|
HC MR ANGIO LOW EXT WO CONT
|
Facility
|
IP
|
$5,885.00
|
|
|
Service Code
|
CPT 73725
|
| Hospital Charge Code |
908801094
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$1,177.00 |
| Max. Negotiated Rate |
$5,002.25 |
| Rate for Payer: Adventist Health Commercial |
$1,177.00
|
| Rate for Payer: Cash Price |
$2,648.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,354.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,354.00
|
| Rate for Payer: Galaxy Health WC |
$5,002.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,531.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,925.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,242.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,642.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,412.40
|
| Rate for Payer: Multiplan Commercial |
$4,708.00
|
| Rate for Payer: Networks By Design Commercial |
$3,825.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,002.25
|
|
|
HC MR ANGIO LOW EXT WO CONT
|
Facility
|
OP
|
$4,898.00
|
|
|
Service Code
|
CPT 73725
|
| Hospital Charge Code |
908801094
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$554.48 |
| Max. Negotiated Rate |
$4,163.30 |
| Rate for Payer: Adventist Health Commercial |
$979.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,212.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,163.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,693.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,673.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,007.86
|
| Rate for Payer: Blue Shield of California Commercial |
$2,997.58
|
| Rate for Payer: Blue Shield of California EPN |
$1,978.79
|
| Rate for Payer: Cash Price |
$2,204.10
|
| Rate for Payer: Cash Price |
$2,204.10
|
| Rate for Payer: Cigna of CA HMO |
$3,134.72
|
| Rate for Payer: Cigna of CA PPO |
$3,624.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,163.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,163.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,163.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,959.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,959.20
|
| Rate for Payer: Galaxy Health WC |
$4,163.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,938.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$554.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,266.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$627.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,031.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,175.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,428.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,428.60
|
| Rate for Payer: Multiplan Commercial |
$3,918.40
|
| Rate for Payer: Networks By Design Commercial |
$3,183.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,163.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,938.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,938.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,114.46
|
| Rate for Payer: United Healthcare All Other HMO |
$1,114.46
|
| Rate for Payer: United Healthcare HMO Rider |
$1,114.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,114.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,163.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,163.30
|
| Rate for Payer: Vantage Medical Group Senior |
$4,163.30
|
|
|
HC MR ANGIO LOW EXT W&WO CON
|
Facility
|
IP
|
$7,680.00
|
|
|
Service Code
|
CPT 73725
|
| Hospital Charge Code |
908801036
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$1,536.00 |
| Max. Negotiated Rate |
$6,528.00 |
| Rate for Payer: Adventist Health Commercial |
$1,536.00
|
| Rate for Payer: Cash Price |
$3,456.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,072.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,072.00
|
| Rate for Payer: Galaxy Health WC |
$6,528.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,608.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,122.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,926.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,753.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,843.20
|
| Rate for Payer: Multiplan Commercial |
$6,144.00
|
| Rate for Payer: Networks By Design Commercial |
$4,992.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,528.00
|
|
|
HC MR ANGIO LOW EXT W&WO CON
|
Facility
|
OP
|
$5,811.00
|
|
|
Service Code
|
CPT 73725
|
| Hospital Charge Code |
908801036
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$554.48 |
| Max. Negotiated Rate |
$4,939.35 |
| Rate for Payer: Adventist Health Commercial |
$1,162.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,811.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,939.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,196.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,358.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,568.54
|
| Rate for Payer: Blue Shield of California Commercial |
$3,556.33
|
| Rate for Payer: Blue Shield of California EPN |
$2,347.64
|
| Rate for Payer: Cash Price |
$2,614.95
|
| Rate for Payer: Cash Price |
$2,614.95
|
| Rate for Payer: Cigna of CA HMO |
$3,719.04
|
| Rate for Payer: Cigna of CA PPO |
$4,300.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,939.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,939.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,939.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,324.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,324.40
|
| Rate for Payer: Galaxy Health WC |
$4,939.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,486.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$554.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,875.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$627.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,597.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,394.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,067.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,067.70
|
| Rate for Payer: Multiplan Commercial |
$4,648.80
|
| Rate for Payer: Networks By Design Commercial |
