|
HC MRI CHEST W WO CONTRAST
|
Facility
|
OP
|
$6,147.00
|
|
|
Service Code
|
CPT 71552
|
| Hospital Charge Code |
908801202
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$453.77 |
| Max. Negotiated Rate |
$5,532.30 |
| Rate for Payer: Adventist Health Commercial |
$1,229.40
|
| 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 |
$5,176.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,610.13
|
| Rate for Payer: Blue Shield of California Commercial |
$3,731.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,440.36
|
| Rate for Payer: Cash Price |
$3,380.85
|
| Rate for Payer: Cash Price |
$3,380.85
|
| Rate for Payer: Cash Price |
$3,380.85
|
| Rate for Payer: Central Health Plan Commercial |
$4,917.60
|
| Rate for Payer: Cigna of CA HMO |
$3,934.08
|
| Rate for Payer: Cigna of CA PPO |
$4,548.78
|
| 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 |
$5,224.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,688.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,532.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$812.56
|
| 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 |
$4,100.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$897.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,229.40
|
| 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 |
$4,610.25
|
| Rate for Payer: Networks By Design Commercial |
$3,995.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$453.77
|
| Rate for Payer: Prime Health Services Commercial |
$5,224.95
|
| 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 |
$3,688.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,688.20
|
| 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 CHEST W WO CONTRAST
|
Facility
|
IP
|
$6,147.00
|
|
|
Service Code
|
CPT 71552
|
| Hospital Charge Code |
908801202
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,229.40 |
| Max. Negotiated Rate |
$5,532.30 |
| Rate for Payer: Adventist Health Commercial |
$1,229.40
|
| Rate for Payer: Cash Price |
$3,380.85
|
| Rate for Payer: Central Health Plan Commercial |
$4,917.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,458.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,458.80
|
| Rate for Payer: Galaxy Health WC |
$5,224.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,688.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,532.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,100.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,342.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,804.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,229.40
|
| Rate for Payer: Multiplan Commercial |
$4,610.25
|
| Rate for Payer: Networks By Design Commercial |
$3,995.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,224.95
|
|
|
HC MRI C-SPINE W & WO CONTRAST
|
Facility
|
OP
|
$5,667.00
|
|
|
Service Code
|
CPT 72156
|
| Hospital Charge Code |
908801104
|
|
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 |
$4,535.56
|
| 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 |
$3,116.85
|
| Rate for Payer: Cash Price |
$3,116.85
|
| Rate for Payer: Cash Price |
$3,116.85
|
| 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 |
$538.77
|
| 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 |
$595.16
|
| 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 C-SPINE W & WO CONTRAST
|
Facility
|
IP
|
$5,667.00
|
|
|
Service Code
|
CPT 72156
|
| Hospital Charge Code |
908801104
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,133.40 |
| Max. Negotiated Rate |
$5,100.30 |
| Rate for Payer: Adventist Health Commercial |
$1,133.40
|
| Rate for Payer: Cash Price |
$3,116.85
|
| Rate for Payer: Central Health Plan Commercial |
$4,533.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,266.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,266.80
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$3,779.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,159.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,507.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,133.40
|
| Rate for Payer: Multiplan Commercial |
$4,250.25
|
| Rate for Payer: Networks By Design Commercial |
$3,683.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,816.95
|
|
|
HC MRI FETAL PELVIC IMG 1ST FETUS
|
Facility
|
IP
|
$1,551.00
|
|
|
Service Code
|
CPT 74712
|
| Hospital Charge Code |
908874712
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$310.20 |
| Max. Negotiated Rate |
$1,395.90 |
| Rate for Payer: Adventist Health Commercial |
$310.20
|
| Rate for Payer: Cash Price |
$853.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,240.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$620.40
|
| Rate for Payer: EPIC Health Plan Senior |
$620.40
|
| Rate for Payer: Galaxy Health WC |
$1,318.35
|
| Rate for Payer: Global Benefits Group Commercial |
$930.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,395.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,034.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$590.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$960.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$310.20
|
| Rate for Payer: Multiplan Commercial |
$1,163.25
|
| Rate for Payer: Networks By Design Commercial |
$1,008.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,318.35
|
|
|
HC MRI FETAL PELVIC IMG 1ST FETUS
|
Facility
|
OP
|
$1,551.00
|
|
|
Service Code
|
CPT 74712
|
| Hospital Charge Code |
908874712
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$4,234.75 |
| Rate for Payer: Adventist Health Commercial |
