|
HC MRI LOWER EXTREM JOIN W & WO CONT
|
Facility
|
OP
|
$6,774.00
|
|
|
Service Code
|
CPT 73723
|
| Hospital Charge Code |
908801377
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$453.77 |
| Max. Negotiated Rate |
$6,096.60 |
| Rate for Payer: Adventist Health Commercial |
$1,354.80
|
| 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 |
$5,198.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,978.37
|
| Rate for Payer: Blue Shield of California Commercial |
$4,111.82
|
| Rate for Payer: Blue Shield of California EPN |
$2,689.28
|
| Rate for Payer: Cash Price |
$3,048.30
|
| Rate for Payer: Cash Price |
$3,048.30
|
| Rate for Payer: Cash Price |
$3,048.30
|
| Rate for Payer: Central Health Plan Commercial |
$5,419.20
|
| Rate for Payer: Cigna of CA HMO |
$4,335.36
|
| Rate for Payer: Cigna of CA PPO |
$5,012.76
|
| 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 |
$5,757.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,064.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,096.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$985.89
|
| 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 |
$4,518.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,089.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,354.80
|
| 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 |
$5,080.50
|
| Rate for Payer: Networks By Design Commercial |
$4,403.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$453.77
|
| Rate for Payer: Prime Health Services Commercial |
$5,757.90
|
| 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 |
$4,064.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,064.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,367.12
|
| Rate for Payer: United Healthcare All Other 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 LOWER EXTREM JOIN W & WO CONT
|
Facility
|
IP
|
$13,414.00
|
|
|
Service Code
|
CPT 73723
|
| Hospital Charge Code |
908801377
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,682.80 |
| Max. Negotiated Rate |
$12,072.60 |
| Rate for Payer: Adventist Health Commercial |
$2,682.80
|
| Rate for Payer: Cash Price |
$6,036.30
|
| Rate for Payer: Central Health Plan Commercial |
$10,731.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,365.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5,365.60
|
| Rate for Payer: Galaxy Health WC |
$11,401.90
|
| Rate for Payer: Global Benefits Group Commercial |
$8,048.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,072.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,947.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,110.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,303.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,682.80
|
| Rate for Payer: Multiplan Commercial |
$10,060.50
|
| Rate for Payer: Networks By Design Commercial |
$8,719.10
|
| Rate for Payer: Prime Health Services Commercial |
$11,401.90
|
|
|
HC MRI LOWER EXTREM W/ CON
|
Facility
|
OP
|
$4,462.00
|
|
|
Service Code
|
CPT 73719
|
| Hospital Charge Code |
908801403
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$453.77 |
| Max. Negotiated Rate |
$4,015.80 |
| Rate for Payer: Adventist Health Commercial |
$892.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$453.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,709.77
|
| 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 |
$2,808.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,620.53
|
| Rate for Payer: Blue Shield of California Commercial |
$2,708.43
|
| Rate for Payer: Blue Shield of California EPN |
$1,771.41
|
| Rate for Payer: Cash Price |
$2,007.90
|
| Rate for Payer: Cash Price |
$2,007.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,569.60
|
| Rate for Payer: Cigna of CA HMO |
$2,855.68
|
| Rate for Payer: Cigna of CA PPO |
$3,301.88
|
| 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 |
$3,792.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,677.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,015.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$822.68
|
| 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 |
$2,976.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$908.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$892.40
|
| 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 |
$3,346.50
|
| Rate for Payer: Networks By Design Commercial |
$2,900.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$453.77
|
| Rate for Payer: Prime Health Services Commercial |
$3,792.70
|
| 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 |
$2,677.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,677.20
|
| 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 |
$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 LOWER EXTREM W/ CON
|
