|
HC MRI LUMBAR SPINE W CONTRAST
|
Facility
|
IP
|
$6,179.00
|
|
|
Service Code
|
CPT 72149
|
| Hospital Charge Code |
908801122
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$4,634.25 |
| Rate for Payer: Adventist Health Commercial |
$1,235.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,244.97
|
| Rate for Payer: Cash Price |
$2,780.55
|
| Rate for Payer: Cash Price |
$2,780.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,183.18
|
| Rate for Payer: Heritage Provider Network Senior |
$4,183.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,118.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,544.75
|
| Rate for Payer: Multiplan Commercial |
$4,634.25
|
|
|
HC MRI PELVIS W/CONTRAST
|
Facility
|
OP
|
$4,256.00
|
|
|
Service Code
|
CPT 72196
|
| Hospital Charge Code |
908801350
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$3,192.00 |
| Rate for Payer: Adventist Health Commercial |
$851.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,574.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,923.87
|
| 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 |
$1,915.20
|
| Rate for Payer: Cash Price |
$1,915.20
|
| Rate for Payer: Cash Price |
$1,915.20
|
| Rate for Payer: Cash Price |
$1,915.20
|
| 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 |
$413.45
|
| 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 |
$770.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$566.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,064.00
|
| 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 |
$3,192.00
|
| 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 |
$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 PELVIS W/CONTRAST
|
Facility
|
IP
|
$4,588.00
|
|
|
Service Code
|
CPT 72196
|
| Hospital Charge Code |
908801350
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$830.43 |
| Max. Negotiated Rate |
$3,441.00 |
| Rate for Payer: Adventist Health Commercial |
$917.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,151.96
|
| Rate for Payer: Cash Price |
$2,064.60
|
| Rate for Payer: Cash Price |
$2,064.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,106.08
|
| Rate for Payer: Heritage Provider Network Senior |
$3,106.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$830.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,147.00
|
| Rate for Payer: Multiplan Commercial |
$3,441.00
|
|
|
HC MRI PELVIS W/O CONTRAST
|
Facility
|
OP
|
$3,874.00
|
|
|
Service Code
|
CPT 72195
|
| Hospital Charge Code |
908801351
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$306.16 |
| 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 |
$353.09
|
| 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 PELVIS W/O CONTRAST
|
Facility
|
IP
|
$4,588.00
|
|
|
Service Code
|
CPT 72195
|
| Hospital Charge Code |
908801351
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$830.43 |
| Max. Negotiated Rate |
$3,441.00 |
| Rate for Payer: Adventist Health Commercial |
$917.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,151.96
|
| Rate for Payer: Cash Price |
$2,064.60
|
| Rate for Payer: Cash Price |
$2,064.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,106.08
|
| Rate for Payer: Heritage Provider Network Senior |
$3,106.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$830.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,147.00
|
| Rate for Payer: Multiplan Commercial |
$3,441.00
|
|
|
HC MRI PELVIS W & WO CONTRAST
|
Facility
|
IP
|
$6,944.00
|
|
|
Service Code
|
CPT 72197
|
| Hospital Charge Code |
908801352
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$5,208.00 |
| Rate for Payer: Adventist Health Commercial |
$1,388.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,770.53
|
| Rate for Payer: Cash Price |
$3,124.80
|
| Rate for Payer: Cash Price |
$3,124.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,701.09
|
| Rate for Payer: Heritage Provider Network Senior |
$4,701.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,256.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,736.00
|
| Rate for Payer: Multiplan Commercial |
$5,208.00
|
|
|
HC MRI PELVIS W & WO CONTRAST
|
Facility
|
OP
|
$4,885.00
|
|
|
Service Code
|
CPT 72197
|
| Hospital Charge Code |
908801352
|
|
Hospital Revenue Code
|
612
|
| 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 |
$519.34
|
| 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 PROCEDURE
|
Facility
|
OP
|
$2,615.00
|
|
|
Service Code
|
CPT 76498
|
| Hospital Charge Code |
908801008
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$113.54 |
| Max. Negotiated Rate |
$1,961.25 |
| Rate for Payer: Adventist Health Commercial |
$523.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$814.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,796.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Blue Shield of California Commercial |
$1,623.92
|
| Rate for Payer: Blue Shield of California EPN |
$1,535.00
|
| Rate for Payer: Cash Price |
$1,176.75
|
| Rate for Payer: Cash Price |
$1,176.75
|
| Rate for Payer: Cash Price |
$1,176.75
|
| Rate for Payer: Cash Price |
$1,176.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: Dignity Health Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$113.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Humana Medicare |
