|
HC MRI BRAIN ASSESS W CONTRAST
|
Facility
IP
|
$1,601.00
|
|
|
Service Code
|
CPT 70558
|
| Hospital Charge Code |
908870558
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$320.20 |
| Max. Negotiated Rate |
$1,440.90 |
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,280.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$640.40
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$1,067.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$320.20
|
| 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
|
|
|
HC MRI BRAIN ASSESS WO CONTRAST
|
Facility
OP
|
$849.00
|
|
|
Service Code
|
CPT 70557
|
| Hospital Charge Code |
908870557
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$169.80 |
| Max. Negotiated Rate |
$86,633.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$689.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,055.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,033.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$689.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,303.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$501.59
|
| Rate for Payer: BCBS Transplant Transplant |
$509.40
|
| Rate for Payer: Blue Shield of California Commercial |
$524.68
|
| Rate for Payer: Blue Shield of California EPN |
$412.61
|
| Rate for Payer: Caremore Medicare Advantage |
$689.28
|
| Rate for Payer: Cash Price |
$382.05
|
| Rate for Payer: Cash Price |
$382.05
|
| Rate for Payer: Central Health Plan Commercial |
$679.20
|
| Rate for Payer: Cigna of CA HMO |
$543.36
|
| Rate for Payer: Cigna of CA PPO |
$628.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,033.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$930.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$689.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$689.28
|
| Rate for Payer: Galaxy Health WC |
$721.65
|
| Rate for Payer: Global Benefits Group Commercial |
$509.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$764.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$636.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,130.42
|
| Rate for Payer: IEHP medi-cal |
$1,137.31
|
| Rate for Payer: IEHP Medicare Advantage |
$689.28
|
| Rate for Payer: Innovage PACE Commercial |
$1,033.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$566.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$689.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$923.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$923.64
|
| Rate for Payer: Multiplan Commercial |
$636.75
|
| Rate for Payer: Networks By Design Commercial |
$551.85
|
| Rate for Payer: Prime Health Services Commercial |
$721.65
|
| Rate for Payer: Prime Health Services Medicare |
$730.64
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$350.00
|
| Rate for Payer: Riverside University Health MISP |
$758.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$509.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$509.40
|
| 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 |
$86,633.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: Vantage Medical Group Senior |
$689.28
|
|
|
HC MRI BRAIN ASSESS WO CONTRAST
|
Facility
IP
|
$849.00
|
|
|
Service Code
|
CPT 70557
|
| Hospital Charge Code |
908870557
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$169.80 |
| Max. Negotiated Rate |
$764.10 |
| Rate for Payer: Cash Price |
$382.05
|
| Rate for Payer: Central Health Plan Commercial |
$679.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$339.60
|
| Rate for Payer: Galaxy Health WC |
$721.65
|
| Rate for Payer: Global Benefits Group Commercial |
$509.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$764.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$566.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.80
|
| Rate for Payer: Multiplan Commercial |
$636.75
|
| Rate for Payer: Networks By Design Commercial |
$551.85
|
| Rate for Payer: Prime Health Services Commercial |
$721.65
|
|
|
HC MRI BRAIN ASSESS WO W CONTRAST
|
Facility
IP
|
$1,681.00
|
|
|
Service Code
|
CPT 70559
|
| Hospital Charge Code |
908870559
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$336.20 |
| Max. Negotiated Rate |
$1,512.90 |
| Rate for Payer: Cash Price |
$756.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,344.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.40
|
| Rate for Payer: Galaxy Health WC |
$1,428.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,008.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,512.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,121.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$336.20
|
| Rate for Payer: Multiplan Commercial |
$1,260.75
|
| Rate for Payer: Networks By Design Commercial |
$1,092.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,428.85
|
|
|
HC MRI BRAIN ASSESS WO W CONTRAST
|
Facility
OP
|
$1,681.00
|
|
|
Service Code
|
CPT 70559
|
| Hospital Charge Code |
908870559
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$229.56 |
| Max. Negotiated Rate |
$136,712.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$229.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,055.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,537.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$993.13