Facility
|
IP
|
$9,233.00
|
|
|
Service Code
|
CPT 73719
|
| Hospital Charge Code |
908801403
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,846.60 |
| Max. Negotiated Rate |
$8,309.70 |
| Rate for Payer: Adventist Health Commercial |
$1,846.60
|
| Rate for Payer: Cash Price |
$4,154.85
|
| Rate for Payer: Central Health Plan Commercial |
$7,386.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,693.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,693.20
|
| Rate for Payer: Galaxy Health WC |
$7,848.05
|
| Rate for Payer: Global Benefits Group Commercial |
$5,539.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,309.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,158.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,517.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,715.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,846.60
|
| Rate for Payer: Multiplan Commercial |
$6,924.75
|
| Rate for Payer: Networks By Design Commercial |
$6,001.45
|
| Rate for Payer: Prime Health Services Commercial |
$7,848.05
|
|
|
HC MRI LOWER EXTREM WO CONT
|
Facility
|
OP
|
$5,012.00
|
|
|
Service Code
|
CPT 73720
|
| Hospital Charge Code |
908801399
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$453.77 |
| Max. Negotiated Rate |
$4,510.80 |
| Rate for Payer: Adventist Health Commercial |
$1,002.40
|
| 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 |
$2,303.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,943.55
|
| Rate for Payer: Blue Shield of California Commercial |
$3,042.28
|
| Rate for Payer: Blue Shield of California EPN |
$1,989.76
|
| Rate for Payer: Cash Price |
$2,255.40
|
| Rate for Payer: Cash Price |
$2,255.40
|
| Rate for Payer: Cash Price |
$2,255.40
|
| Rate for Payer: Central Health Plan Commercial |
$4,009.60
|
| Rate for Payer: Cigna of CA HMO |
$3,207.68
|
| Rate for Payer: Cigna of CA PPO |
$3,708.88
|
| 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 |
$4,260.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,007.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,510.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$572.88
|
| 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 |
$3,343.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$632.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,002.40
|
| 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 |
$3,759.00
|
| Rate for Payer: Networks By Design Commercial |
$3,257.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$453.77
|
| Rate for Payer: Prime Health Services Commercial |
$4,260.20
|
| 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 |
$3,007.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,007.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,367.12
|
| Rate for Payer: United Healthcare All Other 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 LOWER EXTREM WO CONT
|
Facility
|
IP
|
$12,967.00
|
|
|
Service Code
|
CPT 73720
|
| Hospital Charge Code |
908801399
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,593.40 |
| Max. Negotiated Rate |
$11,670.30 |
| Rate for Payer: Adventist Health Commercial |
$2,593.40
|
| Rate for Payer: Cash Price |
$5,835.15
|
| Rate for Payer: Central Health Plan Commercial |
$10,373.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,186.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5,186.80
|
| Rate for Payer: Galaxy Health WC |
$11,021.95
|
| Rate for Payer: Global Benefits Group Commercial |
$7,780.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,670.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,648.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,940.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,026.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,593.40
|
| Rate for Payer: Multiplan Commercial |
$9,725.25
|
| Rate for Payer: Networks By Design Commercial |
$8,428.55
|
| Rate for Payer: Prime Health Services Commercial |
$11,021.95
|
|
|
HC MRI L-SPINE W & WO CONTRAST
|
Facility
|
OP
|
$5,667.00
|
|
|
Service Code
|
CPT 72158
|
| Hospital Charge Code |
908801124
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$453.77 |
| Max. Negotiated Rate |
$5,100.30 |
| Rate for Payer: Adventist Health Commercial |
$1,133.40
|
| 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 |
$4,537.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,328.23
|
| Rate for Payer: Blue Shield of California Commercial |
$3,439.87
|
| Rate for Payer: Blue Shield of California EPN |
$2,249.80
|
| Rate for Payer: Cash Price |
$2,550.15
|
| Rate for Payer: Cash Price |
$2,550.15
|
| Rate for Payer: Cash Price |
$2,550.15
|
| Rate for Payer: Central Health Plan Commercial |
$4,533.60
|
| Rate for Payer: Cigna of CA HMO |
$3,626.88
|