$113.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$215.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$473.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$653.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$143.06
|
| Rate for Payer: Multiplan Commercial |
$1,961.25
|
| 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 |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC MRI PROCEDURE
|
Facility
|
IP
|
$3,310.00
|
|
|
Service Code
|
CPT 76498
|
| Hospital Charge Code |
908801008
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$599.11 |
| Max. Negotiated Rate |
$2,482.50 |
| Rate for Payer: Adventist Health Commercial |
$662.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,273.97
|
| Rate for Payer: Cash Price |
$1,489.50
|
| Rate for Payer: Cash Price |
$1,489.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,240.87
|
| Rate for Payer: Heritage Provider Network Senior |
$2,240.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$599.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$827.50
|
| Rate for Payer: Multiplan Commercial |
$2,482.50
|
|
|
HC MRI SPECTROSCOPY
|
Facility
|
OP
|
$3,452.00
|
|
|
Service Code
|
CPT 76390
|
| Hospital Charge Code |
908801255
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$113.54 |
| Max. Negotiated Rate |
$2,589.00 |
| Rate for Payer: Adventist Health Commercial |
$690.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$814.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,371.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Blue Shield of California Commercial |
$2,241.88
|
| Rate for Payer: Blue Shield of California EPN |
$1,274.89
|
| Rate for Payer: Cash Price |
$1,553.40
|
| Rate for Payer: Cash Price |
$1,553.40
|
| Rate for Payer: Cash Price |
$1,553.40
|
| Rate for Payer: Cash Price |
$1,553.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: Dignity Health Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$113.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Humana Medicare |
$113.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$215.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$624.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$863.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$143.06
|
| Rate for Payer: Multiplan Commercial |
$2,589.00
|
| 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 |
$666.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$666.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC MRI SPECTROSCOPY
|
Facility
|
IP
|
$4,302.00
|
|
|
Service Code
|
CPT 76390
|
| Hospital Charge Code |
908801255
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$778.66 |
| Max. Negotiated Rate |
$3,226.50 |
| Rate for Payer: Adventist Health Commercial |
$860.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,955.47
|
| Rate for Payer: Cash Price |
$1,935.90
|
| Rate for Payer: Cash Price |
$1,935.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,912.45
|
| Rate for Payer: Heritage Provider Network Senior |
$2,912.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$778.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,075.50
|
| Rate for Payer: Multiplan Commercial |
$3,226.50
|
|
|
HC MRI T-SPINE W & WO CONTRAST
|
Facility
|
OP
|
$4,480.00
|
|
|
Service Code
|
CPT 72157
|
| Hospital Charge Code |
908801114
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$5,082.43 |
| Rate for Payer: Adventist Health Commercial |
$896.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$814.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,077.76
|
| 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 |
$5,082.43
|
| Rate for Payer: Blue Shield of California EPN |
$2,890.22
|
| Rate for Payer: Cash Price |
$2,016.00
|
| Rate for Payer: Cash Price |
$2,016.00
|
| Rate for Payer: Cash Price |
$2,016.00
|
| Rate for Payer: Cash Price |
$2,016.00
|
| 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 |
$489.18
|
| 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 |
$810.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$566.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,120.00
|
| 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 |
$3,360.00
|
| 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 |
$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 T-SPINE W & WO CONTRAST
|
Facility
|
IP
|
$7,514.00
|
|
|
Service Code
|
CPT 72157
|
| Hospital Charge Code |
908801114
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$5,635.50 |
| Rate for Payer: Adventist Health Commercial |
$1,502.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,162.12
|
| Rate for Payer: Cash Price |
$3,381.30
|
| Rate for Payer: Cash Price |
$3,381.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,086.98
|
| Rate for Payer: Heritage Provider Network Senior |
$5,086.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,360.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,878.50
|
| Rate for Payer: Multiplan Commercial |
$5,635.50
|
|
|
HC MRI UPPER EXTREM W/O CONT
|
Facility
|
IP
|
$4,309.00
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
908801413
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$779.93 |
| Max. Negotiated Rate |
$3,231.75 |
| Rate for Payer: Adventist Health Commercial |
$861.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,960.28
