|
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 |
$2,734.60
|
| 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 |
$2,734.60
|
| 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
|
$4,972.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801099
|
|
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
|
|
|
HC MR ANGIO SPINAL CAN W OR WO CO
|
Facility
|
OP
|
$3,238.00
|
|
|
Service Code
|
CPT 72159
|
| Hospital Charge Code |
908801033
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$572.83 |
| Max. Negotiated Rate |
$2,752.30 |
| Rate for Payer: Adventist Health Commercial |
$647.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,123.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,752.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,780.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,428.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,988.46
|
| Rate for Payer: Blue Shield of California Commercial |
$1,981.66
|
| Rate for Payer: Blue Shield of California EPN |
$1,308.15
|
| Rate for Payer: Cash Price |
$1,780.90
|
| Rate for Payer: Cash Price |
$1,780.90
|
| Rate for Payer: Cigna of CA HMO |
$2,072.32
|
| Rate for Payer: Cigna of CA PPO |
$2,396.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,752.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,752.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,752.30
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$572.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,159.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$647.84
|
| 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: Molina Healthcare of CA Medi-Cal |
$2,266.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,266.60
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,942.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,942.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,168.48
|
| Rate for Payer: United Healthcare All Other HMO |
$1,168.48
|
| Rate for Payer: United Healthcare HMO Rider |
$1,168.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,168.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,752.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,752.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,752.30
|
|
|
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 |
$1,780.90
|
| 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 |
$1,600.50
|
| 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
|
$2,910.00
|
|
|
Service Code
|
CPT 73225
|
| Hospital Charge Code |
908801035
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$568.34 |
| Max. Negotiated Rate |
$3,443.00 |
| Rate for Payer: Adventist Health Commercial |
$582.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,473.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,600.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,182.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,787.03
|
| Rate for Payer: Blue Shield of California Commercial |
$1,780.92
|
| Rate for Payer: Blue Shield of California EPN |
$1,175.64
|
| Rate for Payer: Cash Price |
$1,600.50
|
| Rate for Payer: Cash Price |
$1,600.50
|
| Rate for Payer: Cash Price |
$1,600.50
|
| Rate for Payer: Cigna of CA HMO |
$1,862.40
|
| Rate for Payer: Cigna of CA PPO |
$2,153.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,473.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,473.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,473.50
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$568.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,940.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$642.77
|
| 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: Molina Healthcare of CA Medi-Cal |
$2,037.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,037.00
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,746.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,746.00
|
| 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 |
$2,473.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,473.50
|
| Rate for Payer: Vantage Medical Group Senior |
$2,473.50
|
|
|
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 |
$5,304.20
|
| 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
|
$9,644.00
|
|
|
Service Code
|
CPT 74185
|
| Hospital Charge Code |
908801096
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$557.81 |
| Max. Negotiated Rate |
$8,197.40 |
| Rate for Payer: Adventist Health Commercial |
$1,928.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,197.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,304.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,233.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,922.38
|
| Rate for Payer: Blue Shield of California Commercial |
$5,902.13
|
| Rate for Payer: Blue Shield of California EPN |
$3,896.18
|
| Rate for Payer: Cash Price |
$5,304.20
|
| Rate for Payer: Cash Price |
$5,304.20
|
| Rate for Payer: Cash Price |
$5,304.20
|
| Rate for Payer: Cigna of CA HMO |
$6,172.16
|
| Rate for Payer: Cigna of CA PPO |
$7,136.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,197.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,197.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,197.40
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$557.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,432.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$630.86
