|
HC MR ANGIO LOW EXT W CONTRAST
|
Facility
|
IP
|
$11,156.00
|
|
|
Service Code
|
CPT 73725
|
| Hospital Charge Code |
908801092
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$2,231.20 |
| Max. Negotiated Rate |
$10,040.40 |
| Rate for Payer: Adventist Health Commercial |
$2,231.20
|
| Rate for Payer: Cash Price |
$5,020.20
|
| Rate for Payer: Central Health Plan Commercial |
$8,924.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,462.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,462.40
|
| Rate for Payer: Galaxy Health WC |
$9,482.60
|
| Rate for Payer: Global Benefits Group Commercial |
$6,693.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,040.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,441.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,250.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,905.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,231.20
|
| Rate for Payer: Multiplan Commercial |
$8,367.00
|
| Rate for Payer: Networks By Design Commercial |
$7,251.40
|
| Rate for Payer: Prime Health Services Commercial |
$9,482.60
|
|
|
HC MR ANGIO LOW EXT W CONTRAST
|
Facility
|
OP
|
$5,356.00
|
|
|
Service Code
|
CPT 73725
|
| Hospital Charge Code |
908801092
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$567.69 |
| Max. Negotiated Rate |
$4,820.40 |
| Rate for Payer: Adventist Health Commercial |
$1,071.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,252.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,552.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,945.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,017.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,308.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,145.58
|
| Rate for Payer: Blue Shield of California Commercial |
$3,251.09
|
| Rate for Payer: Blue Shield of California EPN |
$2,126.33
|
| Rate for Payer: Cash Price |
$2,410.20
|
| Rate for Payer: Cash Price |
$2,410.20
|
| Rate for Payer: Central Health Plan Commercial |
$4,284.80
|
| Rate for Payer: Cigna of CA HMO |
$3,427.84
|
| Rate for Payer: Cigna of CA PPO |
$3,963.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,552.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,552.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,552.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,142.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,142.40
|
| Rate for Payer: Galaxy Health WC |
$4,552.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,213.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,820.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$567.69
|
| Rate for Payer: InnovAge PACE Commercial |
$2,678.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,572.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$627.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,315.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,071.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,749.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,749.20
|
| Rate for Payer: Multiplan Commercial |
$4,017.00
|
| Rate for Payer: Networks By Design Commercial |
$3,481.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,552.60
|
| Rate for Payer: Riverside University Health System MISP |
$2,142.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,213.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,213.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,114.46
|
| Rate for Payer: United Healthcare All Other HMO |
$1,114.46
|
| Rate for Payer: United Healthcare HMO Rider |
$1,114.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,114.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,552.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,552.60
|
| Rate for Payer: Vantage Medical Group Senior |
$4,552.60
|
|
|
HC MR ANGIO LOW EXT WO CONT
|
Facility
|
OP
|
$4,898.00
|
|
|
Service Code
|
CPT 73725
|
| Hospital Charge Code |
908801094
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$567.69 |
| Max. Negotiated Rate |
$4,408.20 |
| Rate for Payer: Adventist Health Commercial |
$979.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,974.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,163.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,693.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,673.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,308.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,876.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,973.09
|
| Rate for Payer: Blue Shield of California EPN |
$1,944.51
|
| Rate for Payer: Cash Price |
$2,204.10
|
| Rate for Payer: Cash Price |
$2,204.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,918.40
|
| Rate for Payer: Cigna of CA HMO |
$3,134.72
|
| Rate for Payer: Cigna of CA PPO |
$3,624.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,163.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,163.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,163.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,959.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,959.20
|
| Rate for Payer: Galaxy Health WC |
$4,163.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,938.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,408.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$567.69
|
| Rate for Payer: InnovAge PACE Commercial |
$2,449.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,266.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$627.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,031.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$979.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,428.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,428.60