|
| Rate for Payer: Cash Price |
$1,939.05
|
| Rate for Payer: Cash Price |
$1,939.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,917.19
|
| Rate for Payer: Heritage Provider Network Senior |
$2,917.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$779.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,077.25
|
| Rate for Payer: Multiplan Commercial |
$3,231.75
|
|
|
HC MRI UPPER EXTREM W/O CONT
|
Facility
|
OP
|
$3,184.00
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
908801413
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$306.16 |
| Max. Negotiated Rate |
$2,388.00 |
| Rate for Payer: Adventist Health Commercial |
$636.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,574.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,187.41
|
| 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 |
$2,258.89
|
| Rate for Payer: Blue Shield of California EPN |
$1,284.56
|
| Rate for Payer: Cash Price |
$1,432.80
|
| Rate for Payer: Cash Price |
$1,432.80
|
| Rate for Payer: Cash Price |
$1,432.80
|
| Rate for Payer: Cash Price |
$1,432.80
|
| 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 |
$473.04
|
| 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 |
$576.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$796.00
|
| 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 |
$2,388.00
|
| 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 |
$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 UPPER EXTREM W & WO CONT
|
Facility
|
IP
|
$5,854.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
908801411
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$4,390.50 |
| Rate for Payer: Adventist Health Commercial |
$1,170.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,021.70
|
| Rate for Payer: Cash Price |
$2,634.30
|
| Rate for Payer: Cash Price |
$2,634.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,963.16
|
| Rate for Payer: Heritage Provider Network Senior |
$3,963.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,059.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,463.50
|
| Rate for Payer: Multiplan Commercial |
$4,390.50
|
|
|
HC MRI UPPER EXTREM W & WO CONT
|
Facility
|
OP
|
$3,746.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
908801411
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$5,016.44 |
| Rate for Payer: Adventist Health Commercial |
$749.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,574.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,573.50
|
| 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 |
$5,016.44
|
| Rate for Payer: Blue Shield of California EPN |
$2,852.70
|
| Rate for Payer: Cash Price |
$1,685.70
|
| Rate for Payer: Cash Price |
$1,685.70
|
| Rate for Payer: Cash Price |
$1,685.70
|
| Rate for Payer: Cash Price |
$1,685.70
|
| 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 |
$609.15
|
| 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 |
$678.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$566.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.50
|
| 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 |
$2,809.50
|
| 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 MRSA DNA
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
CPT 87641
|
| Hospital Charge Code |
900912328
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$287.39 |
| Rate for Payer: Adventist Health Commercial |
$20.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$102.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$70.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$287.39
|
| Rate for Payer: Blue Shield of California Commercial |
$274.13
|
| Rate for Payer: Blue Shield of California EPN |
$214.30
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$66.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$63.76
|
| Rate for Payer: Heritage Provider Network Senior |
$63.76
|
| Rate for Payer: Humana Medicare |
$35.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$48.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$66.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.21
|
| Rate for Payer: Multiplan Commercial |
$77.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$35.09
|
| Rate for Payer: TriValley Medical Group Senior |
$35.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC MRSA DNA
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
CPT 87641
|
| Hospital Charge Code |
900912328
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.21 |
| Max. Negotiated Rate |
$141.75 |
| Rate for Payer: Adventist Health Commercial |
$37.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$129.84
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$127.95
|
| Rate for Payer: Heritage Provider Network Senior |
$127.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.25
|
| Rate for Payer: Multiplan Commercial |
$141.75
|
|
|
HC MSI
|
Facility
|
OP
|
$392.00
|
|
|
Service Code
|
CPT 81301
|
| Hospital Charge Code |
903800318
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$70.95 |
| Max. Negotiated Rate |
$1,383.76 |
| Rate for Payer: Adventist Health Commercial |
$78.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$331.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$269.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$522.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$383.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$348.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,383.76
