|
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 |
$325.00 |
| Max. Negotiated Rate |
$2,635.85 |
| Rate for Payer: Adventist Health Commercial |
$620.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,574.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,130.39
|
| 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 |
$2,325.75
|
| Rate for Payer: Blue Shield of California Commercial |
$2,286.99
|
| Rate for Payer: Blue Shield of California EPN |
$1,300.54
|
| Rate for Payer: Cash Price |
$1,395.45
|
| Rate for Payer: Cash Price |
$1,395.45
|
| Rate for Payer: Cash Price |
$1,395.45
|
| Rate for Payer: Cash Price |
$1,395.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,635.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,635.85
|
| Rate for Payer: Dignity Health Senior |
$2,635.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$516.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,494.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$561.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$775.25
|
| Rate for Payer: Multiplan Commercial |
$2,325.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$696.00
|
| 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
|
$6,923.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801097
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$5,192.25 |
| Rate for Payer: Adventist Health Commercial |
$1,384.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,756.10
|
| Rate for Payer: Cash Price |
$3,115.35
|
| Rate for Payer: Cash Price |
$3,115.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,686.87
|
| Rate for Payer: Heritage Provider Network Senior |
$4,686.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,253.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,730.75
|
| Rate for Payer: Multiplan Commercial |
$5,192.25
|
|
|
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 |
$325.00 |
| Max. Negotiated Rate |
$2,316.25 |
| Rate for Payer: Adventist Health Commercial |
$545.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,574.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,872.08
|
| 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 |
$2,043.75
|
| Rate for Payer: Blue Shield of California Commercial |
$2,286.99
|
| Rate for Payer: Blue Shield of California EPN |
$1,300.54
|
| Rate for Payer: Cash Price |
$1,226.25
|
| Rate for Payer: Cash Price |
$1,226.25
|
| Rate for Payer: Cash Price |
$1,226.25
|
| Rate for Payer: Cash Price |
$1,226.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,316.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,316.25
|
| Rate for Payer: Dignity Health Senior |
$2,316.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$516.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,313.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$493.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$681.25
|
| Rate for Payer: Multiplan Commercial |
$2,043.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$696.00
|
| 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 CONT
|
Facility
|
IP
|
$5,748.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801098
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$4,311.00 |
| Rate for Payer: Adventist Health Commercial |
$1,149.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,948.88
|
| Rate for Payer: Cash Price |
$2,586.60
|
| Rate for Payer: Cash Price |
$2,586.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,891.40
|
| Rate for Payer: Heritage Provider Network Senior |
$3,891.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,040.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,437.00
|
| Rate for Payer: Multiplan Commercial |
$4,311.00
|
|
|
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 |
$929.00 |
| Max. Negotiated Rate |
$5,310.75 |
| Rate for Payer: Adventist Health Commercial |
$1,416.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,864.65
|
| Rate for Payer: Cash Price |
$3,186.45
|
| Rate for Payer: Cash Price |
$3,186.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,793.84
|
| Rate for Payer: Heritage Provider Network Senior |
$4,793.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,281.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,770.25
|
| Rate for Payer: Multiplan Commercial |
$5,310.75
|
|
|
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 |
$325.00 |
| Max. Negotiated Rate |
$2,958.00 |
| Rate for Payer: Adventist Health Commercial |
$696.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,574.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,390.76
|
| 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 |
$2,610.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,286.99
|
| Rate for Payer: Blue Shield of California EPN |
$1,300.54
|
| Rate for Payer: Cash Price |
$1,566.00
|
| Rate for Payer: Cash Price |
$1,566.00
|
| Rate for Payer: Cash Price |
$1,566.00
|
| Rate for Payer: Cash Price |
$1,566.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,958.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,958.00
|
| Rate for Payer: Dignity Health Senior |
$2,958.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$516.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,677.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$629.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$870.00
|
| Rate for Payer: Multiplan Commercial |
$2,610.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$696.00
|
| 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 |
$325.00 |
| Max. Negotiated Rate |
$2,958.00 |
| Rate for Payer: Adventist Health Commercial |
$696.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,574.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,390.76
|
| 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 |
$2,610.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,286.99
|
| Rate for Payer: Blue Shield of California EPN |
$1,300.54
|
| Rate for Payer: Cash Price |
$1,566.00
|
| Rate for Payer: Cash Price |
$1,566.00
|
| Rate for Payer: Cash Price |
$1,566.00
|
| Rate for Payer: Cash Price |
$1,566.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,958.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,958.00
|
| Rate for Payer: Dignity Health Senior |
$2,958.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$516.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,677.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$629.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$870.00
|
| Rate for Payer: Multiplan Commercial |
