|
HC MRI ABDOMEN W/CONTRAST
|
Facility
|
IP
|
$4,279.00
|
|
|
Service Code
|
CPT 74182
|
| Hospital Charge Code |
908801301
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$774.50 |
| Max. Negotiated Rate |
$3,209.25 |
| Rate for Payer: Adventist Health Commercial |
$855.80
|
| Rate for Payer: Cash Price |
$2,353.45
|
| Rate for Payer: Cash Price |
$2,353.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,896.88
|
| Rate for Payer: Heritage Provider Network Senior |
$2,896.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$774.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,069.75
|
| Rate for Payer: Multiplan Commercial |
$3,209.25
|
|
|
HC MRI ABDOMEN W/CONTRAST
|
Facility
|
OP
|
$4,279.00
|
|
|
Service Code
|
CPT 74182
|
| Hospital Charge Code |
908801301
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$3,209.25 |
| Rate for Payer: Adventist Health Commercial |
$855.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,574.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,939.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Blue Shield of California Commercial |
$2,800.03
|
| Rate for Payer: Blue Shield of California EPN |
$2,251.69
|
| Rate for Payer: Cash Price |
$2,353.45
|
| Rate for Payer: Cash Price |
$2,353.45
|
| Rate for Payer: Cash Price |
$2,353.45
|
| Rate for Payer: Cash Price |
$2,353.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Senior |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$453.77
|
| 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 |
$484.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,041.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$774.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$521.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,069.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$571.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$571.75
|
| Rate for Payer: Multiplan Commercial |
$3,209.25
|
| 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 |
$697.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$697.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
HC MRI ABDOMEN W/O CONTRAST
|
Facility
|
OP
|
$3,864.00
|
|
|
Service Code
|
CPT 74181
|
| Hospital Charge Code |
908801300
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$2,898.00 |
| Rate for Payer: Adventist Health Commercial |
$772.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,574.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,654.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Blue Shield of California Commercial |
$2,335.44
|
| Rate for Payer: Blue Shield of California EPN |
$1,878.08
|
| Rate for Payer: Cash Price |
$2,125.20
|
| Rate for Payer: Cash Price |
$2,125.20
|
| Rate for Payer: Cash Price |
$2,125.20
|
| Rate for Payer: Cash Price |
$2,125.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Senior |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$307.13
|
| 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 |
$309.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,843.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$699.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$353.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$966.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$386.98
|
| Rate for Payer: Multiplan Commercial |
$2,898.00
|
| 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 |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC MRI ABDOMEN W/O CONTRAST
|
Facility
|
IP
|
$3,864.00
|
|
|
Service Code
|
CPT 74181
|
| Hospital Charge Code |
908801300
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$699.38 |
| Max. Negotiated Rate |
$2,898.00 |
| Rate for Payer: Adventist Health Commercial |
$772.80
|
| Rate for Payer: Cash Price |
$2,125.20
|
| Rate for Payer: Cash Price |
$2,125.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,615.93
|
| Rate for Payer: Heritage Provider Network Senior |
$2,615.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$699.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$966.00
|
| Rate for Payer: Multiplan Commercial |
$2,898.00
|
|
|
HC MRI ABDOMEN W WO CONTRAST
|
Facility
|
OP
|
$6,953.00
|
|
|
Service Code
|
CPT 74183
|
| Hospital Charge Code |
908801302
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$5,214.75 |
| Rate for Payer: Adventist Health Commercial |
$1,390.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,574.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,776.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Blue Shield of California Commercial |
$5,178.72
|
| Rate for Payer: Blue Shield of California EPN |
$4,164.55
|
| Rate for Payer: Cash Price |
$3,824.15
|
| Rate for Payer: Cash Price |
$3,824.15
|
| Rate for Payer: Cash Price |
$3,824.15
|
| Rate for Payer: Cash Price |
$3,824.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Senior |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$453.77
|
| 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 |
$540.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,316.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,258.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$521.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,738.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$571.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$571.75
|
| Rate for Payer: Multiplan Commercial |
$5,214.75
|