|
| Rate for Payer: Multiplan Commercial |
$3,673.50
|
| Rate for Payer: Networks By Design Commercial |
$3,183.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,163.30
|
| Rate for Payer: Riverside University Health System MISP |
$1,959.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,938.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,938.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,114.46
|
| Rate for Payer: United Healthcare All Other HMO |
$1,114.46
|
| Rate for Payer: United Healthcare HMO Rider |
$1,114.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,114.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,163.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,163.30
|
| Rate for Payer: Vantage Medical Group Senior |
$4,163.30
|
|
|
HC MR ANGIO LOW EXT WO CONT
|
Facility
|
IP
|
$10,141.00
|
|
|
Service Code
|
CPT 73725
|
| Hospital Charge Code |
908801094
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$2,028.20 |
| Max. Negotiated Rate |
$9,126.90 |
| Rate for Payer: Adventist Health Commercial |
$2,028.20
|
| Rate for Payer: Cash Price |
$4,563.45
|
| Rate for Payer: Central Health Plan Commercial |
$8,112.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,056.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,056.40
|
| Rate for Payer: Galaxy Health WC |
$8,619.85
|
| Rate for Payer: Global Benefits Group Commercial |
$6,084.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,126.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,764.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,863.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,277.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,028.20
|
| Rate for Payer: Multiplan Commercial |
$7,605.75
|
| Rate for Payer: Networks By Design Commercial |
$6,591.65
|
| Rate for Payer: Prime Health Services Commercial |
$8,619.85
|
|
|
HC MR ANGIO LOW EXT W&WO CON
|
Facility
|
IP
|
$13,235.00
|
|
|
Service Code
|
CPT 73725
|
| Hospital Charge Code |
908801036
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$2,647.00 |
| Max. Negotiated Rate |
$11,911.50 |
| Rate for Payer: Adventist Health Commercial |
$2,647.00
|
| Rate for Payer: Cash Price |
$5,955.75
|
| Rate for Payer: Central Health Plan Commercial |
$10,588.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,294.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,294.00
|
| Rate for Payer: Galaxy Health WC |
$11,249.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7,941.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,911.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,827.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,042.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,192.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,647.00
|
| Rate for Payer: Multiplan Commercial |
$9,926.25
|
| Rate for Payer: Networks By Design Commercial |
$8,602.75
|
| Rate for Payer: Prime Health Services Commercial |
$11,249.75
|
|
|
HC MR ANGIO LOW EXT W&WO CON
|
Facility
|
OP
|
$5,811.00
|
|
|
Service Code
|
CPT 73725
|
| Hospital Charge Code |
908801036
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$567.69 |
| Max. Negotiated Rate |
$5,229.90 |
| Rate for Payer: Adventist Health Commercial |
$1,162.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,529.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,939.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,196.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,358.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,308.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,412.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,527.28
|
| Rate for Payer: Blue Shield of California EPN |
$2,306.97
|
| Rate for Payer: Cash Price |
$2,614.95
|
| Rate for Payer: Cash Price |
$2,614.95
|
| Rate for Payer: Central Health Plan Commercial |
$4,648.80
|
| Rate for Payer: Cigna of CA HMO |
$3,719.04
|
| Rate for Payer: Cigna of CA PPO |
$4,300.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,939.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,939.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,939.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,324.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,324.40
|
| Rate for Payer: Galaxy Health WC |
$4,939.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,486.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,229.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$567.69
|
| Rate for Payer: InnovAge PACE Commercial |
$2,905.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,875.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$627.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,597.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,162.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,067.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,067.70
|
| Rate for Payer: Multiplan Commercial |
$4,358.25
|
| Rate for Payer: Networks By Design Commercial |
$3,777.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,939.35
|
| Rate for Payer: Riverside University Health System MISP |
$2,324.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,486.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,486.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,114.46
|
| Rate for Payer: United Healthcare All Other HMO |
$1,114.46
|
| Rate for Payer: United Healthcare HMO Rider |
$1,114.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,114.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,939.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,939.35