|
| Rate for Payer: BCBS Transplant Transplant |
$1,008.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,038.86
|
| Rate for Payer: Blue Shield of California EPN |
$816.97
|
| Rate for Payer: Caremore Medicare Advantage |
$229.56
|
| Rate for Payer: Cash Price |
$756.45
|
| Rate for Payer: Cash Price |
$756.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,344.80
|
| Rate for Payer: Cigna of CA HMO |
$1,075.84
|
| Rate for Payer: Cigna of CA PPO |
$1,243.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| 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 |
$1,428.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,008.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,512.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,260.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$376.48
|
| Rate for Payer: IEHP medi-cal |
$378.77
|
| Rate for Payer: IEHP Medicare Advantage |
$229.56
|
| Rate for Payer: Innovage PACE Commercial |
$344.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,121.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$336.20
|
| 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 |
$1,260.75
|
| Rate for Payer: Networks By Design Commercial |
$1,092.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,428.85
|
| Rate for Payer: Prime Health Services Medicare |
$243.33
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$350.00
|
| Rate for Payer: Riverside University Health MISP |
$252.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,008.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,008.60
|
| 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 |
$136,712.00
|
| 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
|
|
|
HC MRI BRAIN WITH CONTRAST
|
Facility
OP
|
$4,480.00
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
908801012
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$111,574.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$480.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,055.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,759.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,646.78
|
| Rate for Payer: BCBS Transplant Transplant |
$2,688.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,768.64
|
| Rate for Payer: Blue Shield of California EPN |
$2,177.28
|
| Rate for Payer: Caremore Medicare Advantage |
$480.50
|
| Rate for Payer: Cash Price |
$2,016.00
|
| Rate for Payer: Cash Price |
$2,016.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,584.00
|
| Rate for Payer: Cigna of CA HMO |
$2,867.20
|
| Rate for Payer: Cigna of CA PPO |
$3,315.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| 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 |
$3,808.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,688.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,032.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,360.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$788.02
|
| Rate for Payer: IEHP medi-cal |
$792.82
|
| Rate for Payer: IEHP Medicare Advantage |
$480.50
|
| Rate for Payer: Innovage PACE Commercial |
$720.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,988.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$896.00
|
| 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 |
$3,360.00
|
| Rate for Payer: Networks By Design Commercial |
$2,912.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,808.00
|
| Rate for Payer: Prime Health Services Medicare |
$509.33
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$350.00
|
| Rate for Payer: Riverside University Health MISP |
$528.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,688.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,688.00
|
| 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 |
$111,574.40
|
| 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 BRAIN WITH CONTRAST
|
Facility
IP
|
$9,660.00
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
908801012
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,932.00 |
| Max. Negotiated Rate |
$8,694.00 |
| Rate for Payer: Cash Price |
$4,347.00
|
| Rate for Payer: Central Health Plan Commercial |
$7,728.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,864.00
|
| Rate for Payer: Galaxy Health WC |
$8,211.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,796.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,694.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,443.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,932.00
|
| Rate for Payer: Multiplan Commercial |
$7,245.00
|
| Rate for Payer: Networks By Design Commercial |
$6,279.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,211.00
|
|
|
HC MRI BRAIN WITH CONTRAST
|
Facility
OP
|
$4,480.00
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
908801013
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$111,574.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$480.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,055.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,759.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,646.78
|
| Rate for Payer: BCBS Transplant Transplant |
$2,688.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,768.64
|
| Rate for Payer: Blue Shield of California EPN |
