|
HC MR ANGIO CHEST W/O CONTRAST
|
Facility
|
IP
|
$10,182.00
|
|
|
Service Code
|
CPT 71555
|
| Hospital Charge Code |
908801091
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$2,036.40 |
| Max. Negotiated Rate |
$9,163.80 |
| Rate for Payer: Cash Price |
$4,581.90
|
| Rate for Payer: Central Health Plan Commercial |
$8,145.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.80
|
| Rate for Payer: Galaxy Health WC |
$8,654.70
|
| Rate for Payer: Global Benefits Group Commercial |
$6,109.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,163.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,791.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,879.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,036.40
|
| Rate for Payer: Multiplan Commercial |
$7,636.50
|
| Rate for Payer: Networks By Design Commercial |
$6,618.30
|
| Rate for Payer: Prime Health Services Commercial |
$8,654.70
|
|
|
HC MR ANGIO CHEST W WO CONTRAST
|
Facility
|
IP
|
$12,128.00
|
|
|
Service Code
|
CPT 71555
|
| Hospital Charge Code |
908801032
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$2,425.60 |
| Max. Negotiated Rate |
$10,915.20 |
| Rate for Payer: Cash Price |
$5,457.60
|
| Rate for Payer: Central Health Plan Commercial |
$9,702.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,851.20
|
| Rate for Payer: Galaxy Health WC |
$10,308.80
|
| Rate for Payer: Global Benefits Group Commercial |
$7,276.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,915.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,089.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,620.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,425.60
|
| Rate for Payer: Multiplan Commercial |
$9,096.00
|
| Rate for Payer: Networks By Design Commercial |
$7,883.20
|
| Rate for Payer: Prime Health Services Commercial |
$10,308.80
|
|
|
HC MR ANGIO CHEST W WO CONTRAST
|
Facility
|
OP
|
$5,580.00
|
|
|
Service Code
|
CPT 71555
|
| Hospital Charge Code |
908801032
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$626.51 |
| Max. Negotiated Rate |
$5,022.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,743.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,069.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,069.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,307.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,296.66
|
| Rate for Payer: Blue Distinction Transplant |
$3,348.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,448.44
|
| Rate for Payer: Blue Shield of California EPN |
$2,711.88
|
| Rate for Payer: Cash Price |
$2,511.00
|
| Rate for Payer: Cash Price |
$2,511.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,464.00
|
| Rate for Payer: Cigna of CA HMO |
$3,571.20
|
| Rate for Payer: Cigna of CA PPO |
$4,129.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,743.00
|
| Rate for Payer: Dignity Health Media |
$4,743.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,743.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,232.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,232.00
|
| Rate for Payer: Galaxy Health WC |
$4,743.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,022.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,185.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,953.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,721.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$626.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,116.00
|
| Rate for Payer: Multiplan Commercial |
$4,185.00
|
| Rate for Payer: Networks By Design Commercial |
$3,627.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,743.00
|
| Rate for Payer: Riverside University Health System MISP |
$2,232.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,110.11
|
| Rate for Payer: United Healthcare All Other HMO |
$1,110.11
|
| Rate for Payer: United Healthcare HMO Rider |
$1,110.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,110.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,743.00
|
| Rate for Payer: Vantage Medical Group Senior |
$4,743.00
|
|
|
HC MR ANGIO LOW EXT W CONTRAST
|
Facility
|
OP
|
$4,426.00
|
|
|
Service Code
|
CPT 73725
|
| Hospital Charge Code |
908801092
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$627.10 |
| Max. Negotiated Rate |
$3,983.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,055.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,762.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,434.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,434.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,308.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,614.88
|
| Rate for Payer: Blue Distinction Transplant |
$2,655.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,735.27
|
| Rate for Payer: Blue Shield of California EPN |
$2,151.04
|
| Rate for Payer: Cash Price |
$1,991.70
|
| Rate for Payer: Cash Price |
$1,991.70
|
| Rate for Payer: Central Health Plan Commercial |
$3,540.80
|
| Rate for Payer: Cigna of CA HMO |
$2,832.64
|
| Rate for Payer: Cigna of CA PPO |
$3,275.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,762.10
|
| Rate for Payer: Dignity Health Media |
$3,762.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,762.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,770.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,770.40
|
| Rate for Payer: Galaxy Health WC |
$3,762.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,655.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,983.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,319.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,549.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,952.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$627.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$885.20
|
| Rate for Payer: Multiplan Commercial |
$3,319.50
|
| Rate for Payer: Networks By Design Commercial |
$2,876.90
|
| Rate for Payer: Prime Health Services Commercial |
$3,762.10
|
| Rate for Payer: Riverside University Health System MISP |
$1,770.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,655.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,655.60
|
| 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 Medi-Cal |
$3,762.10
|
| Rate for Payer: Vantage Medical Group Senior |
$3,762.10
|
|
|
HC MR ANGIO LOW EXT W CONTRAST
|
Facility
|
IP
|
$9,220.00
|
|
|
Service Code
|
