64
|
| Rate for Payer: Cash Price |
$3,219.15
|
| Rate for Payer: Cash Price |
$3,219.15
|
| Rate for Payer: Cash Price |
$3,219.15
|
| Rate for Payer: Central Health Plan Commercial |
$4,682.40
|
| Rate for Payer: Cigna of CA HMO |
$3,745.92
|
| Rate for Payer: Cigna of CA PPO |
$4,331.22
|
| 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 |
$4,975.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,511.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,267.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$413.80
|
| 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 |
$3,903.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$457.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,170.60
|
| 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 |
$4,389.75
|
| Rate for Payer: Networks By Design Commercial |
$3,804.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$453.77
|
| Rate for Payer: Prime Health Services Commercial |
$4,975.05
|
| 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 |
$3,511.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,511.80
|
| 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 ANGIO NECK WO CONTRAST
|
Facility
|
IP
|
$5,651.00
|
|
|
Service Code
|
CPT 70547
|
| Hospital Charge Code |
908801086
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,130.20 |
| Max. Negotiated Rate |
$5,085.90 |
| Rate for Payer: Adventist Health Commercial |
$1,130.20
|
| Rate for Payer: Cash Price |
$3,108.05
|
| Rate for Payer: Central Health Plan Commercial |
$4,520.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,260.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,260.40
|
| Rate for Payer: Galaxy Health WC |
$4,803.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,390.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,085.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,769.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,153.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,497.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,130.20
|
| Rate for Payer: Multiplan Commercial |
$4,238.25
|
| Rate for Payer: Networks By Design Commercial |
$3,673.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,803.35
|
|
|
HC MRI ANGIO NECK WO CONTRAST
|
Facility
|
OP
|
$5,651.00
|
|
|
Service Code
|
CPT 70547
|
| Hospital Charge Code |
908801086
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$5,085.90 |
| Rate for Payer: Adventist Health Commercial |
$1,130.20
|
| 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 |
$2,369.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,318.83
|
| Rate for Payer: Blue Shield of California Commercial |
$3,430.16
|
| Rate for Payer: Blue Shield of California EPN |
$2,243.45
|
| Rate for Payer: Cash Price |
$3,108.05
|
| Rate for Payer: Cash Price |
$3,108.05
|
| Rate for Payer: Cash Price |
$3,108.05
|
| Rate for Payer: Central Health Plan Commercial |
$4,520.80
|
| Rate for Payer: Cigna of CA HMO |
$3,616.64
|
| Rate for Payer: Cigna of CA PPO |
$4,181.74
|
| 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 |
$4,803.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,390.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,085.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$363.93
|
| 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 |
$3,769.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$402.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,130.20
|
| 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 |
$4,238.25
|
| Rate for Payer: Networks By Design Commercial |
$3,673.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$307.13
|
| Rate for Payer: Prime Health Services Commercial |
$4,803.35
|
| 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 |
$3,390.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,390.60
|
| 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 ANGIO NECK WO CONTRAST
|
Facility
|
OP
|
$5,651.00
|
|
|
Service Code
|
CPT 70547
|
| Hospital Charge Code |
908801018
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$5,085.90 |
| Rate for Payer: Adventist Health Commercial |
$1,130.20
|
| 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 |
$2,369.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,318.83
|
| Rate for Payer: Blue Shield of California Commercial |
$3,430.16
|
| Rate for Payer: Blue Shield of California EPN |
$2,243.45
|
| Rate for Payer: Cash Price |
$3,108.05
|
| Rate for Payer: Cash Price |
$3,108.05
|
| Rate for Payer: Cash Price |
$3,108.05
|
| Rate for Payer: Central Health Plan Commercial |
$4,520.80
|
| Rate for Payer: Cigna of CA HMO |
$3,616.64
|
| Rate for Payer: Cigna of CA PPO |
$4,181.74
|
| 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 |
$4,803.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,390.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,085.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$363.93
|
| 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 |
$3,769.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$402.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,130.20
|
| 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 |
$4,238.25
|
| Rate for Payer: Networks By Design Commercial |
$3,673.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$307.13
|
| Rate for Payer: Prime Health Services Commercial |
$4,803.35
|
| 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 |
$3,390.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,390.60
|
| 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 ANGIO NECK WO CONTRAST
|
Facility
|
IP
|
$5,651.00
|
|
|
Service Code
|
CPT 70547
|
| Hospital Charge Code |
908801018
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,130.20 |
| Max. Negotiated Rate |
$5,085.90 |
| Rate for Payer: Adventist Health Commercial |
$1,130.20
|
| Rate for Payer: Cash Price |
$3,108.05
|
| Rate for Payer: Central Health Plan Commercial |