$2,177.28
|
| Rate for Payer: Caremore Medicare Advantage |
$480.50
|
| Rate for Payer: Cash Price |
$2,016.00
|
| Rate for Payer: Cash Price |
$2,016.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,584.00
|
| Rate for Payer: Cigna of CA HMO |
$2,867.20
|
| Rate for Payer: Cigna of CA PPO |
$3,315.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| 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 |
$3,808.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,688.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,032.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,360.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$788.02
|
| Rate for Payer: IEHP medi-cal |
$792.82
|
| Rate for Payer: IEHP Medicare Advantage |
$480.50
|
| Rate for Payer: Innovage PACE Commercial |
$720.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,988.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$896.00
|
| 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 |
$3,360.00
|
| Rate for Payer: Networks By Design Commercial |
$2,912.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,808.00
|
| Rate for Payer: Prime Health Services Medicare |
$509.33
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$350.00
|
| Rate for Payer: Riverside University Health MISP |
$528.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,688.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,688.00
|
| 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 |
$111,574.40
|
| 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 BRAIN WITH CONTRAST
|
Facility
IP
|
$9,660.00
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
908801013
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,932.00 |
| Max. Negotiated Rate |
$8,694.00 |
| Rate for Payer: Cash Price |
$4,347.00
|
| Rate for Payer: Central Health Plan Commercial |
$7,728.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,864.00
|
| Rate for Payer: Galaxy Health WC |
$8,211.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,796.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,694.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,443.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,932.00
|
| Rate for Payer: Multiplan Commercial |
$7,245.00
|
| Rate for Payer: Networks By Design Commercial |
$6,279.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,211.00
|
|
|
HC MRI BRAIN WO CONTRAST
|
Facility
IP
|
$9,133.00
|
|
|
Service Code
|
CPT 70551
|
| Hospital Charge Code |
908801010
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,826.60 |
| Max. Negotiated Rate |
$8,219.70 |
| Rate for Payer: Cash Price |
$4,109.85
|
| Rate for Payer: Central Health Plan Commercial |
$7,306.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,653.20
|
| Rate for Payer: Galaxy Health WC |
$7,763.05
|
| Rate for Payer: Global Benefits Group Commercial |
$5,479.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,219.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,091.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,826.60
|
| Rate for Payer: Multiplan Commercial |
$6,849.75
|
| Rate for Payer: Networks By Design Commercial |
$5,936.45
|
| Rate for Payer: Prime Health Services Commercial |
$7,763.05
|
|
|
HC MRI BRAIN WO CONTRAST
|
Facility
OP
|
$4,236.00
|
|
|
Service Code
|
CPT 70551
|
| Hospital Charge Code |
908801010
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$306.16 |
| Max. Negotiated Rate |
$86,633.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$306.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,303.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,502.63
|
| Rate for Payer: BCBS Transplant Transplant |
$2,541.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,617.85
|
| Rate for Payer: Blue Shield of California EPN |
$2,058.70
|
| Rate for Payer: Caremore Medicare Advantage |
$306.16
|
| Rate for Payer: Cash Price |
$1,906.20
|
| Rate for Payer: Cash Price |
$1,906.20
|
| Rate for Payer: Central Health Plan Commercial |
$3,388.80
|
| Rate for Payer: Cigna of CA HMO |
$2,711.04
|
| Rate for Payer: Cigna of CA PPO |
$3,134.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| 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 |
$3,600.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,541.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,812.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,177.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$502.10
|
| Rate for Payer: IEHP medi-cal |
$505.16
|
| Rate for Payer: IEHP Medicare Advantage |
$306.16
|
| Rate for Payer: Innovage PACE Commercial |
$459.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,825.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$847.20
|
| 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 |
$3,177.00
|
| Rate for Payer: Networks By Design Commercial |
$2,753.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,600.60
|
| Rate for Payer: Prime Health Services Medicare |
$324.53
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$350.00
|
| Rate for Payer: Riverside University Health MISP |
$336.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,541.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,541.60
|
| 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 |
