|
HC MRI LOWER EXTREM WO CONT
|
Facility
|
IP
|
$5,012.00
|
|
|
Service Code
|
CPT 73720
|
| Hospital Charge Code |
908801399
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,002.40 |
| Max. Negotiated Rate |
$4,510.80 |
| Rate for Payer: Adventist Health Commercial |
$1,002.40
|
| Rate for Payer: Cash Price |
$2,756.60
|
| Rate for Payer: Central Health Plan Commercial |
$4,009.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,004.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,004.80
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$3,343.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,909.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,102.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,002.40
|
| Rate for Payer: Multiplan Commercial |
$3,759.00
|
| Rate for Payer: Networks By Design Commercial |
$3,257.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,260.20
|
|
|
HC MRI L-SPINE W & WO CONTRAST
|
Facility
|
IP
|
$5,667.00
|
|
|
Service Code
|
CPT 72158
|
| Hospital Charge Code |
908801124
|
|
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 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 |
$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 |
$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 LUMBAR SPINE W CONTRAST
|
Facility
|
IP
|
$5,150.00
|
|
|
Service Code
|
CPT 72149
|
| Hospital Charge Code |
908801122
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,030.00 |
| Max. Negotiated Rate |
$4,635.00 |
| Rate for Payer: Adventist Health Commercial |
$1,030.00
|
| Rate for Payer: Cash Price |
$2,832.50
|
| Rate for Payer: Central Health Plan Commercial |
$4,120.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,060.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,060.00
|
| Rate for Payer: Galaxy Health WC |
$4,377.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,090.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,635.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,435.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,962.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,187.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,030.00
|
| Rate for Payer: Multiplan Commercial |
$3,862.50
|
| Rate for Payer: Networks By Design Commercial |
$3,347.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,377.50
|
|
|
HC MRI 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 |
$2,832.50
|
| Rate for Payer: Cash Price |
$2,832.50
|
| Rate for Payer: Cash Price |
$2,832.50
|
| Rate for Payer: Central Health Plan Commercial |
$4,120.00
|
| Rate for Payer: Cigna of CA HMO |
$3,296.00
|
| Rate for Payer: Cigna of CA PPO |
$3,811.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.59
|
| Rate for Payer: EPIC Health Plan Senior |
$453.77
|
| Rate for Payer: Galaxy Health WC |
$4,377.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,090.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,635.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$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 |
$2,730.75
|
| Rate for Payer: Cash Price |
$2,730.75
|
| Rate for Payer: Cash Price |
$2,730.75
|
| Rate for Payer: Central Health Plan Commercial |
$3,972.00
|
| Rate for Payer: Cigna of CA HMO |
$3,177.60
|
| Rate for Payer: Cigna of CA PPO |
$3,674.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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
|
$4,965.00
|
|
|
Service Code
|
CPT 72148
|
| Hospital Charge Code |
908801120
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$993.00 |
| Max. Negotiated Rate |
$4,468.50 |
| Rate for Payer: Adventist Health Commercial |
$993.00
|
| Rate for Payer: Cash Price |
$2,730.75
|
| Rate for Payer: Central Health Plan Commercial |
$3,972.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,986.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,986.00
|
| Rate for Payer: Galaxy Health WC |
$4,220.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,979.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,468.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,311.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,891.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,073.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$993.00
|
| Rate for Payer: Multiplan Commercial |
$3,723.75
|
| Rate for Payer: Networks By Design Commercial |
$3,227.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,220.25
|
|
|
HC MRI ORBIT FACE/NECK W CON
|
Facility
|
IP
|
$5,017.00
|
|
|
Service Code
|
CPT 70542
|
| Hospital Charge Code |
908801081
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,003.40 |
| Max. Negotiated Rate |
$4,515.30 |
| Rate for Payer: Adventist Health Commercial |
$1,003.40
|
| Rate for Payer: Cash Price |
$2,759.35
|
| Rate for Payer: Central Health Plan Commercial |
$4,013.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,006.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,006.80
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$3,346.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,911.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,105.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,003.40
|
| Rate for Payer: Multiplan Commercial |
$3,762.75
|
| Rate for Payer: Networks By Design Commercial |
$3,261.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,264.45
|
|
|
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 |
$2,759.35
|
| Rate for Payer: Cash Price |
$2,759.35
|
| Rate for Payer: Cash Price |
$2,759.35
|
| 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 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 |
$2,418.35
|
| Rate for Payer: Cash Price |
$2,418.35
|
| Rate for Payer: Cash Price |
$2,418.35
|
| 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
|
$4,397.00
|
|
|
Service Code
|
CPT 70540
|
| Hospital Charge Code |
908801080
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$879.40 |
| Max. Negotiated Rate |
$3,957.30 |
| Rate for Payer: Adventist Health Commercial |
$879.40
|
| Rate for Payer: Cash Price |
$2,418.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,517.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,758.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,758.80
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$2,932.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,675.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,721.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$879.40
|
| Rate for Payer: Multiplan Commercial |
$3,297.75
|
| Rate for Payer: Networks By Design Commercial |
$2,858.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,737.45
|