| Rate for Payer: Cigna of CA PPO |
$4,193.58
|
| 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 |
$4,816.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,400.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,100.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$537.14
|
| 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 |
$3,779.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$593.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,133.40
|
| 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 |
$4,250.25
|
| Rate for Payer: Networks By Design Commercial |
$3,683.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$453.77
|
| Rate for Payer: Prime Health Services Commercial |
$4,816.95
|
| 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 |
$3,400.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,400.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,367.12
|
| Rate for Payer: United Healthcare All Other 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 L-SPINE W & WO CONTRAST
|
Facility
|
IP
|
$12,346.00
|
|
|
Service Code
|
CPT 72158
|
| Hospital Charge Code |
908801124
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$2,469.20 |
| Max. Negotiated Rate |
$11,111.40 |
| Rate for Payer: Adventist Health Commercial |
$2,469.20
|
| Rate for Payer: Cash Price |
$5,555.70
|
| Rate for Payer: Central Health Plan Commercial |
$9,876.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,938.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,938.40
|
| Rate for Payer: Galaxy Health WC |
$10,494.10
|
| Rate for Payer: Global Benefits Group Commercial |
$7,407.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,111.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,234.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,703.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,642.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,469.20
|
| Rate for Payer: Multiplan Commercial |
$9,259.50
|
| Rate for Payer: Networks By Design Commercial |
$8,024.90
|
| Rate for Payer: Prime Health Services Commercial |
$10,494.10
|
|
|
HC MRI LUMBAR SPINE W CONTRAST
|
Facility
|
IP
|
$11,827.00
|
|
|
Service Code
|
CPT 72149
|
| Hospital Charge Code |
908801122
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$2,365.40 |
| Max. Negotiated Rate |
$10,644.30 |
| Rate for Payer: Adventist Health Commercial |
$2,365.40
|
| Rate for Payer: Cash Price |
$5,322.15
|
| Rate for Payer: Central Health Plan Commercial |
$9,461.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,730.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,730.80
|
| Rate for Payer: Galaxy Health WC |
$10,052.95
|
| Rate for Payer: Global Benefits Group Commercial |
$7,096.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,644.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,888.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,506.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,320.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,365.40
|
| Rate for Payer: Multiplan Commercial |
$8,870.25
|
| Rate for Payer: Networks By Design Commercial |
$7,687.55
|
| Rate for Payer: Prime Health Services Commercial |
$10,052.95
|
|
|
HC MRI LUMBAR SPINE W CONTRAST
|
Facility
|
OP
|
$5,150.00
|
|
|
Service Code
|
CPT 72149
|
| Hospital Charge Code |
908801122
|
|
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 |
$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 |
$2,764.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,024.59
|
| Rate for Payer: Blue Shield of California Commercial |
$3,126.05
|
| Rate for Payer: Blue Shield of California EPN |
$2,044.55
|
| Rate for Payer: Cash Price |
$2,317.50
|
| Rate for Payer: Cash Price |
$2,317.50
|
| Rate for Payer: Cash Price |
$2,317.50
|
| Rate for Payer: Central Health Plan Commercial |
$4,120.00
|
| Rate for Payer: Cigna of CA HMO |
$3,296.00
|
| Rate for Payer: Cigna of CA PPO |
$3,811.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.59
|
| Rate for Payer: EPIC Health Plan Senior |
$453.77
|
| Rate for Payer: Galaxy Health WC |
$4,377.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,090.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,635.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$456.71
|
| 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 |
$504.51
|
| 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 LUMBAR SPINE WO CONTR
|
Facility
|
OP
|
$4,965.00
|
|
|
Service Code
|
CPT 72148
|
| Hospital Charge Code |
908801120
|
|
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 |
$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 |
$2,554.40
|
| 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 |
$2,234.25
|
| Rate for Payer: Cash Price |
$2,234.25
|