$86,633.60
|
| 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 BRAIN W WO CONTRAST
|
Facility
IP
|
$10,805.00
|
|
|
Service Code
|
CPT 70553
|
| Hospital Charge Code |
908801014
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$2,161.00 |
| Max. Negotiated Rate |
$9,724.50 |
| Rate for Payer: Cash Price |
$4,862.25
|
| Rate for Payer: Central Health Plan Commercial |
$8,644.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,322.00
|
| Rate for Payer: Galaxy Health WC |
$9,184.25
|
| Rate for Payer: Global Benefits Group Commercial |
$6,483.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,724.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,206.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,161.00
|
| Rate for Payer: Multiplan Commercial |
$8,103.75
|
| Rate for Payer: Networks By Design Commercial |
$7,023.25
|
| Rate for Payer: Prime Health Services Commercial |
$9,184.25
|
|
|
HC MRI BRAIN W WO CONTRAST
|
Facility
OP
|
$5,010.00
|
|
|
Service Code
|
CPT 70553
|
| Hospital Charge Code |
908801014
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$136,712.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$480.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,537.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,959.91
|
| Rate for Payer: BCBS Transplant Transplant |
$3,006.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,096.18
|
| Rate for Payer: Blue Shield of California EPN |
$2,434.86
|
| Rate for Payer: Caremore Medicare Advantage |
$480.50
|
| Rate for Payer: Cash Price |
$2,254.50
|
| Rate for Payer: Cash Price |
$2,254.50
|
| Rate for Payer: Central Health Plan Commercial |
$4,008.00
|
| Rate for Payer: Cigna of CA HMO |
$3,206.40
|
| Rate for Payer: Cigna of CA PPO |
$3,707.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| 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 |
$4,258.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,006.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,509.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,757.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$788.02
|
| Rate for Payer: IEHP medi-cal |
$792.82
|
| Rate for Payer: IEHP Medicare Advantage |
$480.50
|
| Rate for Payer: Innovage PACE Commercial |
$720.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,341.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,002.00
|
| 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 |
$3,757.50
|
| Rate for Payer: Networks By Design Commercial |
$3,256.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,258.50
|
| Rate for Payer: Prime Health Services Medicare |
$509.33
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$350.00
|
| Rate for Payer: Riverside University Health MISP |
$528.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,006.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,006.00
|
| 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 |
$136,712.00
|
| 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 BREAST BILAT WO CONTRAST
|
Facility
OP
|
$4,011.00
|
|
|
Service Code
|
CPT 77047
|
| Hospital Charge Code |
908801212
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$306.16 |
| Max. Negotiated Rate |
$59,024.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$306.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,055.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,264.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,369.70
|
| Rate for Payer: BCBS Transplant Transplant |
$2,406.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,478.80
|
| Rate for Payer: Blue Shield of California EPN |
$1,949.35
|
| Rate for Payer: Caremore Medicare Advantage |
$306.16
|
| Rate for Payer: Cash Price |
$1,804.95
|
| Rate for Payer: Cash Price |
$1,804.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,208.80
|
| Rate for Payer: Cigna of CA HMO |
$2,567.04
|
| Rate for Payer: Cigna of CA PPO |
$2,968.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| 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 |
$3,409.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,406.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,609.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,008.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$502.10
|
| Rate for Payer: IEHP medi-cal |
$505.16
|
| Rate for Payer: IEHP Medicare Advantage |
$306.16
|
| Rate for Payer: Innovage PACE Commercial |
$459.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,675.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$802.20
|
| 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 |
$3,008.25
|
| Rate for Payer: Networks By Design Commercial |
$2,607.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,409.35
|
| Rate for Payer: Prime Health Services Medicare |
$324.53
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$350.00
|
| Rate for Payer: Riverside University Health MISP |
$336.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,406.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,406.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$590.24
|
| Rate for Payer: United Healthcare All Other HMO |
$590.24
|
| Rate for Payer: United Healthcare HMO Rider |
$590.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59,024.00
