|
HC MP CONTROL LE PROS
|
Facility
|
IP
|
$50,000.00
|
|
|
Service Code
|
CPT L5999
|
| Hospital Charge Code |
915380021
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10,000.00 |
| Max. Negotiated Rate |
$42,500.00 |
| Rate for Payer: Adventist Health Commercial |
$10,000.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$27,500.00
|
| Rate for Payer: Cash Price |
$27,500.00
|
| Rate for Payer: Cigna of CA HMO |
$35,000.00
|
| Rate for Payer: Cigna of CA PPO |
$35,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20,000.00
|
| Rate for Payer: Galaxy Health WC |
$42,500.00
|
| Rate for Payer: Global Benefits Group Commercial |
$30,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33,350.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19,050.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30,950.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,000.00
|
| Rate for Payer: Multiplan Commercial |
$40,000.00
|
| Rate for Payer: Networks By Design Commercial |
$25,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$42,500.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$18,765.00
|
| Rate for Payer: United Healthcare All Other HMO |
$18,265.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,870.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,375.00
|
|
|
HC MP CONTROL LE PROS
|
Facility
|
OP
|
$50,000.00
|
|
|
Service Code
|
CPT L5999
|
| Hospital Charge Code |
915380021
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$12,000.00 |
| Max. Negotiated Rate |
$42,500.00 |
| Rate for Payer: EPIC Health Plan Senior |
$20,000.00
|
| Rate for Payer: Galaxy Health WC |
$42,500.00
|
| Rate for Payer: Adventist Health Commercial |
$20,500.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42,500.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27,500.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37,500.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28,960.00
|
| Rate for Payer: Blue Shield of California Commercial |
$36,900.00
|
| Rate for Payer: Blue Shield of California EPN |
$24,300.00
|
| Rate for Payer: Cash Price |
$27,500.00
|
| Rate for Payer: Cigna of CA HMO |
$35,000.00
|
| Rate for Payer: Cigna of CA PPO |
$35,000.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42,500.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$42,500.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20,000.00
|
| Rate for Payer: Global Benefits Group Commercial |
$30,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33,350.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19,050.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30,950.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,000.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35,000.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35,000.00
|
| Rate for Payer: Multiplan Commercial |
$40,000.00
|
| Rate for Payer: Networks By Design Commercial |
$25,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$42,500.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30,000.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$18,765.00
|
| Rate for Payer: United Healthcare All Other HMO |
$18,265.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,870.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,375.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42,500.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42,500.00
|
| Rate for Payer: Vantage Medical Group Senior |
$42,500.00
|
|
|
HC MP CONTROL LE PROS
|
Facility
|
OP
|
$50,000.00
|
|
|
Service Code
|
CPT L5999
|
| Hospital Charge Code |
905380021
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$12,000.00 |
| Max. Negotiated Rate |
$42,500.00 |
| Rate for Payer: Adventist Health Commercial |
$20,500.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42,500.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27,500.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37,500.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28,960.00
|
| Rate for Payer: Blue Shield of California Commercial |
$36,900.00
|
| Rate for Payer: Blue Shield of California EPN |
$24,300.00
|
| Rate for Payer: Cash Price |
$27,500.00
|
| Rate for Payer: Cigna of CA HMO |
$35,000.00
|
| Rate for Payer: Cigna of CA PPO |
$35,000.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42,500.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$42,500.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20,000.00
|
| Rate for Payer: Galaxy Health WC |
$42,500.00
|
| Rate for Payer: Global Benefits Group Commercial |
$30,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33,350.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19,050.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30,950.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,000.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35,000.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35,000.00
|
| Rate for Payer: Multiplan Commercial |
$40,000.00
|
| Rate for Payer: Networks By Design Commercial |
$25,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$42,500.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30,000.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$18,765.00
|
| Rate for Payer: United Healthcare All Other HMO |
$18,265.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,870.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,375.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42,500.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42,500.00
|
| Rate for Payer: Vantage Medical Group Senior |
$42,500.00
|
|
|
HC MP CONTROL LE PROS
|
Facility
|
IP
|
$50,000.00
|
|
|
Service Code
|
CPT L5999
|
| Hospital Charge Code |
905380021
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10,000.00 |
| Max. Negotiated Rate |
$42,500.00 |
| Rate for Payer: Adventist Health Commercial |