|
| 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: Molina Healthcare of CA Medi-Cal |
$6,750.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,750.80
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,786.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,786.40
|
| 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 |
$8,197.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,197.40
|
| Rate for Payer: Vantage Medical Group Senior |
$8,197.40
|
|
|
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 |
$3,863.20
|
| 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/CONTRAST
|
Facility
|
OP
|
$7,024.00
|
|
|
Service Code
|
CPT 74182
|
| Hospital Charge Code |
908801301
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$453.77 |
| Max. Negotiated Rate |
$5,970.40 |
| Rate for Payer: Adventist Health Commercial |
$1,404.80
|
| 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 |
$4,313.44
|
| Rate for Payer: Blue Shield of California Commercial |
$4,298.69
|
| Rate for Payer: Blue Shield of California EPN |
$2,837.70
|
| Rate for Payer: Cash Price |
$3,863.20
|
| Rate for Payer: Cash Price |
$3,863.20
|
| Rate for Payer: Cash Price |
$3,863.20
|
| Rate for Payer: Cigna of CA HMO |
$4,495.36
|
| Rate for Payer: Cigna of CA PPO |
$5,197.76
|
| 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 |
$5,970.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,214.40
|
| 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 |
$4,685.01
|
| 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 |
$1,685.76
|
| 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 |
$5,619.20
|
| Rate for Payer: Networks By Design Commercial |
$4,565.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,970.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,214.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,214.40
|
| 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/O CONTRAST
|
Facility
|
OP
|
$6,385.00
|
|
|
Service Code
|
CPT 74181
|
| Hospital Charge Code |
908801300
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$5,427.25 |
| Rate for Payer: Adventist Health Commercial |
$1,277.00
|
| 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 |
$3,921.03
|
| Rate for Payer: Blue Shield of California Commercial |
$3,907.62
|
| Rate for Payer: Blue Shield of California EPN |
$2,579.54
|
| Rate for Payer: Cash Price |
$3,511.75
|
| Rate for Payer: Cash Price |
$3,511.75
|
| Rate for Payer: Cash Price |
$3,511.75
|
| Rate for Payer: Cigna of CA HMO |
$4,086.40
|
| Rate for Payer: Cigna of CA PPO |
$4,724.90
|
| 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 |
$5,427.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,831.00
|
| 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 |
$4,258.80
|
| 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 |
$1,532.40
|
| 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 |
$5,108.00
|
| Rate for Payer: Networks By Design Commercial |
$4,150.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,427.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,831.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,831.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| Rate for Payer: United Healthcare All Other HMO |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: 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 |
$3,511.75
|
| 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
|
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 |
$4,712.40
|
| 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 ABDOMEN W WO CONTRAST
|
Facility
|
OP
|
$8,568.00
|
|
|
Service Code
|
CPT 74183
|
| Hospital Charge Code |
908801302
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$453.77 |
| Max. Negotiated Rate |
$7,282.80 |
| Rate for Payer: Adventist Health Commercial |
$1,713.60
|
| 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 |
$5,261.61
|
| Rate for Payer: Blue Shield of California Commercial |
$5,243.62
|
| Rate for Payer: Blue Shield of California EPN |
$3,461.47
|
| Rate for Payer: Cash Price |
$4,712.40
|
| Rate for Payer: Cash Price |
$4,712.40
|
| Rate for Payer: Cash Price |
$4,712.40
|
| Rate for Payer: Cigna of CA HMO |
$5,483.52
|
| Rate for Payer: Cigna of CA PPO |
$6,340.32
|
| 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 |
$7,282.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,140.80
|
| 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 |
$5,714.86
|
| 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 |
$2,056.32
|
| 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 |
$6,854.40
|
| Rate for Payer: Networks By Design Commercial |
$5,569.20
|
| Rate for Payer: Prime Health Services Commercial |
$7,282.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,140.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,140.80
|
| 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 ANGIO HEAD WITH CONTRAST
|
Facility
|
OP
|
$5,913.00
|
|
|
Service Code
|
CPT 70545
|
| Hospital Charge Code |
908801084
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$374.27 |
| Max. Negotiated Rate |
$5,026.05 |
| Rate for Payer: Adventist Health Commercial |
$1,182.60
|
| 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 |
$3,631.17
|
| Rate for Payer: Blue Shield of California Commercial |
$3,618.76
|
| Rate for Payer: Blue Shield of California EPN |
$2,388.85
|
| Rate for Payer: Cash Price |
