|
HC MR ANGIO W/O FOL W/CONT, ABD
|
Facility
|
OP
|
$6,378.00
|
|
|
Service Code
|
CPT 74185
|
| Hospital Charge Code |
908801096
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$630.86 |
| Max. Negotiated Rate |
$5,421.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,421.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,507.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,507.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,800.01
|
| Rate for Payer: Blue Distinction Transplant |
$3,826.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,769.40
|
| Rate for Payer: Blue Shield of California EPN |
$2,991.28
|
| Rate for Payer: Cash Price |
$2,870.10
|
| Rate for Payer: Cash Price |
$2,870.10
|
| Rate for Payer: Cigna of CA HMO |
$4,081.92
|
| Rate for Payer: Cigna of CA PPO |
$4,719.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,421.30
|
| Rate for Payer: Dignity Health Media |
$5,421.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,421.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,551.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,551.20
|
| Rate for Payer: Galaxy Health WC |
$5,421.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,826.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,783.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,254.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$630.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,530.72
|
| Rate for Payer: Multiplan Commercial |
$5,102.40
|
| Rate for Payer: Networks By Design Commercial |
$4,145.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,421.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,826.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,826.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,111.86
|
| Rate for Payer: United Healthcare All Other HMO |
$1,111.86
|
| Rate for Payer: United Healthcare HMO Rider |
$1,111.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,111.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,421.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,421.30
|
| Rate for Payer: Vantage Medical Group Senior |
$5,421.30
|
|
|
HC MR ANGIO W/O FOL W/CONT, ABD
|
Facility
|
IP
|
$11,346.00
|
|
|
Service Code
|
CPT 74185
|
| Hospital Charge Code |
908801096
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$2,723.04 |
| Max. Negotiated Rate |
$9,644.10 |
| Rate for Payer: Cash Price |
$5,105.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,538.40
|
| Rate for Payer: Galaxy Health WC |
$9,644.10
|
| Rate for Payer: Global Benefits Group Commercial |
$6,807.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,567.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,322.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,723.04
|
| Rate for Payer: Multiplan Commercial |
$9,076.80
|
| Rate for Payer: Networks By Design Commercial |
$7,374.90
|
| Rate for Payer: Prime Health Services Commercial |
$9,644.10
|
|
|
HC MRI ABDOMEN W/CONTRAST
|
Facility
|
OP
|
$4,442.00
|
|
|
Service Code
|
CPT 74182
|
| Hospital Charge Code |
908801301
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$480.50 |
| Max. Negotiated Rate |
$3,775.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| 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 HMO/PPO |
$2,646.54
|
| Rate for Payer: Blue Distinction Transplant |
$2,665.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,625.22
|
| Rate for Payer: Blue Shield of California EPN |
$2,083.30
|
| Rate for Payer: Cash Price |
$1,998.90
|
| Rate for Payer: Cash Price |
$1,998.90
|
| Rate for Payer: Cigna of CA HMO |
$2,842.88
|
| Rate for Payer: Cigna of CA PPO |
$3,287.08
|
| 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 |
$3,775.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,665.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,331.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$788.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$788.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$778.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$778.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$480.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,962.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$568.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,066.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$605.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.87
|
| Rate for Payer: Multiplan Commercial |
$3,553.60
|
| Rate for Payer: Networks By Design Commercial |
$2,887.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,775.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,665.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,665.20
|
| 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 ABDOMEN W/CONTRAST
|
Facility
|
IP
|
$8,263.00
|
|
|
Service Code
|
CPT 74182
|
| Hospital Charge Code |
908801301
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,983.12 |
| Max. Negotiated Rate |
$7,023.55 |
| Rate for Payer: Cash Price |
$3,718.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,305.20
|
| Rate for Payer: Galaxy Health WC |
$7,023.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4,957.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,511.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,148.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,983.12
|
| Rate for Payer: Multiplan Commercial |
$6,610.40
|
| Rate for Payer: Networks By Design Commercial |
$5,370.95
|
| Rate for Payer: Prime Health Services Commercial |
$7,023.55
|
|
|
HC MRI ABDOMEN W/O CONTRAST
|
Facility
|
IP
|
$7,512.00
|
|
|
Service Code
|
CPT 74181
|
| Hospital Charge Code |
908801300
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,802.88 |
| Max. Negotiated Rate |
