|
HC MRI CHEST W/ CONTRAST
|
Facility
IP
|
$8,493.00
|
|
|
Service Code
|
CPT 71551
|
| Hospital Charge Code |
908801201
|
|
Hospital Revenue Code
|
610
|
| 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
|
|
|
HC MRI CHEST W/ CONTRAST
|
Facility
OP
|
$4,104.00
|
|
|
Service Code
|
CPT 71551
|
| Hospital Charge Code |
908801201
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$111,574.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,000.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,500.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,000.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,814.95
|
| 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 |
$1,000.40
|
| 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 |
$1,500.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,350.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,000.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,000.40
|
| 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 |
$1,640.66
|
| Rate for Payer: IEHP medi-cal |
$1,650.66
|
| Rate for Payer: IEHP Medicare Advantage |
$1,000.40
|
| Rate for Payer: Innovage PACE Commercial |
$1,500.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,737.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,000.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$820.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,340.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,340.54
|
| 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 |
$1,060.42
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$350.00
|
| Rate for Payer: Riverside University Health MISP |
$1,100.44
|
| 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 |
$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 |
$1,500.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: Vantage Medical Group Senior |
$1,000.40
|
|
|
HC MRI CHEST, W/O CONT
|
Facility
IP
|
$7,599.00
|
|
|
Service Code
|
CPT 71550
|
| Hospital Charge Code |
908801200
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,519.80 |
| Max. Negotiated Rate |
$6,839.10 |
| Rate for Payer: Cash Price |
$3,419.55
|
| Rate for Payer: Central Health Plan Commercial |
$6,079.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,039.60
|
| Rate for Payer: Galaxy Health WC |
$6,459.15
|
| Rate for Payer: Global Benefits Group Commercial |
$4,559.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,839.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,068.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,519.80
|
| Rate for Payer: Multiplan Commercial |
$5,699.25
|
| Rate for Payer: Networks By Design Commercial |
$4,939.35
|
| Rate for Payer: Prime Health Services Commercial |
$6,459.15
|
|
|
HC MRI CHEST, W/O CONT
|
Facility
OP
|
$3,671.00
|
|
|
Service Code
|
CPT 71550
|
| Hospital Charge Code |
908801200
|
|
Hospital Revenue Code
|
610
|
| 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 |
$2,305.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,168.83
|
| Rate for Payer: BCBS Transplant Transplant |
$2,202.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,268.68
|
| Rate for Payer: Blue Shield of California EPN |
$1,784.11
|
| Rate for Payer: Caremore Medicare Advantage |
$306.16
|
| Rate for Payer: Cash Price |
$1,651.95
|
| Rate for Payer: Cash Price |
$1,651.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,936.80
|
| Rate for Payer: Cigna of CA HMO |
$2,349.44
|
| Rate for Payer: Cigna of CA PPO |
$2,716.54
|
| 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 |
$3,120.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,202.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,303.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,753.25
|
| 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 |
$2,448.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$734.20
|
| 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 |
$2,753.25
|
| Rate for Payer: Networks By Design Commercial |
$2,386.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,120.35
|
| 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 |
$2,202.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,202.60
|
| 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 CHEST W WO CONTRAST
|
Facility
IP
|
$12,570.00
|
|
|
Service Code
|
CPT 71552
|
| Hospital Charge Code |
908801202
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,514.00 |
| Max. Negotiated Rate |
$11,313.00 |
| Rate for Payer: Cash Price |
$5,656.50
|
| Rate for Payer: Central Health Plan Commercial |
$10,056.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,028.00
|
| Rate for Payer: Galaxy Health WC |
$10,684.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,542.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,313.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,384.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,514.00
|
| Rate for Payer: Multiplan Commercial |
$9,427.50
|
| Rate for Payer: Networks By Design Commercial |
$8,170.50
|
| Rate for Payer: Prime Health Services Commercial |
$10,684.50
|
|
|
HC MRI CHEST W WO CONTRAST
|
Facility
OP
|
$4,859.00
|
|
|
Service Code
|
CPT 71552
|
| Hospital Charge Code |
908801202
|
|
Hospital Revenue Code
|
610
|
| 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 |
$5,176.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,870.70
|
| Rate for Payer: BCBS Transplant Transplant |
$2,915.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,002.86
|
| Rate for Payer: Blue Shield of California EPN |
