|
HC MR ANGIO LOW EXT W&WO CON
|
Facility
|
IP
|
$5,811.00
|
|
|
Service Code
|
CPT 73725
|
| Hospital Charge Code |
908801036
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$1,162.20 |
| Max. Negotiated Rate |
$5,229.90 |
| Rate for Payer: Adventist Health Commercial |
$1,162.20
|
| Rate for Payer: Cash Price |
$3,196.05
|
| Rate for Payer: Central Health Plan Commercial |
$4,648.80
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$3,875.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,213.99
|
| 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: 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
|
|
|
HC MR ANGIO PELVIS W/CONT
|
Facility
|
IP
|
$3,752.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801097
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$750.40 |
| Max. Negotiated Rate |
$3,376.80 |
| Rate for Payer: Adventist Health Commercial |
$750.40
|
| Rate for Payer: Cash Price |
$2,063.60
|
| Rate for Payer: Central Health Plan Commercial |
$3,001.60
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$2,502.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,429.51
|
| 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: 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
|
|
|
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 |
$2,063.60
|
| Rate for Payer: Cash Price |
$2,063.60
|
| Rate for Payer: Cash Price |
$2,063.60
|
| 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
|
IP
|
$3,298.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801098
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$659.60 |
| Max. Negotiated Rate |
$2,968.20 |
| Rate for Payer: Adventist Health Commercial |
$659.60
|
| Rate for Payer: Cash Price |
$1,813.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,638.40
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$2,199.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,256.54
|
| 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: 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
|
|
|
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 |
$1,813.90
|
| Rate for Payer: Cash Price |
$1,813.90
|
| Rate for Payer: Cash Price |
$1,813.90
|
| 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 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 |
$2,316.05
|
| Rate for Payer: Cash Price |
$2,316.05
|
| Rate for Payer: Cash Price |
$2,316.05
|
| 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
|
$4,211.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801034
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$842.20 |
| Max. Negotiated Rate |
$3,789.90 |
| Rate for Payer: Adventist Health Commercial |
$842.20
|
| Rate for Payer: Cash Price |
$2,316.05
|
| Rate for Payer: Central Health Plan Commercial |
$3,368.80
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$2,808.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,604.39
|
| 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: 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
|
|
|
HC MR ANGIO PELVIS WO FOL W CONT
|
Facility
|
IP
|
$4,211.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801099
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$842.20 |
| Max. Negotiated Rate |
$3,789.90 |
| Rate for Payer: Adventist Health Commercial |
$842.20
|
| Rate for Payer: Cash Price |
$2,316.05
|
| Rate for Payer: Central Health Plan Commercial |
$3,368.80
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$2,808.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,604.39
|
| 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: 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
|
|
|
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 |
$2,316.05
|
| Rate for Payer: Cash Price |
$2,316.05
|
| Rate for Payer: Cash Price |
$2,316.05
|
| 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
|
$2,696.00
|
|
|
Service Code
|
CPT 72159
|
| Hospital Charge Code |
908801033
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$539.20 |
| Max. Negotiated Rate |
$2,426.40 |
| Rate for Payer: Adventist Health Commercial |
$539.20
|
| Rate for Payer: Cash Price |
$1,482.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,156.80
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$1,798.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,027.18
|
| 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: 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
|
|
|
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 |
$1,482.80
|
| Rate for Payer: Cash Price |
$1,482.80
|
| 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 |
$1,392.05
|
| Rate for Payer: Cash Price |
$1,392.05
|
| Rate for Payer: Cash Price |
$1,392.05
|
| 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
|
$2,531.00
|
|
|
Service Code
|
CPT 73225
|
| Hospital Charge Code |
908801035
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$506.20 |
| Max. Negotiated Rate |
$2,277.90 |
| Rate for Payer: Adventist Health Commercial |
$506.20
|
| Rate for Payer: Cash Price |
$1,392.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,024.80
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$1,688.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$964.31
|
| 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: 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
|
|
|
HC MR ANGIO W/O FOL W/CONT, ABD
|
Facility
|
IP
|
$7,718.00
|
|
|
Service Code
|
CPT 74185
|
| Hospital Charge Code |
908801096
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$1,543.60 |
| Max. Negotiated Rate |
$6,946.20 |
| Rate for Payer: Adventist Health Commercial |
$1,543.60
|