CPT 73725
|
| Hospital Charge Code |
908801092
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$1,844.00 |
| Max. Negotiated Rate |
$8,298.00 |
| Rate for Payer: Cash Price |
$4,149.00
|
| Rate for Payer: Central Health Plan Commercial |
$7,376.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,688.00
|
| Rate for Payer: Galaxy Health WC |
$7,837.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,532.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,298.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,149.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,512.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,844.00
|
| Rate for Payer: Multiplan Commercial |
$6,915.00
|
| Rate for Payer: Networks By Design Commercial |
$5,993.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,837.00
|
|
|
HC MR ANGIO LOW EXT WO CONT
|
Facility
|
IP
|
$8,381.00
|
|
|
Service Code
|
CPT 73725
|
| Hospital Charge Code |
908801094
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$1,676.20 |
| Max. Negotiated Rate |
$7,542.90 |
| Rate for Payer: Cash Price |
$3,771.45
|
| Rate for Payer: Central Health Plan Commercial |
$6,704.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,352.40
|
| Rate for Payer: Galaxy Health WC |
$7,123.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,028.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,542.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,590.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,193.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,676.20
|
| Rate for Payer: Multiplan Commercial |
$6,285.75
|
| Rate for Payer: Networks By Design Commercial |
$5,447.65
|
| Rate for Payer: Prime Health Services Commercial |
$7,123.85
|
|
|
HC MR ANGIO LOW EXT WO CONT
|
Facility
|
OP
|
$4,048.00
|
|
|
Service Code
|
CPT 73725
|
| Hospital Charge Code |
908801094
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$627.10 |
| Max. Negotiated Rate |
$3,643.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,055.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,440.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,226.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,226.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,308.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,391.56
|
| Rate for Payer: Blue Distinction Transplant |
$2,428.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,501.66
|
| Rate for Payer: Blue Shield of California EPN |
$1,967.33
|
| Rate for Payer: Cash Price |
$1,821.60
|
| Rate for Payer: Cash Price |
$1,821.60
|
| Rate for Payer: Central Health Plan Commercial |
$3,238.40
|
| Rate for Payer: Cigna of CA HMO |
$2,590.72
|
| Rate for Payer: Cigna of CA PPO |
$2,995.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,440.80
|
| Rate for Payer: Dignity Health Media |
$3,440.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,440.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,619.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,619.20
|
| Rate for Payer: Galaxy Health WC |
$3,440.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,428.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,643.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,036.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,416.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,700.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$627.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$809.60
|
| Rate for Payer: Multiplan Commercial |
$3,036.00
|
| Rate for Payer: Networks By Design Commercial |
$2,631.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,440.80
|
| Rate for Payer: Riverside University Health System MISP |
$1,619.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,428.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,428.80
|
| 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 Medi-Cal |
$3,440.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,440.80
|
|
|
HC MR ANGIO LOW EXT W&WO CON
|
Facility
|
OP
|
$4,803.00
|
|
|
Service Code
|
CPT 73725
|
| Hospital Charge Code |
908801036
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$627.10 |
| Max. Negotiated Rate |
$4,322.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,055.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,082.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,641.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,641.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,308.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,837.61
|
| Rate for Payer: Blue Distinction Transplant |
$2,881.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,968.25
|
| Rate for Payer: Blue Shield of California EPN |
$2,334.26
|
| Rate for Payer: Cash Price |
$2,161.35
|
| Rate for Payer: Cash Price |
$2,161.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,842.40
|
| Rate for Payer: Cigna of CA HMO |
$3,073.92
|
| Rate for Payer: Cigna of CA PPO |
$3,554.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,082.55
|
| Rate for Payer: Dignity Health Media |
$4,082.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,082.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,921.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,921.20
|
| Rate for Payer: Galaxy Health WC |
$4,082.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,881.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,322.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,602.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,681.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,203.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$627.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$960.60
|
| Rate for Payer: Multiplan Commercial |
$3,602.25
|
| Rate for Payer: Networks By Design Commercial |
$3,121.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,082.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,921.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,881.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,881.80
|
| 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 Medi-Cal |
$4,082.55
|
| Rate for Payer: Vantage Medical Group Senior |
$4,082.55
|
|
|
HC MR ANGIO LOW EXT W&WO CON
|
Facility
|
IP
|
$10,938.00
|
|
|
Service Code
|
CPT 73725
|
| Hospital Charge Code |
908801036
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$2,187.60 |
| Max. Negotiated Rate |