$310.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$307.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$941.92
|
| 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 |
$4,234.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$859.45
|
| Rate for Payer: Blue Shield of California Commercial |
$941.46
|
| Rate for Payer: Blue Shield of California EPN |
$615.75
|
| Rate for Payer: Cash Price |
$853.05
|
| Rate for Payer: Cash Price |
$853.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,240.80
|
| Rate for Payer: Cigna of CA HMO |
$992.64
|
| Rate for Payer: Cigna of CA PPO |
$1,147.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$1,318.35
|
| Rate for Payer: Global Benefits Group Commercial |
$930.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,395.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$690.03
|
| 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 |
$1,034.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$762.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$310.20
|
| 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 |
$1,163.25
|
| Rate for Payer: Networks By Design Commercial |
$1,008.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$307.13
|
| Rate for Payer: Prime Health Services Commercial |
$1,318.35
|
| Rate for Payer: Prime Health Services Medicare |
$325.56
|
| Rate for Payer: Riverside University Health System MISP |
$337.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$930.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$930.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$700.26
|
| Rate for Payer: United Healthcare All Other HMO |
$700.26
|
| Rate for Payer: United Healthcare HMO Rider |
$700.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$700.26
|
| 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 FETAL PELVIC IMG ADD FETUS
|
Facility
|
IP
|
$741.00
|
|
|
Service Code
|
CPT 74713
|
| Hospital Charge Code |
908874713
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$148.20 |
| Max. Negotiated Rate |
$666.90 |
| Rate for Payer: Adventist Health Commercial |
$148.20
|
| Rate for Payer: Cash Price |
$407.55
|
| Rate for Payer: Central Health Plan Commercial |
$592.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$296.40
|
| Rate for Payer: EPIC Health Plan Senior |
$296.40
|
| Rate for Payer: Galaxy Health WC |
$629.85
|
| Rate for Payer: Global Benefits Group Commercial |
$444.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$666.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$494.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$282.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$458.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.20
|
| Rate for Payer: Multiplan Commercial |
$555.75
|
| Rate for Payer: Networks By Design Commercial |
$481.65
|
| Rate for Payer: Prime Health Services Commercial |
$629.85
|
|
|
HC MRI FETAL PELVIC IMG ADD FETUS
|
Facility
|
OP
|
$741.00
|
|
|
Service Code
|
CPT 74713
|
| Hospital Charge Code |
908874713
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$148.20 |
| Max. Negotiated Rate |
$1,814.50 |
| Rate for Payer: Adventist Health Commercial |
$148.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$450.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$629.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$407.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$555.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,814.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$368.26
|
| Rate for Payer: Blue Shield of California Commercial |
$449.79
|
| Rate for Payer: Blue Shield of California EPN |
$294.18
|
| Rate for Payer: Cash Price |
$407.55
|
| Rate for Payer: Cash Price |
$407.55
|
| Rate for Payer: Central Health Plan Commercial |
$592.80
|
| Rate for Payer: Cigna of CA HMO |
$474.24
|
| Rate for Payer: Cigna of CA PPO |
$548.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$629.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$629.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$629.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$296.40
|
| Rate for Payer: EPIC Health Plan Senior |
$296.40
|
| Rate for Payer: Galaxy Health WC |
$629.85
|
| Rate for Payer: Global Benefits Group Commercial |
$444.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$666.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$332.79
|
| Rate for Payer: InnovAge PACE Commercial |
$370.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$494.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$367.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$458.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$518.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$518.70
|
| Rate for Payer: Multiplan Commercial |
$555.75
|
| Rate for Payer: Networks By Design Commercial |
$481.65
|
| Rate for Payer: Prime Health Services Commercial |
$629.85
|
| Rate for Payer: Riverside University Health System MISP |
$296.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$444.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$444.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$370.50
|
| Rate for Payer: United Healthcare All Other HMO |
$370.50
|
| Rate for Payer: United Healthcare HMO Rider |
$370.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$370.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$629.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$629.85
|
| Rate for Payer: Vantage Medical Group Senior |