| Rate for Payer: Cash Price |
$2,234.25
|
| Rate for Payer: Central Health Plan Commercial |
$3,972.00
|
| Rate for Payer: 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 |
$319.92
|
| 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 |
$353.40
|
| 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 LUMBAR SPINE WO CONTR
|
Facility
|
IP
|
$10,563.00
|
|
|
Service Code
|
CPT 72148
|
| Hospital Charge Code |
908801120
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$2,112.60 |
| Max. Negotiated Rate |
$9,506.70 |
| Rate for Payer: Adventist Health Commercial |
$2,112.60
|
| Rate for Payer: Cash Price |
$4,753.35
|
| Rate for Payer: Central Health Plan Commercial |
$8,450.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,225.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,225.20
|
| Rate for Payer: Galaxy Health WC |
$8,978.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6,337.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,506.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,045.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,024.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,538.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,112.60
|
| Rate for Payer: Multiplan Commercial |
$7,922.25
|
| Rate for Payer: Networks By Design Commercial |
$6,865.95
|
| Rate for Payer: Prime Health Services Commercial |
$8,978.55
|
|
|
HC MRI ORBIT FACE/NECK W CON
|
Facility
|
OP
|
$5,017.00
|
|
|
Service Code
|
CPT 70542
|
| Hospital Charge Code |
908801081
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$453.77 |
| Max. Negotiated Rate |
$4,515.30 |
| Rate for Payer: Adventist Health Commercial |
$1,003.40
|
| 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 |
$2,808.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,946.48
|
| Rate for Payer: Blue Shield of California Commercial |
$3,045.32
|
| Rate for Payer: Blue Shield of California EPN |
$1,991.75
|
| Rate for Payer: Cash Price |
$2,257.65
|
| Rate for Payer: Cash Price |
$2,257.65
|
| Rate for Payer: Cash Price |
$2,257.65
|
| Rate for Payer: Central Health Plan Commercial |
$4,013.60
|
| Rate for Payer: Cigna of CA HMO |
$3,210.88
|
| Rate for Payer: Cigna of CA PPO |
$3,712.58
|
| 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 |
$4,264.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,010.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,515.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$455.52
|
| 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 |
$3,346.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$503.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,003.40
|
| 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 |
$3,762.75
|
| Rate for Payer: Networks By Design Commercial |
$3,261.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$453.77
|
| Rate for Payer: Prime Health Services Commercial |
$4,264.45
|
| 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 |
$3,010.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,010.20
|
| 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 |
$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 ORBIT FACE/NECK W CON
|
Facility
|
IP
|
$9,483.00
|
|
|
Service Code
|
CPT 70542
|
| Hospital Charge Code |
908801081
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,896.60 |
| Max. Negotiated Rate |
$8,534.70 |
| Rate for Payer: Adventist Health Commercial |
$1,896.60
|
| Rate for Payer: Cash Price |
$4,267.35
|
| Rate for Payer: Central Health Plan Commercial |
$7,586.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,793.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,793.20
|
| Rate for Payer: Galaxy Health WC |
$8,060.55
|
| Rate for Payer: Global Benefits Group Commercial |
$5,689.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,534.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,325.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,613.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,869.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,896.60
|
| Rate for Payer: Multiplan Commercial |
$7,112.25
|
| Rate for Payer: Networks By Design Commercial |
$6,163.95
|
| Rate for Payer: Prime Health Services Commercial |
$8,060.55
|
|
|
HC MRI ORBIT FACE/NECK WO CON
|
Facility
|
OP
|
$4,397.00
|
|
|
Service Code
|
CPT 70540
|
| Hospital Charge Code |
908801080
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$3,957.30 |
| Rate for Payer: Adventist Health Commercial |
$879.40
|
| 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 |
$2,303.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.36
|
| Rate for Payer: Blue Shield of California Commercial |
$2,668.98
|
| Rate for Payer: Blue Shield of California EPN |
$1,745.61
|
| Rate for Payer: Cash Price |