| 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 |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
HC MRI ABDOMEN W WO CONTRAST
|
Facility
|
IP
|
$6,953.00
|
|
|
Service Code
|
CPT 74183
|
| Hospital Charge Code |
908801302
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$5,214.75 |
| Rate for Payer: Adventist Health Commercial |
$1,390.60
|
| Rate for Payer: Cash Price |
$3,824.15
|
| Rate for Payer: Cash Price |
$3,824.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,707.18
|
| Rate for Payer: Heritage Provider Network Senior |
$4,707.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,258.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,738.25
|
| Rate for Payer: Multiplan Commercial |
$5,214.75
|
|
|
HC MRI ANGIO HEAD WITH CONTRAST
|
Facility
|
OP
|
$7,328.00
|
|
|
Service Code
|
CPT 70545
|
| Hospital Charge Code |
908801084
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$5,496.00 |
| Rate for Payer: Adventist Health Commercial |
$1,465.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,574.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,034.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Blue Shield of California Commercial |
$2,355.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,894.37
|
| Rate for Payer: Cash Price |
$4,030.40
|
| Rate for Payer: Cash Price |
$4,030.40
|
| Rate for Payer: Cash Price |
$4,030.40
|
| Rate for Payer: Cash Price |
$4,030.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Senior |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$453.77
|
| 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 |
$360.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,495.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,326.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$521.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,832.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$571.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$571.75
|
| Rate for Payer: Multiplan Commercial |
$5,496.00
|
| 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 |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
HC MRI ANGIO HEAD WITH CONTRAST
|
Facility
|
IP
|
$7,328.00
|
|
|
Service Code
|
CPT 70545
|
| Hospital Charge Code |
908801084
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$5,496.00 |
| Rate for Payer: Adventist Health Commercial |
$1,465.60
|
| Rate for Payer: Cash Price |
$4,030.40
|
| Rate for Payer: Cash Price |
$4,030.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,961.06
|
| Rate for Payer: Heritage Provider Network Senior |
$4,961.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,326.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,832.00
|
| Rate for Payer: Multiplan Commercial |
$5,496.00
|
|
|
HC MRI ANGIO HEAD WO CNTRAST
|
Facility
|
OP
|
$5,226.00
|
|
|
Service Code
|
CPT 70544
|
| Hospital Charge Code |
908801083
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$3,919.50 |
| Rate for Payer: Adventist Health Commercial |
$1,045.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,574.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,590.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Blue Shield of California Commercial |
$2,355.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,894.37
|
| Rate for Payer: Cash Price |
$2,874.30
|
| Rate for Payer: Cash Price |
$2,874.30
|
| Rate for Payer: Cash Price |
$2,874.30
|
| Rate for Payer: Cash Price |
$2,874.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Senior |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$307.13
|
| 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 |
$341.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,492.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$945.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$353.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,306.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$386.98
|
| Rate for Payer: Multiplan Commercial |
$3,919.50
|
| 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 |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC MRI ANGIO HEAD WO CNTRAST
|
Facility
|
IP
|
$5,357.00
|
|
|
Service Code
|
CPT 70544
|
| Hospital Charge Code |
908801015
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$4,017.75 |
| Rate for Payer: Adventist Health Commercial |
$1,071.40
|
| Rate for Payer: Cash Price |
$2,946.35
|
| Rate for Payer: Cash Price |
$2,946.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,626.69
|
| Rate for Payer: Heritage Provider Network Senior |
$3,626.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$969.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,339.25
|
| Rate for Payer: Multiplan Commercial |
$4,017.75
|
|
|
HC MRI ANGIO HEAD WO CNTRAST
|
Facility
|
IP
|
$5,226.00
|
|
|
Service Code
|
CPT 70544
|
| Hospital Charge Code |
908801083
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$3,919.50 |
| Rate for Payer: Adventist Health Commercial |
$1,045.20
|
| Rate for Payer: Cash Price |
$2,874.30
|
| Rate for Payer: Cash Price |
$2,874.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,538.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,538.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$945.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,306.50
|
| Rate for Payer: Multiplan Commercial |
$3,919.50
|
|
|
HC MRI ANGIO HEAD WO CNTRAST
|
Facility
|
OP
|
