|
HC MRI SPECTROSCOPY
|
Facility
|
OP
|
$3,452.00
|
|
|
Service Code
|
CPT 76390
|
| Hospital Charge Code |
908801255
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$113.54 |
| Max. Negotiated Rate |
$3,106.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$113.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,055.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,332.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,039.44
|
| Rate for Payer: Blue Distinction Transplant |
$2,071.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,133.34
|
| Rate for Payer: Blue Shield of California EPN |
$1,677.67
|
| Rate for Payer: Caremore Medicare Advantage |
$113.54
|
| Rate for Payer: Cash Price |
$1,553.40
|
| Rate for Payer: Cash Price |
$1,553.40
|
| Rate for Payer: Central Health Plan Commercial |
$2,761.60
|
| Rate for Payer: Cigna of CA HMO |
$2,209.28
|
| Rate for Payer: Cigna of CA PPO |
$2,554.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| 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 |
$2,934.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,071.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,106.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,589.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$186.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$187.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: InnovAge PACE Commercial |
$170.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,302.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,315.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$690.40
|
| 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 |
$2,589.00
|
| Rate for Payer: Networks By Design Commercial |
$2,243.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,934.20
|
| Rate for Payer: Prime Health Services Medicare |
$120.35
|
| Rate for Payer: Riverside University Health System MISP |
$124.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,071.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,071.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,065.68
|
| Rate for Payer: United Healthcare All Other HMO |
$1,065.68
|
| Rate for Payer: United Healthcare HMO Rider |
$1,065.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,065.68
|
| 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
|
|
|
HC MRI SPECTROSCOPY
|
Facility
|
IP
|
$7,145.00
|
|
|
Service Code
|
CPT 76390
|
| Hospital Charge Code |
908801255
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,429.00 |
| Max. Negotiated Rate |
$6,430.50 |
| Rate for Payer: Cash Price |
$3,215.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,716.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,858.00
|
| Rate for Payer: Galaxy Health WC |
$6,073.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,287.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,430.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,765.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,722.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,429.00
|
| Rate for Payer: Multiplan Commercial |
$5,358.75
|
| Rate for Payer: Networks By Design Commercial |
$4,644.25
|
| Rate for Payer: Prime Health Services Commercial |
$6,073.25
|
|
|
HC MRI THORACIC SPINE WITH CONTRA
|
Facility
|
OP
|
$4,256.00
|
|
|
Service Code
|
CPT 72147
|
| Hospital Charge Code |
908801112
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$480.50 |
| Max. Negotiated Rate |
$3,830.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$480.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,766.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,514.44
|
| Rate for Payer: Blue Distinction 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: Dignity Health Media |
$480.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$480.50
|
| Rate for Payer: Galaxy Health WC |
$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) Other |
$3,192.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$788.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$792.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$480.50
|
| Rate for Payer: InnovAge PACE Commercial |
$720.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,838.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$508.71
|
| 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: Riverside University Health System 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 |
$1,115.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC MRI THORACIC SPINE WITH CONTRA
|
Facility
|
IP
|
$9,341.00
|
|
|
Service Code
|
CPT 72147
|
| Hospital Charge Code |
908801112
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,868.20 |
| Max. Negotiated Rate |
$8,406.90 |
| Rate for Payer: Cash Price |
$4,203.45
|
| Rate for Payer: Central Health Plan Commercial |
$7,472.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,736.40
|
| Rate for Payer: Galaxy Health WC |
$7,939.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,604.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,406.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,230.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,558.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,868.20
|
| Rate for Payer: Multiplan Commercial |
$7,005.75
|
| Rate for Payer: Networks By Design Commercial |
$6,071.65
|
| Rate for Payer: Prime Health Services Commercial |
$7,939.85
|
|
|
HC MRI THORACIC SPINE WO CON
|
Facility
|
IP
|
$8,493.00
|
|
|
Service Code
|
CPT 72146
|
| Hospital Charge Code |
908801110
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,698.60 |
| Max. Negotiated Rate |
$7,643.70 |
| Rate for Payer: Cash Price |
$3,821.85
|
| Rate for Payer: Central Health Plan Commercial |
$6,794.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,397.20
|
| Rate for Payer: Galaxy Health WC |
$7,219.05
|
| Rate for Payer: Global Benefits Group Commercial |