$6,385.20 |
| Rate for Payer: Cash Price |
$3,380.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,004.80
|
| Rate for Payer: Galaxy Health WC |
$6,385.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,507.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,010.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,862.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,802.88
|
| Rate for Payer: Multiplan Commercial |
$6,009.60
|
| Rate for Payer: Networks By Design Commercial |
$4,882.80
|
| Rate for Payer: Prime Health Services Commercial |
$6,385.20
|
|
|
HC MRI ABDOMEN W/O CONTRAST
|
Facility
|
OP
|
$3,874.00
|
|
|
Service Code
|
CPT 74181
|
| Hospital Charge Code |
908801300
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$306.16 |
| Max. Negotiated Rate |
$3,443.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| 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 HMO/PPO |
$2,308.13
|
| Rate for Payer: Blue Distinction Transplant |
$2,324.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,289.53
|
| Rate for Payer: Blue Shield of California EPN |
$1,816.91
|
| Rate for Payer: Cash Price |
$1,743.30
|
| Rate for Payer: Cash Price |
$1,743.30
|
| Rate for Payer: Cigna of CA HMO |
$2,479.36
|
| Rate for Payer: Cigna of CA PPO |
$2,866.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Media |
$306.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$306.16
|
| Rate for Payer: Galaxy Health WC |
$3,292.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,324.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,905.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$502.10
|
| Rate for Payer: Heritage Provider Network Transplant |
$502.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$495.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$495.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,583.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$362.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$929.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410.25
|
| Rate for Payer: Multiplan Commercial |
$3,099.20
|
| Rate for Payer: Networks By Design Commercial |
$2,518.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,292.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,324.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,324.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| Rate for Payer: United Healthcare All Other HMO |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC MRI ABDOMEN W WO CONTRAST
|
Facility
|
OP
|
$4,885.00
|
|
|
Service Code
|
CPT 74183
|
| Hospital Charge Code |
908801302
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$480.50 |
| Max. Negotiated Rate |
$4,152.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| 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 HMO/PPO |
$2,910.48
|
| Rate for Payer: Blue Distinction Transplant |
$2,931.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,887.04
|
| Rate for Payer: Blue Shield of California EPN |
$2,291.06
|
| Rate for Payer: Cash Price |
$2,198.25
|
| Rate for Payer: Cash Price |
$2,198.25
|
| Rate for Payer: Cigna of CA HMO |
$3,126.40
|
| Rate for Payer: Cigna of CA PPO |
$3,614.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: Dignity Health Media |
$480.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$480.50
|
| Rate for Payer: Galaxy Health WC |
$4,152.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,931.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,663.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$788.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$788.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$778.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$778.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$480.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,258.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$633.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,172.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$605.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.87
|
| Rate for Payer: Multiplan Commercial |
$3,908.00
|
| Rate for Payer: Networks By Design Commercial |
$3,175.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,152.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,931.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,931.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,367.12
|
| Rate for Payer: United Healthcare All Other HMO |
$1,367.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1,367.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,367.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC MRI ABDOMEN W WO CONTRAST
|
Facility
|
IP
|
$10,080.00
|
|
|
Service Code
|
CPT 74183
|
| Hospital Charge Code |
908801302
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,419.20 |
| Max. Negotiated Rate |
$8,568.00 |
| Rate for Payer: Cash Price |
$4,536.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,032.00
|
| Rate for Payer: Galaxy Health WC |
$8,568.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,048.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,723.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,840.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,419.20
|
| Rate for Payer: Multiplan Commercial |
$8,064.00
|
| Rate for Payer: Networks By Design Commercial |
$6,552.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,568.00
|
|
|
HC MRI ANGIO HEAD WITH CONTRAST
|
Facility
|
IP
|
$7,324.00
|
|
|
Service Code
|
CPT 70545
|
| Hospital Charge Code |
908801084
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,757.76 |
| Max. Negotiated Rate |
$6,225.40 |
| Rate for Payer: Cash Price |
$3,295.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,929.60
|