$4,520.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,260.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,260.40
|
| Rate for Payer: Galaxy Health WC |
$4,803.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,390.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,085.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,769.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,153.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,497.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,130.20
|
| Rate for Payer: Multiplan Commercial |
$4,238.25
|
| Rate for Payer: Networks By Design Commercial |
$3,673.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,803.35
|
|
|
HC MRI ANGIO NECK W WO CONTRAST
|
Facility
|
OP
|
$6,472.00
|
|
|
Service Code
|
CPT 70549
|
| Hospital Charge Code |
908801088
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$453.77 |
| Max. Negotiated Rate |
$5,824.80 |
| Rate for Payer: Adventist Health Commercial |
$1,294.40
|
| 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 |
$4,659.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,801.01
|
| Rate for Payer: Blue Shield of California Commercial |
$3,928.50
|
| Rate for Payer: Blue Shield of California EPN |
$2,569.38
|
| Rate for Payer: Cash Price |
$3,559.60
|
| Rate for Payer: Cash Price |
$3,559.60
|
| Rate for Payer: Cash Price |
$3,559.60
|
| Rate for Payer: Central Health Plan Commercial |
$5,177.60
|
| Rate for Payer: Cigna of CA HMO |
$4,142.08
|
| Rate for Payer: Cigna of CA PPO |
$4,789.28
|
| 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 |
$5,501.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,883.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,824.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$583.18
|
| 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 |
$4,316.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$644.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,294.40
|
| 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 |
$4,854.00
|
| Rate for Payer: Networks By Design Commercial |
$4,206.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$453.77
|
| Rate for Payer: Prime Health Services Commercial |
$5,501.20
|
| 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 |
$3,883.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,883.20
|
| 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 ANGIO NECK W WO CONTRAST
|
Facility
|
IP
|
$6,472.00
|
|
|
Service Code
|
CPT 70549
|
| Hospital Charge Code |
908801088
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,294.40 |
| Max. Negotiated Rate |
$5,824.80 |
| Rate for Payer: Adventist Health Commercial |
$1,294.40
|
| Rate for Payer: Cash Price |
$3,559.60
|
| Rate for Payer: Central Health Plan Commercial |
$5,177.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,588.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,588.80
|
| Rate for Payer: Galaxy Health WC |
$5,501.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,883.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,824.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,316.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,465.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,006.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,294.40
|
| Rate for Payer: Multiplan Commercial |
$4,854.00
|
| Rate for Payer: Networks By Design Commercial |
$4,206.80
|
| Rate for Payer: Prime Health Services Commercial |
$5,501.20
|
|
|
HC MRI BILATERAL TMJ
|
Facility
|
IP
|
$5,653.00
|
|
|
Service Code
|
CPT 70336
|
| Hospital Charge Code |
908801055
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,130.60 |
| Max. Negotiated Rate |
$5,087.70 |
| Rate for Payer: Adventist Health Commercial |
$1,130.60
|
| Rate for Payer: Cash Price |
$3,109.15
|
| Rate for Payer: Central Health Plan Commercial |
$4,522.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,261.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,261.20
|
| Rate for Payer: Galaxy Health WC |
$4,805.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,391.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,087.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,770.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,153.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,499.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,130.60
|
| Rate for Payer: Multiplan Commercial |
$4,239.75
|
| Rate for Payer: Networks By Design Commercial |
$3,674.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,805.05
|
|
|
HC MRI BILATERAL TMJ
|
Facility
|
OP
|
$5,653.00
|
|
|
Service Code
|
CPT 70336
|
| Hospital Charge Code |
908801055
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$5,087.70 |
| Rate for Payer: Adventist Health Commercial |
$1,130.60
|
| 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 |
$2,044.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,320.01
|
| Rate for Payer: Blue Shield of California Commercial |
$3,431.37
|
| Rate for Payer: Blue Shield of California EPN |
$2,244.24
|
| Rate for Payer: Cash Price |
$3,109.15
|
| Rate for Payer: Cash Price |
$3,109.15
|
| Rate for Payer: Cash Price |
$3,109.15
|
| Rate for Payer: Central Health Plan Commercial |
$4,522.40
|
| Rate for Payer: Cigna of CA HMO |
$3,617.92
|
| Rate for Payer: Cigna of CA PPO |
$4,183.22
|
| 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 |
$4,805.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,391.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,087.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.69
|
| 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 |
$3,770.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,153.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,130.60
|
| 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 |
$4,239.75
|
| Rate for Payer: Networks By Design Commercial |