$9,844.20 |
| Rate for Payer: Cash Price |
$4,922.10
|
| Rate for Payer: Central Health Plan Commercial |
$8,750.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,375.20
|
| Rate for Payer: Galaxy Health WC |
$9,297.30
|
| Rate for Payer: Global Benefits Group Commercial |
$6,562.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,844.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,295.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,167.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,187.60
|
| Rate for Payer: Multiplan Commercial |
$8,203.50
|
| Rate for Payer: Networks By Design Commercial |
$7,109.70
|
| Rate for Payer: Prime Health Services Commercial |
$9,297.30
|
|
|
HC MR ANGIO PELVIS W/CONT
|
Facility
|
OP
|
$3,101.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801097
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$620.20 |
| Max. Negotiated Rate |
$2,954.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,635.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,705.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,705.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,308.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,832.07
|
| Rate for Payer: Blue Distinction Transplant |
$1,860.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,916.42
|
| Rate for Payer: Blue Shield of California EPN |
$1,507.09
|
| Rate for Payer: Cash Price |
$1,395.45
|
| Rate for Payer: Cash Price |
$1,395.45
|
| Rate for Payer: Central Health Plan Commercial |
$2,480.80
|
| Rate for Payer: Cigna of CA HMO |
$1,984.64
|
| Rate for Payer: Cigna of CA PPO |
$2,294.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,635.85
|
| Rate for Payer: Dignity Health Media |
$2,635.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,635.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,240.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,240.40
|
| Rate for Payer: Galaxy Health WC |
$2,635.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,860.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,790.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,325.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,085.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,068.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$629.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$620.20
|
| Rate for Payer: Multiplan Commercial |
$2,325.75
|
| Rate for Payer: Networks By Design Commercial |
$2,015.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,635.85
|
| Rate for Payer: Riverside University Health System MISP |
$1,240.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,860.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,860.60
|
| 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 Medi-Cal |
$2,635.85
|
| Rate for Payer: Vantage Medical Group Senior |
$2,635.85
|
|
|
HC MR ANGIO PELVIS W/CONT
|
Facility
|
IP
|
$6,742.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801097
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$1,348.40 |
| Max. Negotiated Rate |
$6,067.80 |
| Rate for Payer: Cash Price |
$3,033.90
|
| Rate for Payer: Central Health Plan Commercial |
$5,393.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,696.80
|
| Rate for Payer: Galaxy Health WC |
$5,730.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,045.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,067.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,496.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,568.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,348.40
|
| Rate for Payer: Multiplan Commercial |
$5,056.50
|
| Rate for Payer: Networks By Design Commercial |
$4,382.30
|
| Rate for Payer: Prime Health Services Commercial |
$5,730.70
|
|
|
HC MR ANGIO PELVIS WO CONT
|
Facility
|
IP
|
$6,422.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801098
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$1,284.40 |
| Max. Negotiated Rate |
$5,779.80 |
| Rate for Payer: Cash Price |
$2,889.90
|
| Rate for Payer: Central Health Plan Commercial |
$5,137.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,568.80
|
| Rate for Payer: Galaxy Health WC |
$5,458.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,853.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,779.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,283.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,446.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,284.40
|
| Rate for Payer: Multiplan Commercial |
$4,816.50
|
| Rate for Payer: Networks By Design Commercial |
$4,174.30
|
| Rate for Payer: Prime Health Services Commercial |
$5,458.70
|
|
|
HC MR ANGIO PELVIS WO CONT
|
Facility
|
OP
|
$2,725.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801098
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$545.00 |
| Max. Negotiated Rate |
$2,954.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,316.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,498.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,498.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,308.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,609.93
|
| Rate for Payer: Blue Distinction Transplant |
$1,635.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,684.05
|
| Rate for Payer: Blue Shield of California EPN |
$1,324.35
|
| Rate for Payer: Cash Price |
$1,226.25
|
| Rate for Payer: Cash Price |
$1,226.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,180.00
|
| Rate for Payer: Cigna of CA HMO |
$1,744.00
|
| Rate for Payer: Cigna of CA PPO |
$2,016.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,316.25
|
| Rate for Payer: Dignity Health Media |
$2,316.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,316.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,090.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,090.00
|
| Rate for Payer: Galaxy Health WC |
$2,316.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,635.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,452.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,043.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$953.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,817.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$629.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$545.00
|
| Rate for Payer: Multiplan Commercial |
$2,043.75
|