|
|
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 |
$3,692.70
|
| Rate for Payer: Cash Price |
$3,692.70
|
| Rate for Payer: Cash Price |
$3,692.70
|
| 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 ORBIT FACE/NECK W WO CON
|
Facility
|
IP
|
$6,714.00
|
|
|
Service Code
|
CPT 70543
|
| Hospital Charge Code |
908801082
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,342.80 |
| Max. Negotiated Rate |
$6,042.60 |
| Rate for Payer: Adventist Health Commercial |
$1,342.80
|
| Rate for Payer: Cash Price |
$3,692.70
|
| Rate for Payer: Central Health Plan Commercial |
$5,371.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,685.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,685.60
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$4,478.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,558.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,155.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,342.80
|
| Rate for Payer: Multiplan Commercial |
$5,035.50
|
| Rate for Payer: Networks By Design Commercial |
$4,364.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,706.90
|
|
|
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 |
$2,832.50
|
| Rate for Payer: Cash Price |
$2,832.50
|
| Rate for Payer: Cash Price |
$2,832.50
|
| Rate for Payer: Central Health Plan Commercial |
$4,120.00
|
| Rate for Payer: Cigna of CA HMO |
$3,296.00
|
| Rate for Payer: Cigna of CA PPO |
$3,811.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.59
|
| Rate for Payer: EPIC Health Plan Senior |
$453.77
|
| Rate for Payer: Galaxy Health WC |
$4,377.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,090.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,635.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$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
|
$5,150.00
|
|
|
Service Code
|
CPT 72196
|
| Hospital Charge Code |
908801350
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,030.00 |
| Max. Negotiated Rate |
$4,635.00 |
| Rate for Payer: Adventist Health Commercial |
$1,030.00
|
| Rate for Payer: Cash Price |
$2,832.50
|
| Rate for Payer: Central Health Plan Commercial |
$4,120.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,060.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,060.00
|
| Rate for Payer: Galaxy Health WC |
$4,377.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,090.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,635.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,435.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,962.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,187.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,030.00
|
| Rate for Payer: Multiplan Commercial |
$3,862.50
|
| Rate for Payer: Networks By Design Commercial |
$3,347.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,377.50
|
|
|
HC MRI 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 |
$2,577.85
|
| Rate for Payer: Cash Price |
$2,577.85
|
| Rate for Payer: Cash Price |
$2,577.85
|
| 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
|
$4,687.00
|
|
|
Service Code
|
CPT 72195
|
| Hospital Charge Code |
908801351
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$937.40 |
| Max. Negotiated Rate |
$4,218.30 |
| Rate for Payer: Adventist Health Commercial |
$937.40
|
| Rate for Payer: Cash Price |
$2,577.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,749.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,874.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,874.80
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$3,126.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,785.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,901.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$937.40
|
| Rate for Payer: Multiplan Commercial |
$3,515.25
|
| Rate for Payer: Networks By Design Commercial |
$3,046.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,983.95
|
|
|
HC MRI PELVIS W & WO CONTRAST
|
Facility
|
IP
|
$6,180.00
|
|
|
Service Code
|
CPT 72197
|
| Hospital Charge Code |
908801352
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,236.00 |
| Max. Negotiated Rate |
$5,562.00 |
| Rate for Payer: Adventist Health Commercial |
$1,236.00
|
| Rate for Payer: Cash Price |
$3,399.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,944.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,472.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,472.00
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$4,122.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,354.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,825.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,236.00
|
| Rate for Payer: Multiplan Commercial |
$4,635.00
|
| Rate for Payer: Networks By Design Commercial |
$4,017.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,253.00
|
|
|
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 |
$3,399.00
|
| Rate for Payer: Cash Price |
$3,399.00
|
| Rate for Payer: Cash Price |
$3,399.00
|
| 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 PROCEDURE
|
Facility
|
IP
|
$3,164.00
|
|
|
Service Code
|
CPT 76498
|
| Hospital Charge Code |
908801008
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$632.80 |
| Max. Negotiated Rate |
$2,847.60 |
| Rate for Payer: Adventist Health Commercial |
$632.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,921.50
|
| Rate for Payer: Cash Price |
$1,740.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,531.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,265.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,265.60
|
| Rate for Payer: Galaxy Health WC |
$2,689.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,898.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,847.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,110.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,205.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,958.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$632.80
|
| Rate for Payer: Multiplan Commercial |
$2,373.00
|
| Rate for Payer: Networks By Design Commercial |
$2,056.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,689.40
|
|
|
HC MRI PROCEDURE
|
Facility
|
OP
|
$3,164.00
|
|
|
Service Code
|
CPT 76498
|
| Hospital Charge Code |
908801008
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$111.88 |
| Max. Negotiated Rate |
$2,847.60 |
| Rate for Payer: Adventist Health Commercial |
$632.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,921.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,532.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,858.22
|
