|
HC MRI THORACIC SPINE WO CON
|
Facility
|
OP
|
$4,965.00
|
|
|
Service Code
|
CPT 72146
|
| Hospital Charge Code |
908801110
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$4,468.50 |
| Rate for Payer: Adventist Health Commercial |
$993.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$307.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,015.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,556.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,915.94
|
| Rate for Payer: Blue Shield of California Commercial |
$3,013.76
|
| Rate for Payer: Blue Shield of California EPN |
$1,971.11
|
| Rate for Payer: Cash Price |
$2,730.75
|
| Rate for Payer: Cash Price |
$2,730.75
|
| Rate for Payer: Central Health Plan Commercial |
$3,972.00
|
| Rate for Payer: Cigna of CA HMO |
$3,177.60
|
| Rate for Payer: Cigna of CA PPO |
$3,674.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$4,220.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,979.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,468.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$318.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: InnovAge PACE Commercial |
$460.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,311.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$352.17
|
| 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 THORACIC SPINE WO CON
|
Facility
|
IP
|
$4,965.00
|
|
|
Service Code
|
CPT 72146
|
| Hospital Charge Code |
908801110
|
|
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 T-SPINE W & WO CONTRAST
|
Facility
|
OP
|
$5,667.00
|
|
|
Service Code
|
CPT 72157
|
| Hospital Charge Code |
908801114
|
|
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 |
$3,441.57
|
| 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: 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 |
$539.36
|
| 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 |
$595.80
|
| 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 T-SPINE W & WO CONTRAST
|
Facility
|
IP
|
$5,667.00
|
|
|
Service Code
|
CPT 72157
|
| Hospital Charge Code |
908801114
|
|
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 UPPER EXT JNT W & WO CONT
|
Facility
|
OP
|
$5,612.00
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
908801435
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$453.77 |
| Max. Negotiated Rate |
$5,198.91 |
| Rate for Payer: Adventist Health Commercial |
$1,122.40
|
| 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 |
$5,198.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,295.93
|
| Rate for Payer: Blue Shield of California Commercial |
$3,406.48
|
| Rate for Payer: Blue Shield of California EPN |
$2,227.96
|
| Rate for Payer: Cash Price |
$3,086.60
|
| Rate for Payer: Cash Price |
$3,086.60
|
| Rate for Payer: Cash Price |
$3,086.60
|
| Rate for Payer: Central Health Plan Commercial |
$4,489.60
|
| Rate for Payer: Cigna of CA HMO |
$3,591.68
|
| Rate for Payer: Cigna of CA PPO |
$4,152.88
|
| 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 |
$4,770.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,367.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,050.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$664.14
|
| 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 |
$3,743.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$733.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,122.40
|
| 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 |
$4,209.00
|
| Rate for Payer: Networks By Design Commercial |
$3,647.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$453.77
|
| Rate for Payer: Prime Health Services Commercial |
$4,770.20
|
| 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 |
$3,367.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,367.20
|
| 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 UPPER EXT JNT W & WO CONT
|
Facility
|
IP
|
$5,612.00
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
908801435
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,122.40 |
| Max. Negotiated Rate |
$5,050.80 |
| Rate for Payer: Adventist Health Commercial |
$1,122.40
|
| Rate for Payer: Cash Price |
$3,086.60
|
| Rate for Payer: Central Health Plan Commercial |
$4,489.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,244.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,244.80
|
| Rate for Payer: Galaxy Health WC |
$4,770.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,367.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,050.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,743.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,138.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,473.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,122.40
|
| Rate for Payer: Multiplan Commercial |
$4,209.00
|
| Rate for Payer: Networks By Design Commercial |
$3,647.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,770.20
|
|
|
HC MRI UPPER EXTREM JOINT W/CONT
|
Facility
|
IP
|
$3,846.00
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
908801433
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$769.20 |
| Max. Negotiated Rate |
$3,461.40 |
| Rate for Payer: Adventist Health Commercial |
$769.20
|
| Rate for Payer: Cash Price |
$2,115.30
|
| Rate for Payer: Central Health Plan Commercial |
$3,076.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,538.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,538.40
|
| Rate for Payer: Galaxy Health WC |
$3,269.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,307.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,461.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,565.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,465.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,380.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$769.20
|
| Rate for Payer: Multiplan Commercial |
$2,884.50
|
| Rate for Payer: Networks By Design Commercial |
$2,499.90
|
| Rate for Payer: Prime Health Services Commercial |
$3,269.10
|
|
|