| Rate for Payer: Networks By Design Commercial |
$1,771.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,316.25
|
| Rate for Payer: Riverside University Health System MISP |
$1,090.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,635.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,635.00
|
| 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 Medi-Cal |
$2,316.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,316.25
|
|
|
HC MR ANGIO PELVIS WO FOL W CONT
|
Facility
|
IP
|
$7,081.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801099
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$1,416.20 |
| Max. Negotiated Rate |
$6,372.90 |
| Rate for Payer: Cash Price |
$3,186.45
|
| Rate for Payer: Central Health Plan Commercial |
$5,664.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,832.40
|
| Rate for Payer: Galaxy Health WC |
$6,018.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,248.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,372.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,723.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,697.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,416.20
|
| Rate for Payer: Multiplan Commercial |
$5,310.75
|
| Rate for Payer: Networks By Design Commercial |
$4,602.65
|
| Rate for Payer: Prime Health Services Commercial |
$6,018.85
|
|
|
HC MR ANGIO PELVIS WO FOL W CONT
|
Facility
|
OP
|
$3,480.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801099
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$629.64 |
| Max. Negotiated Rate |
$3,132.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,958.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,914.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,914.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,308.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,055.98
|
| Rate for Payer: Blue Distinction Transplant |
$2,088.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,150.64
|
| Rate for Payer: Blue Shield of California EPN |
$1,691.28
|
| Rate for Payer: Cash Price |
$1,566.00
|
| Rate for Payer: Cash Price |
$1,566.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,784.00
|
| Rate for Payer: Cigna of CA HMO |
$2,227.20
|
| Rate for Payer: Cigna of CA PPO |
$2,575.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,958.00
|
| Rate for Payer: Dignity Health Media |
$2,958.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,958.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,392.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,392.00
|
| Rate for Payer: Galaxy Health WC |
$2,958.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,088.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,132.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,610.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,218.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,321.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$629.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$696.00
|
| Rate for Payer: Multiplan Commercial |
$2,610.00
|
| Rate for Payer: Networks By Design Commercial |
$2,262.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,958.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,392.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,088.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,088.00
|
| 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 Medi-Cal |
$2,958.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,958.00
|
|
|
HC MR ANGIO PELVIS WO FOL W CONT
|
Facility
|
OP
|
$3,480.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801034
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$629.64 |
| Max. Negotiated Rate |
$3,132.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,958.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,914.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,914.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,308.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,055.98
|
| Rate for Payer: Blue Distinction Transplant |
$2,088.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,150.64
|
| Rate for Payer: Blue Shield of California EPN |
$1,691.28
|
| Rate for Payer: Cash Price |
$1,566.00
|
| Rate for Payer: Cash Price |
$1,566.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,784.00
|
| Rate for Payer: Cigna of CA HMO |
$2,227.20
|
| Rate for Payer: Cigna of CA PPO |
$2,575.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,958.00
|
| Rate for Payer: Dignity Health Media |
$2,958.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,958.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,392.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,392.00
|
| Rate for Payer: Galaxy Health WC |
$2,958.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,088.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,132.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,610.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,218.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,321.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$629.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$696.00
|
| Rate for Payer: Multiplan Commercial |
$2,610.00
|
| Rate for Payer: Networks By Design Commercial |
$2,262.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,958.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,392.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,088.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,088.00
|
| 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 Medi-Cal |
$2,958.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,958.00
|
|
|
HC MR ANGIO PELVIS WO FOL W CONT
|
Facility
|
IP
|
$7,081.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801034
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$1,416.20 |
| Max. Negotiated Rate |
$6,372.90 |
| Rate for Payer: Cash Price |
$3,186.45
|
| Rate for Payer: Central Health Plan Commercial |
$5,664.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,832.40
|
| Rate for Payer: Galaxy Health WC |
$6,018.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,248.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,372.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,723.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,697.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,416.20
|
| Rate for Payer: Multiplan Commercial |