$1,978.65
|
| Rate for Payer: Cash Price |
$1,978.65
|
| Rate for Payer: Cash Price |
$1,978.65
|
| Rate for Payer: Central Health Plan Commercial |
$3,517.60
|
| Rate for Payer: Cigna of CA HMO |
$2,814.08
|
| Rate for Payer: Cigna of CA PPO |
$3,253.78
|
| 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 |
$3,737.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,638.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,957.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$383.51
|
| 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 |
$2,932.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$423.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$879.40
|
| 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 |
$3,297.75
|
| Rate for Payer: Networks By Design Commercial |
$2,858.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$307.13
|
| Rate for Payer: Prime Health Services Commercial |
$3,737.45
|
| 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 |
$2,638.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,638.20
|
| 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
|
|
|
HC MRI ORBIT FACE/NECK WO CON
|
Facility
|
IP
|
$8,624.00
|
|
|
Service Code
|
CPT 70540
|
| Hospital Charge Code |
908801080
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,724.80 |
| Max. Negotiated Rate |
$7,761.60 |
| Rate for Payer: Adventist Health Commercial |
$1,724.80
|
| Rate for Payer: Cash Price |
$3,880.80
|
| Rate for Payer: Central Health Plan Commercial |
$6,899.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,449.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,449.60
|
| Rate for Payer: Galaxy Health WC |
$7,330.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,174.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,761.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,752.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,285.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,338.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,724.80
|
| Rate for Payer: Multiplan Commercial |
$6,468.00
|
| Rate for Payer: Networks By Design Commercial |
$5,605.60
|
| Rate for Payer: Prime Health Services Commercial |
$7,330.40
|
|
|
HC MRI ORBIT FACE/NECK W WO CON
|
Facility
|
IP
|
$13,845.00
|
|
|
Service Code
|
CPT 70543
|
| Hospital Charge Code |
908801082
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$2,769.00 |
| Max. Negotiated Rate |
$12,460.50 |
| Rate for Payer: Adventist Health Commercial |
$2,769.00
|
| Rate for Payer: Cash Price |
$6,230.25
|
| Rate for Payer: Central Health Plan Commercial |
$11,076.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,538.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,538.00
|
| Rate for Payer: Galaxy Health WC |
$11,768.25
|
| Rate for Payer: Global Benefits Group Commercial |
$8,307.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,460.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,234.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,274.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,570.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,769.00
|
| Rate for Payer: Multiplan Commercial |
$10,383.75
|
| Rate for Payer: Networks By Design Commercial |
$8,999.25
|
| Rate for Payer: Prime Health Services Commercial |
$11,768.25
|
|
|
HC MRI ORBIT FACE/NECK W WO CON
|
Facility
|
OP
|
$6,714.00
|
|
|
Service Code
|
CPT 70543
|
| Hospital Charge Code |
908801082
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$453.77 |
| Max. Negotiated Rate |
$6,042.60 |
| Rate for Payer: Adventist Health Commercial |
$1,342.80
|
| 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 |
$5,198.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,943.13
|
| Rate for Payer: Blue Shield of California Commercial |
$4,075.40
|
| Rate for Payer: Blue Shield of California EPN |
$2,665.46
|
| Rate for Payer: Cash Price |
$3,021.30
|
| Rate for Payer: Cash Price |
$3,021.30
|
| Rate for Payer: Cash Price |
$3,021.30
|
| Rate for Payer: Central Health Plan Commercial |
$5,371.20
|
| Rate for Payer: Cigna of CA HMO |
$4,296.96
|
| Rate for Payer: Cigna of CA PPO |
$4,968.36
|
| 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 |
$5,706.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,028.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,042.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$573.93
|
| 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 |
$4,478.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$633.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,342.80
|
| 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 |
$5,035.50
|
| Rate for Payer: Networks By Design Commercial |
$4,364.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$453.77
