|
HC MRI ABDOMEN W/O CONTRAST
|
Facility
|
IP
|
$9,093.00
|
|
|
Service Code
|
CPT 74181
|
| Hospital Charge Code |
908801300
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,818.60 |
| Max. Negotiated Rate |
$8,183.70 |
| Rate for Payer: Cash Price |
$4,091.85
|
| Rate for Payer: Central Health Plan Commercial |
$7,274.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,637.20
|
| Rate for Payer: Galaxy Health WC |
$7,729.05
|
| Rate for Payer: Global Benefits Group Commercial |
$5,455.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,183.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,065.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,464.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,818.60
|
| Rate for Payer: Multiplan Commercial |
$6,819.75
|
| Rate for Payer: Networks By Design Commercial |
$5,910.45
|
| Rate for Payer: Prime Health Services Commercial |
$7,729.05
|
|
|
HC MRI ABDOMEN W/O CONTRAST
|
Facility
|
OP
|
$3,874.00
|
|
|
Service Code
|
CPT 74181
|
| Hospital Charge Code |
908801300
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$306.16 |
| Max. Negotiated Rate |
$3,486.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$306.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,305.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,288.76
|
| Rate for Payer: Blue Distinction Transplant |
$2,324.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,394.13
|
| Rate for Payer: Blue Shield of California EPN |
$1,882.76
|
| Rate for Payer: Caremore Medicare Advantage |
$306.16
|
| Rate for Payer: Cash Price |
$1,743.30
|
| Rate for Payer: Cash Price |
$1,743.30
|
| Rate for Payer: Central Health Plan Commercial |
$3,099.20
|
| Rate for Payer: Cigna of CA HMO |
$2,479.36
|
| Rate for Payer: Cigna of CA PPO |
$2,866.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Media |
$306.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$306.16
|
| Rate for Payer: Galaxy Health WC |
$3,292.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,324.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,486.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,905.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$502.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$505.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.16
|
| Rate for Payer: InnovAge PACE Commercial |
$459.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,583.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$362.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$774.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$410.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410.25
|
| Rate for Payer: Multiplan Commercial |
$2,905.50
|
| Rate for Payer: Networks By Design Commercial |
$2,518.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,292.90
|
| Rate for Payer: Prime Health Services Medicare |
$324.53
|
| Rate for Payer: Riverside University Health System MISP |
$336.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,324.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,324.40
|
| 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: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC MRI ABDOMEN W WO CONTRAST
|
Facility
|
OP
|
$4,885.00
|
|
|
Service Code
|
CPT 74183
|
| Hospital Charge Code |
908801302
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$480.50 |
| Max. Negotiated Rate |
$5,208.41 |
| Rate for Payer: Adventist Health Medi-Cal |
$480.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,208.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,886.06
|
| Rate for Payer: Blue Distinction Transplant |
$2,931.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,018.93
|
| Rate for Payer: Blue Shield of California EPN |
$2,374.11
|
| Rate for Payer: Caremore Medicare Advantage |
$480.50
|
| Rate for Payer: Cash Price |
$2,198.25
|
| Rate for Payer: Cash Price |
$2,198.25
|
| Rate for Payer: Central Health Plan Commercial |
$3,908.00
|
| Rate for Payer: Cigna of CA HMO |
$3,126.40
|
| Rate for Payer: Cigna of CA PPO |
$3,614.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: Dignity Health Media |
$480.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$480.50
|
| Rate for Payer: Galaxy Health WC |
$4,152.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,931.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,396.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,663.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$788.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$792.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$480.50
|
| Rate for Payer: InnovAge PACE Commercial |
$720.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,258.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$633.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$977.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.87
|
| Rate for Payer: Multiplan Commercial |
$3,663.75
|
| Rate for Payer: Networks By Design Commercial |
$3,175.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,152.25
|
| Rate for Payer: Prime Health Services Medicare |
$509.33
|
| Rate for Payer: Riverside University Health System MISP |
$528.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,931.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,931.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC MRI ABDOMEN W WO CONTRAST
|
Facility
|
IP
|
$12,203.00
|
|
|
Service Code
|
CPT 74183
|
| Hospital Charge Code |
908801302
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,440.60 |
| Max. Negotiated Rate |
$10,982.70 |
| Rate for Payer: Cash Price |
$5,491.35
|
| Rate for Payer: Central Health Plan Commercial |
$9,762.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,881.20