$3,252.15
|
| Rate for Payer: Cash Price |
$3,252.15
|
| Rate for Payer: Cash Price |
$3,252.15
|
| Rate for Payer: Cigna of CA HMO |
$3,784.32
|
| Rate for Payer: Cigna of CA PPO |
$4,375.62
|
| 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 |
$5,026.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,547.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$374.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,943.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$423.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,419.12
|
| 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 |
$4,730.40
|
| Rate for Payer: Networks By Design Commercial |
$3,843.45
|
| Rate for Payer: Prime Health Services Commercial |
$5,026.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,547.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,547.80
|
| 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 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 |
$3,252.15
|
| 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
|
|
|
HC MRI ANGIO HEAD WO CNTRAST
|
Facility
|
OP
|
$5,632.00
|
|
|
Service Code
|
CPT 70544
|
| Hospital Charge Code |
908801015
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$4,787.20 |
| Rate for Payer: Adventist Health Commercial |
$1,126.40
|
| 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 |
$3,458.61
|
| Rate for Payer: Blue Shield of California Commercial |
$3,446.78
|
| Rate for Payer: Blue Shield of California EPN |
$2,275.33
|
| Rate for Payer: Cash Price |
$3,097.60
|
| Rate for Payer: Cash Price |
$3,097.60
|
| Rate for Payer: Cash Price |
$3,097.60
|
| Rate for Payer: Cigna of CA HMO |
$3,604.48
|
| Rate for Payer: Cigna of CA PPO |
$4,167.68
|
| 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 |
$4,787.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,379.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$354.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,756.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$400.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,351.68
|
| 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 |
$4,505.60
|
| Rate for Payer: Networks By Design Commercial |
$3,660.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,787.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,379.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,379.20
|
| 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 ANGIO HEAD WO CNTRAST
|
Facility
|
IP
|
$5,632.00
|
|
|
Service Code
|
CPT 70544
|
| Hospital Charge Code |
908801015
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,126.40 |
| Max. Negotiated Rate |
$4,787.20 |
| Rate for Payer: Adventist Health Commercial |
$1,126.40
|
| Rate for Payer: Cash Price |
$3,097.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,252.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,252.80
|
| Rate for Payer: Galaxy Health WC |
$4,787.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,379.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,756.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,145.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,486.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,351.68
|
| Rate for Payer: Multiplan Commercial |
$4,505.60
|
| Rate for Payer: Networks By Design Commercial |
$3,660.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,787.20
|
|
|
HC MRI ANGIO HEAD WO CNTRAST
|
Facility
|
IP
|
$5,632.00
|
|
|
Service Code
|
CPT 70544
|
| Hospital Charge Code |
908801083
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,126.40 |
| Max. Negotiated Rate |
$4,787.20 |
| Rate for Payer: Adventist Health Commercial |
$1,126.40
|
| Rate for Payer: Cash Price |
$3,097.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,252.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,252.80
|
| Rate for Payer: Galaxy Health WC |
$4,787.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,379.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,756.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,145.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,486.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,351.68
|
| Rate for Payer: Multiplan Commercial |
$4,505.60
|
| Rate for Payer: Networks By Design Commercial |
$3,660.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,787.20
|
|
|
HC MRI ANGIO HEAD WO CNTRAST
|
Facility
|
OP
|
$5,632.00
|
|
|
Service Code
|
CPT 70544
|
| Hospital Charge Code |
908801083
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$4,787.20 |
| Rate for Payer: Adventist Health Commercial |
$1,126.40
|
| 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 |
$3,458.61
|
| Rate for Payer: Blue Shield of California Commercial |
$3,446.78
|
| Rate for Payer: Blue Shield of California EPN |
$2,275.33
|
| Rate for Payer: Cash Price |
$3,097.60
|
| Rate for Payer: Cash Price |
$3,097.60
|
| Rate for Payer: Cash Price |
$3,097.60
|
| Rate for Payer: Cigna of CA HMO |
$3,604.48
|
| Rate for Payer: Cigna of CA PPO |
$4,167.68
|
| 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 |
$4,787.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,379.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$354.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,756.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$400.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,351.68
|