$629.85
|
|
|
HC MRI FOR TISSUE ABLATION
|
Facility
|
OP
|
$1,263.00
|
|
|
Service Code
|
CPT 77022
|
| Hospital Charge Code |
908877022
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$252.60 |
| Max. Negotiated Rate |
$2,364.46 |
| Rate for Payer: Adventist Health Commercial |
$252.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$767.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,073.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$694.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$947.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,364.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$741.76
|
| Rate for Payer: Blue Shield of California Commercial |
$766.64
|
| Rate for Payer: Blue Shield of California EPN |
$501.41
|
| Rate for Payer: Cash Price |
$694.65
|
| Rate for Payer: Cash Price |
$694.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,010.40
|
| Rate for Payer: Cigna of CA HMO |
$808.32
|
| Rate for Payer: Cigna of CA PPO |
$934.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,073.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,073.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,073.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$505.20
|
| Rate for Payer: EPIC Health Plan Senior |
$505.20
|
| Rate for Payer: Galaxy Health WC |
$1,073.55
|
| Rate for Payer: Global Benefits Group Commercial |
$757.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,136.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$295.13
|
| Rate for Payer: InnovAge PACE Commercial |
$631.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$842.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$326.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$781.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$884.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$884.10
|
| Rate for Payer: Multiplan Commercial |
$947.25
|
| Rate for Payer: Networks By Design Commercial |
$820.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,073.55
|
| Rate for Payer: Riverside University Health System MISP |
$505.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$757.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$757.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$631.50
|
| Rate for Payer: United Healthcare All Other HMO |
$631.50
|
| Rate for Payer: United Healthcare HMO Rider |
$631.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$631.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,073.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,073.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,073.55
|
|
|
HC MRI FOR TISSUE ABLATION
|
Facility
|
IP
|
$1,263.00
|
|
|
Service Code
|
CPT 77022
|
| Hospital Charge Code |
908877022
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$252.60 |
| Max. Negotiated Rate |
$1,136.70 |
| Rate for Payer: Adventist Health Commercial |
$252.60
|
| Rate for Payer: Cash Price |
$694.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,010.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$505.20
|
| Rate for Payer: EPIC Health Plan Senior |
$505.20
|
| Rate for Payer: Galaxy Health WC |
$1,073.55
|
| Rate for Payer: Global Benefits Group Commercial |
$757.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,136.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$842.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$481.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$781.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.60
|
| Rate for Payer: Multiplan Commercial |
$947.25
|
| Rate for Payer: Networks By Design Commercial |
$820.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,073.55
|
|
|
HC MRI GUID BX/NEEDLE LOC/ASPIR
|
Facility
|
OP
|
$6,290.00
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
909002020
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$630.83 |
| Max. Negotiated Rate |
$5,661.00 |
| Rate for Payer: Adventist Health Commercial |
$1,258.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,819.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,346.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,459.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,717.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,364.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,694.12
|
| Rate for Payer: Blue Shield of California Commercial |
$3,818.03
|
| Rate for Payer: Blue Shield of California EPN |
$2,497.13
|
| Rate for Payer: Cash Price |
$3,459.50
|
| Rate for Payer: Cash Price |
$3,459.50
|
| Rate for Payer: Central Health Plan Commercial |
$5,032.00
|
| Rate for Payer: Cigna of CA HMO |
$4,025.60
|
| Rate for Payer: Cigna of CA PPO |
$4,654.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,346.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,346.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,346.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,516.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,516.00
|
| Rate for Payer: Galaxy Health WC |
$5,346.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,774.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,661.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$630.83
|
| Rate for Payer: InnovAge PACE Commercial |
$3,145.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,195.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$696.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,893.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,258.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,403.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,403.00