$3,777.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,939.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,486.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,486.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,114.46
|
| Rate for Payer: United Healthcare All Other HMO |
$1,114.46
|
| Rate for Payer: United Healthcare HMO Rider |
$1,114.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,114.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,939.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,939.35
|
| Rate for Payer: Vantage Medical Group Senior |
$4,939.35
|
|
|
HC MR ANGIO PELVIS W/CONT
|
Facility
|
OP
|
$3,752.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801097
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$556.74 |
| Max. Negotiated Rate |
$3,443.00 |
| Rate for Payer: Adventist Health Commercial |
$750.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,189.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,063.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,814.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,304.10
|
| Rate for Payer: Blue Shield of California Commercial |
$2,296.22
|
| Rate for Payer: Blue Shield of California EPN |
$1,515.81
|
| Rate for Payer: Cash Price |
$1,688.40
|
| Rate for Payer: Cash Price |
$1,688.40
|
| Rate for Payer: Cash Price |
$1,688.40
|
| Rate for Payer: Cigna of CA HMO |
$2,401.28
|
| Rate for Payer: Cigna of CA PPO |
$2,776.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,189.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,189.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,189.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,500.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,500.80
|
| Rate for Payer: Galaxy Health WC |
$3,189.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,251.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$556.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,502.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$629.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,322.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$900.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,626.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,626.40
|
| Rate for Payer: Multiplan Commercial |
$3,001.60
|
| Rate for Payer: Networks By Design Commercial |
$2,438.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,189.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,251.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,251.20
|
| 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 |
$3,189.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,189.20
|
| Rate for Payer: Vantage Medical Group Senior |
$3,189.20
|
|
|
HC MR ANGIO PELVIS W/CONT
|
Facility
|
IP
|
$4,734.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801097
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$946.80 |
| Max. Negotiated Rate |
$4,023.90 |
| Rate for Payer: Adventist Health Commercial |
$946.80
|
| Rate for Payer: Cash Price |
$2,130.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,893.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,893.60
|
| Rate for Payer: Galaxy Health WC |
$4,023.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,840.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,157.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,803.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,930.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,136.16
|
| Rate for Payer: Multiplan Commercial |
$3,787.20
|
| Rate for Payer: Networks By Design Commercial |
$3,077.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,023.90
|
|
|
HC MR ANGIO PELVIS WO CONT
|
Facility
|
IP
|
$4,509.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801098
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$901.80 |
| Max. Negotiated Rate |
$3,832.65 |
| Rate for Payer: Adventist Health Commercial |
$901.80
|
| Rate for Payer: Cash Price |
$2,029.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,803.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,803.60
|
| Rate for Payer: Galaxy Health WC |
$3,832.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,705.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,007.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,717.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,791.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,082.16
|
| Rate for Payer: Multiplan Commercial |
$3,607.20
|
| Rate for Payer: Networks By Design Commercial |
$2,930.85
|
| Rate for Payer: Prime Health Services Commercial |
$3,832.65
|
|
|
HC MR ANGIO PELVIS WO CONT
|
Facility
|
OP
|
$3,298.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801098
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$556.74 |
| Max. Negotiated Rate |
$3,443.00 |
| Rate for Payer: Adventist Health Commercial |
$659.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,803.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,813.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,473.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,025.30
|
| Rate for Payer: Blue Shield of California Commercial |
$2,018.38
|
| Rate for Payer: Blue Shield of California EPN |
$1,332.39
|
| Rate for Payer: Cash Price |
$1,484.10
|
| Rate for Payer: Cash Price |
$1,484.10
|
| Rate for Payer: Cash Price |
$1,484.10
|
| Rate for Payer: Cigna of CA HMO |
$2,110.72
|
| Rate for Payer: Cigna of CA PPO |
$2,440.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,803.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,803.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,803.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,319.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,319.20
|
| Rate for Payer: Galaxy Health WC |
$2,803.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,978.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$556.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,199.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$629.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,041.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$791.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,308.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,308.60