|
| Rate for Payer: Prime Health Services Commercial |
$5,706.90
|
| 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 |
$4,028.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,028.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,367.12
|
| Rate for Payer: United Healthcare All Other 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 PELVIS W/CONTRAST
|
Facility
|
OP
|
$5,150.00
|
|
|
Service Code
|
CPT 72196
|
| Hospital Charge Code |
908801350
|
|
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 |
$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 |
$2,305.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,024.59
|
| Rate for Payer: Blue Shield of California Commercial |
$3,126.05
|
| Rate for Payer: Blue Shield of California EPN |
$2,044.55
|
| Rate for Payer: Cash Price |
$2,317.50
|
| Rate for Payer: Cash Price |
$2,317.50
|
| Rate for Payer: Cash Price |
$2,317.50
|
| Rate for Payer: Central Health Plan Commercial |
$4,120.00
|
| Rate for Payer: Cigna of CA HMO |
$3,296.00
|
| Rate for Payer: Cigna of CA PPO |
$3,811.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.59
|
| Rate for Payer: EPIC Health Plan Senior |
$453.77
|
| Rate for Payer: Galaxy Health WC |
$4,377.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,090.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,635.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$455.85
|
| 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 |
$503.56
|
| 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 PELVIS W/CONTRAST
|
Facility
|
IP
|
$12,126.00
|
|
|
Service Code
|
CPT 72196
|
| Hospital Charge Code |
908801350
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$2,425.20 |
| Max. Negotiated Rate |
$10,913.40 |
| Rate for Payer: Adventist Health Commercial |
$2,425.20
|
| Rate for Payer: Cash Price |
$5,456.70
|
| Rate for Payer: Central Health Plan Commercial |
$9,700.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,850.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,850.40
|
| Rate for Payer: Galaxy Health WC |
$10,307.10
|
| Rate for Payer: Global Benefits Group Commercial |
$7,275.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,913.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,088.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,620.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,505.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,425.20
|
| Rate for Payer: Multiplan Commercial |
$9,094.50
|
| Rate for Payer: Networks By Design Commercial |
$7,881.90
|
| Rate for Payer: Prime Health Services Commercial |
$10,307.10
|
|
|
HC MRI PELVIS W/O CONTRAST
|
Facility
|
OP
|
$4,687.00
|
|
|
Service Code
|
CPT 72195
|
| Hospital Charge Code |
908801351
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$4,218.30 |
| Rate for Payer: Adventist Health Commercial |
$937.40
|
| 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 |
$2,350.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,752.68
|
| Rate for Payer: Blue Shield of California Commercial |
$2,845.01
|
| Rate for Payer: Blue Shield of California EPN |
$1,860.74
|
| Rate for Payer: Cash Price |
$2,109.15
|
| Rate for Payer: Cash Price |
$2,109.15
|
| Rate for Payer: Cash Price |
$2,109.15
|
| Rate for Payer: Central Health Plan Commercial |
$3,749.60
|
| Rate for Payer: Cigna of CA HMO |
$2,999.68
|
| Rate for Payer: Cigna of CA PPO |
$3,468.38
|
| 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 |
$3,983.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,812.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,218.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$389.30
|
| 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 |
$3,126.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$430.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$937.40
|
| 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 |
$3,515.25
|
| Rate for Payer: Networks By Design Commercial |
$3,046.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$307.13
|
| Rate for Payer: Prime Health Services Commercial |
$3,983.95
|
| 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 |
$2,812.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,812.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| Rate for Payer: United Healthcare All Other 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 PELVIS W/O CONTRAST
|
Facility
|
IP
|
$10,659.00
|
|
|
Service Code
|
CPT 72195
|
| Hospital Charge Code |
908801351
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,131.80 |
| Max. Negotiated Rate |
$9,593.10 |
| Rate for Payer: Adventist Health Commercial |
$2,131.80
|
| Rate for Payer: Cash Price |
$4,796.55
|
| Rate for Payer: Central Health Plan Commercial |