$10,000.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$27,500.00
|
| Rate for Payer: Cash Price |
$27,500.00
|
| Rate for Payer: Cigna of CA HMO |
$35,000.00
|
| Rate for Payer: Cigna of CA PPO |
$35,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20,000.00
|
| Rate for Payer: Galaxy Health WC |
$42,500.00
|
| Rate for Payer: Global Benefits Group Commercial |
$30,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33,350.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19,050.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30,950.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,000.00
|
| Rate for Payer: Multiplan Commercial |
$40,000.00
|
| Rate for Payer: Networks By Design Commercial |
$25,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$42,500.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$18,765.00
|
| Rate for Payer: United Healthcare All Other HMO |
$18,265.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,870.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,375.00
|
|
|
HC MR ANGIO ABDOMEN W CONTRAST
|
Facility
|
OP
|
$9,184.00
|
|
|
Service Code
|
CPT 74185
|
| Hospital Charge Code |
908801037
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$557.81 |
| Max. Negotiated Rate |
$7,806.40 |
| Rate for Payer: Adventist Health Commercial |
$1,836.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,806.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,051.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,888.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,639.89
|
| Rate for Payer: Blue Shield of California Commercial |
$5,620.61
|
| Rate for Payer: Blue Shield of California EPN |
$3,710.34
|
| Rate for Payer: Cash Price |
$5,051.20
|
| Rate for Payer: Cash Price |
$5,051.20
|
| Rate for Payer: Cash Price |
$5,051.20
|
| Rate for Payer: Cigna of CA HMO |
$5,877.76
|
| Rate for Payer: Cigna of CA PPO |
$6,796.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,806.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,806.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,806.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,673.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,673.60
|
| Rate for Payer: Galaxy Health WC |
$7,806.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,510.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$557.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,125.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$630.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,684.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,204.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,428.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,428.80
|
| Rate for Payer: Multiplan Commercial |
$7,347.20
|
| Rate for Payer: Networks By Design Commercial |
$5,969.60
|
| Rate for Payer: Prime Health Services Commercial |
$7,806.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,510.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,510.40
|
| 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 |
$7,806.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,806.40
|
| Rate for Payer: Vantage Medical Group Senior |
$7,806.40
|
|
|
HC MR ANGIO ABDOMEN W CONTRAST
|
Facility
|
IP
|
$9,184.00
|
|
|
Service Code
|
CPT 74185
|
| Hospital Charge Code |
908801037
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$1,836.80 |
| Max. Negotiated Rate |
$7,806.40 |
| Rate for Payer: Adventist Health Commercial |
$1,836.80
|
| Rate for Payer: Cash Price |
$5,051.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,673.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,673.60
|
| Rate for Payer: Galaxy Health WC |
$7,806.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,510.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,125.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,499.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,684.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,204.16
|
| Rate for Payer: Multiplan Commercial |
$7,347.20
|
| Rate for Payer: Networks By Design Commercial |
$5,969.60
|
| Rate for Payer: Prime Health Services Commercial |
$7,806.40
|
|
|
HC MR ANGIO ABD W/O CONTRAST
|
Facility
|
IP
|
$8,746.00
|
|
|
Service Code
|
CPT 74185
|
| Hospital Charge Code |
908801089
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$1,749.20 |
| Max. Negotiated Rate |
$7,434.10 |
| Rate for Payer: Adventist Health Commercial |
$1,749.20
|
| Rate for Payer: Cash Price |
$4,810.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,498.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,498.40
|
| Rate for Payer: Galaxy Health WC |
$7,434.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,247.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,833.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,332.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,413.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,099.04
|
| Rate for Payer: Multiplan Commercial |
$6,996.80
|
| Rate for Payer: Networks By Design Commercial |
$5,684.90
|
| Rate for Payer: Prime Health Services Commercial |
$7,434.10
|
|
|
HC MR ANGIO ABD W/O CONTRAST
|
Facility
|
OP
|
$8,746.00
|
|
|
Service Code
|
CPT 74185
|
| Hospital Charge Code |
908801089
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$557.81 |
| Max. Negotiated Rate |
$7,434.10 |
| Rate for Payer: Adventist Health Commercial |
$1,749.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,434.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,810.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,559.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,370.92
|
| Rate for Payer: Blue Shield of California Commercial |
$5,352.55
|
| Rate for Payer: Blue Shield of California EPN |
$3,533.38
|
| Rate for Payer: Cash Price |
$4,810.30
|
| Rate for Payer: Cash Price |
$4,810.30