|
| Rate for Payer: Multiplan Commercial |
$2,638.40
|
| Rate for Payer: Networks By Design Commercial |
$2,143.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,803.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,978.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,978.80
|
| 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 |
$2,803.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,803.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,803.30
|
|
|
HC MR ANGIO PELVIS WO FOL W CONT
|
Facility
|
OP
|
$4,211.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801099
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$556.74 |
| Max. Negotiated Rate |
$3,579.35 |
| Rate for Payer: Adventist Health Commercial |
$842.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,579.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,316.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,158.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,585.98
|
| Rate for Payer: Blue Shield of California Commercial |
$2,577.13
|
| Rate for Payer: Blue Shield of California EPN |
$1,701.24
|
| Rate for Payer: Cash Price |
$1,894.95
|
| Rate for Payer: Cash Price |
$1,894.95
|
| Rate for Payer: Cash Price |
$1,894.95
|
| Rate for Payer: Cigna of CA HMO |
$2,695.04
|
| Rate for Payer: Cigna of CA PPO |
$3,116.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,579.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,579.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,579.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,684.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,684.40
|
| Rate for Payer: Galaxy Health WC |
$3,579.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,526.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$556.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,808.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$629.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,606.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,010.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,947.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,947.70
|
| Rate for Payer: Multiplan Commercial |
$3,368.80
|
| Rate for Payer: Networks By Design Commercial |
$2,737.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,579.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,526.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,526.60
|
| 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 |
$3,579.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,579.35
|
| Rate for Payer: Vantage Medical Group Senior |
$3,579.35
|
|
|
HC MR ANGIO PELVIS WO FOL W CONT
|
Facility
|
IP
|
$4,972.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801034
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$994.40 |
| Max. Negotiated Rate |
$4,226.20 |
| Rate for Payer: Adventist Health Commercial |
$994.40
|
| Rate for Payer: Cash Price |
$2,237.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,988.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,988.80
|
| Rate for Payer: Galaxy Health WC |
$4,226.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,983.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,316.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,894.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,077.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,193.28
|
| Rate for Payer: Multiplan Commercial |
$3,977.60
|
| Rate for Payer: Networks By Design Commercial |
$3,231.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,226.20
|
|
|
HC MR ANGIO PELVIS WO FOL W CONT
|
Facility
|
IP
|
$4,972.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801099
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$994.40 |
| Max. Negotiated Rate |
$4,226.20 |
| Rate for Payer: Adventist Health Commercial |
$994.40
|
| Rate for Payer: Cash Price |
$2,237.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,988.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,988.80
|
| Rate for Payer: Galaxy Health WC |
$4,226.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,983.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,316.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,894.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,077.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,193.28
|
| Rate for Payer: Multiplan Commercial |
$3,977.60
|
| Rate for Payer: Networks By Design Commercial |
$3,231.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,226.20
|
|
|
HC MR ANGIO PELVIS WO FOL W CONT
|
Facility
|
OP
|
$4,211.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801034
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$556.74 |
| Max. Negotiated Rate |
$3,579.35 |
| Rate for Payer: Adventist Health Commercial |
$842.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,579.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,316.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,158.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,585.98
|
| Rate for Payer: Blue Shield of California Commercial |
$2,577.13
|
| Rate for Payer: Blue Shield of California EPN |
$1,701.24
|
| Rate for Payer: Cash Price |
$1,894.95
|
| Rate for Payer: Cash Price |
$1,894.95
|
| Rate for Payer: Cash Price |
$1,894.95
|
| Rate for Payer: Cigna of CA HMO |
$2,695.04
|
| Rate for Payer: Cigna of CA PPO |
$3,116.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,579.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,579.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,579.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,684.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,684.40
|
| Rate for Payer: Galaxy Health WC |
$3,579.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,526.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$556.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,808.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$629.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,606.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,010.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,947.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,947.70