|
| Rate for Payer: Vantage Medical Group Senior |
$4,939.35
|
|
|
HC MR ANGIO PELVIS W/CONT
|
Facility
|
IP
|
$8,158.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801097
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$1,631.60 |
| Max. Negotiated Rate |
$7,342.20 |
| Rate for Payer: Adventist Health Commercial |
$1,631.60
|
| Rate for Payer: Cash Price |
$3,671.10
|
| Rate for Payer: Central Health Plan Commercial |
$6,526.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,263.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,263.20
|
| Rate for Payer: Galaxy Health WC |
$6,934.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,894.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,342.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,441.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,108.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,049.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,631.60
|
| Rate for Payer: Multiplan Commercial |
$6,118.50
|
| Rate for Payer: Networks By Design Commercial |
$5,302.70
|
| Rate for Payer: Prime Health Services Commercial |
$6,934.30
|
|
|
HC MR ANGIO PELVIS W/CONT
|
Facility
|
OP
|
$3,752.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801097
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$569.99 |
| Max. Negotiated Rate |
$3,376.80 |
| Rate for Payer: Adventist Health Commercial |
$750.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,189.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,063.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,814.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,308.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,203.55
|
| Rate for Payer: Blue Shield of California Commercial |
$2,277.46
|
| Rate for Payer: Blue Shield of California EPN |
$1,489.54
|
| Rate for Payer: Cash Price |
$1,688.40
|
| Rate for Payer: Cash Price |
$1,688.40
|
| Rate for Payer: Cash Price |
$1,688.40
|
| Rate for Payer: Central Health Plan Commercial |
$3,001.60
|
| Rate for Payer: Cigna of CA HMO |
$2,401.28
|
| Rate for Payer: Cigna of CA PPO |
$2,776.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,189.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,189.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,189.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,500.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,500.80
|
| Rate for Payer: Galaxy Health WC |
$3,189.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,251.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,376.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$569.99
|
| Rate for Payer: InnovAge PACE Commercial |
$1,876.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,502.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$629.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,322.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$750.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,626.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,626.40
|
| Rate for Payer: Multiplan Commercial |
$2,814.00
|
| Rate for Payer: Networks By Design Commercial |
$2,438.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,189.20
|
| Rate for Payer: Riverside University Health System MISP |
$1,500.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,251.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,251.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,113.60
|
| Rate for Payer: United Healthcare All Other HMO |
$1,113.60
|
| Rate for Payer: United Healthcare HMO Rider |
$1,113.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,113.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,189.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,189.20
|
| Rate for Payer: Vantage Medical Group Senior |
$3,189.20
|
|
|
HC MR ANGIO PELVIS WO CONT
|
Facility
|
OP
|
$3,298.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801098
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$569.99 |
| Max. Negotiated Rate |
$2,968.20 |
| Rate for Payer: Adventist Health Commercial |
$659.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,803.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,813.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,473.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,308.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,936.92
|
| Rate for Payer: Blue Shield of California Commercial |
$2,001.89
|
| Rate for Payer: Blue Shield of California EPN |
$1,309.31
|
| Rate for Payer: Cash Price |
$1,484.10
|
| Rate for Payer: Cash Price |
$1,484.10
|
| Rate for Payer: Cash Price |
$1,484.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,638.40
|
| Rate for Payer: Cigna of CA HMO |
$2,110.72
|
| Rate for Payer: Cigna of CA PPO |
$2,440.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,803.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,803.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,803.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,319.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,319.20
|
| Rate for Payer: Galaxy Health WC |
$2,803.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,978.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,968.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$569.99
|
| Rate for Payer: InnovAge PACE Commercial |