| Rate for Payer: Cash Price |
$4,244.90
|
| Rate for Payer: Central Health Plan Commercial |
$6,174.40
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$5,147.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,940.56
|
| 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: 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
|
|
|
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 |
$4,244.90
|
| Rate for Payer: Cash Price |
$4,244.90
|
| Rate for Payer: Cash Price |
$4,244.90
|
| 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 MRI ABDOMEN W/CONTRAST
|
Facility
|
IP
|
$5,375.00
|
|
|
Service Code
|
CPT 74182
|
| Hospital Charge Code |
908801301
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,075.00 |
| Max. Negotiated Rate |
$4,837.50 |
| Rate for Payer: Adventist Health Commercial |
$1,075.00
|
| Rate for Payer: Cash Price |
$2,956.25
|
| Rate for Payer: Central Health Plan Commercial |
$4,300.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,150.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,150.00
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$3,585.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,047.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,327.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,075.00
|
| Rate for Payer: Multiplan Commercial |
$4,031.25
|
| Rate for Payer: Networks By Design Commercial |
$3,493.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,568.75
|
|
|
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 |
$2,956.25
|
| Rate for Payer: Cash Price |
$2,956.25
|
| Rate for Payer: Cash Price |
$2,956.25
|
| 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
|
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 |
$2,577.85
|
| Rate for Payer: Cash Price |
$2,577.85
|
| Rate for Payer: Cash Price |
$2,577.85
|
| 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/O CONTRAST
|
Facility
|
IP
|
$4,687.00
|
|
|
Service Code
|
CPT 74181
|
| Hospital Charge Code |
908801300
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$937.40 |
| Max. Negotiated Rate |
$4,218.30 |
| Rate for Payer: Adventist Health Commercial |
$937.40
|
| Rate for Payer: Cash Price |
$2,577.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,749.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,874.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,874.80
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$3,126.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,785.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,901.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$937.40
|
| Rate for Payer: Multiplan Commercial |
$3,515.25
|
| Rate for Payer: Networks By Design Commercial |
$3,046.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,983.95
|
|
|
HC MRI ABDOMEN W WO CONTRAST
|
Facility
|
OP
|
$6,180.00
|
|
|
Service Code
|
CPT 74183
|
| Hospital Charge Code |
908801302
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$453.77 |
| Max. Negotiated Rate |
$5,562.00 |
| Rate for Payer: Adventist Health Commercial |
$1,236.00
|
| 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 |
$5,208.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,629.51
|
| Rate for Payer: Blue Shield of California Commercial |
$3,751.26
|
| Rate for Payer: Blue Shield of California EPN |
$2,453.46
|
| Rate for Payer: Cash Price |
$3,399.00
|
| Rate for Payer: Cash Price |
$3,399.00
|
| Rate for Payer: Cash Price |
$3,399.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,944.00
|
| Rate for Payer: Cigna of CA HMO |
$3,955.20
|
| Rate for Payer: Cigna of CA PPO |
$4,573.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.59
|
| Rate for Payer: EPIC Health Plan Senior |
$453.77
|
| Rate for Payer: Galaxy Health WC |
$5,253.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,708.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,562.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$573.65
|
| 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 |
$4,122.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$633.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,236.00
|
| 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 |
$4,635.00
|
| Rate for Payer: Networks By Design Commercial |
$4,017.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$453.77
|
| Rate for Payer: Prime Health Services Commercial |
$5,253.00
|
| 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 |
$3,708.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,708.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,367.12
|
| Rate for Payer: United Healthcare All Other HMO |
$1,367.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1,367.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,367.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$453.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
HC MRI ABDOMEN W WO CONTRAST
|
Facility
|
IP
|
$6,180.00
|
|
|
Service Code
|
CPT 74183
|
| Hospital Charge Code |
908801302
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,236.00 |
| Max. Negotiated Rate |
$5,562.00 |
| Rate for Payer: Adventist Health Commercial |
$1,236.00
|
| Rate for Payer: Cash Price |
$3,399.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,944.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,472.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,472.00
|
| Rate for Payer: Galaxy Health WC |
$5,253.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,708.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,562.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,122.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,354.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,825.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,236.00