|
| Rate for Payer: Multiplan Commercial |
$3,368.80
|
| Rate for Payer: Networks By Design Commercial |
$2,737.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,579.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,526.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,526.60
|
| 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 |
$3,579.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,579.35
|
| Rate for Payer: Vantage Medical Group Senior |
$3,579.35
|
|
|
HC MR ANGIO SPINAL CAN W OR WO CO
|
Facility
|
OP
|
$2,696.00
|
|
|
Service Code
|
CPT 72159
|
| Hospital Charge Code |
908801033
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$539.20 |
| Max. Negotiated Rate |
$2,291.60 |
| Rate for Payer: Adventist Health Commercial |
$539.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,768.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,291.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,482.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,022.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,655.61
|
| Rate for Payer: Blue Shield of California Commercial |
$1,649.95
|
| Rate for Payer: Blue Shield of California EPN |
$1,089.18
|
| Rate for Payer: Cash Price |
$1,213.20
|
| Rate for Payer: Cash Price |
$1,213.20
|
| Rate for Payer: Cigna of CA HMO |
$1,725.44
|
| Rate for Payer: Cigna of CA PPO |
$1,995.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,291.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,291.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,291.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,078.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,078.40
|
| Rate for Payer: Galaxy Health WC |
$2,291.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,617.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$572.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,798.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$647.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,668.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$647.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,887.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,887.20
|
| Rate for Payer: Multiplan Commercial |
$2,156.80
|
| Rate for Payer: Networks By Design Commercial |
$1,752.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,291.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,617.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,617.60
|
| 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 |
$2,291.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,291.60
|
| Rate for Payer: Vantage Medical Group Senior |
$2,291.60
|
|
|
HC MR ANGIO SPINAL CAN W OR WO CO
|
Facility
|
IP
|
$3,238.00
|
|
|
Service Code
|
CPT 72159
|
| Hospital Charge Code |
908801033
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$647.60 |
| Max. Negotiated Rate |
$2,752.30 |
| Rate for Payer: Adventist Health Commercial |
$647.60
|
| Rate for Payer: Cash Price |
$1,457.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,295.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,295.20
|
| Rate for Payer: Galaxy Health WC |
$2,752.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,942.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,159.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,233.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,004.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$777.12
|
| Rate for Payer: Multiplan Commercial |
$2,590.40
|
| Rate for Payer: Networks By Design Commercial |
$2,104.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,752.30
|
|
|
HC MR ANGIO UPPER EXT W/WO CONTR
|
Facility
|
IP
|
$2,910.00
|
|
|
Service Code
|
CPT 73225
|
| Hospital Charge Code |
908801035
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$582.00 |
| Max. Negotiated Rate |
$2,473.50 |
| Rate for Payer: Adventist Health Commercial |
$582.00
|
| Rate for Payer: Cash Price |
$1,309.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,164.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,164.00
|
| Rate for Payer: Galaxy Health WC |
$2,473.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,746.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,940.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,108.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,801.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$698.40
|
| Rate for Payer: Multiplan Commercial |
$2,328.00
|
| Rate for Payer: Networks By Design Commercial |
$1,891.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,473.50
|
|
|
HC MR ANGIO UPPER EXT W/WO CONTR
|
Facility
|
OP
|
$2,531.00
|
|
|
Service Code
|
CPT 73225
|
| Hospital Charge Code |
908801035
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$506.20 |
| Max. Negotiated Rate |
$3,443.00 |
| Rate for Payer: Adventist Health Commercial |
$506.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,151.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,392.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,898.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,554.29
|
| Rate for Payer: Blue Shield of California Commercial |
$1,548.97
|
| Rate for Payer: Blue Shield of California EPN |
$1,022.52
|
| Rate for Payer: Cash Price |
$1,138.95
|
| Rate for Payer: Cash Price |
$1,138.95
|
| Rate for Payer: Cash Price |
$1,138.95
|
| Rate for Payer: Cigna of CA HMO |
$1,619.84
|
| Rate for Payer: Cigna of CA PPO |
$1,872.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,151.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,151.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,151.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,012.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,012.40
|
| Rate for Payer: Galaxy Health WC |
$2,151.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,518.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$568.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,688.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$642.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,566.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$607.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,771.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,771.70