|
| 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 BREAST BILAT WO CONTRAST
|
Facility
IP
|
$8,301.00
|
|
|
Service Code
|
CPT 77047
|
| Hospital Charge Code |
908801212
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,660.20 |
| Max. Negotiated Rate |
$7,470.90 |
| Rate for Payer: Cash Price |
$3,735.45
|
| Rate for Payer: Central Health Plan Commercial |
$6,640.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,320.40
|
| Rate for Payer: Galaxy Health WC |
$7,055.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,980.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,470.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,536.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,660.20
|
| Rate for Payer: Multiplan Commercial |
$6,225.75
|
| Rate for Payer: Networks By Design Commercial |
$5,395.65
|
| Rate for Payer: Prime Health Services Commercial |
$7,055.85
|
|
|
HC MRI BREAST UNI WO CONTRAST
|
Facility
IP
|
$7,373.00
|
|
|
Service Code
|
CPT 77046
|
| Hospital Charge Code |
908801219
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,474.60 |
| Max. Negotiated Rate |
$6,635.70 |
| Rate for Payer: Cash Price |
$3,317.85
|
| Rate for Payer: Central Health Plan Commercial |
$5,898.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,949.20
|
| Rate for Payer: Galaxy Health WC |
$6,267.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,423.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,635.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,917.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,474.60
|
| Rate for Payer: Multiplan Commercial |
$5,529.75
|
| Rate for Payer: Networks By Design Commercial |
$4,792.45
|
| Rate for Payer: Prime Health Services Commercial |
$6,267.05
|
|
|
HC MRI BREAST UNI WO CONTRAST
|
Facility
OP
|
$3,562.00
|
|
|
Service Code
|
CPT 77046
|
| Hospital Charge Code |
908801219
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$306.16 |
| Max. Negotiated Rate |
$59,024.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$306.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,055.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,272.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,104.43
|
| Rate for Payer: BCBS Transplant Transplant |
$2,137.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,201.32
|
| Rate for Payer: Blue Shield of California EPN |
$1,731.13
|
| Rate for Payer: Caremore Medicare Advantage |
$306.16
|
| Rate for Payer: Cash Price |
$1,602.90
|
| Rate for Payer: Cash Price |
$1,602.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,849.60
|
| Rate for Payer: Cigna of CA HMO |
$2,279.68
|
| Rate for Payer: Cigna of CA PPO |
$2,635.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| 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 |
$3,027.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,137.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,205.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,671.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$502.10
|
| Rate for Payer: IEHP medi-cal |
$505.16
|
| Rate for Payer: IEHP Medicare Advantage |
$306.16
|
| Rate for Payer: Innovage PACE Commercial |
$459.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,375.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$712.40
|
| 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 |
$2,671.50
|
| Rate for Payer: Networks By Design Commercial |
$2,315.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,027.70
|
| Rate for Payer: Prime Health Services Medicare |
$324.53
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$350.00
|
| Rate for Payer: Riverside University Health MISP |
$336.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,137.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,137.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$590.24
|
| Rate for Payer: United Healthcare All Other HMO |
$590.24
|
| Rate for Payer: United Healthcare HMO Rider |
$590.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59,024.00
|
| 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 BRST BI W WO CNTRST W CAD
|
Facility
IP
|
$10,113.00
|
|
|
Service Code
|
CPT 77049
|
| Hospital Charge Code |
908801210
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,022.60 |
| Max. Negotiated Rate |
$9,101.70 |
| Rate for Payer: Cash Price |
$4,550.85
|
| Rate for Payer: Central Health Plan Commercial |
$8,090.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,045.20
|
| Rate for Payer: Galaxy Health WC |
$8,596.05
|
| Rate for Payer: Global Benefits Group Commercial |
$6,067.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,101.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,745.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,022.60
|
| Rate for Payer: Multiplan Commercial |
$7,584.75
|
| Rate for Payer: Networks By Design Commercial |
$6,573.45
|
| Rate for Payer: Prime Health Services Commercial |
$8,596.05
|
|
|
HC MRI BRST BI W WO CNTRST W CAD
|
Facility
OP
|
$4,885.00
|
|
|
Service Code
|
CPT 77049
|
| Hospital Charge Code |
908801210