$2,361.47
|
| Rate for Payer: Caremore Medicare Advantage |
$480.50
|
| Rate for Payer: Cash Price |
$2,186.55
|
| Rate for Payer: Cash Price |
$2,186.55
|
| Rate for Payer: Central Health Plan Commercial |
$3,887.20
|
| Rate for Payer: Cigna of CA HMO |
$3,109.76
|
| Rate for Payer: Cigna of CA PPO |
$3,595.66
|
| 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 |
$4,130.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,915.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,373.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,644.25
|
| 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 |
$3,240.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$971.80
|
| 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 |
$3,644.25
|
| Rate for Payer: Networks By Design Commercial |
$3,158.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,130.15
|
| 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 |
$2,915.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,915.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,367.12
|
| Rate for Payer: United Healthcare All Other HMO |
$1,367.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1,367.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$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 C-SPINE W & WO CONTRAST
|
Facility
IP
|
$10,204.00
|
|
|
Service Code
|
CPT 72156
|
| Hospital Charge Code |
908801104
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$2,040.80 |
| Max. Negotiated Rate |
$9,183.60 |
| Rate for Payer: Cash Price |
$4,591.80
|
| Rate for Payer: Central Health Plan Commercial |
$8,163.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,081.60
|
| Rate for Payer: Galaxy Health WC |
$8,673.40
|
| Rate for Payer: Global Benefits Group Commercial |
$6,122.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,183.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,806.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,040.80
|
| Rate for Payer: Multiplan Commercial |
$7,653.00
|
| Rate for Payer: Networks By Design Commercial |
$6,632.60
|
| Rate for Payer: Prime Health Services Commercial |
$8,673.40
|
|
|
HC MRI C-SPINE W & WO CONTRAST
|
Facility
OP
|
$4,480.00
|
|
|
Service Code
|
CPT 72156
|
| Hospital Charge Code |
908801104
|
|
Hospital Revenue Code
|
612
|
| 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 |
$4,535.56
|
| 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 |
$1,367.12
|
| 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 FETAL PELVIC IMG 1ST FETUS
|
Facility
IP
|
$1,226.00
|
|
|
Service Code
|
CPT 74712
|
| Hospital Charge Code |
908874712
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$245.20 |
| Max. Negotiated Rate |
$1,103.40 |
| Rate for Payer: Cash Price |
$551.70
|
| Rate for Payer: Central Health Plan Commercial |
$980.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$490.40
|
| Rate for Payer: Galaxy Health WC |
$1,042.10
|
| Rate for Payer: Global Benefits Group Commercial |
$735.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,103.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$817.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$245.20
|
| Rate for Payer: Multiplan Commercial |
$919.50
|
| Rate for Payer: Networks By Design Commercial |
$796.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,042.10
|
|
|
HC MRI FETAL PELVIC IMG 1ST FETUS
|
Facility
OP
|
$1,226.00
|
|
|
Service Code
|
CPT 74712
|
| Hospital Charge Code |
908874712
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$245.20 |
| Max. Negotiated Rate |
$5,165.36 |
| 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 |
$4,234.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,165.36
|
| Rate for Payer: BCBS Transplant Transplant |
$735.60
|
| Rate for Payer: Blue Shield of California Commercial |
$757.67
|
| Rate for Payer: Blue Shield of California EPN |
$595.84
|
| Rate for Payer: Caremore Medicare Advantage |
$306.16
|
| Rate for Payer: Cash Price |
$551.70
|
| Rate for Payer: Cash Price |
$551.70
|
| Rate for Payer: Central Health Plan Commercial |
$980.80
|
| Rate for Payer: Cigna of CA HMO |
$784.64
|
| Rate for Payer: Cigna of CA PPO |
$907.24
|
| 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 |
$1,042.10
|
| Rate for Payer: Global Benefits Group Commercial |
$735.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,103.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$919.50
|
| 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 |
$817.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$245.20
|
| 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 |
$919.50
|
| Rate for Payer: Networks By Design Commercial |
$796.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,042.10
|
| Rate for Payer: Prime Health Services Medicare |
$324.53
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$735.60
|
| Rate for Payer: Riverside University Health MISP |
$336.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$735.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$735.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$700.26
|
| Rate for Payer: United Healthcare All Other HMO |
$700.26
|
| Rate for Payer: United Healthcare HMO Rider |
$700.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$700.26
|
| Rate for Payer: 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 FETAL PELVIC IMG ADD FETUS
|
Facility
IP
|
$613.00
|
|
|
Service Code
|
CPT 74713
|
| Hospital Charge Code |
908874713