|
| Rate for Payer: Cash Price |
$4,810.30
|
| Rate for Payer: Cigna of CA HMO |
$5,597.44
|
| Rate for Payer: Cigna of CA PPO |
$6,472.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,434.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,434.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,434.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,498.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,498.40
|
| Rate for Payer: Galaxy Health WC |
$7,434.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,247.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$557.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,833.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$630.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,413.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,099.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,122.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,122.20
|
| Rate for Payer: Multiplan Commercial |
$6,996.80
|
| Rate for Payer: Networks By Design Commercial |
$5,684.90
|
| Rate for Payer: Prime Health Services Commercial |
$7,434.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,247.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,247.60
|
| 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 |
$7,434.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,434.10
|
| Rate for Payer: Vantage Medical Group Senior |
$7,434.10
|
|
|
HC MR ANGIO CHEST W CONTRAST
|
Facility
|
OP
|
$7,865.00
|
|
|
Service Code
|
CPT 71555
|
| Hospital Charge Code |
908801090
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$553.96 |
| Max. Negotiated Rate |
$6,685.25 |
| Rate for Payer: Adventist Health Commercial |
$1,573.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,685.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,325.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,898.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,829.90
|
| Rate for Payer: Blue Shield of California Commercial |
$4,813.38
|
| Rate for Payer: Blue Shield of California EPN |
$3,177.46
|
| Rate for Payer: Cash Price |
$4,325.75
|
| Rate for Payer: Cash Price |
$4,325.75
|
| Rate for Payer: Cash Price |
$4,325.75
|
| Rate for Payer: Cigna of CA HMO |
$5,033.60
|
| Rate for Payer: Cigna of CA PPO |
$5,820.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,685.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,685.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,685.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,146.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,146.00
|
| Rate for Payer: Galaxy Health WC |
$6,685.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,719.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$553.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,245.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$626.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,868.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,887.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,505.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,505.50
|
| Rate for Payer: Multiplan Commercial |
$6,292.00
|
| Rate for Payer: Networks By Design Commercial |
$5,112.25
|
| Rate for Payer: Prime Health Services Commercial |
$6,685.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,719.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,719.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,110.11
|
| Rate for Payer: United Healthcare All Other HMO |
$1,110.11
|
| Rate for Payer: United Healthcare HMO Rider |
$1,110.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,110.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,685.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,685.25
|
| Rate for Payer: Vantage Medical Group Senior |
$6,685.25
|
|
|
HC MR ANGIO CHEST W CONTRAST
|
Facility
|
IP
|
$7,865.00
|
|
|
Service Code
|
CPT 71555
|
| Hospital Charge Code |
908801090
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$1,573.00 |
| Max. Negotiated Rate |
$6,685.25 |
| Rate for Payer: Adventist Health Commercial |
$1,573.00
|
| Rate for Payer: Cash Price |
$4,325.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,146.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,146.00
|
| Rate for Payer: Galaxy Health WC |
$6,685.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,719.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,245.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,996.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,868.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,887.60
|
| Rate for Payer: Multiplan Commercial |
$6,292.00
|
| Rate for Payer: Networks By Design Commercial |
$5,112.25
|
| Rate for Payer: Prime Health Services Commercial |
$6,685.25
|
|
|
HC MR ANGIO CHEST W/O CONTRAST
|
Facility
|
IP
|
$7,149.00
|
|
|
Service Code
|
CPT 71555
|
| Hospital Charge Code |
908801091
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$1,429.80 |
| Max. Negotiated Rate |
$6,076.65 |
| Rate for Payer: Adventist Health Commercial |
$1,429.80
|
| Rate for Payer: Cash Price |
$3,931.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,859.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,859.60
|
| Rate for Payer: Galaxy Health WC |
$6,076.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,289.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,768.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,723.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,425.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,715.76
|
| Rate for Payer: Multiplan Commercial |
$5,719.20
|
| Rate for Payer: Networks By Design Commercial |
$4,646.85
|
| Rate for Payer: Prime Health Services Commercial |
$6,076.65
|
|
|
HC MR ANGIO CHEST W/O CONTRAST
|
Facility
|
OP
|
$7,149.00
|
|
|
Service Code
|
CPT 71555
|