$1,649.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,199.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$629.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,041.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$659.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,308.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,308.60
|
| Rate for Payer: Multiplan Commercial |
$2,473.50
|
| Rate for Payer: Networks By Design Commercial |
$2,143.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,803.30
|
| Rate for Payer: Riverside University Health System MISP |
$1,319.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,978.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,978.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,113.60
|
| Rate for Payer: United Healthcare All Other HMO |
$1,113.60
|
| Rate for Payer: United Healthcare HMO Rider |
$1,113.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,113.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,803.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,803.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,803.30
|
|
|
HC MR ANGIO PELVIS WO CONT
|
Facility
|
IP
|
$7,770.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801098
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$1,554.00 |
| Max. Negotiated Rate |
$6,993.00 |
| Rate for Payer: Adventist Health Commercial |
$1,554.00
|
| Rate for Payer: Cash Price |
$3,496.50
|
| Rate for Payer: Central Health Plan Commercial |
$6,216.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,108.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,108.00
|
| Rate for Payer: Galaxy Health WC |
$6,604.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,662.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,993.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,182.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,960.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,809.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,554.00
|
| Rate for Payer: Multiplan Commercial |
$5,827.50
|
| Rate for Payer: Networks By Design Commercial |
$5,050.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,604.50
|
|
|
HC MR ANGIO PELVIS WO FOL W CONT
|
Facility
|
OP
|
$4,211.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801099
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$569.99 |
| Max. Negotiated Rate |
$3,789.90 |
| Rate for Payer: Adventist Health Commercial |
$842.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,579.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,316.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,158.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,308.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,473.12
|
| Rate for Payer: Blue Shield of California Commercial |
$2,556.08
|
| Rate for Payer: Blue Shield of California EPN |
$1,671.77
|
| Rate for Payer: Cash Price |
$1,894.95
|
| Rate for Payer: Cash Price |
$1,894.95
|
| Rate for Payer: Cash Price |
$1,894.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,368.80
|
| Rate for Payer: Cigna of CA HMO |
$2,695.04
|
| Rate for Payer: Cigna of CA PPO |
$3,116.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,579.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,579.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,579.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,684.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,684.40
|
| Rate for Payer: Galaxy Health WC |
$3,579.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,526.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,789.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$569.99
|
| Rate for Payer: InnovAge PACE Commercial |
$2,105.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,808.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$629.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,606.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$842.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,947.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,947.70
|
| Rate for Payer: Multiplan Commercial |
$3,158.25
|
| Rate for Payer: Networks By Design Commercial |
$2,737.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,579.35
|
| Rate for Payer: Riverside University Health System MISP |
$1,684.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,526.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,526.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,113.60
|
| Rate for Payer: United Healthcare All Other HMO |
$1,113.60
|
| Rate for Payer: United Healthcare HMO Rider |
$1,113.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,113.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,579.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,579.35
|
| Rate for Payer: Vantage Medical Group Senior |
$3,579.35
|
|
|
HC MR ANGIO PELVIS WO FOL W CONT
|
Facility
|
IP
|
$8,568.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801034
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$1,713.60 |
| Max. Negotiated Rate |
$7,711.20 |
| Rate for Payer: Adventist Health Commercial |
$1,713.60
|
| Rate for Payer: Cash Price |
$3,855.60
|
| Rate for Payer: Central Health Plan Commercial |
$6,854.40
|
| 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: Health Management Network EPO/PPO |
$7,711.20
|
| 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 |
$1,713.60
|
| Rate for Payer: Multiplan Commercial |
$6,426.00
|
| Rate for Payer: Networks By Design Commercial |
$5,569.20
|
| Rate for Payer: Prime Health Services Commercial |
$7,282.80
|
|
|
HC MR ANGIO PELVIS WO FOL W CONT
|
Facility
|
IP
|
$8,568.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801099
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$1,713.60 |