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$122.60 |
| Max. Negotiated Rate |
$551.70 |
| Rate for Payer: Cash Price |
$275.85
|
| Rate for Payer: Central Health Plan Commercial |
$490.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$245.20
|
| Rate for Payer: Galaxy Health WC |
$521.05
|
| Rate for Payer: Global Benefits Group Commercial |
$367.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$551.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$408.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.60
|
| Rate for Payer: Multiplan Commercial |
$459.75
|
| Rate for Payer: Networks By Design Commercial |
$398.45
|
| Rate for Payer: Prime Health Services Commercial |
$521.05
|
|
|
HC MRI FETAL PELVIC IMG ADD FETUS
|
Facility
OP
|
$613.00
|
|
|
Service Code
|
CPT 74713
|
| Hospital Charge Code |
908874713
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$122.60 |
| Max. Negotiated Rate |
$2,213.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,055.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$521.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$337.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$337.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,814.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,213.25
|
| Rate for Payer: BCBS Transplant Transplant |
$367.80
|
| Rate for Payer: Blue Shield of California Commercial |
$378.83
|
| Rate for Payer: Blue Shield of California EPN |
$297.92
|
| Rate for Payer: Cash Price |
$275.85
|
| Rate for Payer: Cash Price |
$275.85
|
| Rate for Payer: Central Health Plan Commercial |
$490.40
|
| Rate for Payer: Cigna of CA HMO |
$392.32
|
| Rate for Payer: Cigna of CA PPO |
$453.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$521.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$245.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$245.20
|
| Rate for Payer: Galaxy Health WC |
$521.05
|
| Rate for Payer: Global Benefits Group Commercial |
$367.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$551.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$459.75
|
| Rate for Payer: IEHP medi-cal |
$214.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$408.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.60
|
| Rate for Payer: Multiplan Commercial |
$459.75
|
| Rate for Payer: Networks By Design Commercial |
$398.45
|
| Rate for Payer: Prime Health Services Commercial |
$521.05
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$367.80
|
| Rate for Payer: Riverside University Health MISP |
$245.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$367.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$367.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$306.50
|
| Rate for Payer: United Healthcare All Other HMO |
$306.50
|
| Rate for Payer: United Healthcare HMO Rider |
$306.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$306.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$521.05
|
| Rate for Payer: Vantage Medical Group Senior |
$521.05
|
|
|
HC MRI FOR TISSUE ABLATION
|
Facility
IP
|
$1,044.00
|
|
|
Service Code
|
CPT 77022
|
| Hospital Charge Code |
908877022
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$208.80 |
| Max. Negotiated Rate |
$939.60 |
| Rate for Payer: Cash Price |
$469.80
|
| Rate for Payer: Central Health Plan Commercial |
$835.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$417.60
|
| Rate for Payer: Galaxy Health WC |
$887.40
|
| Rate for Payer: Global Benefits Group Commercial |
$626.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$939.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$696.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.80
|
| Rate for Payer: Multiplan Commercial |
$783.00
|
| Rate for Payer: Networks By Design Commercial |
$678.60
|
| Rate for Payer: Prime Health Services Commercial |
$887.40
|
|
|
HC MRI FOR TISSUE ABLATION
|
Facility
OP
|
$1,044.00
|
|
|
Service Code
|
CPT 77022
|
| Hospital Charge Code |
908877022
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$208.80 |
| Max. Negotiated Rate |
$2,364.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,055.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$887.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$574.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$574.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,364.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$616.80
|
| Rate for Payer: BCBS Transplant Transplant |
$626.40
|
| Rate for Payer: Blue Shield of California Commercial |
$645.19
|
| Rate for Payer: Blue Shield of California EPN |
$507.38
|
| Rate for Payer: Cash Price |
$469.80
|
| Rate for Payer: Cash Price |
$469.80
|
| Rate for Payer: Central Health Plan Commercial |
$835.20
|
| Rate for Payer: Cigna of CA HMO |
$668.16
|
| Rate for Payer: Cigna of CA PPO |
$772.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$887.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$417.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$417.60
|
| Rate for Payer: Galaxy Health WC |
$887.40
|
| Rate for Payer: Global Benefits Group Commercial |
$626.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$939.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$783.00
|
| Rate for Payer: IEHP medi-cal |
$365.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$696.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.80
|
| Rate for Payer: Multiplan Commercial |
$783.00
|
| Rate for Payer: Networks By Design Commercial |
$678.60
|