$5,095.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,643.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,664.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,235.83
|
| 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 THORACIC SPINE WO CON
|
Facility
|
OP
|
$4,104.00
|
|
|
Service Code
|
CPT 72146
|
| Hospital Charge Code |
908801110
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$306.16 |
| Max. Negotiated Rate |
$3,693.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$306.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,055.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,556.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,424.64
|
| Rate for Payer: Blue Distinction 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: Dignity Health Media |
$306.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$306.16
|
| Rate for Payer: Galaxy Health WC |
$3,488.40
|
| 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) Other |
$3,078.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$502.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$505.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.16
|
| Rate for Payer: InnovAge PACE Commercial |
$459.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,737.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$352.16
|
| 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: Riverside University Health System 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 |
$866.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC MRI T-SPINE W & WO CONTRAST
|
Facility
|
OP
|
$4,480.00
|
|
|
Service Code
|
CPT 72157
|
| Hospital Charge Code |
908801114
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$480.50 |
| Max. Negotiated Rate |
$4,535.56 |
| Rate for Payer: Adventist Health Medi-Cal |
$480.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,055.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,535.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,646.78
|
| Rate for Payer: Blue Distinction 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: Dignity Health Media |
$480.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$480.50
|
| Rate for Payer: Galaxy Health WC |
$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) Other |
$3,360.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$788.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$792.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$480.50
|
| Rate for Payer: InnovAge PACE Commercial |
$720.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,988.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$595.80
|
| 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: Riverside University Health System 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 |
$1,367.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC MRI T-SPINE W & WO CONTRAST
|
Facility
|
IP
|
$10,204.00
|
|
|
Service Code
|
CPT 72157
|
| Hospital Charge Code |
908801114
|
|
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: Kaiser Permanente of CA Medi-Cal |
$3,887.72
|
| 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 UPPER EXT JNT W & WO CONT
|
Facility
|
IP
|
$10,712.00
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
908801435
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,142.40 |
| Max. Negotiated Rate |
$9,640.80 |
| Rate for Payer: Cash Price |
$4,820.40
|
| Rate for Payer: Central Health Plan Commercial |
$8,569.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,284.80
|
| Rate for Payer: Galaxy Health WC |
$9,105.20
|
| Rate for Payer: Global Benefits Group Commercial |
$6,427.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,640.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,144.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,081.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,142.40
|
| Rate for Payer: Multiplan Commercial |
$8,034.00
|
| Rate for Payer: Networks By Design Commercial |
$6,962.80
|
| Rate for Payer: Prime Health Services Commercial |
$9,105.20
|
|
|
HC MRI UPPER EXT JNT W & WO CONT
|
Facility
|
OP
|
$4,880.00
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
908801435
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$480.50 |
| Max. Negotiated Rate |
$5,198.91 |
| Rate for Payer: Adventist Health Medi-Cal |
$480.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,198.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,883.10
|
| Rate for Payer: Blue Distinction Transplant |
$2,928.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,015.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,371.68
|
| Rate for Payer: Caremore Medicare Advantage |
$480.50
|
| Rate for Payer: Cash Price |
$2,196.00
|
| Rate for Payer: Cash Price |
$2,196.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,904.00
|
| Rate for Payer: Cigna of CA HMO |
$3,123.20
|
| Rate for Payer: Cigna of CA PPO |
$3,611.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: Dignity Health Media |
$480.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$480.50
|
| Rate for Payer: Galaxy Health WC |
$4,148.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,928.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,392.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,660.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$788.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$792.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$480.50
|
| Rate for Payer: InnovAge PACE Commercial |
$720.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,254.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$733.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$976.00
|
| 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 |
$3,660.00
|
| Rate for Payer: Networks By Design Commercial |
$3,172.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,148.00
|
| Rate for Payer: Prime Health Services Medicare |