|
| Rate for Payer: Multiplan Commercial |
$4,717.50
|
| Rate for Payer: Networks By Design Commercial |
$4,088.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,346.50
|
| Rate for Payer: Riverside University Health System MISP |
$2,516.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,774.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,774.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,145.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,145.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,145.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,145.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,346.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,346.50
|
| Rate for Payer: Vantage Medical Group Senior |
$5,346.50
|
|
|
HC MRI GUID BX/NEEDLE LOC/ASPIR
|
Facility
|
IP
|
$6,290.00
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
909002020
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,258.00 |
| Max. Negotiated Rate |
$5,661.00 |
| Rate for Payer: Adventist Health Commercial |
$1,258.00
|
| Rate for Payer: Cash Price |
$3,459.50
|
| Rate for Payer: Central Health Plan Commercial |
$5,032.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,516.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,516.00
|
| Rate for Payer: Galaxy Health WC |
$5,346.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,774.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,661.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,195.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,396.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,893.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,258.00
|
| Rate for Payer: Multiplan Commercial |
$4,717.50
|
| Rate for Payer: Networks By Design Commercial |
$4,088.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,346.50
|
|
|
HC MRI INSERTABLE IMAGING COIL
|
Facility
|
OP
|
$525.00
|
|
|
Service Code
|
CPT C1770
|
| Hospital Charge Code |
908801710
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$472.50 |
| Rate for Payer: Adventist Health Commercial |
$105.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$446.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$288.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$393.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$239.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$290.69
|
| Rate for Payer: Blue Shield of California Commercial |
$405.82
|
| Rate for Payer: Blue Shield of California EPN |
$264.60
|
| Rate for Payer: Cash Price |
$288.75
|
| Rate for Payer: Central Health Plan Commercial |
$420.00
|
| Rate for Payer: Cigna of CA HMO |
$367.50
|
| Rate for Payer: Cigna of CA PPO |
$367.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$446.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$446.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$446.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.00
|
| Rate for Payer: EPIC Health Plan Senior |
$210.00
|
| Rate for Payer: Galaxy Health WC |
$446.25
|
| Rate for Payer: Global Benefits Group Commercial |
$315.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$472.50
|
| Rate for Payer: InnovAge PACE Commercial |
$262.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$350.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$324.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$367.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$367.50
|
| Rate for Payer: Multiplan Commercial |
$393.75
|
| Rate for Payer: Networks By Design Commercial |
$262.50
|
| Rate for Payer: Prime Health Services Commercial |
$446.25
|
| Rate for Payer: Riverside University Health System MISP |
$210.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$315.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$315.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$197.03
|
| Rate for Payer: United Healthcare All Other HMO |
$191.78
|
| Rate for Payer: United Healthcare HMO Rider |
$187.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$171.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$446.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$446.25
|
| Rate for Payer: Vantage Medical Group Senior |
$446.25
|
|
|
HC MRI INSERTABLE IMAGING COIL
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
CPT C1770
|
| Hospital Charge Code |
908801710
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$472.50 |
| Rate for Payer: Adventist Health Commercial |
$105.00
|
| Rate for Payer: Blue Shield of California Commercial |
$405.82
|
| Rate for Payer: Blue Shield of California EPN |
$264.60
|
| Rate for Payer: Cash Price |
$288.75
|
| Rate for Payer: Central Health Plan Commercial |
$420.00
|
| Rate for Payer: Cigna of CA HMO |
$367.50
|
| Rate for Payer: Cigna of CA PPO |
$367.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.00
|
| Rate for Payer: EPIC Health Plan Senior |
$210.00
|
| Rate for Payer: Galaxy Health WC |
$446.25
|
| Rate for Payer: Global Benefits Group Commercial |
$315.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$472.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$350.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$324.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.00
|
| Rate for Payer: Multiplan Commercial |
$393.75
|
| Rate for Payer: Networks By Design Commercial |
$262.50
|
| Rate for Payer: Prime Health Services Commercial |
$446.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$197.03