| 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 |
$4,505.60
|
| Rate for Payer: Networks By Design Commercial |
$3,660.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,787.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,379.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,379.20
|
| 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 ANGIO HEAD W WO CONTRAST
|
Facility
|
IP
|
$7,381.00
|
|
|
Service Code
|
CPT 70546
|
| Hospital Charge Code |
908801085
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,476.20 |
| Max. Negotiated Rate |
$6,273.85 |
| Rate for Payer: Adventist Health Commercial |
$1,476.20
|
| Rate for Payer: Cash Price |
$4,059.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,952.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,952.40
|
| Rate for Payer: Galaxy Health WC |
$6,273.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,428.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,923.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,812.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,568.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,771.44
|
| Rate for Payer: Multiplan Commercial |
$5,904.80
|
| Rate for Payer: Networks By Design Commercial |
$4,797.65
|
| Rate for Payer: Prime Health Services Commercial |
$6,273.85
|
|
|
HC MRI ANGIO HEAD W WO CONTRAST
|
Facility
|
OP
|
$7,381.00
|
|
|
Service Code
|
CPT 70546
|
| Hospital Charge Code |
908801085
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$453.77 |
| Max. Negotiated Rate |
$6,273.85 |
| Rate for Payer: Adventist Health Commercial |
$1,476.20
|
| 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 |
$4,532.67
|
| Rate for Payer: Blue Shield of California Commercial |
$4,517.17
|
| Rate for Payer: Blue Shield of California EPN |
$2,981.92
|
| Rate for Payer: Cash Price |
$4,059.55
|
| Rate for Payer: Cash Price |
$4,059.55
|
| Rate for Payer: Cash Price |
$4,059.55
|
| Rate for Payer: Cigna of CA HMO |
$4,723.84
|
| Rate for Payer: Cigna of CA PPO |
$5,461.94
|
| 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 |
$6,273.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,428.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$544.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,923.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$615.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,771.44
|
| 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 |
$5,904.80
|
| Rate for Payer: Networks By Design Commercial |
$4,797.65
|
| Rate for Payer: Prime Health Services Commercial |
$6,273.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,428.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,428.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,367.12
|
| Rate for Payer: United Healthcare All Other HMO |
$1,367.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1,367.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,367.12
|
| Rate for Payer: 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 ANGIO NECK W CONTRAST
|
Facility
|
IP
|
$5,564.00
|
|
|
Service Code
|
CPT 70548
|
| Hospital Charge Code |
908801087
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,112.80 |
| Max. Negotiated Rate |
$4,729.40 |
| Rate for Payer: Adventist Health Commercial |
$1,112.80
|
| Rate for Payer: Cash Price |
$3,060.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,225.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,225.60
|
| Rate for Payer: Galaxy Health WC |
$4,729.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,338.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,711.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,119.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,444.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,335.36
|
| Rate for Payer: Multiplan Commercial |
$4,451.20
|
| Rate for Payer: Networks By Design Commercial |
$3,616.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,729.40
|
|
|
HC MRI ANGIO NECK W CONTRAST
|
Facility
|
OP
|
$5,564.00
|
|
|
Service Code
|
CPT 70548
|
| Hospital Charge Code |
908801087
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$404.17 |
| Max. Negotiated Rate |
$4,729.40 |
| Rate for Payer: Adventist Health Commercial |
$1,112.80
|
| 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 |
$3,416.85
|
| Rate for Payer: Blue Shield of California Commercial |
$3,405.17
|
| Rate for Payer: Blue Shield of California EPN |
$2,247.86
|
| Rate for Payer: Cash Price |
$3,060.20
|
| Rate for Payer: Cash Price |
$3,060.20
|
| Rate for Payer: Cash Price |
$3,060.20
|
| Rate for Payer: Cigna of CA HMO |
$3,560.96
|
| Rate for Payer: Cigna of CA PPO |
$4,117.36
|
| 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 |
$4,729.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,338.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$404.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,711.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$457.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,335.36
|
| 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 |
$4,451.20
|
| Rate for Payer: Networks By Design Commercial |
$3,616.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,729.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,338.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,338.40
|
| 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
|
|