$3,674.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$307.13
|
| Rate for Payer: Prime Health Services Commercial |
$4,805.05
|
| 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 |
$3,391.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,391.80
|
| 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 BN MARROW(2 SEQ)
|
Facility
|
OP
|
$3,706.00
|
|
|
Service Code
|
CPT 77084
|
| Hospital Charge Code |
908801140
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$3,335.40 |
| Rate for Payer: Adventist Health Commercial |
$741.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$307.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,250.65
|
| 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 |
$2,305.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,176.53
|
| Rate for Payer: Blue Shield of California Commercial |
$2,249.54
|
| Rate for Payer: Blue Shield of California EPN |
$1,471.28
|
| Rate for Payer: Cash Price |
$2,038.30
|
| Rate for Payer: Cash Price |
$2,038.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,964.80
|
| Rate for Payer: Cigna of CA HMO |
$2,371.84
|
| Rate for Payer: Cigna of CA PPO |
$2,742.44
|
| 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 |
$3,150.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,223.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,335.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.69
|
| 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 |
$2,471.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,411.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$741.20
|
| 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 |
$2,779.50
|
| Rate for Payer: Networks By Design Commercial |
$2,408.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$307.13
|
| Rate for Payer: Prime Health Services Commercial |
$3,150.10
|
| 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 |
$2,223.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,223.60
|
| 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 BN MARROW(2 SEQ)
|
Facility
|
IP
|
$3,706.00
|
|
|
Service Code
|
CPT 77084
|
| Hospital Charge Code |
908801140
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$741.20 |
| Max. Negotiated Rate |
$3,335.40 |
| Rate for Payer: Adventist Health Commercial |
$741.20
|
| Rate for Payer: Cash Price |
$2,038.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,964.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,482.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,482.40
|
| Rate for Payer: Galaxy Health WC |
$3,150.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,223.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,335.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,471.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,411.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,294.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$741.20
|
| Rate for Payer: Multiplan Commercial |
$2,779.50
|
| Rate for Payer: Networks By Design Commercial |
$2,408.90
|
| Rate for Payer: Prime Health Services Commercial |
$3,150.10
|
|
|
HC MRI BRAIN ASSESS W CONTRAST
|
Facility
|
OP
|
$1,937.00
|
|
|
Service Code
|
CPT 70558
|
| Hospital Charge Code |
908870558
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$2,759.80 |
| Rate for Payer: Adventist Health Commercial |
$387.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$226.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,176.34
|
| 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 |
$2,759.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,137.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,175.76
|
| Rate for Payer: Blue Shield of California EPN |
$768.99
|
| Rate for Payer: Cash Price |
$1,065.35
|
| Rate for Payer: Cash Price |
$1,065.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,549.60
|
| Rate for Payer: Cigna of CA HMO |
$1,239.68
|
| Rate for Payer: Cigna of CA PPO |
$1,433.38
|
| 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 |
$1,646.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,162.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,743.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$304.87
|
| 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 |
$1,291.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$336.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$387.40
|
| 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 |
$1,452.75
|
| Rate for Payer: Networks By Design Commercial |
$1,259.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$226.19
|
| Rate for Payer: Prime Health Services Commercial |
$1,646.45
|
| 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 |
$1,162.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,162.20
|
| 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 |
$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 ASSESS W CONTRAST
|
Facility
|
IP
|
$1,937.00
|
|
|
Service Code
|
CPT 70558
|
| Hospital Charge Code |
908870558
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$387.40 |
| Max. Negotiated Rate |
$1,743.30 |
| Rate for Payer: Adventist Health Commercial |
$387.40
|
| Rate for Payer: Cash Price |
$1,065.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,549.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$774.80
|
| Rate for Payer: EPIC Health Plan Senior |
$774.80
|
| Rate for Payer: Galaxy Health WC |
$1,646.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,162.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,743.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,291.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$738.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,199.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$387.40
|
| Rate for Payer: Multiplan Commercial |
$1,452.75
|
| Rate for Payer: Networks By Design Commercial |
$1,259.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,646.45
|
|
|