| Max. Negotiated Rate |
$7,711.20 |
| Rate for Payer: Adventist Health Commercial |
$1,713.60
|
| Rate for Payer: Cash Price |
$3,855.60
|
| Rate for Payer: Central Health Plan Commercial |
$6,854.40
|
| 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: Health Management Network EPO/PPO |
$7,711.20
|
| 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 |
$1,713.60
|
| Rate for Payer: Multiplan Commercial |
$6,426.00
|
| Rate for Payer: Networks By Design Commercial |
$5,569.20
|
| Rate for Payer: Prime Health Services Commercial |
$7,282.80
|
|
|
HC MR ANGIO PELVIS WO FOL W CONT
|
Facility
|
OP
|
$4,211.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801034
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$569.99 |
| Max. Negotiated Rate |
$3,789.90 |
| Rate for Payer: Adventist Health Commercial |
$842.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,579.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,316.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,158.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,308.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,473.12
|
| Rate for Payer: Blue Shield of California Commercial |
$2,556.08
|
| Rate for Payer: Blue Shield of California EPN |
$1,671.77
|
| Rate for Payer: Cash Price |
$1,894.95
|
| Rate for Payer: Cash Price |
$1,894.95
|
| Rate for Payer: Cash Price |
$1,894.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,368.80
|
| Rate for Payer: Cigna of CA HMO |
$2,695.04
|
| Rate for Payer: Cigna of CA PPO |
$3,116.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,579.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,579.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,579.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,684.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,684.40
|
| Rate for Payer: Galaxy Health WC |
$3,579.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,526.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,789.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$569.99
|
| Rate for Payer: InnovAge PACE Commercial |
$2,105.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,808.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$629.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,606.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$842.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,947.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,947.70
|
| Rate for Payer: Multiplan Commercial |
$3,158.25
|
| Rate for Payer: Networks By Design Commercial |
$2,737.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,579.35
|
| Rate for Payer: Riverside University Health System MISP |
$1,684.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,526.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,526.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,113.60
|
| Rate for Payer: United Healthcare All Other HMO |
$1,113.60
|
| Rate for Payer: United Healthcare HMO Rider |
$1,113.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,113.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,579.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,579.35
|
| Rate for Payer: Vantage Medical Group Senior |
$3,579.35
|
|
|
HC MR ANGIO SPINAL CAN W OR WO CO
|
Facility
|
IP
|
$5,581.00
|
|
|
Service Code
|
CPT 72159
|
| Hospital Charge Code |
908801033
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$1,116.20 |
| Max. Negotiated Rate |
$5,022.90 |
| Rate for Payer: Adventist Health Commercial |
$1,116.20
|
| Rate for Payer: Cash Price |
$2,511.45
|
| Rate for Payer: Central Health Plan Commercial |
$4,464.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,232.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,232.40
|
| Rate for Payer: Galaxy Health WC |
$4,743.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,348.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,022.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,722.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,126.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,454.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,116.20
|
| Rate for Payer: Multiplan Commercial |
$4,185.75
|
| Rate for Payer: Networks By Design Commercial |
$3,627.65
|
| Rate for Payer: Prime Health Services Commercial |
$4,743.85
|
|
|
HC MR ANGIO SPINAL CAN W OR WO CO
|
Facility
|
OP
|
$2,696.00
|
|
|
Service Code
|
CPT 72159
|
| Hospital Charge Code |
908801033
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$539.20 |
| Max. Negotiated Rate |
$2,559.78 |
| Rate for Payer: Adventist Health Commercial |
$539.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,637.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,291.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,482.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,022.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,559.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,583.36
|
| Rate for Payer: Blue Shield of California Commercial |
$1,636.47
|
| Rate for Payer: Blue Shield of California EPN |
$1,070.31
|
| Rate for Payer: Cash Price |
$1,213.20
|
| Rate for Payer: Cash Price |
$1,213.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,156.80
|
| Rate for Payer: Cigna of CA HMO |
$1,725.44
|
| Rate for Payer: Cigna of CA PPO |
$1,995.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,291.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,291.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,291.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,078.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,078.40