|
| Rate for Payer: Galaxy Health WC |
$10,372.55
|
| Rate for Payer: Global Benefits Group Commercial |
$7,321.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,982.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,139.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,649.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,440.60
|
| Rate for Payer: Multiplan Commercial |
$9,152.25
|
| Rate for Payer: Networks By Design Commercial |
$7,931.95
|
| Rate for Payer: Prime Health Services Commercial |
$10,372.55
|
|
|
HC MRI ANGIO HEAD WITH CONTRAST
|
Facility
|
IP
|
$8,865.00
|
|
|
Service Code
|
CPT 70545
|
| Hospital Charge Code |
908801084
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,773.00 |
| Max. Negotiated Rate |
$7,978.50 |
| Rate for Payer: Cash Price |
$3,989.25
|
| Rate for Payer: Central Health Plan Commercial |
$7,092.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,546.00
|
| Rate for Payer: Galaxy Health WC |
$7,535.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,319.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,978.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,912.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,377.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,773.00
|
| Rate for Payer: Multiplan Commercial |
$6,648.75
|
| Rate for Payer: Networks By Design Commercial |
$5,762.25
|
| Rate for Payer: Prime Health Services Commercial |
$7,535.25
|
|
|
HC MRI ANGIO HEAD WITH CONTRAST
|
Facility
|
OP
|
$4,837.00
|
|
|
Service Code
|
CPT 70545
|
| Hospital Charge Code |
908801084
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$423.28 |
| Max. Negotiated Rate |
$4,353.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$480.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,369.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,857.70
|
| Rate for Payer: Blue Distinction Transplant |
$2,902.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,989.27
|
| Rate for Payer: Blue Shield of California EPN |
$2,350.78
|
| Rate for Payer: Caremore Medicare Advantage |
$480.50
|
| Rate for Payer: Cash Price |
$2,176.65
|
| Rate for Payer: Cash Price |
$2,176.65
|
| Rate for Payer: Central Health Plan Commercial |
$3,869.60
|
| Rate for Payer: Cigna of CA HMO |
$3,095.68
|
| Rate for Payer: Cigna of CA PPO |
$3,579.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: Dignity Health Media |
$480.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$480.50
|
| Rate for Payer: Galaxy Health WC |
$4,111.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,902.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,353.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,627.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$788.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$792.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$480.50
|
| Rate for Payer: InnovAge PACE Commercial |
$720.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,226.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$423.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$967.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.87
|
| Rate for Payer: Multiplan Commercial |
$3,627.75
|
| Rate for Payer: Networks By Design Commercial |
$3,144.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,111.45
|
| Rate for Payer: Prime Health Services Medicare |
$509.33
|
| Rate for Payer: Riverside University Health System MISP |
$528.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,902.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,902.20
|
| 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: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC MRI ANGIO HEAD WO CNTRAST
|
Facility
|
IP
|
$8,443.00
|
|
|
Service Code
|
CPT 70544
|
| Hospital Charge Code |
908801015
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,688.60 |
| Max. Negotiated Rate |
$7,598.70 |
| Rate for Payer: Cash Price |
$3,799.35
|
| Rate for Payer: Central Health Plan Commercial |
$6,754.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,377.20
|
| Rate for Payer: Galaxy Health WC |
$7,176.55
|
| Rate for Payer: Global Benefits Group Commercial |
$5,065.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,598.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,631.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,216.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,688.60
|
| Rate for Payer: Multiplan Commercial |
$6,332.25
|
| Rate for Payer: Networks By Design Commercial |
$5,487.95
|
| Rate for Payer: Prime Health Services Commercial |
$7,176.55
|
|
|
HC MRI ANGIO HEAD WO CNTRAST
|
Facility
|
IP
|
$8,443.00
|
|
|
Service Code
|
CPT 70544
|
| Hospital Charge Code |
908801083
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,688.60 |
| Max. Negotiated Rate |
$7,598.70 |
| Rate for Payer: Cash Price |
$3,799.35
|
| Rate for Payer: Central Health Plan Commercial |
$6,754.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,377.20
|
| Rate for Payer: Galaxy Health WC |
$7,176.55
|
| Rate for Payer: Global Benefits Group Commercial |
$5,065.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,598.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,631.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,216.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,688.60
|
| Rate for Payer: Multiplan Commercial |
$6,332.25
|
| Rate for Payer: Networks By Design Commercial |
$5,487.95
|
| Rate for Payer: Prime Health Services Commercial |
$7,176.55
|
|
|
HC MRI ANGIO HEAD WO CNTRAST
|
Facility
|
OP
|
$4,319.00
|
|
|
Service Code
|
CPT 70544
|
| Hospital Charge Code |
908801083
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$306.16 |