|
| Rate for Payer: United Healthcare All Other HMO |
$191.78
|
| Rate for Payer: United Healthcare HMO Rider |
$187.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$171.94
|
|
|
HC MRI LOWER EXTREMITY W/O CON
|
Facility
|
OP
|
$4,005.00
|
|
|
Service Code
|
CPT 73718
|
| Hospital Charge Code |
908801402
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$3,604.50 |
| Rate for Payer: Adventist Health Commercial |
$801.00
|
| 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 |
$2,342.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,352.14
|
| Rate for Payer: Blue Shield of California Commercial |
$2,431.03
|
| Rate for Payer: Blue Shield of California EPN |
$1,589.98
|
| Rate for Payer: Cash Price |
$2,202.75
|
| Rate for Payer: Cash Price |
$2,202.75
|
| Rate for Payer: Cash Price |
$2,202.75
|
| Rate for Payer: Central Health Plan Commercial |
$3,204.00
|
| Rate for Payer: Cigna of CA HMO |
$2,563.20
|
| Rate for Payer: Cigna of CA PPO |
$2,963.70
|
| 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 |
$3,404.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,403.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,604.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$378.52
|
| 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 |
$2,671.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$418.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$801.00
|
| 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 |
$3,003.75
|
| Rate for Payer: Networks By Design Commercial |
$2,603.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$307.13
|
| Rate for Payer: Prime Health Services Commercial |
$3,404.25
|
| 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 |
$2,403.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,403.00
|
| 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 LOWER EXTREMITY W/O CON
|
Facility
|
IP
|
$4,005.00
|
|
|
Service Code
|
CPT 73718
|
| Hospital Charge Code |
908801402
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$801.00 |
| Max. Negotiated Rate |
$3,604.50 |
| Rate for Payer: Adventist Health Commercial |
$801.00
|
| Rate for Payer: Cash Price |
$2,202.75
|
| Rate for Payer: Central Health Plan Commercial |
$3,204.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,602.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,602.00
|
| Rate for Payer: Galaxy Health WC |
$3,404.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,403.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,604.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,671.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,525.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,479.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$801.00
|
| Rate for Payer: Multiplan Commercial |
$3,003.75
|
| Rate for Payer: Networks By Design Commercial |
$2,603.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,404.25
|
|
|
HC MRI LOWER EXTREM JOINT W CONT
|
Facility
|
OP
|
$4,231.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
908801376
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$538.38 |
| Max. Negotiated Rate |
$3,807.90 |
| Rate for Payer: Adventist Health Commercial |
$846.20
|
| 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 |
$2,808.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,484.87
|
| Rate for Payer: Blue Shield of California Commercial |
$2,568.22
|
| Rate for Payer: Blue Shield of California EPN |
$1,679.71
|
| Rate for Payer: Cash Price |
$2,327.05
|
| Rate for Payer: Cash Price |
$2,327.05
|
| Rate for Payer: Cash Price |
$2,327.05
|
| Rate for Payer: Central Health Plan Commercial |
$3,384.80
|
| Rate for Payer: Cigna of CA HMO |
$2,707.84
|
| Rate for Payer: Cigna of CA PPO |
$3,130.94
|
| 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 |
$3,596.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,538.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,807.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,646.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$538.38
|
| 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 |
$2,822.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$594.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,003.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$846.20
|
| 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 |
$3,173.25
|
| Rate for Payer: Networks By Design Commercial |
$2,750.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,003.85
|
| Rate for Payer: Prime Health Services Commercial |
$3,596.35
|
| 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 |
$2,538.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,538.60
|
| 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 |
$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 LOWER EXTREM JOINT W CONT
|
Facility
|
IP
|
$4,231.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
908801376
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$846.20 |
| Max. Negotiated Rate |
$3,807.90 |
| Rate for Payer: Adventist Health Commercial |
$846.20
|
| Rate for Payer: Cash Price |
$2,327.05
|
| Rate for Payer: Central Health Plan Commercial |
$3,384.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,692.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,692.40
|
| Rate for Payer: Galaxy Health WC |