|
| Rate for Payer: Blue Shield of California Commercial |
$243.43
|
| Rate for Payer: Blue Shield of California EPN |
$230.10
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$254.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$522.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$383.42
|
| Rate for Payer: Dignity Health Senior |
$348.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$254.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$348.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$242.65
|
| Rate for Payer: Heritage Provider Network Senior |
$242.65
|
| Rate for Payer: Humana Medicare |
$348.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$400.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$348.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$662.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$411.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$439.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$439.19
|
| Rate for Payer: Multiplan Commercial |
$294.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$348.56
|
| Rate for Payer: TriValley Medical Group Senior |
$348.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$376.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$376.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$522.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$383.42
|
| Rate for Payer: Vantage Medical Group Senior |
$348.56
|
|
|
HC MSI
|
Facility
|
IP
|
$540.00
|
|
|
Service Code
|
CPT 81301
|
| Hospital Charge Code |
903800318
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$97.74 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Adventist Health Commercial |
$108.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$370.98
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$365.58
|
| Rate for Payer: Heritage Provider Network Senior |
$365.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.00
|
| Rate for Payer: Multiplan Commercial |
$405.00
|
|
|
HC MULTIHANCE PER ML
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
CPT A9577
|
| Hospital Charge Code |
900009577
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.37
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.19
|
| Rate for Payer: Heritage Provider Network Senior |
$12.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
|
|
HC MULTIHANCE PER ML
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
CPT A9577
|
| Hospital Charge Code |
900009577
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$2.87 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.69
|
| Rate for Payer: Blue Shield of California Commercial |
$11.18
|
| Rate for Payer: Blue Shield of California EPN |
$10.57
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.30
|
| Rate for Payer: Dignity Health Senior |
$15.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.14
|
| Rate for Payer: Heritage Provider Network Senior |
$11.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.20
|
| Rate for Payer: TriValley Medical Group Senior |
$7.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.30
|
| Rate for Payer: Vantage Medical Group Senior |
$15.30
|
|
|
HC MULTI-PLANAR RECON
|
Facility
|
OP
|
$758.00
|
|
|
Service Code
|
CPT 76376
|
| Hospital Charge Code |
909201350
|
|
Hospital Revenue Code
|
359
|
| Min. Negotiated Rate |
$137.20 |
| Max. Negotiated Rate |
$1,024.00 |
| Rate for Payer: Adventist Health Commercial |
$151.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$520.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$644.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$416.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$568.50
|
| Rate for Payer: Blue Shield of California Commercial |
$470.72
|
| Rate for Payer: Blue Shield of California EPN |
$444.95
|
| Rate for Payer: Cash Price |
$341.10
|
| Rate for Payer: Cash Price |
$341.10
|
| Rate for Payer: Cash Price |
$341.10
|
| Rate for Payer: Cash Price |
$341.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$644.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$644.30
|
| Rate for Payer: Dignity Health Senior |
$644.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$365.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.50
|
| Rate for Payer: Multiplan Commercial |
$568.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Senior |
$225.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$644.30
|
| Rate for Payer: Vantage Medical Group Senior |
$644.30
|
|
|
HC MULTI-PLANAR RECON
|
Facility
|
IP
|
$758.00
|
|
|
Service Code
|
CPT 76376
|
| Hospital Charge Code |
909201350
|
|
Hospital Revenue Code
|
359
|
| Min. Negotiated Rate |
$137.20 |
| Max. Negotiated Rate |
$711.00 |
| Rate for Payer: Adventist Health Commercial |
$151.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$520.75
|
| Rate for Payer: Cash Price |
$341.10
|
| Rate for Payer: Cash Price |
$341.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$513.17
|
| Rate for Payer: Heritage Provider Network Senior |
$513.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.50
|
| Rate for Payer: Multiplan Commercial |
$568.50
|
|
