|
HC MR ANGIO PELVIS W/CONT
|
Facility
OP
|
$3,101.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801097
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$3,443.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,635.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,705.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,705.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,847.58
|
| Rate for Payer: BCBS Transplant Transplant |
$1,860.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,832.69
|
| Rate for Payer: Blue Shield of California EPN |
$1,454.37
|
| Rate for Payer: Cash Price |
$1,395.45
|
| Rate for Payer: Cash Price |
$1,395.45
|
| Rate for Payer: Cigna of CA HMO |
$1,984.64
|
| Rate for Payer: Cigna of CA PPO |
$2,294.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,635.85
|
| Rate for Payer: Dignity Health Media |
$2,635.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,635.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,240.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,240.40
|
| Rate for Payer: Galaxy Health WC |
$2,635.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,860.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,325.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,068.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$629.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$744.24
|
| Rate for Payer: Multiplan Commercial |
$2,480.80
|
| Rate for Payer: Networks By Design Commercial |
$2,015.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,635.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$350.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,860.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,860.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,113.60
|
| Rate for Payer: United Healthcare All Other HMO |
$1,113.60
|
| Rate for Payer: United Healthcare HMO Rider |
$1,113.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,113.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,635.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,635.85
|
| Rate for Payer: Vantage Medical Group Senior |
$2,635.85
|
|
|
HC MR ANGIO PELVIS W/CONT
|
Facility
IP
|
$5,570.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801097
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$1,336.80 |
| Max. Negotiated Rate |
$4,734.50 |
| Rate for Payer: Galaxy Health WC |
$4,734.50
|
| Rate for Payer: Cash Price |
$2,506.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,228.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,342.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,715.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,122.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,336.80
|
| Rate for Payer: Multiplan Commercial |
$4,456.00
|
| Rate for Payer: Networks By Design Commercial |
$3,620.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,734.50
|
|
|
HC MR ANGIO PELVIS WO CONT
|
Facility
OP
|
$2,725.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801098
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$3,443.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,316.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,498.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,498.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,623.56
|
| Rate for Payer: BCBS Transplant Transplant |
$1,635.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,610.48
|
| Rate for Payer: Blue Shield of California EPN |
$1,278.02
|
| Rate for Payer: Cash Price |
$1,226.25
|
| Rate for Payer: Cash Price |
$1,226.25
|
| Rate for Payer: Cigna of CA HMO |
$1,744.00
|
| Rate for Payer: Cigna of CA PPO |
$2,016.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,316.25
|
| Rate for Payer: Dignity Health Media |
$2,316.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,316.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,090.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,090.00
|
| Rate for Payer: Galaxy Health WC |
$2,316.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,635.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,043.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,817.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$629.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$654.00
|
| Rate for Payer: Multiplan Commercial |
$2,180.00
|
| Rate for Payer: Networks By Design Commercial |
$1,771.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,316.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$350.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,635.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,635.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,113.60
|
| Rate for Payer: United Healthcare All Other HMO |
$1,113.60
|
| Rate for Payer: United Healthcare HMO Rider |
$1,113.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,113.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,316.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,316.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,316.25
|
|
|
HC MR ANGIO PELVIS WO CONT
|
Facility
IP
|
$5,305.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801098
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$1,273.20 |
| Max. Negotiated Rate |
$4,509.25 |
| Rate for Payer: Cash Price |
$2,387.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,122.00
|
| Rate for Payer: Galaxy Health WC |
$4,509.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,183.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,538.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,021.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,273.20
|
| Rate for Payer: Multiplan Commercial |
$4,244.00
|
| Rate for Payer: Networks By Design Commercial |
$3,448.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,509.25
|
|
|
HC MR ANGIO PELVIS WO FOL W CONT
|
Facility
IP
|
$5,849.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801034
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$1,403.76 |
| Max. Negotiated Rate |
$4,971.65 |
| Rate for Payer: Cash Price |
$2,632.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,339.60
|
| Rate for Payer: Galaxy Health WC |
$4,971.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,509.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,901.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,228.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,403.76
|
| Rate for Payer: Multiplan Commercial |
$4,679.20
|
| Rate for Payer: Networks By Design Commercial |
$3,801.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,971.65
|
|
|
HC MR ANGIO PELVIS WO FOL W CONT
|
Facility
IP
|
$5,849.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801099
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$1,403.76 |
| Max. Negotiated Rate |
$4,971.65 |
| Rate for Payer: Cash Price |
$2,632.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,339.60
|
| Rate for Payer: Galaxy Health WC |