| Rate for Payer: Prime Health Services Commercial |
$887.40
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$350.00
|
| Rate for Payer: Riverside University Health MISP |
$417.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$626.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$626.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$522.00
|
| Rate for Payer: United Healthcare All Other HMO |
$522.00
|
| Rate for Payer: United Healthcare HMO Rider |
$522.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$522.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$887.40
|
| Rate for Payer: Vantage Medical Group Senior |
$887.40
|
|
|
HC MRI GUID BX/NEEDLE LOC/ASPIR
|
Facility
OP
|
$5,198.00
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
909002020
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$4,678.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,055.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,418.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,858.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,858.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,364.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,070.98
|
| Rate for Payer: BCBS Transplant Transplant |
$3,118.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,212.36
|
| Rate for Payer: Blue Shield of California EPN |
$2,526.23
|
| Rate for Payer: Cash Price |
$2,339.10
|
| Rate for Payer: Cash Price |
$2,339.10
|
| Rate for Payer: Central Health Plan Commercial |
$4,158.40
|
| Rate for Payer: Cigna of CA HMO |
$3,326.72
|
| Rate for Payer: Cigna of CA PPO |
$3,846.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,418.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,079.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,079.20
|
| Rate for Payer: Galaxy Health WC |
$4,418.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,118.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,678.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,898.50
|
| Rate for Payer: IEHP medi-cal |
$1,819.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,467.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,039.60
|
| Rate for Payer: Multiplan Commercial |
$3,898.50
|
| Rate for Payer: Networks By Design Commercial |
$3,378.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,418.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$350.00
|
| Rate for Payer: Riverside University Health MISP |
$2,079.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,118.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,118.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,599.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,599.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,599.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,599.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,418.30
|
| Rate for Payer: Vantage Medical Group Senior |
$4,418.30
|
|
|
HC MRI GUID BX/NEEDLE LOC/ASPIR
|
Facility
IP
|
$10,758.00
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
909002020
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,151.60 |
| Max. Negotiated Rate |
$9,682.20 |
| Rate for Payer: Cash Price |
$4,841.10
|
| Rate for Payer: Central Health Plan Commercial |
$8,606.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,303.20
|
| Rate for Payer: Galaxy Health WC |
$9,144.30
|
| Rate for Payer: Global Benefits Group Commercial |
$6,454.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,682.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,175.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,151.60
|
| Rate for Payer: Multiplan Commercial |
$8,068.50
|
| Rate for Payer: Networks By Design Commercial |
$6,992.70
|
| Rate for Payer: Prime Health Services Commercial |
$9,144.30
|
|
|
HC MRI INSERTABLE IMAGING COIL
|
Facility
IP
|
$525.00
|
|
|
Service Code
|
CPT C1770
|
| Hospital Charge Code |
908801710
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$472.50 |
| Rate for Payer: Blue Shield of California EPN |
$280.35
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Central Health Plan Commercial |
$420.00
|
| Rate for Payer: Cigna of CA HMO |
$367.50
|
| Rate for Payer: Cigna of CA PPO |
$367.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$210.00
|
| Rate for Payer: Galaxy Health WC |
$446.25
|
| Rate for Payer: Global Benefits Group Commercial |
$315.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$472.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$350.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.00
|
| Rate for Payer: Multiplan Commercial |
$393.75
|
| Rate for Payer: Prime Health Services Commercial |
$446.25
|
|
|
HC MRI INSERTABLE IMAGING COIL
|
Facility
OP
|
$525.00
|
|
|
Service Code
|
CPT C1770
|
| Hospital Charge Code |
908801710
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$1,321.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,321.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$446.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$288.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$288.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$239.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$292.42
|
| Rate for Payer: BCBS Transplant Transplant |
$315.00
|
| Rate for Payer: Blue Shield of California Commercial |
$393.75
|
| Rate for Payer: Blue Shield of California EPN |
$285.60
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Central Health Plan Commercial |
$420.00
|
| Rate for Payer: Cigna of CA HMO |