| Max. Negotiated Rate |
$3,887.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$306.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,369.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,551.67
|
| Rate for Payer: Blue Distinction Transplant |
$2,591.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,669.14
|
| Rate for Payer: Blue Shield of California EPN |
$2,099.03
|
| Rate for Payer: Caremore Medicare Advantage |
$306.16
|
| Rate for Payer: Cash Price |
$1,943.55
|
| Rate for Payer: Cash Price |
$1,943.55
|
| Rate for Payer: Central Health Plan Commercial |
$3,455.20
|
| Rate for Payer: Cigna of CA HMO |
$2,764.16
|
| Rate for Payer: Cigna of CA PPO |
$3,196.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Media |
$306.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$306.16
|
| Rate for Payer: Galaxy Health WC |
$3,671.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,591.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,887.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,239.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$502.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$505.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.16
|
| Rate for Payer: InnovAge PACE Commercial |
$459.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,880.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$400.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$863.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$410.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410.25
|
| Rate for Payer: Multiplan Commercial |
$3,239.25
|
| Rate for Payer: Networks By Design Commercial |
$2,807.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,671.15
|
| Rate for Payer: Prime Health Services Medicare |
$324.53
|
| Rate for Payer: Riverside University Health System MISP |
$336.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,591.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,591.40
|
| 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: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC MRI ANGIO HEAD WO CNTRAST
|
Facility
|
OP
|
$4,319.00
|
|
|
Service Code
|
CPT 70544
|
| Hospital Charge Code |
908801015
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$306.16 |
| Max. Negotiated Rate |
$3,887.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$306.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,369.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,551.67
|
| Rate for Payer: Blue Distinction Transplant |
$2,591.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,669.14
|
| Rate for Payer: Blue Shield of California EPN |
$2,099.03
|
| Rate for Payer: Caremore Medicare Advantage |
$306.16
|
| Rate for Payer: Cash Price |
$1,943.55
|
| Rate for Payer: Cash Price |
$1,943.55
|
| Rate for Payer: Central Health Plan Commercial |
$3,455.20
|
| Rate for Payer: Cigna of CA HMO |
$2,764.16
|
| Rate for Payer: Cigna of CA PPO |
$3,196.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Media |
$306.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$306.16
|
| Rate for Payer: Galaxy Health WC |
$3,671.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,591.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,887.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,239.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$502.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$505.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.16
|
| Rate for Payer: InnovAge PACE Commercial |
$459.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,880.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$400.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$863.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$410.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410.25
|
| Rate for Payer: Multiplan Commercial |
$3,239.25
|
| Rate for Payer: Networks By Design Commercial |
$2,807.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,671.15
|
| Rate for Payer: Prime Health Services Medicare |
$324.53
|
| Rate for Payer: Riverside University Health System MISP |
$336.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,591.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,591.40
|
| 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: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC MRI ANGIO HEAD W WO CONTRAST
|
Facility
|
IP
|
$11,066.00
|
|
|
Service Code
|
CPT 70546
|
| Hospital Charge Code |
908801085
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$2,213.20 |
| Max. Negotiated Rate |
$9,959.40 |
| Rate for Payer: Cash Price |
$4,979.70
|
| Rate for Payer: Central Health Plan Commercial |
$8,852.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,426.40
|
| Rate for Payer: Galaxy Health WC |
$9,406.10
|
| Rate for Payer: Global Benefits Group Commercial |
$6,639.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,959.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,381.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,216.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,213.20
|
| Rate for Payer: Multiplan Commercial |
$8,299.50
|
| Rate for Payer: Networks By Design Commercial |
$7,192.90
|
| Rate for Payer: Prime Health Services Commercial |
$9,406.10
|
|
|
HC MRI ANGIO HEAD W WO CONTRAST
|
Facility
|
OP
|
$5,182.00
|
|
|
Service Code
|
CPT 70546
|
| Hospital Charge Code |
908801085
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$480.50 |
| Max. Negotiated Rate |
$4,663.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$480.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,659.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,061.53
|
| Rate for Payer: Blue Distinction Transplant |