$4,971.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,509.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,901.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,228.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,403.76
|
| Rate for Payer: Multiplan Commercial |
$4,679.20
|
| Rate for Payer: Networks By Design Commercial |
$3,801.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,971.65
|
|
|
HC MR ANGIO PELVIS WO FOL W CONT
|
Facility
OP
|
$3,480.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801034
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$3,443.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,958.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,914.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,914.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,073.38
|
| Rate for Payer: BCBS Transplant Transplant |
$2,088.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,056.68
|
| Rate for Payer: Blue Shield of California EPN |
$1,632.12
|
| Rate for Payer: Cash Price |
$1,566.00
|
| Rate for Payer: Cash Price |
$1,566.00
|
| Rate for Payer: Cigna of CA HMO |
$2,227.20
|
| Rate for Payer: Cigna of CA PPO |
$2,575.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,958.00
|
| Rate for Payer: Dignity Health Media |
$2,958.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,958.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,392.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,392.00
|
| Rate for Payer: Galaxy Health WC |
$2,958.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,088.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,610.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,321.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$629.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$835.20
|
| Rate for Payer: Multiplan Commercial |
$2,784.00
|
| Rate for Payer: Networks By Design Commercial |
$2,262.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,958.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$350.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,088.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,088.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,113.60
|
| Rate for Payer: United Healthcare All Other HMO |
$1,113.60
|
| Rate for Payer: United Healthcare HMO Rider |
$1,113.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,113.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,958.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,958.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,958.00
|
|
|
HC MR ANGIO PELVIS WO FOL W CONT
|
Facility
OP
|
$3,480.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801099
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$3,443.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,958.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,914.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,914.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,073.38
|
| Rate for Payer: BCBS Transplant Transplant |
$2,088.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,056.68
|
| Rate for Payer: Blue Shield of California EPN |
$1,632.12
|
| Rate for Payer: Cash Price |
$1,566.00
|
| Rate for Payer: Cash Price |
$1,566.00
|
| Rate for Payer: Cigna of CA HMO |
$2,227.20
|
| Rate for Payer: Cigna of CA PPO |
$2,575.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,958.00
|
| Rate for Payer: Dignity Health Media |
$2,958.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,958.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,392.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,392.00
|
| Rate for Payer: Galaxy Health WC |
$2,958.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,088.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,610.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,321.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$629.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$835.20
|
| Rate for Payer: Multiplan Commercial |
$2,784.00
|
| Rate for Payer: Networks By Design Commercial |
$2,262.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,958.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$350.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,088.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,088.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,113.60
|
| Rate for Payer: United Healthcare All Other HMO |
$1,113.60
|
| Rate for Payer: United Healthcare HMO Rider |
$1,113.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,113.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,958.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,958.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,958.00
|
|
|
HC MR ANGIO SPINAL CAN W OR WO CO
|
Facility
IP
|
$3,810.00
|
|
|
Service Code
|
CPT 72159
|
| Hospital Charge Code |
908801033
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$914.40 |
| Max. Negotiated Rate |
$3,238.50 |
| Rate for Payer: Cash Price |
$1,714.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,524.00
|
| Rate for Payer: Galaxy Health WC |
$3,238.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,286.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,541.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,451.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$914.40
|
| Rate for Payer: Multiplan Commercial |
$3,048.00
|
| Rate for Payer: Networks By Design Commercial |
$2,476.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,238.50
|
|
|
HC MR ANGIO SPINAL CAN W OR WO CO
|
Facility
OP
|
$2,228.00
|
|
|
Service Code
|
CPT 72159
|
| Hospital Charge Code |
908801033
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$2,328.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,328.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,893.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,225.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,225.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,327.44
|
| Rate for Payer: BCBS Transplant Transplant |
$1,336.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,316.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,044.93
|
| Rate for Payer: Cash Price |
$1,002.60
|
| Rate for Payer: Cash Price |
$1,002.60
|
| Rate for Payer: Cigna of CA HMO |
$1,425.92
|
| Rate for Payer: Cigna of CA PPO |
$1,648.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,893.80
|
| Rate for Payer: Dignity Health Media |
$1,893.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,893.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$891.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$891.20
|
| Rate for Payer: Galaxy Health WC |
$1,893.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,336.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,671.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,486.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$647.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$534.72
|
| Rate for Payer: Multiplan Commercial |
