|
HC MRI LOWER EXTREM JOIN W & WO CONT
|
Facility
IP
|
$11,086.00
|
|
|
Service Code
|
CPT 73723
|
| Hospital Charge Code |
908801377
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,217.20 |
| Max. Negotiated Rate |
$9,977.40 |
| Rate for Payer: Cash Price |
$4,988.70
|
| Rate for Payer: Central Health Plan Commercial |
$8,868.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,434.40
|
| Rate for Payer: Galaxy Health WC |
$9,423.10
|
| Rate for Payer: Global Benefits Group Commercial |
$6,651.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,977.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,394.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,217.20
|
| Rate for Payer: Multiplan Commercial |
$8,314.50
|
| Rate for Payer: Networks By Design Commercial |
$7,205.90
|
| Rate for Payer: Prime Health Services Commercial |
$9,423.10
|
|
|
HC MRI LOWER EXTREM W/ CON
|
Facility
IP
|
$7,631.00
|
|
|
Service Code
|
CPT 73719
|
| Hospital Charge Code |
908801403
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,526.20 |
| Max. Negotiated Rate |
$6,867.90 |
| Rate for Payer: Cash Price |
$3,433.95
|
| Rate for Payer: Central Health Plan Commercial |
$6,104.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,052.40
|
| Rate for Payer: Galaxy Health WC |
$6,486.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,578.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,867.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,089.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,526.20
|
| Rate for Payer: Multiplan Commercial |
$5,723.25
|
| Rate for Payer: Networks By Design Commercial |
$4,960.15
|
| Rate for Payer: Prime Health Services Commercial |
$6,486.35
|
|
|
HC MRI LOWER EXTREM W/ CON
|
Facility
OP
|
$3,687.00
|
|
|
Service Code
|
CPT 73719
|
| Hospital Charge Code |
908801403
|
|
Hospital Revenue Code
|
614
|
| 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 |
$2,808.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,178.28
|
| Rate for Payer: BCBS Transplant Transplant |
$2,212.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,278.57
|
| Rate for Payer: Blue Shield of California EPN |
$1,791.88
|
| Rate for Payer: Caremore Medicare Advantage |
$480.50
|
| Rate for Payer: Cash Price |
$1,659.15
|
| Rate for Payer: Cash Price |
$1,659.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,949.60
|
| Rate for Payer: Cigna of CA HMO |
$2,359.68
|
| Rate for Payer: Cigna of CA PPO |
$2,728.38
|
| 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 |
$3,133.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,212.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,318.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,765.25
|
| 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 |
$2,459.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$737.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.87
|
| Rate for Payer: Multiplan Commercial |
$2,765.25
|
| Rate for Payer: Networks By Design Commercial |
$2,396.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,133.95
|
| 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 |
$2,212.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,212.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,115.74
|
| Rate for Payer: United Healthcare All Other HMO |
$1,115.74
|
| Rate for Payer: United Healthcare HMO Rider |
$1,115.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$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 LOWER EXTREM WO CONT
|
Facility
IP
|
$10,716.00
|
|
|
Service Code
|
CPT 73720
|
| Hospital Charge Code |
908801399
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,143.20 |
| Max. Negotiated Rate |
$9,644.40 |
| Rate for Payer: Cash Price |
$4,822.20
|
| Rate for Payer: Central Health Plan Commercial |
$8,572.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,286.40
|
| Rate for Payer: Galaxy Health WC |
$9,108.60
|
| Rate for Payer: Global Benefits Group Commercial |
$6,429.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,644.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,147.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,143.20
|
| Rate for Payer: Multiplan Commercial |
$8,037.00
|
| Rate for Payer: Networks By Design Commercial |
$6,965.40
|
| Rate for Payer: Prime Health Services Commercial |
$9,108.60
|
|
|
HC MRI LOWER EXTREM WO CONT
|
Facility
OP
|
$4,142.00
|
|
|
Service Code
|
CPT 73720
|
| Hospital Charge Code |
908801399
|
|
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 |
$2,303.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,447.09
|
| Rate for Payer: BCBS Transplant Transplant |
$2,485.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,559.76
|
| Rate for Payer: Blue Shield of California EPN |
$2,013.01
|
| Rate for Payer: Caremore Medicare Advantage |
$480.50
|
| Rate for Payer: Cash Price |
$1,863.90
|
| Rate for Payer: Cash Price |
$1,863.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,313.60
|
| Rate for Payer: Cigna of CA HMO |
$2,650.88
|
| Rate for Payer: Cigna of CA PPO |
$3,065.08
|
| 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 |