| Hospital Charge Code |
908801091
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$553.96 |
| Max. Negotiated Rate |
$6,076.65 |
| Rate for Payer: Adventist Health Commercial |
$1,429.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,076.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,931.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,361.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,390.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,375.19
|
| Rate for Payer: Blue Shield of California EPN |
$2,888.20
|
| Rate for Payer: Cash Price |
$3,931.95
|
| Rate for Payer: Cash Price |
$3,931.95
|
| Rate for Payer: Cash Price |
$3,931.95
|
| Rate for Payer: Cigna of CA HMO |
$4,575.36
|
| Rate for Payer: Cigna of CA PPO |
$5,290.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,076.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,076.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,076.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,859.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,859.60
|
| Rate for Payer: Galaxy Health WC |
$6,076.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,289.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$553.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,768.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$626.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,425.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,715.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,004.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,004.30
|
| Rate for Payer: Multiplan Commercial |
$5,719.20
|
| Rate for Payer: Networks By Design Commercial |
$4,646.85
|
| Rate for Payer: Prime Health Services Commercial |
$6,076.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,289.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,289.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,110.11
|
| Rate for Payer: United Healthcare All Other HMO |
$1,110.11
|
| Rate for Payer: United Healthcare HMO Rider |
$1,110.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,110.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,076.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,076.65
|
| Rate for Payer: Vantage Medical Group Senior |
$6,076.65
|
|
|
HC MR ANGIO CHEST W WO CONTRAST
|
Facility
|
IP
|
$8,516.00
|
|
|
Service Code
|
CPT 71555
|
| Hospital Charge Code |
908801032
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$1,703.20 |
| Max. Negotiated Rate |
$7,238.60 |
| Rate for Payer: Adventist Health Commercial |
$1,703.20
|
| Rate for Payer: Cash Price |
$4,683.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,406.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,406.40
|
| Rate for Payer: Galaxy Health WC |
$7,238.60
|
| Rate for Payer: Global Benefits Group Commercial |
$5,109.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,680.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,244.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,271.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,043.84
|
| Rate for Payer: Multiplan Commercial |
$6,812.80
|
| Rate for Payer: Networks By Design Commercial |
$5,535.40
|
| Rate for Payer: Prime Health Services Commercial |
$7,238.60
|
|
|
HC MR ANGIO CHEST W WO CONTRAST
|
Facility
|
OP
|
$8,516.00
|
|
|
Service Code
|
CPT 71555
|
| Hospital Charge Code |
908801032
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$553.96 |
| Max. Negotiated Rate |
$7,238.60 |
| Rate for Payer: Adventist Health Commercial |
$1,703.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,238.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,683.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,387.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,229.68
|
| Rate for Payer: Blue Shield of California Commercial |
$5,211.79
|
| Rate for Payer: Blue Shield of California EPN |
$3,440.46
|
| Rate for Payer: Cash Price |
$4,683.80
|
| Rate for Payer: Cash Price |
$4,683.80
|
| Rate for Payer: Cash Price |
$4,683.80
|
| Rate for Payer: Cigna of CA HMO |
$5,450.24
|
| Rate for Payer: Cigna of CA PPO |
$6,301.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,238.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,238.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,238.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,406.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,406.40
|
| Rate for Payer: Galaxy Health WC |
$7,238.60
|
| Rate for Payer: Global Benefits Group Commercial |
$5,109.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$553.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,680.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$626.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,271.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,043.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,961.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,961.20
|
| Rate for Payer: Multiplan Commercial |
$6,812.80
|
| Rate for Payer: Networks By Design Commercial |
$5,535.40
|
| Rate for Payer: Prime Health Services Commercial |
$7,238.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,109.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,109.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,110.11
|
| Rate for Payer: United Healthcare All Other HMO |
$1,110.11
|
| Rate for Payer: United Healthcare HMO Rider |
$1,110.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,110.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,238.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,238.60
|
| Rate for Payer: Vantage Medical Group Senior |
$7,238.60
|
|
|
HC MR ANGIO LOW EXT W CONTRAST
|
Facility
|
OP
|
$6,474.00
|
|
|
Service Code
|
CPT 73725
|
| Hospital Charge Code |
908801092
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$554.48 |
| Max. Negotiated Rate |