| Rate for Payer: Galaxy Health WC |
$6,225.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,394.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,885.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,790.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,757.76
|
| Rate for Payer: Multiplan Commercial |
$5,859.20
|
| Rate for Payer: Networks By Design Commercial |
$4,760.60
|
| Rate for Payer: Prime Health Services Commercial |
$6,225.40
|
|
|
HC MRI ANGIO HEAD WITH CONTRAST
|
Facility
|
OP
|
$4,837.00
|
|
|
Service Code
|
CPT 70545
|
| Hospital Charge Code |
908801084
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$423.28 |
| Max. Negotiated Rate |
$4,111.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| 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 HMO/PPO |
$2,881.88
|
| Rate for Payer: Blue Distinction Transplant |
$2,902.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,858.67
|
| Rate for Payer: Blue Shield of California EPN |
$2,268.55
|
| Rate for Payer: Cash Price |
$2,176.65
|
| Rate for Payer: Cash Price |
$2,176.65
|
| Rate for Payer: Cigna of CA HMO |
$3,095.68
|
| Rate for Payer: Cigna of CA PPO |
$3,579.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: Dignity Health Media |
$480.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$480.50
|
| Rate for Payer: Galaxy Health WC |
$4,111.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,902.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,627.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$788.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$788.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$778.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$778.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$480.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,226.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$423.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,160.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$605.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.87
|
| Rate for Payer: Multiplan Commercial |
$3,869.60
|
| Rate for Payer: Networks By Design Commercial |
$3,144.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,111.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,902.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,902.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,115.74
|
| Rate for Payer: United Healthcare All Other HMO |
$1,115.74
|
| Rate for Payer: United Healthcare HMO Rider |
$1,115.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,115.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC MRI ANGIO HEAD WO CNTRAST
|
Facility
|
OP
|
$4,319.00
|
|
|
Service Code
|
CPT 70544
|
| Hospital Charge Code |
908801083
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$306.16 |
| Max. Negotiated Rate |
$3,671.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| 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 HMO/PPO |
$2,573.26
|
| Rate for Payer: Blue Distinction Transplant |
$2,591.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,552.53
|
| Rate for Payer: Blue Shield of California EPN |
$2,025.61
|
| Rate for Payer: Cash Price |
$1,943.55
|
| Rate for Payer: Cash Price |
$1,943.55
|
| Rate for Payer: Cigna of CA HMO |
$2,764.16
|
| Rate for Payer: Cigna of CA PPO |
$3,196.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Media |
$306.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$306.16
|
| Rate for Payer: Galaxy Health WC |
$3,671.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,591.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,239.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$502.10
|
| Rate for Payer: Heritage Provider Network Transplant |
$502.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$495.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$495.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,880.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$400.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,036.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410.25
|
| Rate for Payer: Multiplan Commercial |
$3,455.20
|
| Rate for Payer: Networks By Design Commercial |
$2,807.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,671.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,591.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,591.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| Rate for Payer: United Healthcare All Other HMO |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC MRI ANGIO HEAD WO CNTRAST
|
Facility
|
IP
|
$6,975.00
|
|
|
Service Code
|
CPT 70544
|
| Hospital Charge Code |
908801015
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,674.00 |
| Max. Negotiated Rate |
$5,928.75 |
| Rate for Payer: Cash Price |
$3,138.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,790.00
|
| Rate for Payer: Galaxy Health WC |
$5,928.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,185.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,652.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,657.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,674.00
|
| Rate for Payer: Multiplan Commercial |
$5,580.00
|
| Rate for Payer: Networks By Design Commercial |
$4,533.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,928.75
|
|
|
HC MRI ANGIO HEAD WO CNTRAST
|
Facility
|
OP
|
$4,319.00
|
|
|
Service Code
|
CPT 70544
|
| Hospital Charge Code |
908801015
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$306.16 |
| Max. Negotiated Rate |
$3,671.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| 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 HMO/PPO |
$2,573.26
|
| Rate for Payer: Blue Distinction Transplant |
$2,591.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,552.53