$3,520.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,485.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,727.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,106.50
|
| 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 |
$2,762.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$828.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.87
|
| Rate for Payer: Multiplan Commercial |
$3,106.50
|
| Rate for Payer: Networks By Design Commercial |
$2,692.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,520.70
|
| 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 |
$2,485.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,485.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,367.12
|
| Rate for Payer: United Healthcare All Other HMO |
$1,367.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1,367.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$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 L-SPINE W & WO CONTRAST
|
Facility
IP
|
$10,204.00
|
|
|
Service Code
|
CPT 72158
|
| Hospital Charge Code |
908801124
|
|
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 L-SPINE W & WO CONTRAST
|
Facility
OP
|
$4,480.00
|
|
|
Service Code
|
CPT 72158
|
| Hospital Charge Code |
908801124
|
|
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 |
$4,537.33
|
| 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 LUMBAR SPINE W CONTRAST
|
Facility
OP
|
$4,256.00
|
|
|
Service Code
|
CPT 72149
|
| Hospital Charge Code |
908801122
|
|
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 |
$2,954.00
|
| 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 |
$2,764.56
|
| 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 LUMBAR SPINE W CONTRAST
|
Facility
IP
|
$9,775.00
|
|
|
Service Code
|
CPT 72149
|
| Hospital Charge Code |
908801122
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,955.00 |
| Max. Negotiated Rate |
$8,797.50 |
| Rate for Payer: Cash Price |
$4,398.75
|
| Rate for Payer: Central Health Plan Commercial |
$7,820.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,910.00
|
| Rate for Payer: Galaxy Health WC |
$8,308.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,865.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,797.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,519.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,955.00
|
| Rate for Payer: Multiplan Commercial |
$7,331.25
|
| Rate for Payer: Networks By Design Commercial |
$6,353.75
|
| Rate for Payer: Prime Health Services Commercial |
$8,308.75
|
|
|
HC MRI LUMBAR SPINE WO CONTR
|
Facility
OP
|
$4,104.00
|
|
|
Service Code
|
CPT 72148
|
| Hospital Charge Code |
908801120
|
|
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 |
$2,954.00
|
| 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 |
$2,554.40
|
| 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 LUMBAR SPINE WO CONTR
|
Facility
IP
|
$8,730.00
|
|
|
Service Code
|
CPT 72148
|
| Hospital Charge Code |
908801120
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,746.00 |
| Max. Negotiated Rate |
$7,857.00 |
| Rate for Payer: Cash Price |
$3,928.50
|
| Rate for Payer: Central Health Plan Commercial |
$6,984.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,492.00
|
| Rate for Payer: Galaxy Health WC |
$7,420.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,238.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,857.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,822.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,746.00
|
| Rate for Payer: Multiplan Commercial |
$6,547.50
|
| Rate for Payer: Networks By Design Commercial |
$5,674.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,420.50
|
|
|
HC MRI ORBIT FACE/NECK W CON
|
Facility
IP
|
$7,837.00
|
|
|
Service Code
|
CPT 70542
|
| Hospital Charge Code |
908801081
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,567.40 |
| Max. Negotiated Rate |
$7,053.30 |
| Rate for Payer: Cash Price |
$3,526.65
|
| Rate for Payer: Central Health Plan Commercial |
$6,269.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,134.80
|
| Rate for Payer: Galaxy Health WC |
$6,661.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,702.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,053.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,227.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,567.40
|
| Rate for Payer: Multiplan Commercial |
$5,877.75
|
| Rate for Payer: Networks By Design Commercial |
$5,094.05
|
| Rate for Payer: Prime Health Services Commercial |
$6,661.45
|
|
|
HC MRI ORBIT FACE/NECK W CON
|
Facility
OP
|
$4,146.00
|
|
|
Service Code
|
CPT 70542
|
| Hospital Charge Code |
908801081
|
|
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 |
$2,954.00
|
| 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 |
$2,808.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,449.46
|
| Rate for Payer: BCBS Transplant Transplant |
$2,487.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,562.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,014.96
|
| Rate for Payer: Caremore Medicare Advantage |