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$75,008.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,055.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,152.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,686.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,686.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,084.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,886.06
|
| Rate for Payer: BCBS Transplant 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: 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 |
$4,152.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,954.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,954.00
|
| 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 Transplant Other |
$3,663.75
|
| Rate for Payer: IEHP medi-cal |
$1,709.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,258.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$977.00
|
| 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: Redlands Yucaipa Medical Group Commercial/Senior |
$350.00
|
| Rate for Payer: Riverside University Health MISP |
$1,954.00
|
| 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 |
$750.08
|
| Rate for Payer: United Healthcare All Other HMO |
$750.08
|
| Rate for Payer: United Healthcare HMO Rider |
$750.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75,008.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,152.25
|
| Rate for Payer: Vantage Medical Group Senior |
$4,152.25
|
|
|
HC MRI BRST UNI W WO CTRST W CAD
|
Facility
OP
|
$4,507.00
|
|
|
Service Code
|
CPT 77048
|
| Hospital Charge Code |
908801215
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$75,376.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,055.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,830.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,478.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,478.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,094.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,662.74
|
| Rate for Payer: BCBS Transplant Transplant |
$2,704.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,785.33
|
| Rate for Payer: Blue Shield of California EPN |
$2,190.40
|
| Rate for Payer: Cash Price |
$2,028.15
|
| Rate for Payer: Cash Price |
$2,028.15
|
| Rate for Payer: Central Health Plan Commercial |
$3,605.60
|
| Rate for Payer: Cigna of CA HMO |
$2,884.48
|
| Rate for Payer: Cigna of CA PPO |
$3,335.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,830.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,802.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,802.80
|
| Rate for Payer: Galaxy Health WC |
$3,830.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,704.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,056.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,380.25
|
| Rate for Payer: IEHP medi-cal |
$1,577.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,006.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$901.40
|
| Rate for Payer: Multiplan Commercial |
$3,380.25
|
| Rate for Payer: Networks By Design Commercial |
$2,929.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,830.95
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$350.00
|
| Rate for Payer: Riverside University Health MISP |
$1,802.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,704.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,704.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$753.76
|
| Rate for Payer: United Healthcare All Other HMO |
$753.76
|
| Rate for Payer: United Healthcare HMO Rider |
$753.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75,376.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,830.95
|
| Rate for Payer: Vantage Medical Group Senior |
$3,830.95
|
|
|
HC MRI BRST UNI W WO CTRST W CAD
|
Facility
IP
|
$9,329.00
|
|
|
Service Code
|
CPT 77048
|
| Hospital Charge Code |
908801215
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,865.80 |
| Max. Negotiated Rate |
$8,396.10 |
| Rate for Payer: Cash Price |
$4,198.05
|
| Rate for Payer: Central Health Plan Commercial |
$7,463.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,731.60
|
| Rate for Payer: Galaxy Health WC |
$7,929.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,597.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,396.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,222.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,865.80
|
| Rate for Payer: Multiplan Commercial |
$6,996.75
|
| Rate for Payer: Networks By Design Commercial |
$6,063.85
|
| Rate for Payer: Prime Health Services Commercial |
$7,929.65
|
|
|
HC MRI CERVICAL SPINE W CONTRA
|
Facility
IP
|
$8,907.00
|
|
|
Service Code
|
CPT 72142
|
| Hospital Charge Code |
908801102
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,781.40 |
| Max. Negotiated Rate |
$8,016.30 |
| Rate for Payer: Cash Price |
$4,008.15
|
| Rate for Payer: Central Health Plan Commercial |
$7,125.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,562.80
|
| Rate for Payer: Galaxy Health WC |
$7,570.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,344.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,016.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,940.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,781.40
|
| Rate for Payer: Multiplan Commercial |
$6,680.25
|
| Rate for Payer: Networks By Design Commercial |