|
| Rate for Payer: Blue Shield of California EPN |
$2,025.61
|
| Rate for Payer: Cash Price |
$1,943.55
|
| Rate for Payer: Cash Price |
$1,943.55
|
| Rate for Payer: Cigna of CA HMO |
$2,764.16
|
| Rate for Payer: Cigna of CA PPO |
$3,196.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Media |
$306.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$306.16
|
| Rate for Payer: Galaxy Health WC |
$3,671.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,591.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,239.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$502.10
|
| Rate for Payer: Heritage Provider Network Transplant |
$502.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$495.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$495.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,880.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$400.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,036.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410.25
|
| Rate for Payer: Multiplan Commercial |
$3,455.20
|
| Rate for Payer: Networks By Design Commercial |
$2,807.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,671.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,591.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,591.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| Rate for Payer: United Healthcare All Other HMO |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC MRI ANGIO HEAD WO CNTRAST
|
Facility
|
IP
|
$6,975.00
|
|
|
Service Code
|
CPT 70544
|
| Hospital Charge Code |
908801083
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,674.00 |
| Max. Negotiated Rate |
$5,928.75 |
| Rate for Payer: Cash Price |
$3,138.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,790.00
|
| Rate for Payer: Galaxy Health WC |
$5,928.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,185.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,652.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,657.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,674.00
|
| Rate for Payer: Multiplan Commercial |
$5,580.00
|
| Rate for Payer: Networks By Design Commercial |
$4,533.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,928.75
|
|
|
HC MRI ANGIO HEAD W WO CONTRAST
|
Facility
|
OP
|
$5,182.00
|
|
|
Service Code
|
CPT 70546
|
| Hospital Charge Code |
908801085
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$480.50 |
| Max. Negotiated Rate |
$4,404.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| 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 HMO/PPO |
$3,087.44
|
| Rate for Payer: Blue Distinction Transplant |
$3,109.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,062.56
|
| Rate for Payer: Blue Shield of California EPN |
$2,430.36
|
| Rate for Payer: Cash Price |
$2,331.90
|
| Rate for Payer: Cash Price |
$2,331.90
|
| Rate for Payer: Cigna of CA HMO |
$3,316.48
|
| Rate for Payer: Cigna of CA PPO |
$3,834.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: Dignity Health Media |
$480.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$480.50
|
| Rate for Payer: Galaxy Health WC |
$4,404.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,109.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,886.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$788.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$788.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$778.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$778.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$480.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,456.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$615.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,243.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$605.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.87
|
| Rate for Payer: Multiplan Commercial |
$4,145.60
|
| Rate for Payer: Networks By Design Commercial |
$3,368.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,404.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,109.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,109.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,367.12
|
| Rate for Payer: United Healthcare All Other HMO |
$1,367.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1,367.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,367.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC MRI ANGIO HEAD W WO CONTRAST
|
Facility
|
IP
|
$9,142.00
|
|
|
Service Code
|
CPT 70546
|
| Hospital Charge Code |
908801085
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$2,194.08 |
| Max. Negotiated Rate |
$7,770.70 |
| Rate for Payer: Cash Price |
$4,113.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,656.80
|
| Rate for Payer: Galaxy Health WC |
$7,770.70
|
| Rate for Payer: Global Benefits Group Commercial |
$5,485.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,097.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,483.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,194.08
|
| Rate for Payer: Multiplan Commercial |
$7,313.60
|
| Rate for Payer: Networks By Design Commercial |
$5,942.30
|
| Rate for Payer: Prime Health Services Commercial |
$7,770.70
|
|
|
HC MRI ANGIO NECK W CONTRAST
|
Facility
|
IP
|
$6,891.00
|
|
|
Service Code
|
CPT 70548
|
| Hospital Charge Code |
908801087
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,653.84 |
| Max. Negotiated Rate |
$5,857.35 |
| Rate for Payer: Cash Price |
$3,100.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,756.40
|
| Rate for Payer: Galaxy Health WC |
$5,857.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,134.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,596.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,625.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,653.84