$2,610.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$696.00
|
| 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
|
$7,270.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801034
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$5,452.50 |
| Rate for Payer: Adventist Health Commercial |
$1,454.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,994.49
|
| Rate for Payer: Cash Price |
$3,271.50
|
| Rate for Payer: Cash Price |
$3,271.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,921.79
|
| Rate for Payer: Heritage Provider Network Senior |
$4,921.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,315.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,817.50
|
| Rate for Payer: Multiplan Commercial |
$5,452.50
|
|
|
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 |
$325.00 |
| Max. Negotiated Rate |
$5,421.30 |
| Rate for Payer: Adventist Health Commercial |
$1,275.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,574.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,381.69
|
| 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 |
$4,783.50
|
| Rate for Payer: Blue Shield of California Commercial |
$2,286.99
|
| Rate for Payer: Blue Shield of California EPN |
$1,300.54
|
| Rate for Payer: Cash Price |
$2,870.10
|
| Rate for Payer: Cash Price |
$2,870.10
|
| Rate for Payer: Cash Price |
$2,870.10
|
| Rate for Payer: Cash Price |
$2,870.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,421.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,421.30
|
| Rate for Payer: Dignity Health Senior |
$5,421.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$517.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,074.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,154.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,594.50
|
| Rate for Payer: Multiplan Commercial |
$4,783.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$694.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$694.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,421.30
|
| Rate for Payer: Vantage Medical Group Senior |
$5,421.30
|
|
|
HC MR ANGIO W/O FOL W/CONT, ABD
|
Facility
|
IP
|
$4,176.00
|
|
|
Service Code
|
CPT 74185
|
| Hospital Charge Code |
908801096
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$755.86 |
| Max. Negotiated Rate |
$3,132.00 |
| Rate for Payer: Adventist Health Commercial |
$835.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,868.91
|
| Rate for Payer: Cash Price |
$1,879.20
|
| Rate for Payer: Cash Price |
$1,879.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,827.15
|
| Rate for Payer: Heritage Provider Network Senior |
$2,827.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$755.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,044.00
|
| Rate for Payer: Multiplan Commercial |
$3,132.00
|
|
|
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 |
$325.00 |
| Max. Negotiated Rate |
$3,331.50 |
| Rate for Payer: Adventist Health Commercial |
$888.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,574.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,051.65
|
| 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: Blue Shield of California Commercial |
$2,718.36
|
| Rate for Payer: Blue Shield of California EPN |
$1,545.85
|
| Rate for Payer: Cash Price |
$1,998.90
|
| Rate for Payer: Cash Price |
$1,998.90
|
| Rate for Payer: Cash Price |
$1,998.90
|
| Rate for Payer: Cash Price |
$1,998.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: Dignity Health Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$480.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Humana Medicare |
$480.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$466.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$480.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$912.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$804.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$566.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,110.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$605.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$605.43
|
| Rate for Payer: Multiplan Commercial |
$3,331.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$697.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$697.34
|
| 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
|
$5,299.00
|
|
|
Service Code
|
CPT 74182
|
| Hospital Charge Code |
908801301
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$3,974.25 |
| Rate for Payer: Adventist Health Commercial |
$1,059.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,640.41
|
| Rate for Payer: Cash Price |
$2,384.55
|
| Rate for Payer: Cash Price |
$2,384.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,587.42
|
| Rate for Payer: Heritage Provider Network Senior |
$3,587.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$959.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,324.75
|
| Rate for Payer: Multiplan Commercial |
$3,974.25
|
|
|
HC MRI ABDOMEN W/O CONTRAST
|
Facility
|
OP
|
$3,874.00
|
|
|
Service Code
|
CPT 74181
|
| Hospital Charge Code |
908801300
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$297.90 |
| Max. Negotiated Rate |
$2,905.50 |
| Rate for Payer: Adventist Health Commercial |
$774.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,574.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,661.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Blue Shield of California Commercial |
$2,267.32
|
| Rate for Payer: Blue Shield of California EPN |
$1,289.36
|
| Rate for Payer: Cash Price |
$1,743.30
|
| Rate for Payer: Cash Price |
$1,743.30
|
| Rate for Payer: Cash Price |
$1,743.30
|
| Rate for Payer: Cash Price |
$1,743.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: Dignity Health Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Humana Medicare |
$306.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$297.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$581.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$701.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$968.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$385.76
|
| Rate for Payer: Multiplan Commercial |
$2,905.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$541.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$541.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC MRI ABDOMEN W/O CONTRAST
|
Facility
|
IP
|
$4,785.00
|
|
|
Service Code
|
CPT 74181
|
| Hospital Charge Code |
908801300
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$866.08 |
| Max. Negotiated Rate |