HC MRI UPPER EXTREM JOINT W/CONT
|
Facility
|
OP
|
$3,846.00
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
908801433
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$537.26 |
| Max. Negotiated Rate |
$3,461.40 |
| Rate for Payer: Adventist Health Commercial |
$769.20
|
| 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 |
$2,258.76
|
| Rate for Payer: Blue Shield of California Commercial |
$2,334.52
|
| Rate for Payer: Blue Shield of California EPN |
$1,526.86
|
| Rate for Payer: Cash Price |
$2,115.30
|
| Rate for Payer: Cash Price |
$2,115.30
|
| Rate for Payer: Cash Price |
$2,115.30
|
| Rate for Payer: Central Health Plan Commercial |
$3,076.80
|
| Rate for Payer: Cigna of CA HMO |
$2,461.44
|
| Rate for Payer: Cigna of CA PPO |
$2,846.04
|
| 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 |
$3,269.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,307.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,461.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,646.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$537.26
|
| 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 |
$2,565.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$593.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,003.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$769.20
|
| 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 |
$2,884.50
|
| Rate for Payer: Networks By Design Commercial |
$2,499.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,003.85
|
| Rate for Payer: Prime Health Services Commercial |
$3,269.10
|
| 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 |
$2,307.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,307.60
|
| 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 UPPER EXTREM JOINT WO CONT
|
Facility
|
IP
|
$3,431.00
|
|
|
Service Code
|
CPT 73221
|
| Hospital Charge Code |
908801431
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$686.20 |
| Max. Negotiated Rate |
$3,087.90 |
| Rate for Payer: Adventist Health Commercial |
$686.20
|
| Rate for Payer: Cash Price |
$1,887.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,744.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,372.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,372.40
|
| Rate for Payer: Galaxy Health WC |
$2,916.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,058.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,087.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,288.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,307.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,123.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$686.20
|
| Rate for Payer: Multiplan Commercial |
$2,573.25
|
| Rate for Payer: Networks By Design Commercial |
$2,230.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,916.35
|
|
|
HC MRI UPPER EXTREM JOINT WO CONT
|
Facility
|
OP
|
$3,431.00
|
|
|
Service Code
|
CPT 73221
|
| Hospital Charge Code |
908801431
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$3,087.90 |
| Rate for Payer: Adventist Health Commercial |
$686.20
|
| 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 |
$2,015.03
|
| Rate for Payer: Blue Shield of California Commercial |
$2,082.62
|
| Rate for Payer: Blue Shield of California EPN |
$1,362.11
|
| Rate for Payer: Cash Price |
$1,887.05
|
| Rate for Payer: Cash Price |
$1,887.05
|
| Rate for Payer: Cash Price |
$1,887.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,744.80
|
| Rate for Payer: Cigna of CA HMO |
$2,195.84
|
| Rate for Payer: Cigna of CA PPO |
$2,538.94
|
| 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 |
$2,916.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,058.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,087.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$339.29
|
| 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 |
$2,288.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$374.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$686.20
|
| 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 |
$2,573.25
|
| Rate for Payer: Networks By Design Commercial |
$2,230.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$307.13
|
| Rate for Payer: Prime Health Services Commercial |
$2,916.35
|
| 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 |
$2,058.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,058.60
|
| 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 UPPER EXTREM W CONT
|
Facility
|
OP
|
$4,310.00
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
908801415
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$453.77 |
| Max. Negotiated Rate |
$3,879.00 |
| Rate for Payer: Adventist Health Commercial |
$862.00
|
| 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 |
$2,823.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,531.26
|
| Rate for Payer: Blue Shield of California Commercial |
$2,616.17
|
| Rate for Payer: Blue Shield of California EPN |
$1,711.07
|
| Rate for Payer: Cash Price |
$2,370.50
|
| Rate for Payer: Cash Price |
$2,370.50
|
| Rate for Payer: Cash Price |
$2,370.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,448.00
|
| Rate for Payer: Cigna of CA HMO |
$2,758.40
|
| Rate for Payer: Cigna of CA PPO |
$3,189.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$3,663.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,586.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,879.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$567.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: InnovAge PACE Commercial |
$680.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,874.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$626.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$862.00
|
| 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 |
$3,232.50
|
| Rate for Payer: Networks By Design Commercial |
$2,801.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$453.77
|
| Rate for Payer: Prime Health Services Commercial |
$3,663.50
|