$367.50
|
| Rate for Payer: Cigna of CA PPO |
$367.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$446.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$210.00
|
| Rate for Payer: Galaxy Health WC |
$446.25
|
| Rate for Payer: Global Benefits Group Commercial |
$315.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$472.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$393.75
|
| Rate for Payer: IEHP medi-cal |
$183.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$350.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.00
|
| Rate for Payer: Multiplan Commercial |
$393.75
|
| Rate for Payer: Networks By Design Commercial |
$262.50
|
| Rate for Payer: Prime Health Services Commercial |
$446.25
|
| Rate for Payer: Riverside University Health MISP |
$210.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$315.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$315.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$262.50
|
| Rate for Payer: United Healthcare All Other HMO |
$262.50
|
| Rate for Payer: United Healthcare HMO Rider |
$262.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$262.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$446.25
|
| Rate for Payer: Vantage Medical Group Senior |
$446.25
|
|
|
HC MRI LOWER EXTREMITY W/O CON
|
Facility
IP
|
$6,990.00
|
|
|
Service Code
|
CPT 73718
|
| Hospital Charge Code |
908801402
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,398.00 |
| Max. Negotiated Rate |
$6,291.00 |
| Rate for Payer: Cash Price |
$3,145.50
|
| Rate for Payer: Central Health Plan Commercial |
$5,592.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,796.00
|
| Rate for Payer: Galaxy Health WC |
$5,941.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,194.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,291.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,662.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,398.00
|
| Rate for Payer: Multiplan Commercial |
$5,242.50
|
| Rate for Payer: Networks By Design Commercial |
$4,543.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,941.50
|
|
|
HC MRI LOWER EXTREMITY W/O CON
|
Facility
OP
|
$3,310.00
|
|
|
Service Code
|
CPT 73718
|
| Hospital Charge Code |
908801402
|
|
Hospital Revenue Code
|
614
|
| 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 |
$2,342.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,955.55
|
| Rate for Payer: BCBS Transplant Transplant |
$1,986.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,045.58
|
| Rate for Payer: Blue Shield of California EPN |
$1,608.66
|
| Rate for Payer: Caremore Medicare Advantage |
$306.16
|
| Rate for Payer: Cash Price |
$1,489.50
|
| Rate for Payer: Cash Price |
$1,489.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,648.00
|
| Rate for Payer: Cigna of CA HMO |
$2,118.40
|
| Rate for Payer: Cigna of CA PPO |
$2,449.40
|
| 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 |
$2,813.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,986.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,979.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,482.50
|
| 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 |
$2,207.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$662.00
|
| 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 |
$2,482.50
|
| Rate for Payer: Networks By Design Commercial |
$2,151.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,813.50
|
| 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 |
$1,986.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,986.00
|
| 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 |
$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 LOWER EXTREM JOINT W CONT
|
Facility
OP
|
$3,496.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
908801376
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$111,574.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,000.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,500.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,000.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,808.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,065.44
|
| Rate for Payer: BCBS Transplant Transplant |
$2,097.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,160.53
|
| Rate for Payer: Blue Shield of California EPN |
$1,699.06
|
| Rate for Payer: Caremore Medicare Advantage |
$1,000.40
|
| Rate for Payer: Cash Price |
$1,573.20
|
| Rate for Payer: Cash Price |
$1,573.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,796.80
|
| Rate for Payer: Cigna of CA HMO |
$2,237.44
|
| Rate for Payer: Cigna of CA PPO |
$2,587.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,500.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,350.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,000.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,000.40
|
| Rate for Payer: Galaxy Health WC |
$2,971.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,097.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,146.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,622.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,640.66
|
| Rate for Payer: IEHP medi-cal |
$1,650.66
|
| Rate for Payer: IEHP Medicare Advantage |
$1,000.40
|
| Rate for Payer: Innovage PACE Commercial |
$1,500.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,331.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,000.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$699.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,340.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,340.54