|
| Rate for Payer: Multiplan Commercial |
$2,024.80
|
| Rate for Payer: Networks By Design Commercial |
$1,645.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,151.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,518.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,518.60
|
| 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 |
$2,151.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,151.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,151.35
|
|
|
HC MR ANGIO W/O FOL W/CONT, ABD
|
Facility
|
IP
|
$9,644.00
|
|
|
Service Code
|
CPT 74185
|
| Hospital Charge Code |
908801096
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$1,928.80 |
| Max. Negotiated Rate |
$8,197.40 |
| Rate for Payer: Adventist Health Commercial |
$1,928.80
|
| Rate for Payer: Cash Price |
$4,339.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,857.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,857.60
|
| Rate for Payer: Galaxy Health WC |
$8,197.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,786.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,432.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,674.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,969.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,314.56
|
| Rate for Payer: Multiplan Commercial |
$7,715.20
|
| Rate for Payer: Networks By Design Commercial |
$6,268.60
|
| Rate for Payer: Prime Health Services Commercial |
$8,197.40
|
|
|
HC MR ANGIO W/O FOL W/CONT, ABD
|
Facility
|
OP
|
$7,718.00
|
|
|
Service Code
|
CPT 74185
|
| Hospital Charge Code |
908801096
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$557.81 |
| Max. Negotiated Rate |
$6,560.30 |
| Rate for Payer: Adventist Health Commercial |
$1,543.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,560.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,244.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,788.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,739.62
|
| Rate for Payer: Blue Shield of California Commercial |
$4,723.42
|
| Rate for Payer: Blue Shield of California EPN |
$3,118.07
|
| Rate for Payer: Cash Price |
$3,473.10
|
| Rate for Payer: Cash Price |
$3,473.10
|
| Rate for Payer: Cash Price |
$3,473.10
|
| Rate for Payer: Cigna of CA HMO |
$4,939.52
|
| Rate for Payer: Cigna of CA PPO |
$5,711.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,560.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,560.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,560.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,087.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,087.20
|
| Rate for Payer: Galaxy Health WC |
$6,560.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,630.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$557.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,147.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$630.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,777.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,852.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,402.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,402.60
|
| Rate for Payer: Multiplan Commercial |
$6,174.40
|
| Rate for Payer: Networks By Design Commercial |
$5,016.70
|
| Rate for Payer: Prime Health Services Commercial |
$6,560.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,630.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,630.80
|
| 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 |
$6,560.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,560.30
|
| Rate for Payer: Vantage Medical Group Senior |
$6,560.30
|
|
|
HC MRI ABDOMEN W/CONTRAST
|
Facility
|
OP
|
$5,375.00
|
|
|
Service Code
|
CPT 74182
|
| Hospital Charge Code |
908801301
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$453.77 |
| Max. Negotiated Rate |
$4,568.75 |
| Rate for Payer: Adventist Health Commercial |
$1,075.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,300.79
|
| Rate for Payer: Blue Shield of California Commercial |
$3,289.50
|
| Rate for Payer: Blue Shield of California EPN |
$2,171.50
|
| Rate for Payer: Cash Price |
$2,418.75
|
| Rate for Payer: Cash Price |
$2,418.75
|
| Rate for Payer: Cash Price |
$2,418.75
|
| Rate for Payer: Cigna of CA HMO |
$3,440.00
|
| Rate for Payer: Cigna of CA PPO |
$3,977.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.59
|
| Rate for Payer: EPIC Health Plan Senior |
$453.77
|
| Rate for Payer: Galaxy Health WC |
$4,568.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,225.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$502.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,585.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$568.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,290.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$571.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$608.05
|
| Rate for Payer: Multiplan Commercial |
$4,300.00
|
| Rate for Payer: Networks By Design Commercial |
$3,493.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,568.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,225.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,225.00
|
| 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: Upland Medical Group Pediatric |
$453.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
HC MRI ABDOMEN W/CONTRAST
|
Facility
|
IP
|
$7,024.00
|
|
|
Service Code
|
CPT 74182
|
| Hospital Charge Code |
908801301
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,404.80 |
| Max. Negotiated Rate |
$5,970.40 |
| Rate for Payer: Adventist Health Commercial |
$1,404.80
|
| Rate for Payer: Cash Price |
$3,160.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,809.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,809.60
|
| Rate for Payer: Galaxy Health WC |
$5,970.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,214.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,685.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,676.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,347.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,685.76