$5,310.75
|
| Rate for Payer: Networks By Design Commercial |
$4,602.65
|
| Rate for Payer: Prime Health Services Commercial |
$6,018.85
|
|
|
HC MR ANGIO SPINAL CAN W OR WO CO
|
Facility
|
IP
|
$4,613.00
|
|
|
Service Code
|
CPT 72159
|
| Hospital Charge Code |
908801033
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$922.60 |
| Max. Negotiated Rate |
$4,151.70 |
| Rate for Payer: Cash Price |
$2,075.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,690.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,845.20
|
| Rate for Payer: Galaxy Health WC |
$3,921.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,767.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,151.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,076.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,757.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$922.60
|
| Rate for Payer: Multiplan Commercial |
$3,459.75
|
| Rate for Payer: Networks By Design Commercial |
$2,998.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,921.05
|
|
|
HC MR ANGIO SPINAL CAN W OR WO CO
|
Facility
|
OP
|
$2,228.00
|
|
|
Service Code
|
CPT 72159
|
| Hospital Charge Code |
908801033
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$445.60 |
| Max. Negotiated Rate |
$2,559.78 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,055.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,893.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,225.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,225.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,559.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,316.30
|
| Rate for Payer: Blue Distinction Transplant |
$1,336.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,376.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,082.81
|
| Rate for Payer: Cash Price |
$1,002.60
|
| Rate for Payer: Cash Price |
$1,002.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,782.40
|
| Rate for Payer: Cigna of CA HMO |
$1,425.92
|
| Rate for Payer: Cigna of CA PPO |
$1,648.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,893.80
|
| Rate for Payer: Dignity Health Media |
$1,893.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,893.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$891.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$891.20
|
| Rate for Payer: Galaxy Health WC |
$1,893.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,336.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,005.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,671.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$779.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,486.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$647.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$445.60
|
| Rate for Payer: Multiplan Commercial |
$1,671.00
|
| Rate for Payer: Networks By Design Commercial |
$1,448.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,893.80
|
| Rate for Payer: Riverside University Health System MISP |
$891.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,336.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,336.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,168.48
|
| Rate for Payer: United Healthcare All Other HMO |
$1,168.48
|
| Rate for Payer: United Healthcare HMO Rider |
$1,168.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,168.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,893.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,893.80
|
|
|
HC MR ANGIO UPPER EXT W/WO CONTR
|
Facility
|
OP
|
$2,001.00
|
|
|
Service Code
|
CPT 73225
|
| Hospital Charge Code |
908801035
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$400.20 |
| Max. Negotiated Rate |
$2,954.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,700.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,100.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,100.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,306.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,182.19
|
| Rate for Payer: Blue Distinction Transplant |
$1,200.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,236.62
|
| Rate for Payer: Blue Shield of California EPN |
$972.49
|
| Rate for Payer: Cash Price |
$900.45
|
| Rate for Payer: Cash Price |
$900.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,600.80
|
| Rate for Payer: Cigna of CA HMO |
$1,280.64
|
| Rate for Payer: Cigna of CA PPO |
$1,480.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,700.85
|
| Rate for Payer: Dignity Health Media |
$1,700.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,700.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$800.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$800.40
|
| Rate for Payer: Galaxy Health WC |
$1,700.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,200.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,800.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,500.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$700.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,334.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$642.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$400.20
|
| Rate for Payer: Multiplan Commercial |
$1,500.75
|
| Rate for Payer: Networks By Design Commercial |
$1,300.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,700.85
|
| Rate for Payer: Riverside University Health System MISP |
$800.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,200.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,200.60
|
| 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 Medi-Cal |
$1,700.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,700.85
|
|
|
HC MR ANGIO UPPER EXT W/WO CONTR
|
Facility
|
IP
|
$4,143.00
|
|
|
Service Code
|
CPT 73225
|
| Hospital Charge Code |
908801035
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$828.60 |
| Max. Negotiated Rate |
$3,728.70 |
| Rate for Payer: Cash Price |
$1,864.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,314.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,657.20
|
| Rate for Payer: Galaxy Health WC |
$3,521.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,485.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,728.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,763.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,578.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$828.60
|