$3,588.75 |
| Rate for Payer: Adventist Health Commercial |
$957.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,287.30
|
| Rate for Payer: Cash Price |
$2,153.25
|
| Rate for Payer: Cash Price |
$2,153.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,239.44
|
| Rate for Payer: Heritage Provider Network Senior |
$3,239.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$866.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,196.25
|
| Rate for Payer: Multiplan Commercial |
$3,588.75
|
|
|
HC MRI ABDOMEN W WO CONTRAST
|
Facility
|
OP
|
$4,885.00
|
|
|
Service Code
|
CPT 74183
|
| Hospital Charge Code |
908801302
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$5,027.67 |
| Rate for Payer: Adventist Health Commercial |
$977.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,574.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,356.00
|
| 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: Blue Shield of California Commercial |
$5,027.67
|
| Rate for Payer: Blue Shield of California EPN |
$2,859.08
|
| Rate for Payer: Cash Price |
$2,198.25
|
| Rate for Payer: Cash Price |
$2,198.25
|
| Rate for Payer: Cash Price |
$2,198.25
|
| Rate for Payer: Cash Price |
$2,198.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: Dignity Health Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$480.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Humana Medicare |
$480.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$520.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$480.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$912.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$884.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$566.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,221.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$605.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$605.43
|
| Rate for Payer: Multiplan Commercial |
$3,663.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$854.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$854.45
|
| 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 WO CONTRAST
|
Facility
|
IP
|
$6,364.00
|
|
|
Service Code
|
CPT 74183
|
| Hospital Charge Code |
908801302
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$4,773.00 |
| Rate for Payer: Adventist Health Commercial |
$1,272.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,372.07
|
| Rate for Payer: Cash Price |
$2,863.80
|
| Rate for Payer: Cash Price |
$2,863.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,308.43
|
| Rate for Payer: Heritage Provider Network Senior |
$4,308.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,151.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,591.00
|
| Rate for Payer: Multiplan Commercial |
$4,773.00
|
|
|
HC MRI ANGIO HEAD WITH CONTRAST
|
Facility
|
IP
|
$5,541.00
|
|
|
Service Code
|
CPT 70545
|
| Hospital Charge Code |
908801084
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$4,155.75 |
| Rate for Payer: Adventist Health Commercial |
$1,108.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,806.67
|
| Rate for Payer: Cash Price |
$2,493.45
|
| Rate for Payer: Cash Price |
$2,493.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,751.26
|
| Rate for Payer: Heritage Provider Network Senior |
$3,751.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,002.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,385.25
|
| Rate for Payer: Multiplan Commercial |
$4,155.75
|
|
|
HC MRI ANGIO HEAD WITH CONTRAST
|
Facility
|
OP
|
$4,837.00
|
|
|
Service Code
|
CPT 70545
|
| Hospital Charge Code |
908801084
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$3,627.75 |
| Rate for Payer: Adventist Health Commercial |
$967.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,574.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,323.02
|
| 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: Blue Shield of California Commercial |
$2,286.99
|
| Rate for Payer: Blue Shield of California EPN |
$1,300.54
|
| Rate for Payer: Cash Price |
$2,176.65
|
| Rate for Payer: Cash Price |
$2,176.65
|
| Rate for Payer: Cash Price |
$2,176.65
|
| Rate for Payer: Cash Price |
$2,176.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: Dignity Health Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$480.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Humana Medicare |
$480.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$347.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$480.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$912.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$875.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$566.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,209.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$605.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$605.43
|
| Rate for Payer: Multiplan Commercial |
$3,627.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$697.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$697.34
|
| 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 ANGIO HEAD WO CNTRAST
|
Facility
|
IP
|
$8,443.00
|
|
|
Service Code
|
CPT 70544
|
| Hospital Charge Code |
908801083
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$6,332.25 |
| Rate for Payer: Adventist Health Commercial |
$1,688.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,800.34
|
| Rate for Payer: Cash Price |
$3,799.35
|
| Rate for Payer: Cash Price |
$3,799.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,715.91
|
| Rate for Payer: Heritage Provider Network Senior |
$5,715.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,528.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,110.75
|
| Rate for Payer: Multiplan Commercial |
$6,332.25
|
|
|
HC MRI ANGIO HEAD WO CNTRAST
|
Facility
|
IP
|
$4,050.00
|
|
|
Service Code
|
CPT 70544
|
| Hospital Charge Code |
908801015
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$733.05 |
| Max. Negotiated Rate |
$3,037.50 |
| Rate for Payer: Adventist Health Commercial |
$810.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,782.35
|
| Rate for Payer: Cash Price |
$1,822.50
|
| Rate for Payer: Cash Price |
$1,822.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,741.85
|
| Rate for Payer: Heritage Provider Network Senior |
$2,741.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$733.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,012.50
|
| Rate for Payer: Multiplan Commercial |
$3,037.50
|
|
|
HC MRI ANGIO HEAD WO CNTRAST
|
Facility
|
OP
|
$4,319.00
|
|
|
Service Code
|
CPT 70544