$3,109.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,202.48
|
| Rate for Payer: Blue Shield of California EPN |
$2,518.45
|
| Rate for Payer: Caremore Medicare Advantage |
$480.50
|
| Rate for Payer: Cash Price |
$2,331.90
|
| Rate for Payer: Cash Price |
$2,331.90
|
| Rate for Payer: Central Health Plan Commercial |
$4,145.60
|
| Rate for Payer: Cigna of CA HMO |
$3,316.48
|
| Rate for Payer: Cigna of CA PPO |
$3,834.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: Dignity Health Media |
$480.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$480.50
|
| Rate for Payer: Galaxy Health WC |
$4,404.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,109.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,663.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,886.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$788.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$792.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$480.50
|
| Rate for Payer: InnovAge PACE Commercial |
$720.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,456.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$615.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,036.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.87
|
| Rate for Payer: Multiplan Commercial |
$3,886.50
|
| Rate for Payer: Networks By Design Commercial |
$3,368.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,404.70
|
| Rate for Payer: Prime Health Services Medicare |
$509.33
|
| Rate for Payer: Riverside University Health System MISP |
$528.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,109.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,109.20
|
| 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: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC MRI ANGIO NECK W CONTRAST
|
Facility
|
OP
|
$4,837.00
|
|
|
Service Code
|
CPT 70548
|
| Hospital Charge Code |
908801087
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$457.10 |
| Max. Negotiated Rate |
$4,353.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$480.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,369.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,857.70
|
| Rate for Payer: Blue Distinction Transplant |
$2,902.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,989.27
|
| Rate for Payer: Blue Shield of California EPN |
$2,350.78
|
| Rate for Payer: Caremore Medicare Advantage |
$480.50
|
| Rate for Payer: Cash Price |
$2,176.65
|
| Rate for Payer: Cash Price |
$2,176.65
|
| Rate for Payer: Central Health Plan Commercial |
$3,869.60
|
| Rate for Payer: Cigna of CA HMO |
$3,095.68
|
| Rate for Payer: Cigna of CA PPO |
$3,579.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: Dignity Health Media |
$480.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$480.50
|
| Rate for Payer: Galaxy Health WC |
$4,111.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,902.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,353.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,627.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$788.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$792.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$480.50
|
| Rate for Payer: InnovAge PACE Commercial |
$720.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,226.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$457.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$967.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.87
|
| Rate for Payer: Multiplan Commercial |
$3,627.75
|
| Rate for Payer: Networks By Design Commercial |
$3,144.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,111.45
|
| Rate for Payer: Prime Health Services Medicare |
$509.33
|
| Rate for Payer: Riverside University Health System MISP |
$528.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,902.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,902.20
|
| 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: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC MRI ANGIO NECK W CONTRAST
|
Facility
|
IP
|
$8,342.00
|
|
|
Service Code
|
CPT 70548
|
| Hospital Charge Code |
908801087
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,668.40 |
| Max. Negotiated Rate |
$7,507.80 |
| Rate for Payer: Cash Price |
$3,753.90
|
| Rate for Payer: Central Health Plan Commercial |
$6,673.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,336.80
|
| Rate for Payer: Galaxy Health WC |
$7,090.70
|
| Rate for Payer: Global Benefits Group Commercial |
$5,005.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,507.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,564.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,178.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,668.40
|
| Rate for Payer: Multiplan Commercial |
$6,256.50
|
| Rate for Payer: Networks By Design Commercial |
$5,422.30
|
| Rate for Payer: Prime Health Services Commercial |
$7,090.70
|
|
|
HC MRI ANGIO NECK WO CONTRAST
|
Facility
|
IP
|
$8,057.00
|
|
|
Service Code
|
CPT 70547
|
| Hospital Charge Code |
908801018
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,611.40 |
| Max. Negotiated Rate |
$7,251.30 |
| Rate for Payer: Cash Price |
$3,625.65
|
| Rate for Payer: Central Health Plan Commercial |
$6,445.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,222.80
|
| Rate for Payer: Galaxy Health WC |
$6,848.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,834.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,251.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,374.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,069.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,611.40
|
| Rate for Payer: Multiplan Commercial |
$6,042.75
|
| Rate for Payer: Networks By Design Commercial |