|
| Rate for Payer: Multiplan Commercial |
$2,622.00
|
| Rate for Payer: Networks By Design Commercial |
$2,272.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,971.60
|
| Rate for Payer: Prime Health Services Medicare |
$1,060.42
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$350.00
|
| Rate for Payer: Riverside University Health MISP |
$1,100.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,097.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,097.60
|
| 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 |
$1,500.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: Vantage Medical Group Senior |
$1,000.40
|
|
|
HC MRI LOWER EXTREM JOINT W CONT
|
Facility
IP
|
$7,237.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
908801376
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,447.40 |
| Max. Negotiated Rate |
$6,513.30 |
| Rate for Payer: Cash Price |
$3,256.65
|
| Rate for Payer: Central Health Plan Commercial |
$5,789.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,894.80
|
| Rate for Payer: Galaxy Health WC |
$6,151.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,342.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,513.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,827.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,447.40
|
| Rate for Payer: Multiplan Commercial |
$5,427.75
|
| Rate for Payer: Networks By Design Commercial |
$4,704.05
|
| Rate for Payer: Prime Health Services Commercial |
$6,151.45
|
|
|
HC MRI LOWER EXTREM JOINT WO CONT
|
Facility
IP
|
$6,849.00
|
|
|
Service Code
|
CPT 73721
|
| Hospital Charge Code |
908801441
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,369.80 |
| Max. Negotiated Rate |
$6,164.10 |
| Rate for Payer: Cash Price |
$3,082.05
|
| Rate for Payer: Central Health Plan Commercial |
$5,479.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,739.60
|
| Rate for Payer: Galaxy Health WC |
$5,821.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,109.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,164.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,568.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,369.80
|
| Rate for Payer: Multiplan Commercial |
$5,136.75
|
| Rate for Payer: Networks By Design Commercial |
$4,451.85
|
| Rate for Payer: Prime Health Services Commercial |
$5,821.65
|
|
|
HC MRI LOWER EXTREM JOINT WO CONT
|
Facility
OP
|
$3,310.00
|
|
|
Service Code
|
CPT 73721
|
| Hospital Charge Code |
908801441
|
|
Hospital Revenue Code
|
610
|
| 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 |
$2,295.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,955.55
|
| Rate for Payer: BCBS Transplant Transplant |
$1,986.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,045.58
|
| Rate for Payer: Blue Shield of California EPN |
$1,608.66
|
| Rate for Payer: Caremore Medicare Advantage |
$306.16
|
| Rate for Payer: Cash Price |
$1,489.50
|
| Rate for Payer: Cash Price |
$1,489.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,648.00
|
| Rate for Payer: Cigna of CA HMO |
$2,118.40
|
| Rate for Payer: Cigna of CA PPO |
$2,449.40
|
| 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 |
$2,813.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,986.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,979.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,482.50
|
| 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 |
$2,207.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$662.00
|
| 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 |
$2,482.50
|
| Rate for Payer: Networks By Design Commercial |
$2,151.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,813.50
|
| 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 |
$1,986.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,986.00
|
| 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 |
$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 LOWER EXTREM JOIN W & WO CONT
|
Facility
OP
|
$5,355.00
|
|
|
Service Code
|
CPT 73723
|
| Hospital Charge Code |
908801377
|
|
Hospital Revenue Code
|
610
|
| 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 |
$5,198.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,163.73
|
| Rate for Payer: BCBS Transplant Transplant |
$3,213.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,309.39
|
| Rate for Payer: Blue Shield of California EPN |
$2,602.53
|
| Rate for Payer: Caremore Medicare Advantage |
$480.50
|
| Rate for Payer: Cash Price |
$2,409.75
|
| Rate for Payer: Cash Price |
$2,409.75
|
| Rate for Payer: Central Health Plan Commercial |
$4,284.00
|
| Rate for Payer: Cigna of CA HMO |
$3,427.20
|
| Rate for Payer: Cigna of CA PPO |
$3,962.70
|
| 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 |
$4,551.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,213.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,819.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,016.25
|
| 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 |
$3,571.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,071.00
|
| 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 |
$4,016.25
|
| Rate for Payer: Networks By Design Commercial |
$3,480.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,551.75
|
| 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 |
$3,213.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,213.00
|
| 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
|
|