|
| Hospital Charge Code |
908801015
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$306.16 |
| Max. Negotiated Rate |
$3,239.25 |
| Rate for Payer: Adventist Health Commercial |
$863.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,574.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,967.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Blue Shield of California Commercial |
$2,286.99
|
| Rate for Payer: Blue Shield of California EPN |
$1,300.54
|
| Rate for Payer: Cash Price |
$1,943.55
|
| Rate for Payer: Cash Price |
$1,943.55
|
| Rate for Payer: Cash Price |
$1,943.55
|
| Rate for Payer: Cash Price |
$1,943.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: Dignity Health Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Humana Medicare |
$306.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$329.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$581.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$781.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,079.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$385.76
|
| Rate for Payer: Multiplan Commercial |
$3,239.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$541.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$541.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC MRI ANGIO HEAD WO CNTRAST
|
Facility
|
OP
|
$4,319.00
|
|
|
Service Code
|
CPT 70544
|
| Hospital Charge Code |
908801083
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$306.16 |
| Max. Negotiated Rate |
$3,239.25 |
| Rate for Payer: Adventist Health Commercial |
$863.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,574.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,967.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Blue Shield of California Commercial |
$2,286.99
|
| Rate for Payer: Blue Shield of California EPN |
$1,300.54
|
| Rate for Payer: Cash Price |
$1,943.55
|
| Rate for Payer: Cash Price |
$1,943.55
|
| Rate for Payer: Cash Price |
$1,943.55
|
| Rate for Payer: Cash Price |
$1,943.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: Dignity Health Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Humana Medicare |
$306.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$329.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$581.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$781.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,079.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$385.76
|
| Rate for Payer: Multiplan Commercial |
$3,239.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$541.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$541.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC MRI ANGIO HEAD W WO CONTRAST
|
Facility
|
OP
|
$5,182.00
|
|
|
Service Code
|
CPT 70546
|
| Hospital Charge Code |
908801085
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$4,493.08 |
| Rate for Payer: Adventist Health Commercial |
$1,036.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,574.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,560.03
|
| 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: Blue Shield of California Commercial |
$4,493.08
|
| Rate for Payer: Blue Shield of California EPN |
$2,555.08
|
| Rate for Payer: Cash Price |
$2,331.90
|
| Rate for Payer: Cash Price |
$2,331.90
|
| Rate for Payer: Cash Price |
$2,331.90
|
| Rate for Payer: Cash Price |
$2,331.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: Dignity Health Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$480.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Humana Medicare |
$480.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$505.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$480.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$912.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$937.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$566.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,295.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$605.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$605.43
|
| Rate for Payer: Multiplan Commercial |
$3,886.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$854.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$854.45
|
| 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 ANGIO HEAD W WO CONTRAST
|
Facility
|
IP
|
$6,474.00
|
|
|
Service Code
|
CPT 70546
|
| Hospital Charge Code |
908801085
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$4,855.50 |
| Rate for Payer: Adventist Health Commercial |
$1,294.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,447.64
|
| Rate for Payer: Cash Price |
$2,913.30
|
| Rate for Payer: Cash Price |
$2,913.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,382.90
|
| Rate for Payer: Heritage Provider Network Senior |
$4,382.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,171.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,618.50
|
| Rate for Payer: Multiplan Commercial |
$4,855.50
|
|
|
HC MRI ANGIO NECK W CONTRAST
|
Facility
|
OP
|
$4,837.00
|
|
|
Service Code
|
CPT 70548
|
| Hospital Charge Code |
908801087
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$3,627.75 |
| Rate for Payer: Adventist Health Commercial |
$967.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,574.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,323.02
|
| 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: Blue Shield of California Commercial |
$2,286.99
|
| Rate for Payer: Blue Shield of California EPN |
$1,300.54
|
| Rate for Payer: Cash Price |
$2,176.65
|
| Rate for Payer: Cash Price |
$2,176.65
|
| Rate for Payer: Cash Price |
$2,176.65
|
| Rate for Payer: Cash Price |
$2,176.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: Dignity Health Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$480.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Humana Medicare |
$480.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$375.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$480.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$912.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$875.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$566.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,209.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$605.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$605.43
|
| Rate for Payer: Multiplan Commercial |
$3,627.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$697.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$697.34
|
| 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
|
|