$1,782.40
|
| Rate for Payer: Networks By Design Commercial |
$1,448.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,893.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$350.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,336.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,336.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,168.48
|
| Rate for Payer: United Healthcare All Other HMO |
$1,168.48
|
| Rate for Payer: United Healthcare HMO Rider |
$1,168.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,168.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,893.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,893.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,893.80
|
|
|
HC MR ANGIO UPPER EXT W/WO CONTR
|
Facility
OP
|
$2,001.00
|
|
|
Service Code
|
CPT 73225
|
| Hospital Charge Code |
908801035
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$3,443.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,700.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,100.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,100.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,192.20
|
| Rate for Payer: BCBS Transplant Transplant |
$1,200.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,182.59
|
| Rate for Payer: Blue Shield of California EPN |
$938.47
|
| Rate for Payer: Cash Price |
$900.45
|
| Rate for Payer: Cash Price |
$900.45
|
| Rate for Payer: Cigna of CA HMO |
$1,280.64
|
| Rate for Payer: Cigna of CA PPO |
$1,480.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,700.85
|
| Rate for Payer: Dignity Health Media |
$1,700.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,700.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$800.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$800.40
|
| Rate for Payer: Galaxy Health WC |
$1,700.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,200.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,500.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,334.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$642.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$480.24
|
| Rate for Payer: Multiplan Commercial |
$1,600.80
|
| Rate for Payer: Networks By Design Commercial |
$1,300.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,700.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$350.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,200.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,200.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,124.94
|
| Rate for Payer: United Healthcare All Other HMO |
$1,124.94
|
| Rate for Payer: United Healthcare HMO Rider |
$1,124.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,124.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,700.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,700.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,700.85
|
|
|
HC MR ANGIO UPPER EXT W/WO CONTR
|
Facility
IP
|
$3,423.00
|
|
|
Service Code
|
CPT 73225
|
| Hospital Charge Code |
908801035
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$821.52 |
| Max. Negotiated Rate |
$2,909.55 |
| Rate for Payer: Cash Price |
$1,540.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,369.20
|
| Rate for Payer: Galaxy Health WC |
$2,909.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,053.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,283.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,304.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$821.52
|
| Rate for Payer: Multiplan Commercial |
$2,738.40
|
| Rate for Payer: Networks By Design Commercial |
$2,224.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,909.55
|
|
|
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 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 |
$350.00 |
| Max. Negotiated Rate |
$5,421.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,421.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,507.90
|
| Rate for Payer: AlphaCare 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: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$350.00
|
| 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 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/CONTRAST
|
Facility
OP
|
$4,442.00
|
|
|
Service Code
|
CPT 74182
|
| Hospital Charge Code |
908801301
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$3,775.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,646.54
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: IEHP Medi-Cal |
$778.41
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$778.41
|
| Rate for Payer: 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: Redlands Yucaipa Medical Group Commercial/Senior |
$350.00
|
| 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/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: AlphaCare Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,308.13
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: IEHP Medi-Cal |
$495.98
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$495.98
|
| Rate for Payer: 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: Redlands Yucaipa Medical Group Commercial/Senior |
$350.00
|
| 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/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 WO CONTRAST
|
Facility
OP
|
$4,885.00
|
|
|
Service Code
|
CPT 74183
|
| Hospital Charge Code |
908801302
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$4,152.25 |
| Rate for Payer: IEHP Medicare Advantage |
$480.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,910.48
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: IEHP Medi-Cal |
$778.41
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$778.41
|
| 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: Redlands Yucaipa Medical Group Commercial/Senior |
$350.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,931.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,931.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$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 |
$350.00 |
| Max. Negotiated Rate |
$4,111.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,881.88
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: IEHP Medi-Cal |
$778.41
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$778.41
|
| Rate for Payer: 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: Redlands Yucaipa Medical Group Commercial/Senior |
$350.00
|
| 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
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 |
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: AlphaCare Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,573.26
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: IEHP Medi-Cal |
$495.98
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$495.98
|
| Rate for Payer: 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: Redlands Yucaipa Medical Group Commercial/Senior |
$350.00
|
| 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
|
|