$5,237.05
|
| Rate for Payer: Prime Health Services Commercial |
$6,848.45
|
|
|
HC MRI ANGIO NECK WO CONTRAST
|
Facility
|
OP
|
$4,670.00
|
|
|
Service Code
|
CPT 70547
|
| Hospital Charge Code |
908801086
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$306.16 |
| Max. Negotiated Rate |
$4,203.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$306.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,369.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,759.04
|
| Rate for Payer: Blue Distinction Transplant |
$2,802.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,886.06
|
| Rate for Payer: Blue Shield of California EPN |
$2,269.62
|
| Rate for Payer: Caremore Medicare Advantage |
$306.16
|
| Rate for Payer: Cash Price |
$2,101.50
|
| Rate for Payer: Cash Price |
$2,101.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,736.00
|
| Rate for Payer: Cigna of CA HMO |
$2,988.80
|
| Rate for Payer: Cigna of CA PPO |
$3,455.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Media |
$306.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$306.16
|
| Rate for Payer: Galaxy Health WC |
$3,969.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,802.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,203.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,502.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$502.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$505.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.16
|
| Rate for Payer: InnovAge PACE Commercial |
$459.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,114.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$402.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$934.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$410.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410.25
|
| Rate for Payer: Multiplan Commercial |
$3,502.50
|
| Rate for Payer: Networks By Design Commercial |
$3,035.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,969.50
|
| Rate for Payer: Prime Health Services Medicare |
$324.53
|
| Rate for Payer: Riverside University Health System MISP |
$336.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,802.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,802.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC MRI ANGIO NECK WO CONTRAST
|
Facility
|
IP
|
$8,057.00
|
|
|
Service Code
|
CPT 70547
|
| Hospital Charge Code |
908801086
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,611.40 |
| Max. Negotiated Rate |
$7,251.30 |
| Rate for Payer: Cash Price |
$3,625.65
|
| Rate for Payer: Central Health Plan Commercial |
$6,445.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,222.80
|
| Rate for Payer: Galaxy Health WC |
$6,848.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,834.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,251.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,374.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,069.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,611.40
|
| Rate for Payer: Multiplan Commercial |
$6,042.75
|
| Rate for Payer: Networks By Design Commercial |
$5,237.05
|
| Rate for Payer: Prime Health Services Commercial |
$6,848.45
|
|
|
HC MRI ANGIO NECK WO CONTRAST
|
Facility
|
OP
|
$4,670.00
|
|
|
Service Code
|
CPT 70547
|
| Hospital Charge Code |
908801018
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$306.16 |
| Max. Negotiated Rate |
$4,203.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$306.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,369.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,759.04
|
| Rate for Payer: Blue Distinction Transplant |
$2,802.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,886.06
|
| Rate for Payer: Blue Shield of California EPN |
$2,269.62
|
| Rate for Payer: Caremore Medicare Advantage |
$306.16
|
| Rate for Payer: Cash Price |
$2,101.50
|
| Rate for Payer: Cash Price |
$2,101.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,736.00
|
| Rate for Payer: Cigna of CA HMO |
$2,988.80
|
| Rate for Payer: Cigna of CA PPO |
$3,455.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Media |
$306.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$306.16
|
| Rate for Payer: Galaxy Health WC |
$3,969.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,802.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,203.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,502.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$502.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$505.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.16
|
| Rate for Payer: InnovAge PACE Commercial |
$459.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,114.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$402.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$934.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$410.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410.25
|
| Rate for Payer: Multiplan Commercial |
$3,502.50
|
| Rate for Payer: Networks By Design Commercial |
$3,035.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,969.50
|
| Rate for Payer: Prime Health Services Medicare |
$324.53
|
| Rate for Payer: Riverside University Health System MISP |
$336.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,802.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,802.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC MRI ANGIO NECK W WO CONTRAST
|
Facility
|
IP
|
$9,896.00
|
|
|
Service Code
|
CPT 70549
|
| Hospital Charge Code |
908801088
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,979.20 |
| Max. Negotiated Rate |
$8,906.40 |
| Rate for Payer: Cash Price |
$4,453.20
|
| Rate for Payer: Central Health Plan Commercial |