$5,789.55
|
| Rate for Payer: Prime Health Services Commercial |
$7,570.95
|
|
|
HC MRI CERVICAL SPINE W CONTRA
|
Facility
OP
|
$4,256.00
|
|
|
Service Code
|
CPT 72142
|
| Hospital Charge Code |
908801102
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$111,574.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$480.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,055.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,766.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,514.44
|
| Rate for Payer: BCBS Transplant Transplant |
$2,553.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,630.21
|
| Rate for Payer: Blue Shield of California EPN |
$2,068.42
|
| Rate for Payer: Caremore Medicare Advantage |
$480.50
|
| Rate for Payer: Cash Price |
$1,915.20
|
| Rate for Payer: Cash Price |
$1,915.20
|
| Rate for Payer: Central Health Plan Commercial |
$3,404.80
|
| Rate for Payer: Cigna of CA HMO |
$2,723.84
|
| Rate for Payer: Cigna of CA PPO |
$3,149.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| 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 |
$3,617.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,553.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,830.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,192.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$788.02
|
| Rate for Payer: IEHP medi-cal |
$792.82
|
| Rate for Payer: IEHP Medicare Advantage |
$480.50
|
| Rate for Payer: Innovage PACE Commercial |
$720.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,838.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$851.20
|
| 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 |
$3,192.00
|
| Rate for Payer: Networks By Design Commercial |
$2,766.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,617.60
|
| Rate for Payer: Prime Health Services Medicare |
$509.33
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$350.00
|
| Rate for Payer: Riverside University Health MISP |
$528.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,553.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,553.60
|
| 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 |
$111,574.40
|
| 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 CERVICAL SPINE WO CONT
|
Facility
OP
|
$4,104.00
|
|
|
Service Code
|
CPT 72141
|
| Hospital Charge Code |
908801100
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$306.16 |
| Max. Negotiated Rate |
$86,633.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$306.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,055.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: AlphaCare 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 |
$2,424.64
|
| Rate for Payer: BCBS Transplant Transplant |
$2,462.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,536.27
|
| Rate for Payer: Blue Shield of California EPN |
$1,994.54
|
| Rate for Payer: Caremore Medicare Advantage |
$306.16
|
| Rate for Payer: Cash Price |
$1,846.80
|
| Rate for Payer: Cash Price |
$1,846.80
|
| Rate for Payer: Central Health Plan Commercial |
$3,283.20
|
| Rate for Payer: Cigna of CA HMO |
$2,626.56
|
| Rate for Payer: Cigna of CA PPO |
$3,036.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| 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 |
$3,488.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,462.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,693.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,078.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$502.10
|
| Rate for Payer: IEHP medi-cal |
$505.16
|
| Rate for Payer: IEHP Medicare Advantage |
$306.16
|
| Rate for Payer: Innovage PACE Commercial |
$459.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,737.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$820.80
|
| 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 |
$3,078.00
|
| Rate for Payer: Networks By Design Commercial |
$2,667.60
|
| Rate for Payer: Prime Health Services Commercial |
$3,488.40
|
| Rate for Payer: Prime Health Services Medicare |
$324.53
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$350.00
|
| Rate for Payer: Riverside University Health MISP |
$336.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,462.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,462.40
|
| 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 |
$86,633.60
|
| 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 CERVICAL SPINE WO CONT
|
Facility
IP
|
$8,493.00
|
|
|
Service Code
|
CPT 72141
|
| Hospital Charge Code |
908801100
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,698.60 |
| Max. Negotiated Rate |
$7,643.70 |
| Rate for Payer: Cash Price |
$3,821.85
|
| Rate for Payer: Central Health Plan Commercial |
$6,794.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,397.20
|
| Rate for Payer: Galaxy Health WC |
$7,219.05
|
| Rate for Payer: Global Benefits Group Commercial |
$5,095.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,643.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,664.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,698.60
|
| Rate for Payer: Multiplan Commercial |
$6,369.75
|
| Rate for Payer: Networks By Design Commercial |
$5,520.45
|
| Rate for Payer: Prime Health Services Commercial |
$7,219.05
|
|