| 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 |
$2,586.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,586.00
|
| 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 UPPER EXTREM W CONT
|
Facility
|
IP
|
$4,310.00
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
908801415
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$862.00 |
| Max. Negotiated Rate |
$3,879.00 |
| Rate for Payer: Adventist Health Commercial |
$862.00
|
| Rate for Payer: Cash Price |
$2,370.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,448.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,724.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,724.00
|
| Rate for Payer: Galaxy Health WC |
$3,663.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,586.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,879.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,874.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,642.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,667.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$862.00
|
| Rate for Payer: Multiplan Commercial |
$3,232.50
|
| Rate for Payer: Networks By Design Commercial |
$2,801.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,663.50
|
|
|
HC MRI UPPER EXTREM W/O CONT
|
Facility
|
OP
|
$3,852.00
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
908801413
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$3,466.80 |
| Rate for Payer: Adventist Health Commercial |
$770.40
|
| 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 |
$2,342.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,262.28
|
| Rate for Payer: Blue Shield of California Commercial |
$2,338.16
|
| Rate for Payer: Blue Shield of California EPN |
$1,529.24
|
| Rate for Payer: Cash Price |
$2,118.60
|
| Rate for Payer: Cash Price |
$2,118.60
|
| Rate for Payer: Cash Price |
$2,118.60
|
| Rate for Payer: Central Health Plan Commercial |
$3,081.60
|
| Rate for Payer: Cigna of CA HMO |
$2,465.28
|
| Rate for Payer: Cigna of CA PPO |
$2,850.48
|
| 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 |
$3,274.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,311.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,466.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$521.56
|
| 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 |
$2,569.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$576.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$770.40
|
| 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 |
$2,889.00
|
| Rate for Payer: Networks By Design Commercial |
$2,503.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$307.13
|
| Rate for Payer: Prime Health Services Commercial |
$3,274.20
|
| 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 |
$2,311.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,311.20
|
| 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 UPPER EXTREM W/O CONT
|
Facility
|
IP
|
$3,852.00
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
908801413
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$770.40 |
| Max. Negotiated Rate |
$3,466.80 |
| Rate for Payer: Adventist Health Commercial |
$770.40
|
| Rate for Payer: Cash Price |
$2,118.60
|
| Rate for Payer: Central Health Plan Commercial |
$3,081.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,540.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,540.80
|
| Rate for Payer: Galaxy Health WC |
$3,274.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,311.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,466.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,569.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,467.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,384.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$770.40
|
| Rate for Payer: Multiplan Commercial |
$2,889.00
|
| Rate for Payer: Networks By Design Commercial |
$2,503.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,274.20
|
|
|
HC MRI UPPER EXTREM W & WO CONT
|
Facility
|
OP
|
$4,533.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
908801411
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$453.77 |
| Max. Negotiated Rate |
$4,079.70 |
| Rate for Payer: Adventist Health Commercial |
$906.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$453.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,303.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,662.23
|
| Rate for Payer: Blue Shield of California Commercial |
$2,751.53
|
| Rate for Payer: Blue Shield of California EPN |
$1,799.60
|
| Rate for Payer: Cash Price |
$2,493.15
|
| Rate for Payer: Cash Price |
$2,493.15
|
| Rate for Payer: Cash Price |
$2,493.15
|
| Rate for Payer: Central Health Plan Commercial |
$3,626.40
|
| Rate for Payer: Cigna of CA HMO |
$2,901.12
|
| Rate for Payer: Cigna of CA PPO |
$3,354.42
|
| 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 |
$3,853.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,719.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,079.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$671.63
|
| 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 |
$3,023.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$741.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$906.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$608.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$608.05
|
| Rate for Payer: Multiplan Commercial |
$3,399.75
|
| Rate for Payer: Networks By Design Commercial |
$2,946.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$453.77
|
| Rate for Payer: Prime Health Services Commercial |
$3,853.05
|
| Rate for Payer: Prime Health Services Medicare |
$481.00
|
| Rate for Payer: Riverside University Health System MISP |
$499.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,719.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,719.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,367.12
|
| Rate for Payer: United Healthcare All Other HMO |