|
| Rate for Payer: Galaxy Health WC |
$2,291.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,617.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,426.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$586.47
|
| Rate for Payer: InnovAge PACE Commercial |
$1,348.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,798.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$647.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,668.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$539.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,887.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,887.20
|
| Rate for Payer: Multiplan Commercial |
$2,022.00
|
| Rate for Payer: Networks By Design Commercial |
$1,752.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,291.60
|
| Rate for Payer: Riverside University Health System MISP |
$1,078.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,617.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,617.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,168.48
|
| Rate for Payer: United Healthcare All Other HMO |
$1,168.48
|
| Rate for Payer: United Healthcare HMO Rider |
$1,168.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,168.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,291.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,291.60
|
| Rate for Payer: Vantage Medical Group Senior |
$2,291.60
|
|
|
HC MR ANGIO UPPER EXT W/WO CONTR
|
Facility
|
OP
|
$2,531.00
|
|
|
Service Code
|
CPT 73225
|
| Hospital Charge Code |
908801035
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$506.20 |
| Max. Negotiated Rate |
$2,954.00 |
| Rate for Payer: Adventist Health Commercial |
$506.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,151.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,392.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,898.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,306.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,486.46
|
| Rate for Payer: Blue Shield of California Commercial |
$1,536.32
|
| Rate for Payer: Blue Shield of California EPN |
$1,004.81
|
| Rate for Payer: Cash Price |
$1,138.95
|
| Rate for Payer: Cash Price |
$1,138.95
|
| Rate for Payer: Cash Price |
$1,138.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,024.80
|
| Rate for Payer: Cigna of CA HMO |
$1,619.84
|
| Rate for Payer: Cigna of CA PPO |
$1,872.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,151.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,151.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,151.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,012.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,012.40
|
| Rate for Payer: Galaxy Health WC |
$2,151.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,518.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,277.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$581.88
|
| Rate for Payer: InnovAge PACE Commercial |
$1,265.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,688.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$642.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,566.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$506.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,771.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,771.70
|
| Rate for Payer: Multiplan Commercial |
$1,898.25
|
| Rate for Payer: Networks By Design Commercial |
$1,645.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,151.35
|
| Rate for Payer: Riverside University Health System MISP |
$1,012.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,518.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,518.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,124.94
|
| Rate for Payer: United Healthcare All Other HMO |
$1,124.94
|
| Rate for Payer: United Healthcare HMO Rider |
$1,124.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,124.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,151.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,151.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,151.35
|
|
|
HC MR ANGIO UPPER EXT W/WO CONTR
|
Facility
|
IP
|
$5,013.00
|
|
|
Service Code
|
CPT 73225
|
| Hospital Charge Code |
908801035
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$1,002.60 |
| Max. Negotiated Rate |
$4,511.70 |
| Rate for Payer: Adventist Health Commercial |
$1,002.60
|
| Rate for Payer: Cash Price |
$2,255.85
|
| Rate for Payer: Central Health Plan Commercial |
$4,010.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,005.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,005.20
|
| Rate for Payer: Galaxy Health WC |
$4,261.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,007.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,511.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,343.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,909.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,103.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,002.60
|
| Rate for Payer: Multiplan Commercial |
$3,759.75
|
| Rate for Payer: Networks By Design Commercial |
$3,258.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,261.05
|
|
|
HC MR ANGIO W/O FOL W/CONT, ABD
|
Facility
|
OP
|
$7,718.00
|
|
|
Service Code
|
CPT 74185
|
| Hospital Charge Code |
908801096
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$571.09 |
| Max. Negotiated Rate |
$6,946.20 |
| Rate for Payer: Adventist Health Commercial |