$7,916.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,958.40
|
| Rate for Payer: Galaxy Health WC |
$8,411.60
|
| Rate for Payer: Global Benefits Group Commercial |
$5,937.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,906.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,600.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,770.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,979.20
|
| Rate for Payer: Multiplan Commercial |
$7,422.00
|
| Rate for Payer: Networks By Design Commercial |
$6,432.40
|
| Rate for Payer: Prime Health Services Commercial |
$8,411.60
|
|
|
HC MRI ANGIO NECK W WO CONTRAST
|
Facility
|
OP
|
$5,116.00
|
|
|
Service Code
|
CPT 70549
|
| Hospital Charge Code |
908801088
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$480.50 |
| Max. Negotiated Rate |
$4,659.04 |
| Rate for Payer: Adventist Health Medi-Cal |
$480.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,659.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,022.53
|
| Rate for Payer: Blue Distinction Transplant |
$3,069.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,161.69
|
| Rate for Payer: Blue Shield of California EPN |
$2,486.38
|
| Rate for Payer: Caremore Medicare Advantage |
$480.50
|
| Rate for Payer: Cash Price |
$2,302.20
|
| Rate for Payer: Cash Price |
$2,302.20
|
| Rate for Payer: Central Health Plan Commercial |
$4,092.80
|
| Rate for Payer: Cigna of CA HMO |
$3,274.24
|
| Rate for Payer: Cigna of CA PPO |
$3,785.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: Dignity Health Media |
$480.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$480.50
|
| Rate for Payer: Galaxy Health WC |
$4,348.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,069.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,604.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,837.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$788.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$792.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$480.50
|
| Rate for Payer: InnovAge PACE Commercial |
$720.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,412.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$644.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,023.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.87
|
| Rate for Payer: Multiplan Commercial |
$3,837.00
|
| Rate for Payer: Networks By Design Commercial |
$3,325.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,348.60
|
| Rate for Payer: Prime Health Services Medicare |
$509.33
|
| Rate for Payer: Riverside University Health System MISP |
$528.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,069.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,069.60
|
| 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: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC MRI BILATERAL TMJ
|
Facility
|
OP
|
$4,672.00
|
|
|
Service Code
|
CPT 70336
|
| Hospital Charge Code |
908801055
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$306.16 |
| Max. Negotiated Rate |
$4,204.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$306.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,044.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,760.22
|
| Rate for Payer: Blue Distinction Transplant |
$2,803.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,887.30
|
| Rate for Payer: Blue Shield of California EPN |
$2,270.59
|
| Rate for Payer: Caremore Medicare Advantage |
$306.16
|
| Rate for Payer: Cash Price |
$2,102.40
|
| Rate for Payer: Cash Price |
$2,102.40
|
| Rate for Payer: Central Health Plan Commercial |
$3,737.60
|
| Rate for Payer: Cigna of CA HMO |
$2,990.08
|
| Rate for Payer: Cigna of CA PPO |
$3,457.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Media |
$306.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$306.16
|
| Rate for Payer: Galaxy Health WC |
$3,971.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,803.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,204.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,504.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$502.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$505.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.16
|
| Rate for Payer: InnovAge PACE Commercial |
$459.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,116.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,780.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$934.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$410.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410.25
|
| Rate for Payer: Multiplan Commercial |
$3,504.00
|
| Rate for Payer: Networks By Design Commercial |
$3,036.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,971.20
|
| Rate for Payer: Prime Health Services Medicare |
$324.53
|
| Rate for Payer: Riverside University Health System MISP |
$336.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,803.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,803.20
|
| 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: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC MRI BILATERAL TMJ
|
Facility
|
IP
|
$9,670.00
|
|
|
Service Code
|
CPT 70336
|
| Hospital Charge Code |
908801055
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,934.00 |
| Max. Negotiated Rate |
$8,703.00 |
| Rate for Payer: Cash Price |
$4,351.50
|
| Rate for Payer: Central Health Plan Commercial |
$7,736.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,868.00
|
| Rate for Payer: Galaxy Health WC |
$8,219.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,802.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,703.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,449.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,684.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,934.00