| Rate for Payer: Multiplan Commercial |
$3,107.25
|
| Rate for Payer: Networks By Design Commercial |
$2,692.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,521.55
|
|
|
HC MR ANGIO W/O FOL W/CONT, ABD
|
Facility
|
IP
|
$13,734.00
|
|
|
Service Code
|
CPT 74185
|
| Hospital Charge Code |
908801096
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$2,746.80 |
| Max. Negotiated Rate |
$12,360.60 |
| Rate for Payer: Cash Price |
$6,180.30
|
| Rate for Payer: Central Health Plan Commercial |
$10,987.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,493.60
|
| Rate for Payer: Galaxy Health WC |
$11,673.90
|
| Rate for Payer: Global Benefits Group Commercial |
$8,240.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,360.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,160.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,232.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,746.80
|
| Rate for Payer: Multiplan Commercial |
$10,300.50
|
| Rate for Payer: Networks By Design Commercial |
$8,927.10
|
| Rate for Payer: Prime Health Services Commercial |
$11,673.90
|
|
|
HC MR ANGIO W/O FOL W/CONT, ABD
|
Facility
|
OP
|
$6,378.00
|
|
|
Service Code
|
CPT 74185
|
| Hospital Charge Code |
908801096
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$630.86 |
| Max. Negotiated Rate |
$5,740.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,421.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,507.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,507.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,308.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,768.12
|
| Rate for Payer: Blue Distinction Transplant |
$3,826.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,941.60
|
| Rate for Payer: Blue Shield of California EPN |
$3,099.71
|
| Rate for Payer: Cash Price |
$2,870.10
|
| Rate for Payer: Cash Price |
$2,870.10
|
| Rate for Payer: Central Health Plan Commercial |
$5,102.40
|
| Rate for Payer: Cigna of CA HMO |
$4,081.92
|
| Rate for Payer: Cigna of CA PPO |
$4,719.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,421.30
|
| Rate for Payer: Dignity Health Media |
$5,421.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,421.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,551.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,551.20
|
| Rate for Payer: Galaxy Health WC |
$5,421.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,826.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,740.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,783.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,232.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,254.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$630.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,275.60
|
| Rate for Payer: Multiplan Commercial |
$4,783.50
|
| Rate for Payer: Networks By Design Commercial |
$4,145.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,421.30
|
| Rate for Payer: Riverside University Health System MISP |
$2,551.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,826.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,826.80
|
| 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 Medi-Cal |
$5,421.30
|
| Rate for Payer: Vantage Medical Group Senior |
$5,421.30
|
|
|
HC MRI ABDOMEN W/CONTRAST
|
Facility
|
OP
|
$4,442.00
|
|
|
Service Code
|
CPT 74182
|
| Hospital Charge Code |
908801301
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$480.50 |
| Max. Negotiated Rate |
$3,997.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$480.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,814.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,624.33
|
| Rate for Payer: Blue Distinction Transplant |
$2,665.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,745.16
|
| Rate for Payer: Blue Shield of California EPN |
$2,158.81
|
| Rate for Payer: Caremore Medicare Advantage |
$480.50
|
| Rate for Payer: Cash Price |
$1,998.90
|
| Rate for Payer: Cash Price |
$1,998.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,553.60
|
| Rate for Payer: Cigna of CA HMO |
$2,842.88
|
| Rate for Payer: Cigna of CA PPO |
$3,287.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: Dignity Health Media |
$480.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$480.50
|
| Rate for Payer: Galaxy Health WC |
$3,775.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,665.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,997.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,331.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$788.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$792.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$480.50
|
| Rate for Payer: InnovAge PACE Commercial |
$720.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,962.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$568.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$888.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.87
|
| Rate for Payer: Multiplan Commercial |
$3,331.50
|
| Rate for Payer: Networks By Design Commercial |
$2,887.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,775.70
|
| Rate for Payer: Prime Health Services Medicare |
$509.33
|
| Rate for Payer: Riverside University Health System MISP |
$528.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,665.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,665.20
|
| 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: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC MRI ABDOMEN W/CONTRAST
|
Facility
|
IP
|
$10,003.00
|
|
|
Service Code
|
CPT 74182
|
| Hospital Charge Code |
908801301
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,000.60 |
| Max. Negotiated Rate |
$9,002.70 |
| Rate for Payer: Cash Price |
$4,501.35
|
| Rate for Payer: Central Health Plan Commercial |
$8,002.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,001.20
|
| Rate for Payer: Galaxy Health WC |
$8,502.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6,001.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,002.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,672.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,811.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,000.60
|
| Rate for Payer: Multiplan Commercial |
$7,502.25
|
| Rate for Payer: Networks By Design Commercial |
$6,501.95
|
| Rate for Payer: Prime Health Services Commercial |
$8,502.55
|
|