$480.50
|
| Rate for Payer: Cash Price |
$1,865.70
|
| Rate for Payer: Cash Price |
$1,865.70
|
| Rate for Payer: Central Health Plan Commercial |
$3,316.80
|
| Rate for Payer: Cigna of CA HMO |
$2,653.44
|
| Rate for Payer: Cigna of CA PPO |
$3,068.04
|
| 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 |
$3,524.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,487.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,731.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,109.50
|
| 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 |
$2,765.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$829.20
|
| 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 |
$3,109.50
|
| Rate for Payer: Networks By Design Commercial |
$2,694.90
|
| Rate for Payer: Prime Health Services Commercial |
$3,524.10
|
| 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 |
$2,487.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,487.60
|
| 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 ORBIT FACE/NECK WO CON
|
Facility
IP
|
$7,127.00
|
|
|
Service Code
|
CPT 70540
|
| Hospital Charge Code |
908801080
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,425.40 |
| Max. Negotiated Rate |
$6,414.30 |
| Rate for Payer: Cash Price |
$3,207.15
|
| Rate for Payer: Central Health Plan Commercial |
$5,701.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,850.80
|
| Rate for Payer: Galaxy Health WC |
$6,057.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,276.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,414.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,753.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,425.40
|
| Rate for Payer: Multiplan Commercial |
$5,345.25
|
| Rate for Payer: Networks By Design Commercial |
$4,632.55
|
| Rate for Payer: Prime Health Services Commercial |
$6,057.95
|
|
|
HC MRI ORBIT FACE/NECK WO CON
|
Facility
OP
|
$3,634.00
|
|
|
Service Code
|
CPT 70540
|
| Hospital Charge Code |
908801080
|
|
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 |
$2,146.97
|
| Rate for Payer: BCBS Transplant Transplant |
$2,180.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,245.81
|
| Rate for Payer: Blue Shield of California EPN |
$1,766.12
|
| Rate for Payer: Caremore Medicare Advantage |
$306.16
|
| Rate for Payer: Cash Price |
$1,635.30
|
| Rate for Payer: Cash Price |
$1,635.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,907.20
|
| Rate for Payer: Cigna of CA HMO |
$2,325.76
|
| Rate for Payer: Cigna of CA PPO |
$2,689.16
|
| 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 |
$3,088.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,180.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,270.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,725.50
|
| 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 |
$2,423.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$726.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$410.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410.25
|
| Rate for Payer: Multiplan Commercial |
$2,725.50
|
| Rate for Payer: Networks By Design Commercial |
$2,362.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,088.90
|
| 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 |
$2,180.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,180.40
|
| 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 ORBIT FACE/NECK W WO CON
|
Facility
IP
|
$11,442.00
|
|
|
Service Code
|
CPT 70543
|
| Hospital Charge Code |
908801082
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$2,288.40 |
| Max. Negotiated Rate |
$10,297.80 |
| Rate for Payer: Cash Price |
$5,148.90
|
| Rate for Payer: Central Health Plan Commercial |
$9,153.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,576.80
|
| Rate for Payer: Galaxy Health WC |
$9,725.70
|
| Rate for Payer: Global Benefits Group Commercial |
$6,865.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,297.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,631.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,288.40
|
| Rate for Payer: Multiplan Commercial |
$8,581.50
|
| Rate for Payer: Networks By Design Commercial |
$7,437.30
|
| Rate for Payer: Prime Health Services Commercial |
$9,725.70
|
|
|
HC MRI ORBIT FACE/NECK W WO CON
|
Facility
OP
|
$5,307.00
|
|
|
Service Code
|
CPT 70543
|
| Hospital Charge Code |
908801082
|
|
Hospital Revenue Code
|
615
|
| 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 |
$3,135.38
|
| Rate for Payer: BCBS Transplant Transplant |
$3,184.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,279.73
|
| Rate for Payer: Blue Shield of California EPN |
$2,579.20
|
| Rate for Payer: Caremore Medicare Advantage |
$480.50
|
| Rate for Payer: Cash Price |
$2,388.15
|
| Rate for Payer: Cash Price |
$2,388.15
|
| Rate for Payer: Central Health Plan Commercial |
$4,245.60
|
| Rate for Payer: Cigna of CA HMO |
$3,396.48
|
| Rate for Payer: Cigna of CA PPO |
$3,927.18
|
| 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 |
$4,510.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,184.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,776.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,980.25