$509.33
|
| Rate for Payer: Riverside University Health System MISP |
$528.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,928.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,928.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,367.12
|
| Rate for Payer: United Healthcare All Other HMO |
$1,367.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1,367.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,367.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC MRI UPPER EXTREM JOINT W/CONT
|
Facility
|
OP
|
$3,496.00
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
908801433
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$593.48 |
| Max. Negotiated Rate |
$3,146.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,000.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: Alpha Care 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: Blue Distinction 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: Dignity Health Media |
$1,000.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,100.44
|
| 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) Other |
$2,622.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,640.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,650.66
|
| Rate for Payer: Inland Empire Health Plan (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 Medi-Cal |
$593.48
|
| 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: Riverside University Health System 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 |
$1,115.74
|
| 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 UPPER EXTREM JOINT W/CONT
|
Facility
|
IP
|
$7,237.00
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
908801433
|
|
Hospital Revenue Code
|
614
|
| 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: Kaiser Permanente of CA Medi-Cal |
$2,757.30
|
| 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 UPPER EXTREM JOINT WO CONT
|
Facility
|
OP
|
$3,119.00
|
|
|
Service Code
|
CPT 73221
|
| Hospital Charge Code |
908801431
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$306.16 |
| Max. Negotiated Rate |
$2,954.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$306.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,295.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,842.71
|
| Rate for Payer: Blue Distinction Transplant |
$1,871.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,927.54
|
| Rate for Payer: Blue Shield of California EPN |
$1,515.83
|
| Rate for Payer: Caremore Medicare Advantage |
$306.16
|
| Rate for Payer: Cash Price |
$1,403.55
|
| Rate for Payer: Cash Price |
$1,403.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,495.20
|
| Rate for Payer: Cigna of CA HMO |
$1,996.16
|
| Rate for Payer: Cigna of CA PPO |
$2,308.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Media |
$306.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$306.16
|
| Rate for Payer: Galaxy Health WC |
$2,651.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,871.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,807.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,339.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$502.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$505.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.16
|
| Rate for Payer: InnovAge PACE Commercial |
$459.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,080.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$374.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$623.80
|
| 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 |
$2,339.25
|
| Rate for Payer: Networks By Design Commercial |
$2,027.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,651.15
|
| Rate for Payer: Prime Health Services Medicare |
$324.53
|
| Rate for Payer: Riverside University Health System MISP |
$336.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,871.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,871.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| Rate for Payer: United Healthcare All Other HMO |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC MRI UPPER EXTREM JOINT WO CONT
|
Facility
|
IP
|
$6,962.00
|
|
|
Service Code
|
CPT 73221
|
| Hospital Charge Code |
908801431
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,392.40 |
| Max. Negotiated Rate |
$6,265.80 |
| Rate for Payer: Cash Price |
$3,132.90
|
| Rate for Payer: Central Health Plan Commercial |
$5,569.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,784.80
|
| Rate for Payer: Galaxy Health WC |
$5,917.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,177.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,265.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,643.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,652.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,392.40
|
| Rate for Payer: Multiplan Commercial |
$5,221.50
|
| Rate for Payer: Networks By Design Commercial |
$4,525.30
|
| Rate for Payer: Prime Health Services Commercial |
$5,917.70
|
|
|
HC MRI UPPER EXTREM W CONT
|
Facility
|
OP
|
$3,562.00
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
908801415
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$480.50 |
| Max. Negotiated Rate |
$3,205.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$480.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,823.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,104.43
|
| Rate for Payer: Blue Distinction Transplant |
$2,137.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,201.32
|
| Rate for Payer: Blue Shield of California EPN |
$1,731.13
|
| Rate for Payer: Caremore Medicare Advantage |
$480.50
|
| Rate for Payer: Cash Price |
$1,602.90
|
| Rate for Payer: Cash Price |
$1,602.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,849.60
|
| Rate for Payer: Cigna of CA HMO |
$2,279.68
|
| Rate for Payer: Cigna of CA PPO |