$8,527.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,263.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,263.60
|
| Rate for Payer: Galaxy Health WC |
$9,060.15
|
| Rate for Payer: Global Benefits Group Commercial |
$6,395.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,593.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,109.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,061.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,597.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,131.80
|
| Rate for Payer: Multiplan Commercial |
$7,994.25
|
| Rate for Payer: Networks By Design Commercial |
$6,928.35
|
| Rate for Payer: Prime Health Services Commercial |
$9,060.15
|
|
|
HC MRI PELVIS W & WO CONTRAST
|
Facility
|
OP
|
$6,180.00
|
|
|
Service Code
|
CPT 72197
|
| Hospital Charge Code |
908801352
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$453.77 |
| Max. Negotiated Rate |
$5,562.00 |
| Rate for Payer: Adventist Health Commercial |
$1,236.00
|
| 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 |
$5,208.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,629.51
|
| Rate for Payer: Blue Shield of California Commercial |
$3,751.26
|
| Rate for Payer: Blue Shield of California EPN |
$2,453.46
|
| Rate for Payer: Cash Price |
$2,781.00
|
| Rate for Payer: Cash Price |
$2,781.00
|
| Rate for Payer: Cash Price |
$2,781.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,944.00
|
| Rate for Payer: Cigna of CA HMO |
$3,955.20
|
| Rate for Payer: Cigna of CA PPO |
$4,573.20
|
| 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 |
$5,253.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,708.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,562.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$572.61
|
| 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 |
$4,122.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$632.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,236.00
|
| 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 |
$4,635.00
|
| Rate for Payer: Networks By Design Commercial |
$4,017.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$453.77
|
| Rate for Payer: Prime Health Services Commercial |
$5,253.00
|
| 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 |
$3,708.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,708.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,367.12
|
| Rate for Payer: United Healthcare All Other 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 PELVIS W & WO CONTRAST
|
Facility
|
IP
|
$13,460.00
|
|
|
Service Code
|
CPT 72197
|
| Hospital Charge Code |
908801352
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$2,692.00 |
| Max. Negotiated Rate |
$12,114.00 |
| Rate for Payer: Adventist Health Commercial |
$2,692.00
|
| Rate for Payer: Cash Price |
$6,057.00
|
| Rate for Payer: Central Health Plan Commercial |
$10,768.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,384.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,384.00
|
| Rate for Payer: Galaxy Health WC |
$11,441.00
|
| Rate for Payer: Global Benefits Group Commercial |
$8,076.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,114.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,977.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,128.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,331.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,692.00
|
| Rate for Payer: Multiplan Commercial |
$10,095.00
|
| Rate for Payer: Networks By Design Commercial |
$8,749.00
|
| Rate for Payer: Prime Health Services Commercial |
$11,441.00
|
|
|
HC MRI PROCEDURE
|
Facility
|
IP
|
$6,549.00
|
|
|
Service Code
|
CPT 76498
|
| Hospital Charge Code |
908801008
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,309.80 |
| Max. Negotiated Rate |
$5,894.10 |
| Rate for Payer: Adventist Health Commercial |
$1,309.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,977.21
|
| Rate for Payer: Cash Price |
$2,947.05
|
| Rate for Payer: Central Health Plan Commercial |
$5,239.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,619.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,619.60
|
| Rate for Payer: Galaxy Health WC |
$5,566.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,929.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,894.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,368.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,495.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,053.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,309.80
|
| Rate for Payer: Multiplan Commercial |
$4,911.75
|
| Rate for Payer: Networks By Design Commercial |
$4,256.85
|
| Rate for Payer: Prime Health Services Commercial |
$5,566.65
|
|