|
| 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 |
$3,539.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,061.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.87
|
| Rate for Payer: Multiplan Commercial |
$3,980.25
|
| Rate for Payer: Networks By Design Commercial |
$3,449.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,510.95
|
| 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 |
$3,184.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,184.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,367.12
|
| Rate for Payer: United Healthcare All Other HMO |
$1,367.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1,367.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$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 PELVIS W/CONTRAST
|
Facility
OP
|
$4,256.00
|
|
|
Service Code
|
CPT 72196
|
| Hospital Charge Code |
908801350
|
|
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 |
$2,954.00
|
| 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 |
$2,305.15
|
| 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 PELVIS W/CONTRAST
|
Facility
IP
|
$10,022.00
|
|
|
Service Code
|
CPT 72196
|
| Hospital Charge Code |
908801350
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$2,004.40 |
| Max. Negotiated Rate |
$9,019.80 |
| Rate for Payer: Cash Price |
$4,509.90
|
| Rate for Payer: Central Health Plan Commercial |
$8,017.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,008.80
|
| Rate for Payer: Galaxy Health WC |
$8,518.70
|
| Rate for Payer: Global Benefits Group Commercial |
$6,013.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,019.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,684.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,004.40
|
| Rate for Payer: Multiplan Commercial |
$7,516.50
|
| Rate for Payer: Networks By Design Commercial |
$6,514.30
|
| Rate for Payer: Prime Health Services Commercial |
$8,518.70
|
|
|
HC MRI PELVIS W/O CONTRAST
|
Facility
IP
|
$8,809.00
|
|
|
Service Code
|
CPT 72195
|
| Hospital Charge Code |
908801351
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,761.80 |
| Max. Negotiated Rate |
$7,928.10 |
| Rate for Payer: Cash Price |
$3,964.05
|
| Rate for Payer: Central Health Plan Commercial |
$7,047.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,523.60
|
| Rate for Payer: Galaxy Health WC |
$7,487.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,285.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,928.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,875.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,761.80
|
| Rate for Payer: Multiplan Commercial |
$6,606.75
|
| Rate for Payer: Networks By Design Commercial |
$5,725.85
|
| Rate for Payer: Prime Health Services Commercial |
$7,487.65
|
|
|
HC MRI PELVIS W/O CONTRAST
|
Facility
OP
|
$3,874.00
|
|
|
Service Code
|
CPT 72195
|
| Hospital Charge Code |
908801351
|
|
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 |
$2,350.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,288.76
|
| Rate for Payer: BCBS Transplant Transplant |
$2,324.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,394.13
|
| Rate for Payer: Blue Shield of California EPN |
$1,882.76
|
| Rate for Payer: Caremore Medicare Advantage |
$306.16
|
| Rate for Payer: Cash Price |
$1,743.30
|
| Rate for Payer: Cash Price |
$1,743.30
|
| Rate for Payer: Central Health Plan Commercial |
$3,099.20
|
| Rate for Payer: Cigna of CA HMO |
$2,479.36
|
| Rate for Payer: Cigna of CA PPO |
$2,866.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$306.16
|
| Rate for Payer: Galaxy Health WC |
$3,292.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,324.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,486.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,905.50
|
| 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 |
$2,583.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$774.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$410.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410.25
|
| Rate for Payer: Multiplan Commercial |
$2,905.50
|
| Rate for Payer: Networks By Design Commercial |
$2,518.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,292.90
|
| Rate for Payer: Prime Health Services Medicare |
$324.53
|
| Rate for Payer: 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 |
$2,324.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,324.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| Rate for Payer: United Healthcare All Other HMO |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$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 PELVIS W & WO CONTRAST
|
Facility
IP
|
$11,124.00
|
|
|
Service Code
|
CPT 72197
|
| Hospital Charge Code |
908801352
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$2,224.80 |
| Max. Negotiated Rate |
$10,011.60 |
| Rate for Payer: Cash Price |
$5,005.80
|
| Rate for Payer: Central Health Plan Commercial |
$8,899.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,449.60
|
| Rate for Payer: Galaxy Health WC |