$3,596.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,538.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,807.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,822.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,612.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,618.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$846.20
|
| Rate for Payer: Multiplan Commercial |
$3,173.25
|
| Rate for Payer: Networks By Design Commercial |
$2,750.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,596.35
|
|
|
HC MRI LOWER EXTREM JOINT WO CONT
|
Facility
|
IP
|
$3,641.00
|
|
|
Service Code
|
CPT 73721
|
| Hospital Charge Code |
908801441
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$728.20 |
| Max. Negotiated Rate |
$3,276.90 |
| Rate for Payer: Adventist Health Commercial |
$728.20
|
| Rate for Payer: Cash Price |
$2,002.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,912.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,456.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,456.40
|
| Rate for Payer: Galaxy Health WC |
$3,094.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,184.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,276.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,428.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,387.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,253.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$728.20
|
| Rate for Payer: Multiplan Commercial |
$2,730.75
|
| Rate for Payer: Networks By Design Commercial |
$2,366.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,094.85
|
|
|
HC MRI LOWER EXTREM JOINT WO CONT
|
Facility
|
OP
|
$3,641.00
|
|
|
Service Code
|
CPT 73721
|
| Hospital Charge Code |
908801441
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$3,276.90 |
| Rate for Payer: Adventist Health Commercial |
$728.20
|
| 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 |
$2,295.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,138.36
|
| Rate for Payer: Blue Shield of California Commercial |
$2,210.09
|
| Rate for Payer: Blue Shield of California EPN |
$1,445.48
|
| Rate for Payer: Cash Price |
$2,002.55
|
| Rate for Payer: Cash Price |
$2,002.55
|
| Rate for Payer: Cash Price |
$2,002.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,912.80
|
| Rate for Payer: Cigna of CA HMO |
$2,330.24
|
| Rate for Payer: Cigna of CA PPO |
$2,694.34
|
| 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 |
$3,094.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,184.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,276.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$671.63
|
| 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 |
$2,428.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$741.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$728.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$411.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$2,730.75
|
| Rate for Payer: Networks By Design Commercial |
$2,366.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$307.13
|
| Rate for Payer: Prime Health Services Commercial |
$3,094.85
|
| 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 |
$2,184.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,184.60
|
| 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 LOWER EXTREM JOIN W & WO CONT
|
Facility
|
IP
|
$6,774.00
|
|
|
Service Code
|
CPT 73723
|
| Hospital Charge Code |
908801377
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,354.80 |
| Max. Negotiated Rate |
$6,096.60 |
| Rate for Payer: Adventist Health Commercial |
$1,354.80
|
| Rate for Payer: Cash Price |
$3,725.70
|
| Rate for Payer: Central Health Plan Commercial |
$5,419.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,709.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,709.60
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$4,518.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,580.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,193.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,354.80
|
| Rate for Payer: Multiplan Commercial |
$5,080.50
|
| Rate for Payer: Networks By Design Commercial |
$4,403.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,757.90
|
|
|
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 |
$3,725.70
|
| Rate for Payer: Cash Price |
$3,725.70
|
| Rate for Payer: Cash Price |
$3,725.70
|
| 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 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 |
$2,454.10
|
| Rate for Payer: Cash Price |
$2,454.10
|
| 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
|
$4,462.00
|
|
|
Service Code
|
CPT 73719
|
| Hospital Charge Code |
908801403
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$892.40 |
| Max. Negotiated Rate |
$4,015.80 |
| Rate for Payer: Adventist Health Commercial |
$892.40
|
| Rate for Payer: Cash Price |
$2,454.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,569.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,784.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,784.80
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$2,976.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,700.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,761.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$892.40
|
| Rate for Payer: Multiplan Commercial |
$3,346.50
|
| Rate for Payer: Networks By Design Commercial |
$2,900.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,792.70
|
|
|
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 |
$2,756.60
|
| Rate for Payer: Cash Price |
$2,756.60
|
| Rate for Payer: Cash Price |
$2,756.60
|
| 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
|
|