$5,502.90 |
| Rate for Payer: Adventist Health Commercial |
$1,294.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,246.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,502.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,560.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,855.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,975.68
|
| Rate for Payer: Blue Shield of California Commercial |
$3,962.09
|
| Rate for Payer: Blue Shield of California EPN |
$2,615.50
|
| Rate for Payer: Cash Price |
$3,560.70
|
| Rate for Payer: Cash Price |
$3,560.70
|
| Rate for Payer: Cigna of CA HMO |
$4,143.36
|
| Rate for Payer: Cigna of CA PPO |
$4,790.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,502.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,502.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,502.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,589.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,589.60
|
| Rate for Payer: Galaxy Health WC |
$5,502.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,884.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$554.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,318.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$627.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,007.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,553.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,531.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,531.80
|
| Rate for Payer: Multiplan Commercial |
$5,179.20
|
| Rate for Payer: Networks By Design Commercial |
$4,208.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,502.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,884.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,884.40
|
| 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 |
$5,502.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,502.90
|
| Rate for Payer: Vantage Medical Group Senior |
$5,502.90
|
|
|
HC MR ANGIO LOW EXT W CONTRAST
|
Facility
|
IP
|
$6,474.00
|
|
|
Service Code
|
CPT 73725
|
| Hospital Charge Code |
908801092
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$1,294.80 |
| Max. Negotiated Rate |
$5,502.90 |
| Rate for Payer: Adventist Health Commercial |
$1,294.80
|
| Rate for Payer: Cash Price |
$3,560.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,589.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,589.60
|
| Rate for Payer: Galaxy Health WC |
$5,502.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,884.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,318.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,466.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,007.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,553.76
|
| Rate for Payer: Multiplan Commercial |
$5,179.20
|
| Rate for Payer: Networks By Design Commercial |
$4,208.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,502.90
|
|
|
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 |
$3,236.75
|
| 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
|
$5,885.00
|
|
|
Service Code
|
CPT 73725
|
| Hospital Charge Code |
908801094
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$554.48 |
| Max. Negotiated Rate |
$5,002.25 |
| Rate for Payer: Adventist Health Commercial |
$1,177.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,859.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,002.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,236.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,413.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,613.98
|
| Rate for Payer: Blue Shield of California Commercial |
$3,601.62
|
| Rate for Payer: Blue Shield of California EPN |
$2,377.54
|
| Rate for Payer: Cash Price |
$3,236.75
|
| Rate for Payer: Cash Price |
$3,236.75
|
| Rate for Payer: Cigna of CA HMO |
$3,766.40
|
| Rate for Payer: Cigna of CA PPO |
$4,354.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,002.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,002.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,002.25
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$554.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,925.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$627.10
|
| 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: Molina Healthcare of CA Medi-Cal |
$4,119.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,119.50
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,531.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,531.00
|
| 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 |
$5,002.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,002.25
|
| Rate for Payer: Vantage Medical Group Senior |
$5,002.25
|
|
|
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 |
$4,224.00
|
| 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
|
$7,680.00
|
|
|
Service Code
|
CPT 73725
|
| Hospital Charge Code |
908801036
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$554.48 |
| Max. Negotiated Rate |
$6,528.00 |
| Rate for Payer: Adventist Health Commercial |
$1,536.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5,037.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,528.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,224.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,760.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,716.29
|
| Rate for Payer: Blue Shield of California Commercial |
$4,700.16
|
| Rate for Payer: Blue Shield of California EPN |
$3,102.72
|
| Rate for Payer: Cash Price |
$4,224.00
|
| Rate for Payer: Cash Price |
$4,224.00
|
| Rate for Payer: Cigna of CA HMO |
$4,915.20
|
| Rate for Payer: Cigna of CA PPO |
$5,683.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,528.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,528.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,528.00