$2,635.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: Dignity Health Media |
$480.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$480.50
|
| Rate for Payer: Galaxy Health WC |
$3,027.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,137.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,205.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,671.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$788.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$792.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$480.50
|
| Rate for Payer: InnovAge PACE Commercial |
$720.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,375.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$626.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$712.40
|
| 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 |
$2,671.50
|
| Rate for Payer: Networks By Design Commercial |
$2,315.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,027.70
|
| Rate for Payer: Prime Health Services Medicare |
$509.33
|
| Rate for Payer: Riverside University Health System MISP |
$528.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,137.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,137.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,115.74
|
| Rate for Payer: United Healthcare All Other HMO |
$1,115.74
|
| Rate for Payer: United Healthcare HMO Rider |
$1,115.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,115.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC MRI UPPER EXTREM W CONT
|
Facility
|
IP
|
$7,373.00
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
908801415
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,474.60 |
| Max. Negotiated Rate |
$6,635.70 |
| Rate for Payer: Cash Price |
$3,317.85
|
| Rate for Payer: Central Health Plan Commercial |
$5,898.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,949.20
|
| Rate for Payer: Galaxy Health WC |
$6,267.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,423.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,635.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,917.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,809.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,474.60
|
| Rate for Payer: Multiplan Commercial |
$5,529.75
|
| Rate for Payer: Networks By Design Commercial |
$4,792.45
|
| Rate for Payer: Prime Health Services Commercial |
$6,267.05
|
|
|
HC MRI UPPER EXTREM W/O CONT
|
Facility
|
IP
|
$7,055.00
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
908801413
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,411.00 |
| Max. Negotiated Rate |
$6,349.50 |
| Rate for Payer: Cash Price |
$3,174.75
|
| Rate for Payer: Central Health Plan Commercial |
$5,644.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,822.00
|
| Rate for Payer: Galaxy Health WC |
$5,996.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,233.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,349.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,705.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,687.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,411.00
|
| Rate for Payer: Multiplan Commercial |
$5,291.25
|
| Rate for Payer: Networks By Design Commercial |
$4,585.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,996.75
|
|
|
HC MRI UPPER EXTREM W/O CONT
|
Facility
|
OP
|
$3,184.00
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
908801413
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$306.16 |
| Max. Negotiated Rate |
$2,954.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$306.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,342.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,881.11
|
| Rate for Payer: Blue Distinction Transplant |
$1,910.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,967.71
|
| Rate for Payer: Blue Shield of California EPN |
$1,547.42
|
| Rate for Payer: Caremore Medicare Advantage |
$306.16
|
| Rate for Payer: Cash Price |
$1,432.80
|
| Rate for Payer: Cash Price |
$1,432.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,547.20
|
| Rate for Payer: Cigna of CA HMO |
$2,037.76
|
| Rate for Payer: Cigna of CA PPO |
$2,356.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Media |
$306.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$306.16
|
| Rate for Payer: Galaxy Health WC |
$2,706.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,910.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,865.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,388.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$502.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$505.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.16
|
| Rate for Payer: InnovAge PACE Commercial |
$459.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,123.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$576.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$636.80
|
| 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 |
$2,388.00
|
| Rate for Payer: Networks By Design Commercial |
$2,069.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,706.40
|
| Rate for Payer: Prime Health Services Medicare |
$324.53
|
| Rate for Payer: Riverside University Health System MISP |
$336.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,910.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,910.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| Rate for Payer: United Healthcare All Other HMO |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC MRI UPPER EXTREM W & WO CONT
|
Facility
|
IP
|
$9,438.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
908801411
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,887.60 |
| Max. Negotiated Rate |
$8,494.20 |
| Rate for Payer: Cash Price |
$4,247.10
|
| Rate for Payer: Central Health Plan Commercial |
$7,550.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,775.20
|
| Rate for Payer: Galaxy Health WC |