$1,367.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1,367.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,367.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$453.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
HC MRI UPPER EXTREM W & WO CONT
|
Facility
|
IP
|
$4,533.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
908801411
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$906.60 |
| Max. Negotiated Rate |
$4,079.70 |
| Rate for Payer: Adventist Health Commercial |
$906.60
|
| Rate for Payer: Cash Price |
$2,493.15
|
| Rate for Payer: Central Health Plan Commercial |
$3,626.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,813.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,813.20
|
| Rate for Payer: Galaxy Health WC |
$3,853.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,719.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,079.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,023.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,727.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,805.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$906.60
|
| Rate for Payer: Multiplan Commercial |
$3,399.75
|
| Rate for Payer: Networks By Design Commercial |
$2,946.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,853.05
|
|
|
HC MRSA DNA
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 87641
|
| Hospital Charge Code |
900912328
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Central Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.00
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
|
|
HC MRSA DNA
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 87641
|
| Hospital Charge Code |
900912328
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$249.78 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$35.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$60.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$249.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.69
|
| Rate for Payer: Blue Shield of California Commercial |
$60.70
|
| Rate for Payer: Blue Shield of California EPN |
$39.70
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Central Health Plan Commercial |
$80.00
|
| Rate for Payer: Cigna of CA HMO |
$64.00
|
| Rate for Payer: Cigna of CA PPO |
$74.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.37
|
| Rate for Payer: EPIC Health Plan Senior |
$35.09
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$53.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: InnovAge PACE Commercial |
$52.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$35.09
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: Prime Health Services Medicare |
$37.20
|
| Rate for Payer: Riverside University Health System MISP |
$38.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC MR SAFETY DETERMINATION PHYSICIAN/OTHER QHP
|
Facility
|
IP
|
$308.00
|
|
|
Service Code
|
CPT 76016
|
| Hospital Charge Code |
908801502
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$61.60 |
| Max. Negotiated Rate |
$277.20 |
| Rate for Payer: Adventist Health Commercial |
$61.60
|
| Rate for Payer: Cash Price |
$169.40
|
| Rate for Payer: Central Health Plan Commercial |
$246.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$123.20
|
| Rate for Payer: EPIC Health Plan Senior |
$123.20
|
| Rate for Payer: Galaxy Health WC |
$261.80
|
| Rate for Payer: Global Benefits Group Commercial |
$184.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$277.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$205.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$190.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.60
|
| Rate for Payer: Multiplan Commercial |
$231.00
|
| Rate for Payer: Networks By Design Commercial |
$200.20
|
| Rate for Payer: Prime Health Services Commercial |
$261.80
|
|
|
HC MR SAFETY DETERMINATION PHYSICIAN/OTHER QHP
|
Facility
|
OP
|
$308.00
|
|
|
Service Code
|
CPT 76016
|
| Hospital Charge Code |
908801502
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.91 |
| Max. Negotiated Rate |
$277.20 |
| Rate for Payer: Adventist Health Commercial |
$61.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$187.05
|
| 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 |
$265.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.91
|
| Rate for Payer: Blue Shield of California Commercial |
$186.96
|
| Rate for Payer: Blue Shield of California EPN |
$122.28
|
| Rate for Payer: Cash Price |
$169.40
|
| Rate for Payer: Cash Price |
$169.40
|
| Rate for Payer: Central Health Plan Commercial |
$246.40
|
| Rate for Payer: Cigna of CA HMO |
$197.12
|
| Rate for Payer: Cigna of CA PPO |
$227.92
|
| 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 |
$261.80
|
| Rate for Payer: Global Benefits Group Commercial |
$184.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$277.20
|
| 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 |
$205.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.60
|
| 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 |
$231.00
|
| Rate for Payer: Networks By Design Commercial |
$200.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.88
|
| Rate for Payer: Prime Health Services Commercial |
$261.80
|
| 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 |
$184.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$184.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$154.00
|
| Rate for Payer: United Healthcare All Other HMO |
$154.00
|
| Rate for Payer: United Healthcare HMO Rider |
$154.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$154.00
|
| 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 MR SAFETY IMPL AND FB ASSMT CLIN STAFF 1ST 15 MIN
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT 76014
|
| Hospital Charge Code |
908801500
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$12.98 |
| Max. Negotiated Rate |
$77.40 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$31.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$52.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$63.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.98
