|
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 |
$2,981.55
|
| 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
|
|
|
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 |
$2,819.30
|
| Rate for Payer: Cash Price |
$2,819.30
|
| Rate for Payer: Cash Price |
$2,819.30
|
| 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
|
$5,126.00
|
|
|
Service Code
|
CPT 70551
|
| Hospital Charge Code |
908801010
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,025.20 |
| Max. Negotiated Rate |
$4,613.40 |
| Rate for Payer: Adventist Health Commercial |
$1,025.20
|
| Rate for Payer: Cash Price |
$2,819.30
|
| Rate for Payer: Central Health Plan Commercial |
$4,100.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,050.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,050.40
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$3,419.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,953.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,172.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,025.20
|
| Rate for Payer: Multiplan Commercial |
$3,844.50
|
| Rate for Payer: Networks By Design Commercial |
$3,331.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,357.10
|
|
|
HC MRI BRAIN W WO CONTRAST
|
Facility
|
IP
|
$6,338.00
|
|
|
Service Code
|
CPT 70553
|
| Hospital Charge Code |
908801014
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,267.60 |
| Max. Negotiated Rate |
$5,704.20 |
| Rate for Payer: Adventist Health Commercial |
$1,267.60
|
| Rate for Payer: Cash Price |
$3,485.90
|
| Rate for Payer: Central Health Plan Commercial |
$5,070.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,535.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,535.20
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$4,227.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,414.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,923.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,267.60
|
| Rate for Payer: Multiplan Commercial |
$4,753.50
|
| Rate for Payer: Networks By Design Commercial |
$4,119.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,387.30
|
|
|
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 |
$3,485.90
|
| Rate for Payer: Cash Price |
$3,485.90
|
| Rate for Payer: Cash Price |
$3,485.90
|
| 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
|
$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: Cash Price |
$2,920.50
|
| Rate for Payer: Central Health Plan Commercial |
$4,248.00
|
| 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: 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: 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
|
|
|
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 |
$2,920.50
|
| Rate for Payer: Cash Price |
$2,920.50
|
| 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
|
IP
|
$4,853.00
|
|
|
Service Code
|
CPT 77047
|
| Hospital Charge Code |
908801212
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$970.60 |
| Max. Negotiated Rate |
$4,367.70 |
| Rate for Payer: Adventist Health Commercial |
$970.60
|
| Rate for Payer: Cash Price |
$2,669.15
|
| Rate for Payer: Central Health Plan Commercial |
$3,882.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,941.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,941.20
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$3,236.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,848.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,004.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$970.60
|
| Rate for Payer: Multiplan Commercial |
$3,639.75
|
| Rate for Payer: Networks By Design Commercial |
$3,154.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,125.05
|
|
|
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 |
$2,669.15
|
| Rate for Payer: Cash Price |
$2,669.15
|
| 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 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 |
$2,748.90
|
| Rate for Payer: Cash Price |
$2,748.90
|
| 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 W/CONTRAST
|
Facility
|
IP
|
$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: Cash Price |
$2,748.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,998.40
|
| 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: 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: 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
|
|
|
HC MRI BREAST UNI WO CONTRAST
|
Facility
|
IP
|
$4,310.00
|
|
|
Service Code
|
CPT 77046
|
| Hospital Charge Code |
908801219
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$862.00 |
| Max. Negotiated Rate |
$3,879.00 |
| Rate for Payer: Adventist Health Commercial |
$862.00
|
| Rate for Payer: Cash Price |
$2,370.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,448.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,724.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,724.00
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$2,874.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,642.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,667.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$862.00
|
| Rate for Payer: Multiplan Commercial |
$3,232.50
|
| Rate for Payer: Networks By Design Commercial |
$2,801.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,663.50
|
|
|
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 |
$2,370.50
|
| Rate for Payer: Cash Price |
$2,370.50
|
| 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 BRST BI W WO CNTRST W CAD
|
Facility
|
IP
|
$5,911.00
|
|
|
Service Code
|
CPT 77049
|
| Hospital Charge Code |
908801210
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,182.20 |
| Max. Negotiated Rate |
$5,319.90 |
| Rate for Payer: Adventist Health Commercial |
$1,182.20
|
| Rate for Payer: Cash Price |
$3,251.05
|
| Rate for Payer: Central Health Plan Commercial |
$4,728.80