$9,455.40
|
| Rate for Payer: Global Benefits Group Commercial |
$6,674.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,011.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,419.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,224.80
|
| Rate for Payer: Multiplan Commercial |
$8,343.00
|
| Rate for Payer: Networks By Design Commercial |
$7,230.60
|
| Rate for Payer: Prime Health Services Commercial |
$9,455.40
|
|
|
HC MRI PELVIS W & WO CONTRAST
|
Facility
OP
|
$4,885.00
|
|
|
Service Code
|
CPT 72197
|
| Hospital Charge Code |
908801352
|
|
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 |
$5,208.41
|
| 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: Caremore Medicare Advantage |
$480.50
|
| Rate for Payer: Cash Price |
$2,198.25
|
| Rate for Payer: Cash Price |
$2,198.25
|
| Rate for Payer: Central Health Plan Commercial |
$3,908.00
|
| Rate for Payer: Cigna of CA HMO |
$3,126.40
|
| Rate for Payer: Cigna of CA PPO |
$3,614.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$480.50
|
| Rate for Payer: Galaxy Health WC |
$4,152.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,931.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,396.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,663.75
|
| 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 |
$3,258.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$977.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.87
|
| Rate for Payer: Multiplan Commercial |
$3,663.75
|
| Rate for Payer: Networks By Design Commercial |
$3,175.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,152.25
|
| Rate for Payer: Prime Health Services Medicare |
$509.33
|
| Rate for Payer: 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 |
$2,931.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,931.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,367.12
|
| Rate for Payer: United Healthcare All Other HMO |
$1,367.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1,367.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$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 PROCEDURE
|
Facility
IP
|
$5,413.00
|
|
|
Service Code
|
CPT 76498
|
| Hospital Charge Code |
908801008
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,082.60 |
| Max. Negotiated Rate |
$4,871.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,287.31
|
| Rate for Payer: Cash Price |
$2,435.85
|
| Rate for Payer: Central Health Plan Commercial |
$4,330.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,165.20
|
| Rate for Payer: Galaxy Health WC |
$4,601.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,247.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,871.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,610.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,082.60
|
| Rate for Payer: Multiplan Commercial |
$4,059.75
|
| Rate for Payer: Networks By Design Commercial |
$3,518.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,601.05
|
|
|
HC MRI PROCEDURE
|
Facility
OP
|
$2,615.00
|
|
|
Service Code
|
CPT 76498
|
| Hospital Charge Code |
908801008
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$113.54 |
| Max. Negotiated Rate |
$86,633.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$113.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,588.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,266.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,544.94
|
| Rate for Payer: BCBS Transplant Transplant |
$1,569.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,616.07
|
| Rate for Payer: Blue Shield of California EPN |
$1,270.89
|
| Rate for Payer: Caremore Medicare Advantage |
$113.54
|
| Rate for Payer: Cash Price |
$1,176.75
|
| Rate for Payer: Cash Price |
$1,176.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,092.00
|
| Rate for Payer: Cigna of CA HMO |
$1,673.60
|
| Rate for Payer: Cigna of CA PPO |
$1,935.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$2,222.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,569.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,353.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,961.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$186.21
|
| Rate for Payer: IEHP medi-cal |
$187.34
|
| Rate for Payer: IEHP Medicare Advantage |
$113.54
|
| Rate for Payer: Innovage PACE Commercial |
$170.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,744.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$523.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$152.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$1,961.25
|
| Rate for Payer: Networks By Design Commercial |
$1,699.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,222.75
|
| Rate for Payer: Prime Health Services Medicare |
$120.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$350.00
|
| Rate for Payer: Riverside University Health MISP |
$124.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,569.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,569.00
|
| 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 |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