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$554.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,122.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$627.10
|
| 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: Molina Healthcare of CA Medi-Cal |
$5,376.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,376.00
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,608.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,608.00
|
| 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 |
$6,528.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,528.00
|
| Rate for Payer: Vantage Medical Group Senior |
$6,528.00
|
|
|
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 |
$2,603.70
|
| 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 W/CONT
|
Facility
|
OP
|
$4,734.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801097
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$556.74 |
| Max. Negotiated Rate |
$4,023.90 |
| Rate for Payer: Adventist Health Commercial |
$946.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,023.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,603.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,550.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,907.15
|
| Rate for Payer: Blue Shield of California Commercial |
$2,897.21
|
| Rate for Payer: Blue Shield of California EPN |
$1,912.54
|
| Rate for Payer: Cash Price |
$2,603.70
|
| Rate for Payer: Cash Price |
$2,603.70
|
| Rate for Payer: Cash Price |
$2,603.70
|
| Rate for Payer: Cigna of CA HMO |
$3,029.76
|
| Rate for Payer: Cigna of CA PPO |
$3,503.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,023.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,023.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,023.90
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$556.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,157.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$629.64
|
| 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: Molina Healthcare of CA Medi-Cal |
$3,313.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,313.80
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,840.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,840.40
|
| 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 |
$4,023.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,023.90
|
| Rate for Payer: Vantage Medical Group Senior |
$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 |
$2,479.95
|
| 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
|
$4,509.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801098
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$556.74 |
| Max. Negotiated Rate |
$3,832.65 |
| Rate for Payer: Adventist Health Commercial |
$901.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,832.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,479.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,381.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,768.98
|
| Rate for Payer: Blue Shield of California Commercial |
$2,759.51
|
| Rate for Payer: Blue Shield of California EPN |
$1,821.64
|
| Rate for Payer: Cash Price |
$2,479.95
|
| Rate for Payer: Cash Price |
$2,479.95
|
| Rate for Payer: Cash Price |
$2,479.95
|
| Rate for Payer: Cigna of CA HMO |
$2,885.76
|
| Rate for Payer: Cigna of CA PPO |
$3,336.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,832.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,832.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,832.65
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$556.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,007.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$629.64
|
| 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: Molina Healthcare of CA Medi-Cal |
$3,156.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,156.30
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,705.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,705.40
|
| 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 |
$3,832.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,832.65
|
| Rate for Payer: Vantage Medical Group Senior |
$3,832.65
|
|
|
HC MR ANGIO PELVIS WO FOL W CONT
|
Facility
|
OP
|
$4,972.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801034
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$556.74 |
| Max. Negotiated Rate |
$4,226.20 |
| Rate for Payer: Adventist Health Commercial |
$994.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,226.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,734.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,729.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,053.31
|
| Rate for Payer: Blue Shield of California Commercial |
$3,042.86
|
| Rate for Payer: Blue Shield of California EPN |
$2,008.69
|
| Rate for Payer: Cash Price |
$2,734.60
|
| Rate for Payer: Cash Price |
$2,734.60
|
| Rate for Payer: Cash Price |
$2,734.60
|
| Rate for Payer: Cigna of CA HMO |
$3,182.08
|
| Rate for Payer: Cigna of CA PPO |
$3,679.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,226.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,226.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,226.20
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$556.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,316.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$629.64
|
| 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: Molina Healthcare of CA Medi-Cal |
$3,480.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,480.40
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,983.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,983.20
|
| 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 |
$4,226.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,226.20
|
| Rate for Payer: Vantage Medical Group Senior |
$4,226.20
|
|