HC MRI BRAIN ASSESS WO CONTRAST
|
Facility
|
IP
|
$1,027.00
|
|
|
Service Code
|
CPT 70557
|
| Hospital Charge Code |
908870557
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$205.40 |
| Max. Negotiated Rate |
$924.30 |
| Rate for Payer: Adventist Health Commercial |
$205.40
|
| Rate for Payer: Cash Price |
$564.85
|
| Rate for Payer: Central Health Plan Commercial |
$821.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$410.80
|
| Rate for Payer: EPIC Health Plan Senior |
$410.80
|
| Rate for Payer: Galaxy Health WC |
$872.95
|
| Rate for Payer: Global Benefits Group Commercial |
$616.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$924.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$685.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$391.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$635.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.40
|
| Rate for Payer: Multiplan Commercial |
$770.25
|
| Rate for Payer: Networks By Design Commercial |
$667.55
|
| Rate for Payer: Prime Health Services Commercial |
$872.95
|
|
|
HC MRI BRAIN ASSESS WO CONTRAST
|
Facility
|
OP
|
$1,027.00
|
|
|
Service Code
|
CPT 70557
|
| Hospital Charge Code |
908870557
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$205.40 |
| Max. Negotiated Rate |
$2,303.98 |
| Rate for Payer: Adventist Health Commercial |
$205.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$696.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$623.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$766.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$696.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,303.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$603.16
|
| Rate for Payer: Blue Shield of California Commercial |
$623.39
|
| Rate for Payer: Blue Shield of California EPN |
$407.72
|
| Rate for Payer: Cash Price |
$564.85
|
| Rate for Payer: Cash Price |
$564.85
|
| Rate for Payer: Central Health Plan Commercial |
$821.60
|
| Rate for Payer: Cigna of CA HMO |
$657.28
|
| Rate for Payer: Cigna of CA PPO |
$759.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$766.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$696.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$940.50
|
| Rate for Payer: EPIC Health Plan Senior |
$696.67
|
| Rate for Payer: Galaxy Health WC |
$872.95
|
| Rate for Payer: Global Benefits Group Commercial |
$616.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$924.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,142.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$295.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$696.67
|
| Rate for Payer: InnovAge PACE Commercial |
$1,045.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$685.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$326.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$696.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$933.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$933.54
|
| Rate for Payer: Multiplan Commercial |
$770.25
|
| Rate for Payer: Networks By Design Commercial |
$667.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$696.67
|
| Rate for Payer: Prime Health Services Commercial |
$872.95
|
| Rate for Payer: Prime Health Services Medicare |
$738.47
|
| Rate for Payer: Riverside University Health System MISP |
$766.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$616.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$616.20
|
| 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 |
$696.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$766.34
|
| Rate for Payer: Vantage Medical Group Senior |
$696.67
|
|
|
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 |
$1,118.70
|
| Rate for Payer: Cash Price |
$1,118.70
|
| 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 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 |
$1,118.70
|
| 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 WITH CONTRAST
|
Facility
|
IP
|
$5,421.00
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
908801013
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,084.20 |
| Max. Negotiated Rate |
$4,878.90 |
| Rate for Payer: Adventist Health Commercial |
$1,084.20
|
| Rate for Payer: Cash Price |
$2,981.55
|
| Rate for Payer: Central Health Plan Commercial |
$4,336.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,168.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,168.40
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$3,615.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,065.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,355.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,084.20
|
| Rate for Payer: Multiplan Commercial |
$4,065.75
|
| Rate for Payer: Networks By Design Commercial |
$3,523.65
|
| Rate for Payer: Prime Health Services Commercial |
$4,607.85
|
|
|
HC MRI BRAIN WITH CONTRAST
|
Facility
|
IP
|
$5,421.00
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
908801012
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,084.20 |
| Max. Negotiated Rate |
$4,878.90 |
| Rate for Payer: Adventist Health Commercial |
$1,084.20
|
| Rate for Payer: Cash Price |
$2,981.55
|
| Rate for Payer: Central Health Plan Commercial |
$4,336.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,168.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,168.40
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$3,615.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,065.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,355.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,084.20
|
| Rate for Payer: Multiplan Commercial |
$4,065.75
|
| Rate for Payer: Networks By Design Commercial |
$3,523.65
|
| Rate for Payer: Prime Health Services Commercial |
$4,607.85
|
|
|
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 |
$2,981.55
|
| Rate for Payer: Cash Price |
$2,981.55
|
| 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
|
|