$1,543.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,560.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,244.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,788.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,308.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,532.78
|
| Rate for Payer: Blue Shield of California Commercial |
$4,684.83
|
| Rate for Payer: Blue Shield of California EPN |
$3,064.05
|
| Rate for Payer: Cash Price |
$3,473.10
|
| Rate for Payer: Cash Price |
$3,473.10
|
| Rate for Payer: Cash Price |
$3,473.10
|
| Rate for Payer: Central Health Plan Commercial |
$6,174.40
|
| Rate for Payer: Cigna of CA HMO |
$4,939.52
|
| Rate for Payer: Cigna of CA PPO |
$5,711.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,560.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,560.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,560.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,087.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,087.20
|
| Rate for Payer: Galaxy Health WC |
$6,560.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,630.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,946.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$571.09
|
| Rate for Payer: InnovAge PACE Commercial |
$3,859.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,147.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$630.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,777.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,543.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,402.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,402.60
|
| Rate for Payer: Multiplan Commercial |
$5,788.50
|
| Rate for Payer: Networks By Design Commercial |
$5,016.70
|
| Rate for Payer: Prime Health Services Commercial |
$6,560.30
|
| Rate for Payer: Riverside University Health System MISP |
$3,087.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,630.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,630.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,111.86
|
| Rate for Payer: United Healthcare All Other HMO |
$1,111.86
|
| Rate for Payer: United Healthcare HMO Rider |
$1,111.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,111.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,560.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,560.30
|
| Rate for Payer: Vantage Medical Group Senior |
$6,560.30
|
|
|
HC MR ANGIO W/O FOL W/CONT, ABD
|
Facility
|
IP
|
$16,618.00
|
|
|
Service Code
|
CPT 74185
|
| Hospital Charge Code |
908801096
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$3,323.60 |
| Max. Negotiated Rate |
$14,956.20 |
| Rate for Payer: Adventist Health Commercial |
$3,323.60
|
| Rate for Payer: Cash Price |
$7,478.10
|
| Rate for Payer: Central Health Plan Commercial |
$13,294.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,647.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,647.20
|
| Rate for Payer: Galaxy Health WC |
$14,125.30
|
| Rate for Payer: Global Benefits Group Commercial |
$9,970.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,956.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,084.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,331.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,286.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,323.60
|
| Rate for Payer: Multiplan Commercial |
$12,463.50
|
| Rate for Payer: Networks By Design Commercial |
$10,801.70
|
| Rate for Payer: Prime Health Services Commercial |
$14,125.30
|
|
|
HC MRI ABDOMEN W/CONTRAST
|
Facility
|
IP
|
$12,103.00
|
|
|
Service Code
|
CPT 74182
|
| Hospital Charge Code |
908801301
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,420.60 |
| Max. Negotiated Rate |
$10,892.70 |
| Rate for Payer: Adventist Health Commercial |
$2,420.60
|
| Rate for Payer: Cash Price |
$5,446.35
|
| Rate for Payer: Central Health Plan Commercial |
$9,682.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,841.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,841.20
|
| Rate for Payer: Galaxy Health WC |
$10,287.55
|
| Rate for Payer: Global Benefits Group Commercial |
$7,261.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,892.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,072.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,611.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,491.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,420.60
|
| Rate for Payer: Multiplan Commercial |
$9,077.25
|
| Rate for Payer: Networks By Design Commercial |
$7,866.95
|
| Rate for Payer: Prime Health Services Commercial |
$10,287.55
|
|
|
HC MRI ABDOMEN W/CONTRAST
|
Facility
|
OP
|
$5,375.00
|
|
|
Service Code
|
CPT 74182
|
| Hospital Charge Code |
908801301
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$453.77 |
| Max. Negotiated Rate |
$4,837.50 |
| Rate for Payer: Adventist Health Commercial |
$1,075.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$453.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| 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 Exchange |
$2,814.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,156.74
|
| Rate for Payer: Blue Shield of California Commercial |
$3,262.62
|
| Rate for Payer: Blue Shield of California EPN |
$2,133.88
|
| Rate for Payer: Cash Price |
$2,418.75
|
| Rate for Payer: Cash Price |
$2,418.75
|
| Rate for Payer: Cash Price |
$2,418.75
|
| Rate for Payer: Central Health Plan Commercial |
$4,300.00
|
| Rate for Payer: Cigna of CA HMO |
$3,440.00
|
| Rate for Payer: Cigna of CA PPO |
$3,977.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.59
|
| Rate for Payer: EPIC Health Plan Senior |
$453.77
|
| Rate for Payer: Galaxy Health WC |