$8,022.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,662.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,494.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,295.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,595.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,887.60
|
| Rate for Payer: Multiplan Commercial |
$7,078.50
|
| Rate for Payer: Networks By Design Commercial |
$6,134.70
|
| Rate for Payer: Prime Health Services Commercial |
$8,022.30
|
|
|
HC MRI UPPER EXTREM W & WO CONT
|
Facility
|
OP
|
$3,746.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
908801411
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$480.50 |
| Max. Negotiated Rate |
$3,371.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$480.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,303.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,213.14
|
| Rate for Payer: Blue Distinction Transplant |
$2,247.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,315.03
|
| Rate for Payer: Blue Shield of California EPN |
$1,820.56
|
| Rate for Payer: Caremore Medicare Advantage |
$480.50
|
| Rate for Payer: Cash Price |
$1,685.70
|
| Rate for Payer: Cash Price |
$1,685.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,996.80
|
| Rate for Payer: Cigna of CA HMO |
$2,397.44
|
| Rate for Payer: Cigna of CA PPO |
$2,772.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: Dignity Health Media |
$480.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$480.50
|
| Rate for Payer: Galaxy Health WC |
$3,184.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,247.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,371.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,809.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$788.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$792.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$480.50
|
| Rate for Payer: InnovAge PACE Commercial |
$720.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,498.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$741.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$749.20
|
| 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 |
$2,809.50
|
| Rate for Payer: Networks By Design Commercial |
$2,434.90
|
| Rate for Payer: Prime Health Services Commercial |
$3,184.10
|
| Rate for Payer: Prime Health Services Medicare |
$509.33
|
| Rate for Payer: Riverside University Health System MISP |
$528.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,247.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,247.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,367.12
|
| Rate for Payer: United Healthcare All Other HMO |
$1,367.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1,367.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,367.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC MRSA DNA
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
CPT 87641
|
| Hospital Charge Code |
900912328
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.60 |
| Max. Negotiated Rate |
$304.67 |
| Rate for Payer: Adventist Health Medi-Cal |
$35.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$257.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$249.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$304.67
|
| Rate for Payer: Blue Distinction Transplant |
$61.80
|
| Rate for Payer: Blue Shield of California Commercial |
$63.65
|
| Rate for Payer: Blue Shield of California EPN |
$50.06
|
| Rate for Payer: Caremore Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Central Health Plan Commercial |
$82.40
|
| Rate for Payer: Cigna of CA HMO |
$65.92
|
| Rate for Payer: Cigna of CA PPO |
$76.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.64
|
| Rate for Payer: Dignity Health Media |
$35.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.37
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$35.09
|
| Rate for Payer: Galaxy Health WC |
$87.55
|
| Rate for Payer: Global Benefits Group Commercial |
$61.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$92.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$77.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$57.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: InnovAge PACE Commercial |
$52.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$68.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$77.25
|
| Rate for Payer: Networks By Design Commercial |
$66.95
|
| Rate for Payer: Prime Health Services Commercial |
$87.55
|
| Rate for Payer: Prime Health Services Medicare |
$37.20
|
| Rate for Payer: Riverside University Health System MISP |
$38.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$61.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$61.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC MRSA DNA
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
CPT 87641
|
| Hospital Charge Code |
900912328
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$170.10 |
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Central Health Plan Commercial |
$151.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.60
|
| Rate for Payer: Galaxy Health WC |
$160.65
|
| Rate for Payer: Global Benefits Group Commercial |
$113.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$170.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$126.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.80
|
| Rate for Payer: Multiplan Commercial |
$141.75
|
| Rate for Payer: Networks By Design Commercial |
$122.85
|
| Rate for Payer: Prime Health Services Commercial |
$160.65
|
|
|
HC MSCL TST MNL W RPT; EXT OR TRK
|
Facility
|
OP
|
$373.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800411
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$74.60 |
| Max. Negotiated Rate |