|
| Rate for Payer: Multiplan Commercial |
$4,635.00
|
| Rate for Payer: Networks By Design Commercial |
$4,017.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,253.00
|
|
|
HC MRI ANGIO HEAD WITH CONTRAST
|
Facility
|
OP
|
$5,853.00
|
|
|
Service Code
|
CPT 70545
|
| Hospital Charge Code |
908801084
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$383.18 |
| Max. Negotiated Rate |
$5,267.70 |
| Rate for Payer: Adventist Health Commercial |
$1,170.60
|
| 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 |
$2,369.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,437.47
|
| Rate for Payer: Blue Shield of California Commercial |
$3,552.77
|
| Rate for Payer: Blue Shield of California EPN |
$2,323.64
|
| Rate for Payer: Cash Price |
$3,219.15
|
| Rate for Payer: Cash Price |
$3,219.15
|
| Rate for Payer: Cash Price |
$3,219.15
|
| Rate for Payer: Central Health Plan Commercial |
$4,682.40
|
| Rate for Payer: Cigna of CA HMO |
$3,745.92
|
| Rate for Payer: Cigna of CA PPO |
$4,331.22
|
| 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 |
$4,975.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,511.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,267.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$383.18
|
| 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 |
$3,903.95
|
| 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 |
$1,170.60
|
| 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 |
$4,389.75
|
| Rate for Payer: Networks By Design Commercial |
$3,804.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$453.77
|
| Rate for Payer: Prime Health Services Commercial |
$4,975.05
|
| 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 |
$3,511.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,511.80
|
| 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
|
$5,853.00
|
|
|
Service Code
|
CPT 70545
|
| Hospital Charge Code |
908801084
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,170.60 |
| Max. Negotiated Rate |
$5,267.70 |
| Rate for Payer: Adventist Health Commercial |
$1,170.60
|
| Rate for Payer: Cash Price |
$3,219.15
|
| Rate for Payer: Central Health Plan Commercial |
$4,682.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,341.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,341.20
|
| Rate for Payer: Galaxy Health WC |
$4,975.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,511.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,267.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,903.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,229.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,623.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,170.60
|
| Rate for Payer: Multiplan Commercial |
$4,389.75
|
| Rate for Payer: Networks By Design Commercial |
$3,804.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,975.05
|
|
|
HC MRI ANGIO HEAD WO CNTRAST
|
Facility
|
OP
|
$5,226.00
|
|
|
Service Code
|
CPT 70544
|
| Hospital Charge Code |
908801015
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$4,703.40 |
| Rate for Payer: Adventist Health Commercial |
$1,045.20
|
| 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 |
$2,369.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,069.23
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.18
|
| Rate for Payer: Blue Shield of California EPN |
$2,074.72
|
| Rate for Payer: Cash Price |
$2,874.30
|
| Rate for Payer: Cash Price |
$2,874.30
|
| Rate for Payer: Cash Price |
$2,874.30
|
| Rate for Payer: Central Health Plan Commercial |
$4,180.80
|
| Rate for Payer: Cigna of CA HMO |
$3,344.64
|
| Rate for Payer: Cigna of CA PPO |
$3,867.24
|
| 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 |
$4,442.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,135.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,703.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$362.82
|
| 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 |
$3,485.74
|
| 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 |
$1,045.20
|
| 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 |
$3,919.50
|
| Rate for Payer: Networks By Design Commercial |
$3,396.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$307.13
|
| Rate for Payer: Prime Health Services Commercial |
$4,442.10
|
| 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 |
$3,135.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,135.60
|
| 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
|
$5,226.00
|
|
|
Service Code
|
CPT 70544
|
| Hospital Charge Code |
908801015
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,045.20 |
| Max. Negotiated Rate |
$4,703.40 |
| Rate for Payer: Adventist Health Commercial |
$1,045.20
|
| Rate for Payer: Cash Price |
$2,874.30
|
| Rate for Payer: Central Health Plan Commercial |
$4,180.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,090.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,090.40
|
| Rate for Payer: Galaxy Health WC |
$4,442.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,135.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,703.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,485.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,991.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,234.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,045.20
|
| Rate for Payer: Multiplan Commercial |
$3,919.50
|
| Rate for Payer: Networks By Design Commercial |
$3,396.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,442.10
|
|