$4,568.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,225.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,837.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$514.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: InnovAge PACE Commercial |
$680.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,585.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$568.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,075.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$608.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$608.05
|
| Rate for Payer: Multiplan Commercial |
$4,031.25
|
| Rate for Payer: Networks By Design Commercial |
$3,493.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$453.77
|
| Rate for Payer: Prime Health Services Commercial |
$4,568.75
|
| Rate for Payer: Prime Health Services Medicare |
$481.00
|
| Rate for Payer: Riverside University Health System MISP |
$499.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,225.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,115.74
|
| Rate for Payer: United Healthcare All Other HMO |
$1,115.74
|
| Rate for Payer: United Healthcare HMO Rider |
$1,115.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,115.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$453.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
HC MRI ABDOMEN W/O CONTRAST
|
Facility
|
IP
|
$11,002.00
|
|
|
Service Code
|
CPT 74181
|
| Hospital Charge Code |
908801300
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,200.40 |
| Max. Negotiated Rate |
$9,901.80 |
| Rate for Payer: Adventist Health Commercial |
$2,200.40
|
| Rate for Payer: Cash Price |
$4,950.90
|
| Rate for Payer: Central Health Plan Commercial |
$8,801.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,400.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,400.80
|
| Rate for Payer: Galaxy Health WC |
$9,351.70
|
| Rate for Payer: Global Benefits Group Commercial |
$6,601.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,901.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,338.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,191.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,810.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,200.40
|
| Rate for Payer: Multiplan Commercial |
$8,251.50
|
| Rate for Payer: Networks By Design Commercial |
$7,151.30
|
| Rate for Payer: Prime Health Services Commercial |
$9,351.70
|
|
|
HC MRI ABDOMEN W/O CONTRAST
|
Facility
|
OP
|
$4,687.00
|
|
|
Service Code
|
CPT 74181
|
| Hospital Charge Code |
908801300
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$4,218.30 |
| Rate for Payer: Adventist Health Commercial |
$937.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$307.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| 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 Exchange |
$2,305.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,752.68
|
| Rate for Payer: Blue Shield of California Commercial |
$2,845.01
|
| Rate for Payer: Blue Shield of California EPN |
$1,860.74
|
| Rate for Payer: Cash Price |
$2,109.15
|
| Rate for Payer: Cash Price |
$2,109.15
|
| Rate for Payer: Cash Price |
$2,109.15
|
| Rate for Payer: Central Health Plan Commercial |
$3,749.60
|
| Rate for Payer: Cigna of CA HMO |
$2,999.68
|
| Rate for Payer: Cigna of CA PPO |
$3,468.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$3,983.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,812.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,218.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$328.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: InnovAge PACE Commercial |
$460.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,126.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$362.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$937.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$411.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$3,515.25
|
| Rate for Payer: Networks By Design Commercial |
$3,046.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$307.13
|
| Rate for Payer: Prime Health Services Commercial |
$3,983.95
|
| Rate for Payer: Prime Health Services Medicare |
$325.56
|
| Rate for Payer: Riverside University Health System MISP |
$337.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,812.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,812.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| Rate for Payer: United Healthcare All Other HMO |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC MRI ABDOMEN W WO CONTRAST
|
Facility
|
IP
|
$14,765.00
|
|
|
Service Code
|
CPT 74183
|
| Hospital Charge Code |
908801302
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,953.00 |
| Max. Negotiated Rate |
$13,288.50 |
| Rate for Payer: Adventist Health Commercial |
$2,953.00
|
| Rate for Payer: Cash Price |
$6,644.25
|
| Rate for Payer: Central Health Plan Commercial |
$11,812.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,906.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,906.00
|
| Rate for Payer: Galaxy Health WC |
$12,550.25
|
| Rate for Payer: Global Benefits Group Commercial |
$8,859.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,288.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,848.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,625.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,139.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,953.00
|
| Rate for Payer: Multiplan Commercial |
$11,073.75
|
| Rate for Payer: Networks By Design Commercial |
$9,597.25
|
| Rate for Payer: Prime Health Services Commercial |
$12,550.25
|
|