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$3,942.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,252.09
|
| 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: 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
|
|
|
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 |
$3,251.05
|
| Rate for Payer: Cash Price |
$3,251.05
|
| 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 UNI W WO CTRST W CAD
|
Facility
|
IP
|
$5,454.00
|
|
|
Service Code
|
CPT 77048
|
| Hospital Charge Code |
908801215
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,090.80 |
| Max. Negotiated Rate |
$4,908.60 |
| Rate for Payer: Adventist Health Commercial |
$1,090.80
|
| Rate for Payer: Cash Price |
$2,999.70
|
| Rate for Payer: Central Health Plan Commercial |
$4,363.20
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$3,637.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,077.97
|
| 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: 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
|
|
|
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 |
$2,999.70
|
| Rate for Payer: Cash Price |
$2,999.70
|
| 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
|
IP
|
$5,150.00
|
|
|
Service Code
|
CPT 72142
|
| Hospital Charge Code |
908801102
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,030.00 |
| Max. Negotiated Rate |
$4,635.00 |
| Rate for Payer: Adventist Health Commercial |
$1,030.00
|
| Rate for Payer: Cash Price |
$2,832.50
|
| Rate for Payer: Central Health Plan Commercial |
$4,120.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,060.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,060.00
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$3,435.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,962.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,187.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,030.00
|
| Rate for Payer: Multiplan Commercial |
$3,862.50
|
| Rate for Payer: Networks By Design Commercial |
$3,347.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,377.50
|
|
|
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 |
$2,832.50
|
| Rate for Payer: Cash Price |
$2,832.50
|
| 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 WO CONT
|
Facility
|
IP
|
$4,965.00
|
|
|
Service Code
|
CPT 72141
|
| Hospital Charge Code |
908801100
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$993.00 |
| Max. Negotiated Rate |
$4,468.50 |
| Rate for Payer: Adventist Health Commercial |
$993.00
|
| Rate for Payer: Cash Price |
$2,730.75
|
| Rate for Payer: Central Health Plan Commercial |
$3,972.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,986.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,986.00
|
| Rate for Payer: Galaxy Health WC |
$4,220.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,979.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,468.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,311.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,891.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,073.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$993.00
|
| Rate for Payer: Multiplan Commercial |
$3,723.75
|
| Rate for Payer: Networks By Design Commercial |
$3,227.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,220.25
|
|
|
HC MRI CERVICAL SPINE WO CONT
|
Facility
|
OP
|
$4,965.00
|
|
|
Service Code
|
CPT 72141
|
| Hospital Charge Code |
908801100
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$4,468.50 |
| Rate for Payer: Adventist Health Commercial |
$993.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$307.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,015.24
|
| 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 |
$2,305.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,915.94
|
| Rate for Payer: Blue Shield of California Commercial |
$3,013.76
|
| Rate for Payer: Blue Shield of California EPN |
$1,971.11
|
| Rate for Payer: Cash Price |
$2,730.75
|
| Rate for Payer: Cash Price |
$2,730.75
|
| Rate for Payer: Central Health Plan Commercial |
$3,972.00
|
| Rate for Payer: Cigna of CA HMO |
$3,177.60
|
| Rate for Payer: Cigna of CA PPO |
$3,674.10
|
| 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 |
$4,220.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,979.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,468.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$319.32
|
| 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 |
$3,311.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$352.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$993.00
|
| 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 |
$3,723.75
|
| Rate for Payer: Networks By Design Commercial |
$3,227.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$307.13
|
| Rate for Payer: Prime Health Services Commercial |
$4,220.25
|
| 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 |
$2,979.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,979.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| Rate for Payer: United Healthcare All Other 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 CHEST W/ CONTRAST
|
Facility
|
OP
|
$4,965.00
|
|
|
Service Code
|
CPT 71551
|
| Hospital Charge Code |
908801201
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$643.50 |
| Max. Negotiated Rate |
$4,468.50 |
| Rate for Payer: Adventist Health Commercial |
$993.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,003.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,104.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,003.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,814.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,915.94
|
| Rate for Payer: Blue Shield of California Commercial |
$3,013.76
|
| Rate for Payer: Blue Shield of California EPN |
$1,971.11
|
| Rate for Payer: Cash Price |
$2,730.75