| Rate for Payer: Blue Shield of California Commercial |
$1,920.55
|
| Rate for Payer: Blue Shield of California EPN |
$1,256.11
|
| Rate for Payer: Cash Price |
$1,740.20
|
| Rate for Payer: Cash Price |
$1,740.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,531.20
|
| Rate for Payer: Cigna of CA HMO |
$2,024.96
|
| Rate for Payer: Cigna of CA PPO |
$2,341.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$2,689.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,898.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,847.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: InnovAge PACE Commercial |
$167.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,110.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$632.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$2,373.00
|
| Rate for Payer: Networks By Design Commercial |
$2,056.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.88
|
| Rate for Payer: Prime Health Services Commercial |
$2,689.40
|
| Rate for Payer: Prime Health Services Medicare |
$118.59
|
| Rate for Payer: Riverside University Health System MISP |
$123.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,898.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,898.40
|
| 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 |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC MRI SPECTROSCOPY
|
Facility
|
OP
|
$4,177.00
|
|
|
Service Code
|
CPT 76390
|
| Hospital Charge Code |
908801255
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$111.88 |
| Max. Negotiated Rate |
$3,759.30 |
| Rate for Payer: Adventist Health Commercial |
$835.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,536.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,332.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,453.15
|
| Rate for Payer: Blue Shield of California Commercial |
$2,535.44
|
| Rate for Payer: Blue Shield of California EPN |
$1,658.27
|
| Rate for Payer: Cash Price |
$2,297.35
|
| Rate for Payer: Cash Price |
$2,297.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,341.60
|
| Rate for Payer: Cigna of CA HMO |
$2,673.28
|
| Rate for Payer: Cigna of CA PPO |
$3,090.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$3,550.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,506.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,759.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: InnovAge PACE Commercial |
$167.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,786.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,591.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$835.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$3,132.75
|
| Rate for Payer: Networks By Design Commercial |
$2,715.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.88
|
| Rate for Payer: Prime Health Services Commercial |
$3,550.45
|
| Rate for Payer: Prime Health Services Medicare |
$118.59
|
| Rate for Payer: Riverside University Health System MISP |
$123.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,506.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,506.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,065.68
|
| Rate for Payer: United Healthcare All Other HMO |
$1,065.68
|
| Rate for Payer: United Healthcare HMO Rider |
$1,065.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,065.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC MRI SPECTROSCOPY
|
Facility
|
IP
|
$4,177.00
|
|
|
Service Code
|
CPT 76390
|
| Hospital Charge Code |
908801255
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$835.40 |
| Max. Negotiated Rate |
$3,759.30 |
| Rate for Payer: Adventist Health Commercial |
$835.40
|
| Rate for Payer: Cash Price |
$2,297.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,341.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,670.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,670.80
|
| Rate for Payer: Galaxy Health WC |
$3,550.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,506.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,759.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,786.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,591.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,585.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$835.40
|
| Rate for Payer: Multiplan Commercial |
$3,132.75
|
| Rate for Payer: Networks By Design Commercial |
$2,715.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,550.45
|
|
|
HC MRI THORACIC SPINE WITH CONTRA
|
Facility
|
IP
|
$5,150.00
|
|
|
Service Code
|
CPT 72147
|
| Hospital Charge Code |
908801112
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,030.00 |
| Max. Negotiated Rate |
$4,635.00 |
| Rate for Payer: Adventist Health Commercial |
$1,030.00
|
| Rate for Payer: Cash Price |
$2,832.50
|
| Rate for Payer: Central Health Plan Commercial |
$4,120.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,060.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,060.00
|
| Rate for Payer: Galaxy Health WC |
$4,377.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,090.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,635.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,435.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,962.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,187.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,030.00
|
| Rate for Payer: Multiplan Commercial |
$3,862.50
|
| Rate for Payer: Networks By Design Commercial |
$3,347.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,377.50
|
|
|
HC MRI THORACIC SPINE WITH CONTRA
|
Facility
|
OP
|
$5,150.00
|
|
|
Service Code
|
CPT 72147
|
| Hospital Charge Code |
908801112
|
|
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 |
$2,766.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,024.59
|
| Rate for Payer: Blue Shield of California Commercial |
$3,126.05
|
| Rate for Payer: Blue Shield of California EPN |
$2,044.55
|
| Rate for Payer: Cash Price |
$2,832.50
|
| Rate for Payer: Cash Price |
$2,832.50
|
| Rate for Payer: Cash Price |
$2,832.50
|
| Rate for Payer: Central Health Plan Commercial |
$4,120.00
|
| Rate for Payer: Cigna of CA HMO |
$3,296.00
|
| Rate for Payer: Cigna of CA PPO |
$3,811.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.59
|
| Rate for Payer: EPIC Health Plan Senior |
$453.77
|
| Rate for Payer: Galaxy Health WC |
$4,377.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,090.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,635.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$460.51
|
| 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 |
$508.71
|
| 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
|
|