|
| Rate for Payer: Blue Shield of California Commercial |
$52.20
|
| Rate for Payer: Blue Shield of California EPN |
$34.14
|
| Rate for Payer: Cash Price |
$47.30
|
| Rate for Payer: Cash Price |
$47.30
|
| Rate for Payer: Central Health Plan Commercial |
$68.80
|
| Rate for Payer: Cigna of CA HMO |
$55.04
|
| Rate for Payer: Cigna of CA PPO |
$63.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.01
|
| Rate for Payer: EPIC Health Plan Senior |
$31.12
|
| Rate for Payer: Galaxy Health WC |
$73.10
|
| Rate for Payer: Global Benefits Group Commercial |
$51.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$77.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$51.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31.12
|
| Rate for Payer: InnovAge PACE Commercial |
$46.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.70
|
| Rate for Payer: Multiplan Commercial |
$64.50
|
| Rate for Payer: Networks By Design Commercial |
$55.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$31.12
|
| Rate for Payer: Prime Health Services Commercial |
$73.10
|
| Rate for Payer: Prime Health Services Medicare |
$32.99
|
| Rate for Payer: Riverside University Health System MISP |
$34.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$43.00
|
| Rate for Payer: United Healthcare All Other HMO |
$43.00
|
| Rate for Payer: United Healthcare HMO Rider |
$43.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$31.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Vantage Medical Group Senior |
$31.12
|
|
|
HC MR SAFETY IMPL AND FB ASSMT CLIN STAFF 1ST 15 MIN
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
CPT 76014
|
| Hospital Charge Code |
908801500
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$77.40 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Cash Price |
$47.30
|
| Rate for Payer: Central Health Plan Commercial |
$68.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.40
|
| Rate for Payer: EPIC Health Plan Senior |
$34.40
|
| Rate for Payer: Galaxy Health WC |
$73.10
|
| Rate for Payer: Global Benefits Group Commercial |
$51.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$77.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.20
|
| Rate for Payer: Multiplan Commercial |
$64.50
|
| Rate for Payer: Networks By Design Commercial |
$55.90
|
| Rate for Payer: Prime Health Services Commercial |
$73.10
|
|
|
HC MR SAFETY IMPL AND FB ASSMT CLIN STAFF EA ADD 30 MIN
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
CPT 76015
|
| Hospital Charge Code |
908801501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$8.60 |
| Max. Negotiated Rate |
$38.70 |
| Rate for Payer: Adventist Health Commercial |
$8.60
|
| Rate for Payer: Cash Price |
$23.65
|
| Rate for Payer: Central Health Plan Commercial |
$34.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.20
|
| Rate for Payer: EPIC Health Plan Senior |
$17.20
|
| Rate for Payer: Galaxy Health WC |
$36.55
|
| Rate for Payer: Global Benefits Group Commercial |
$25.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.60
|
| Rate for Payer: Multiplan Commercial |
$32.25
|
| Rate for Payer: Networks By Design Commercial |
$27.95
|
| Rate for Payer: Prime Health Services Commercial |
$36.55
|
|
|
HC MR SAFETY IMPL AND FB ASSMT CLIN STAFF EA ADD 30 MIN
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
CPT 76015
|
| Hospital Charge Code |
908801501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$8.60 |
| Max. Negotiated Rate |
$308.11 |
| Rate for Payer: Adventist Health Commercial |
$8.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$308.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.53
|
| Rate for Payer: Blue Shield of California Commercial |
$26.10
|
| Rate for Payer: Blue Shield of California EPN |
$17.07
|
| Rate for Payer: Cash Price |
$23.65
|
| Rate for Payer: Cash Price |
$23.65
|
| Rate for Payer: Central Health Plan Commercial |
$34.40
|
| Rate for Payer: Cigna of CA HMO |
$27.52
|
| Rate for Payer: Cigna of CA PPO |
$31.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$36.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.20
|
| Rate for Payer: EPIC Health Plan Senior |
$17.20
|
| Rate for Payer: Galaxy Health WC |
$36.55
|
| Rate for Payer: Global Benefits Group Commercial |
$25.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.70
|
| Rate for Payer: InnovAge PACE Commercial |
$21.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.10
|
| Rate for Payer: Multiplan Commercial |
$32.25
|
| Rate for Payer: Networks By Design Commercial |
$27.95
|
| Rate for Payer: Prime Health Services Commercial |
$36.55
|
| Rate for Payer: Riverside University Health System MISP |
$17.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.50
|
| Rate for Payer: United Healthcare All Other HMO |
$21.50
|
| Rate for Payer: United Healthcare HMO Rider |
$21.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.55
|
| Rate for Payer: Vantage Medical Group Senior |
$36.55
|
|
|
HC MR SAFETY IMPL ELECTRONICS PREP SUP PHYS/QHP
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
CPT 76018
|
| Hospital Charge Code |
908801504
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$64.20 |
| Max. Negotiated Rate |
$288.90 |
| Rate for Payer: Adventist Health Commercial |
$64.20
|
| Rate for Payer: Cash Price |
$176.55
|
| Rate for Payer: Central Health Plan Commercial |
$256.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.40
|
| Rate for Payer: EPIC Health Plan Senior |
$128.40
|
| Rate for Payer: Galaxy Health WC |
$272.85
|
| Rate for Payer: Global Benefits Group Commercial |
$192.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$288.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$214.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.20
|
| Rate for Payer: Multiplan Commercial |
$240.75
|
| Rate for Payer: Networks By Design Commercial |
$208.65
|
| Rate for Payer: Prime Health Services Commercial |
$272.85
|
|