|
| Rate for Payer: Multiplan Commercial |
$5,512.80
|
| Rate for Payer: Networks By Design Commercial |
$4,479.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,857.35
|
|
|
HC MRI ANGIO NECK W CONTRAST
|
Facility
|
OP
|
$4,837.00
|
|
|
Service Code
|
CPT 70548
|
| Hospital Charge Code |
908801087
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$457.10 |
| Max. Negotiated Rate |
$4,111.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| 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 HMO/PPO |
$2,881.88
|
| Rate for Payer: Blue Distinction Transplant |
$2,902.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,858.67
|
| Rate for Payer: Blue Shield of California EPN |
$2,268.55
|
| Rate for Payer: Cash Price |
$2,176.65
|
| Rate for Payer: Cash Price |
$2,176.65
|
| Rate for Payer: Cigna of CA HMO |
$3,095.68
|
| Rate for Payer: Cigna of CA PPO |
$3,579.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: Dignity Health Media |
$480.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$480.50
|
| Rate for Payer: Galaxy Health WC |
$4,111.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,902.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,627.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$788.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$788.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$778.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$778.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$480.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,226.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$457.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,160.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$605.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.87
|
| Rate for Payer: Multiplan Commercial |
$3,869.60
|
| Rate for Payer: Networks By Design Commercial |
$3,144.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,111.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,902.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,902.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,115.74
|
| Rate for Payer: United Healthcare All Other HMO |
$1,115.74
|
| Rate for Payer: United Healthcare HMO Rider |
$1,115.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,115.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC MRI ANGIO NECK WO CONTRAST
|
Facility
|
IP
|
$6,656.00
|
|
|
Service Code
|
CPT 70547
|
| Hospital Charge Code |
908801086
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,597.44 |
| Max. Negotiated Rate |
$5,657.60 |
| Rate for Payer: Cash Price |
$2,995.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,662.40
|
| Rate for Payer: Galaxy Health WC |
$5,657.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,993.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,439.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,535.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,597.44
|
| Rate for Payer: Multiplan Commercial |
$5,324.80
|
| Rate for Payer: Networks By Design Commercial |
$4,326.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,657.60
|
|
|
HC MRI ANGIO NECK WO CONTRAST
|
Facility
|
OP
|
$4,670.00
|
|
|
Service Code
|
CPT 70547
|
| Hospital Charge Code |
908801018
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$306.16 |
| Max. Negotiated Rate |
$3,969.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| 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 HMO/PPO |
$2,782.39
|
| Rate for Payer: Blue Distinction Transplant |
$2,802.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,759.97
|
| Rate for Payer: Blue Shield of California EPN |
$2,190.23
|
| Rate for Payer: Cash Price |
$2,101.50
|
| Rate for Payer: Cash Price |
$2,101.50
|
| Rate for Payer: Cigna of CA HMO |
$2,988.80
|
| Rate for Payer: Cigna of CA PPO |
$3,455.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Media |
$306.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$306.16
|
| Rate for Payer: Galaxy Health WC |
$3,969.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,802.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,502.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$502.10
|
| Rate for Payer: Heritage Provider Network Transplant |
$502.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$495.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$495.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,114.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$402.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,120.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410.25
|
| Rate for Payer: Multiplan Commercial |
$3,736.00
|
| Rate for Payer: Networks By Design Commercial |
$3,035.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,969.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,802.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,802.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| Rate for Payer: United Healthcare All Other HMO |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC MRI ANGIO NECK WO CONTRAST
|
Facility
|
IP
|
$6,656.00
|
|
|
Service Code
|
CPT 70547
|
| Hospital Charge Code |
908801018
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,597.44 |
| Max. Negotiated Rate |
$5,657.60 |
| Rate for Payer: Cash Price |
$2,995.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,662.40
|
| Rate for Payer: Galaxy Health WC |
$5,657.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,993.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,439.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,535.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,597.44
|
| Rate for Payer: Multiplan Commercial |
$5,324.80
|