|
| Rate for Payer: Cash Price |
$2,730.75
|
| Rate for Payer: Cash Price |
$2,730.75
|
| Rate for Payer: Central Health Plan Commercial |
$3,972.00
|
| Rate for Payer: Cigna of CA HMO |
$3,177.60
|
| Rate for Payer: Cigna of CA PPO |
$3,674.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,104.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,003.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,355.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,003.85
|
| Rate for Payer: Galaxy Health WC |
$4,220.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,979.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,468.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,646.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$643.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,003.85
|
| Rate for Payer: InnovAge PACE Commercial |
$1,505.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,311.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$710.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,003.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$993.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,345.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,345.16
|
| Rate for Payer: Multiplan Commercial |
$3,723.75
|
| Rate for Payer: Networks By Design Commercial |
$3,227.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,003.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,220.25
|
| Rate for Payer: Prime Health Services Medicare |
$1,064.08
|
| Rate for Payer: Riverside University Health System MISP |
$1,104.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,979.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,979.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,115.74
|
| Rate for Payer: United Healthcare All Other 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 |
$1,003.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,104.23
|
| Rate for Payer: Vantage Medical Group Senior |
$1,003.85
|
|
|
HC MRI CHEST W/ CONTRAST
|
Facility
|
IP
|
$4,965.00
|
|
|
Service Code
|
CPT 71551
|
| Hospital Charge Code |
908801201
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$993.00 |
| Max. Negotiated Rate |
$4,468.50 |
| Rate for Payer: Adventist Health Commercial |
$993.00
|
| Rate for Payer: Cash Price |
$2,730.75
|
| Rate for Payer: Central Health Plan Commercial |
$3,972.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,986.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,986.00
|
| Rate for Payer: Galaxy Health WC |
$4,220.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,979.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,468.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,311.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,891.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,073.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$993.00
|
| Rate for Payer: Multiplan Commercial |
$3,723.75
|
| Rate for Payer: Networks By Design Commercial |
$3,227.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,220.25
|
|
|
HC MRI CHEST, W/O CONT
|
Facility
|
IP
|
$4,442.00
|
|
|
Service Code
|
CPT 71550
|
| Hospital Charge Code |
908801200
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$888.40 |
| Max. Negotiated Rate |
$3,997.80 |
| Rate for Payer: Adventist Health Commercial |
$888.40
|
| Rate for Payer: Cash Price |
$2,443.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,553.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,776.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,776.80
|
| Rate for Payer: Galaxy Health WC |
$3,775.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,665.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,997.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,962.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,692.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,749.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$888.40
|
| Rate for Payer: Multiplan Commercial |
$3,331.50
|
| Rate for Payer: Networks By Design Commercial |
$2,887.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,775.70
|
|
|
HC MRI CHEST, W/O CONT
|
Facility
|
OP
|
$4,442.00
|
|
|
Service Code
|
CPT 71550
|
| Hospital Charge Code |
908801200
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$3,997.80 |
| Rate for Payer: Adventist Health Commercial |
$888.40
|
| 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 |
$2,305.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,608.79
|
| Rate for Payer: Blue Shield of California Commercial |
$2,696.29
|
| Rate for Payer: Blue Shield of California EPN |
$1,763.47
|
| Rate for Payer: Cash Price |
$2,443.10
|
| Rate for Payer: Cash Price |
$2,443.10
|
| Rate for Payer: Cash Price |
$2,443.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,553.60
|
| Rate for Payer: Cigna of CA HMO |
$2,842.88
|
| Rate for Payer: Cigna of CA PPO |
$3,287.08
|
| 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 |
$3,775.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,665.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,997.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$582.39
|
| 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 |
$2,962.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$643.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$888.40
|
| 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 |
$3,331.50
|
| Rate for Payer: Networks By Design Commercial |
$2,887.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$307.13
|
| Rate for Payer: Prime Health Services Commercial |
$3,775.70
|
| 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 |
$2,665.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,665.20
|
| 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 |
$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
|
|