|
| Rate for Payer: Multiplan Commercial |
$5,619.20
|
| Rate for Payer: Networks By Design Commercial |
$4,565.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,970.40
|
|
|
HC MRI ABDOMEN W/O CONTRAST
|
Facility
|
OP
|
$4,687.00
|
|
|
Service Code
|
CPT 74181
|
| Hospital Charge Code |
908801300
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$3,983.95 |
| Rate for Payer: Adventist Health Commercial |
$937.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,878.29
|
| Rate for Payer: Blue Shield of California Commercial |
$2,868.44
|
| Rate for Payer: Blue Shield of California EPN |
$1,893.55
|
| Rate for Payer: Cash Price |
$2,109.15
|
| Rate for Payer: Cash Price |
$2,109.15
|
| Rate for Payer: Cash Price |
$2,109.15
|
| Rate for Payer: Cigna of CA HMO |
$2,999.68
|
| Rate for Payer: Cigna of CA PPO |
$3,468.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$3,983.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,812.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$320.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,126.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$362.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,124.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$3,749.60
|
| Rate for Payer: Networks By Design Commercial |
$3,046.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,983.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,812.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,812.20
|
| 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: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC MRI ABDOMEN W/O CONTRAST
|
Facility
|
IP
|
$6,385.00
|
|
|
Service Code
|
CPT 74181
|
| Hospital Charge Code |
908801300
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,277.00 |
| Max. Negotiated Rate |
$5,427.25 |
| Rate for Payer: Adventist Health Commercial |
$1,277.00
|
| Rate for Payer: Cash Price |
$2,873.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,554.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,554.00
|
| Rate for Payer: Galaxy Health WC |
$5,427.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,831.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,258.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,432.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,952.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,532.40
|
| Rate for Payer: Multiplan Commercial |
$5,108.00
|
| Rate for Payer: Networks By Design Commercial |
$4,150.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,427.25
|
|
|
HC MRI ABDOMEN W WO CONTRAST
|
Facility
|
OP
|
$6,180.00
|
|
|
Service Code
|
CPT 74183
|
| Hospital Charge Code |
908801302
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$453.77 |
| Max. Negotiated Rate |
$5,253.00 |
| Rate for Payer: Adventist Health Commercial |
$1,236.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,795.14
|
| Rate for Payer: Blue Shield of California Commercial |
$3,782.16
|
| Rate for Payer: Blue Shield of California EPN |
$2,496.72
|
| Rate for Payer: Cash Price |
$2,781.00
|
| Rate for Payer: Cash Price |
$2,781.00
|
| Rate for Payer: Cash Price |
$2,781.00
|
| Rate for Payer: Cigna of CA HMO |
$3,955.20
|
| Rate for Payer: Cigna of CA PPO |
$4,573.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.59
|
| Rate for Payer: EPIC Health Plan Senior |
$453.77
|
| Rate for Payer: Galaxy Health WC |
$5,253.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,708.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$560.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,122.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$633.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,483.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$571.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$608.05
|
| Rate for Payer: Multiplan Commercial |
$4,944.00
|
| Rate for Payer: Networks By Design Commercial |
$4,017.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,253.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,708.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,708.00
|
| 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: Upland Medical Group Pediatric |
$453.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
HC MRI ABDOMEN W WO CONTRAST
|
Facility
|
IP
|
$8,568.00
|
|
|
Service Code
|
CPT 74183
|
| Hospital Charge Code |
908801302
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,713.60 |
| Max. Negotiated Rate |
$7,282.80 |
| Rate for Payer: Adventist Health Commercial |
$1,713.60
|
| Rate for Payer: Cash Price |
$3,855.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,427.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,427.20
|
| Rate for Payer: Galaxy Health WC |
$7,282.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,140.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,714.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,264.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,303.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,056.32
|
| Rate for Payer: Multiplan Commercial |
$6,854.40
|
| Rate for Payer: Networks By Design Commercial |
$5,569.20
|
| Rate for Payer: Prime Health Services Commercial |
$7,282.80
|
|
|
HC MRI ANGIO HEAD WITH CONTRAST
|
Facility
|
IP
|
$5,913.00
|
|
|
Service Code
|
CPT 70545
|
| Hospital Charge Code |
908801084
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,182.60 |
| Max. Negotiated Rate |
$5,026.05 |
| Rate for Payer: Adventist Health Commercial |
$1,182.60
|
| Rate for Payer: Cash Price |
$2,660.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,365.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,365.20
|
| Rate for Payer: Galaxy Health WC |
$5,026.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,547.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,943.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,252.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,660.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,419.12
|
| Rate for Payer: Multiplan Commercial |
$4,730.40
|
| Rate for Payer: Networks By Design Commercial |
$3,843.45
|
| Rate for Payer: Prime Health Services Commercial |
$5,026.05
|
|