|
| Rate for Payer: Multiplan Commercial |
$7,252.50
|
| Rate for Payer: Networks By Design Commercial |
$6,285.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,219.50
|
|
|
HC MRI BN MARROW(2 SEQ)
|
Facility
|
OP
|
$3,063.00
|
|
|
Service Code
|
CPT 77084
|
| Hospital Charge Code |
908801140
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$306.16 |
| Max. Negotiated Rate |
$2,756.70 |
| Rate for Payer: Adventist Health Medi-Cal |
$306.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,055.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,305.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,809.62
|
| Rate for Payer: Blue Distinction Transplant |
$1,837.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,892.93
|
| Rate for Payer: Blue Shield of California EPN |
$1,488.62
|
| Rate for Payer: Caremore Medicare Advantage |
$306.16
|
| Rate for Payer: Cash Price |
$1,378.35
|
| Rate for Payer: Cash Price |
$1,378.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,450.40
|
| Rate for Payer: Cigna of CA HMO |
$1,960.32
|
| Rate for Payer: Cigna of CA PPO |
$2,266.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Media |
$306.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$306.16
|
| Rate for Payer: Galaxy Health WC |
$2,603.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,837.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,756.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,297.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$502.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$505.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.16
|
| Rate for Payer: InnovAge PACE Commercial |
$459.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,043.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,167.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$612.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$410.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410.25
|
| Rate for Payer: Multiplan Commercial |
$2,297.25
|
| Rate for Payer: Networks By Design Commercial |
$1,990.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,603.55
|
| Rate for Payer: Prime Health Services Medicare |
$324.53
|
| Rate for Payer: Riverside University Health System MISP |
$336.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,837.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,837.80
|
| 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: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC MRI BN MARROW(2 SEQ)
|
Facility
|
IP
|
$6,341.00
|
|
|
Service Code
|
CPT 77084
|
| Hospital Charge Code |
908801140
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,268.20 |
| Max. Negotiated Rate |
$5,706.90 |
| Rate for Payer: Cash Price |
$2,853.45
|
| Rate for Payer: Central Health Plan Commercial |
$5,072.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,536.40
|
| Rate for Payer: Galaxy Health WC |
$5,389.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,804.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,706.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,229.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,415.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,268.20
|
| Rate for Payer: Multiplan Commercial |
$4,755.75
|
| Rate for Payer: Networks By Design Commercial |
$4,121.65
|
| Rate for Payer: Prime Health Services Commercial |
$5,389.85
|
|
|
HC MRI BRAIN ASSESS W CONTRAST
|
Facility
|
OP
|
$1,601.00
|
|
|
Service Code
|
CPT 70558
|
| Hospital Charge Code |
908870558
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$229.56 |
| Max. Negotiated Rate |
$2,759.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$229.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,055.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,759.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$945.87
|
| Rate for Payer: Blue Distinction Transplant |
$960.60
|
| Rate for Payer: Blue Shield of California Commercial |
$989.42
|
| Rate for Payer: Blue Shield of California EPN |
$778.09
|
| Rate for Payer: Caremore Medicare Advantage |
$229.56
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,280.80
|
| Rate for Payer: Cigna of CA HMO |
$1,024.64
|
| Rate for Payer: Cigna of CA PPO |
$1,184.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Media |
$229.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$229.56
|
| Rate for Payer: Galaxy Health WC |
$1,360.85
|
| Rate for Payer: Global Benefits Group Commercial |
$960.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,440.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,200.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$376.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$378.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: InnovAge PACE Commercial |
$344.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,067.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$336.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$320.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$307.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$307.61
|
| Rate for Payer: Multiplan Commercial |
$1,200.75
|
| Rate for Payer: Networks By Design Commercial |
$1,040.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,360.85
|
| Rate for Payer: Prime Health Services Medicare |
$243.33
|
| Rate for Payer: Riverside University Health System MISP |
$252.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$960.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$960.60
|
| 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: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