$725.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$195.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$226.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$180.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$220.37
|
| Rate for Payer: Blue Distinction Transplant |
$223.80
|
| Rate for Payer: Blue Shield of California Commercial |
$230.51
|
| Rate for Payer: Blue Shield of California EPN |
$181.28
|
| Rate for Payer: Caremore Medicare Advantage |
$195.17
|
| Rate for Payer: Cash Price |
$167.85
|
| Rate for Payer: Cash Price |
$167.85
|
| Rate for Payer: Cash Price |
$167.85
|
| Rate for Payer: Central Health Plan Commercial |
$298.40
|
| Rate for Payer: Cigna of CA HMO |
$238.72
|
| Rate for Payer: Cigna of CA PPO |
$276.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: Dignity Health Media |
$195.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.48
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$195.17
|
| Rate for Payer: Galaxy Health WC |
$317.05
|
| Rate for Payer: Global Benefits Group Commercial |
$223.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$335.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$279.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$320.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$322.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$195.17
|
| Rate for Payer: InnovAge PACE Commercial |
$292.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$248.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$261.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$261.53
|
| Rate for Payer: Multiplan Commercial |
$279.75
|
| Rate for Payer: Networks By Design Commercial |
$242.45
|
| Rate for Payer: Prime Health Services Commercial |
$317.05
|
| Rate for Payer: Prime Health Services Medicare |
$206.88
|
| Rate for Payer: Riverside University Health System MISP |
$214.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$223.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$223.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$725.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$696.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$636.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC MSCL TST MNL W RPT; EXT OR TRK
|
Facility
|
IP
|
$373.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800411
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$74.60 |
| Max. Negotiated Rate |
$335.70 |
| Rate for Payer: Cash Price |
$167.85
|
| Rate for Payer: Central Health Plan Commercial |
$298.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$149.20
|
| Rate for Payer: Galaxy Health WC |
$317.05
|
| Rate for Payer: Global Benefits Group Commercial |
$223.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$335.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$248.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.60
|
| Rate for Payer: Multiplan Commercial |
$279.75
|
| Rate for Payer: Networks By Design Commercial |
$242.45
|
| Rate for Payer: Prime Health Services Commercial |
$317.05
|
|
|
HC MSI
|
Facility
|
OP
|
$392.00
|
|
|
Service Code
|
CPT 81301
|
| Hospital Charge Code |
903800318
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$78.40 |
| Max. Negotiated Rate |
$1,466.98 |
| Rate for Payer: Adventist Health Medi-Cal |
$348.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$836.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$522.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$383.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$348.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,202.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,466.98
|
| Rate for Payer: Blue Distinction Transplant |
$235.20
|
| Rate for Payer: Blue Shield of California Commercial |
$242.26
|
| Rate for Payer: Blue Shield of California EPN |
$190.51
|
| Rate for Payer: Caremore Medicare Advantage |
$348.56
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Central Health Plan Commercial |
$313.60
|
| Rate for Payer: Cigna of CA HMO |
$250.88
|
| Rate for Payer: Cigna of CA PPO |
$290.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$522.84
|
| Rate for Payer: Dignity Health Media |
$348.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$383.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$470.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$348.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$348.56
|
| Rate for Payer: Galaxy Health WC |
$333.20
|
| Rate for Payer: Global Benefits Group Commercial |
$235.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$352.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$294.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$571.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$575.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$348.56
|
| Rate for Payer: InnovAge PACE Commercial |
$522.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$261.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$487.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$348.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$467.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$467.07
|
| Rate for Payer: Multiplan Commercial |
$294.00
|
| Rate for Payer: Networks By Design Commercial |
$254.80
|
| Rate for Payer: Prime Health Services Commercial |
$333.20
|
| Rate for Payer: Prime Health Services Medicare |
$369.47
|
| Rate for Payer: Riverside University Health System MISP |
$383.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$235.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$235.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$282.33
|
| Rate for Payer: United Healthcare All Other HMO |
$282.33
|
| Rate for Payer: United Healthcare HMO Rider |
$282.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$282.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$522.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$383.42
|
| Rate for Payer: Vantage Medical Group Senior |
$348.56
|
|