| Rate for Payer: Networks By Design Commercial |
$4,326.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,657.60
|
|
|
HC MRI ANGIO NECK WO CONTRAST
|
Facility
|
OP
|
$4,670.00
|
|
|
Service Code
|
CPT 70547
|
| Hospital Charge Code |
908801086
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$306.16 |
| Max. Negotiated Rate |
$3,969.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| 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 HMO/PPO |
$2,782.39
|
| Rate for Payer: Blue Distinction Transplant |
$2,802.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,759.97
|
| Rate for Payer: Blue Shield of California EPN |
$2,190.23
|
| Rate for Payer: Cash Price |
$2,101.50
|
| Rate for Payer: Cash Price |
$2,101.50
|
| Rate for Payer: Cigna of CA HMO |
$2,988.80
|
| Rate for Payer: Cigna of CA PPO |
$3,455.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Media |
$306.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$306.16
|
| Rate for Payer: Galaxy Health WC |
$3,969.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,802.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,502.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$502.10
|
| Rate for Payer: Heritage Provider Network Transplant |
$502.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$495.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$495.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,114.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$402.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,120.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410.25
|
| Rate for Payer: Multiplan Commercial |
$3,736.00
|
| Rate for Payer: Networks By Design Commercial |
$3,035.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,969.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,802.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,802.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| Rate for Payer: United Healthcare All Other HMO |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC MRI ANGIO NECK W WO CONTRAST
|
Facility
|
IP
|
$8,175.00
|
|
|
Service Code
|
CPT 70549
|
| Hospital Charge Code |
908801088
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,962.00 |
| Max. Negotiated Rate |
$6,948.75 |
| Rate for Payer: Cash Price |
$3,678.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,270.00
|
| Rate for Payer: Galaxy Health WC |
$6,948.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,905.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,452.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,114.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,962.00
|
| Rate for Payer: Multiplan Commercial |
$6,540.00
|
| Rate for Payer: Networks By Design Commercial |
$5,313.75
|
| Rate for Payer: Prime Health Services Commercial |
$6,948.75
|
|
|
HC MRI ANGIO NECK W WO CONTRAST
|
Facility
|
OP
|
$5,116.00
|
|
|
Service Code
|
CPT 70549
|
| Hospital Charge Code |
908801088
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$480.50 |
| Max. Negotiated Rate |
$4,348.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| 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 HMO/PPO |
$3,048.11
|
| Rate for Payer: Blue Distinction Transplant |
$3,069.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,023.56
|
| Rate for Payer: Blue Shield of California EPN |
$2,399.40
|
| Rate for Payer: Cash Price |
$2,302.20
|
| Rate for Payer: Cash Price |
$2,302.20
|
| Rate for Payer: Cigna of CA HMO |
$3,274.24
|
| Rate for Payer: Cigna of CA PPO |
$3,785.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: Dignity Health Media |
$480.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$480.50
|
| Rate for Payer: Galaxy Health WC |
$4,348.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,069.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,837.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$788.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$788.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$778.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$778.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$480.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,412.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$644.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,227.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$605.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.87
|
| Rate for Payer: Multiplan Commercial |
$4,092.80
|
| Rate for Payer: Networks By Design Commercial |
$3,325.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,348.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,069.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,069.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,367.12
|
| Rate for Payer: United Healthcare All Other HMO |
$1,367.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1,367.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,367.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC MRI BILATERAL TMJ
|
Facility
|
IP
|
$7,989.00
|
|
|
Service Code
|
CPT 70336
|
| Hospital Charge Code |
908801055
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,917.36 |
| Max. Negotiated Rate |
$6,790.65 |
| Rate for Payer: Cash Price |
$3,595.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,195.60
|
| Rate for Payer: Galaxy Health WC |
$6,790.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,793.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,328.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,043.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,917.36
|
| Rate for Payer: Multiplan Commercial |
$6,391.20
|
| Rate for Payer: Networks By Design Commercial |
$5,192.85
|
| Rate for Payer: Prime Health Services Commercial |
$6,790.65
|
|