$5,357.00
|
|
|
Service Code
|
CPT 70544
|
| Hospital Charge Code |
908801015
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$4,017.75 |
| Rate for Payer: Adventist Health Commercial |
$1,071.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,574.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,680.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Blue Shield of California Commercial |
$2,355.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,894.37
|
| Rate for Payer: Cash Price |
$2,946.35
|
| Rate for Payer: Cash Price |
$2,946.35
|
| Rate for Payer: Cash Price |
$2,946.35
|
| Rate for Payer: Cash Price |
$2,946.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Senior |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$307.13
|
| 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 |
$341.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,555.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$969.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$353.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,339.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$386.98
|
| Rate for Payer: Multiplan Commercial |
$4,017.75
|
| 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 |
$541.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$541.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC MRI ANGIO HEAD W WO CONTRAST
|
Facility
|
OP
|
$8,562.00
|
|
|
Service Code
|
CPT 70546
|
| Hospital Charge Code |
908801085
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$6,421.50 |
| Rate for Payer: Adventist Health Commercial |
$1,712.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,574.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,882.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Blue Shield of California Commercial |
$4,628.06
|
| Rate for Payer: Blue Shield of California EPN |
$3,721.73
|
| Rate for Payer: Cash Price |
$4,709.10
|
| Rate for Payer: Cash Price |
$4,709.10
|
| Rate for Payer: Cash Price |
$4,709.10
|
| Rate for Payer: Cash Price |
$4,709.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Senior |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$453.77
|
| 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 |
$525.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,084.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,549.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$521.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,140.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$571.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$571.75
|
| Rate for Payer: Multiplan Commercial |
$6,421.50
|
| 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 |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
HC MRI ANGIO HEAD W WO CONTRAST
|
Facility
|
IP
|
$8,562.00
|
|
|
Service Code
|
CPT 70546
|
| Hospital Charge Code |
908801085
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$6,421.50 |
| Rate for Payer: Adventist Health Commercial |
$1,712.40
|
| Rate for Payer: Cash Price |
$4,709.10
|
| Rate for Payer: Cash Price |
$4,709.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,796.47
|
| Rate for Payer: Heritage Provider Network Senior |
$5,796.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,549.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,140.50
|
| Rate for Payer: Multiplan Commercial |
$6,421.50
|
|
|
HC MRI ANGIO NECK W CONTRAST
|
Facility
|
IP
|
$7,990.00
|
|
|
Service Code
|
CPT 70548
|
| Hospital Charge Code |
908801087
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$5,992.50 |
| Rate for Payer: Adventist Health Commercial |
$1,598.00
|
| Rate for Payer: Cash Price |
$4,394.50
|
| Rate for Payer: Cash Price |
$4,394.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,409.23
|
| Rate for Payer: Heritage Provider Network Senior |
$5,409.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,446.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,997.50
|
| Rate for Payer: Multiplan Commercial |
$5,992.50
|
|
|
HC MRI ANGIO NECK W CONTRAST
|
Facility
|
OP
|
$7,990.00
|
|
|
Service Code
|
CPT 70548
|
| Hospital Charge Code |
908801087
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$5,992.50 |
| Rate for Payer: Adventist Health Commercial |
$1,598.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,574.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,489.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Blue Shield of California Commercial |
$2,355.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,894.37
|
| Rate for Payer: Cash Price |
$4,394.50
|
| Rate for Payer: Cash Price |
$4,394.50
|
| Rate for Payer: Cash Price |
$4,394.50
|
| Rate for Payer: Cash Price |
$4,394.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Senior |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$453.77
|
| 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 |
$389.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,811.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,446.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$521.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,997.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$571.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$571.75
|
| Rate for Payer: Multiplan Commercial |
$5,992.50
|
| 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 |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
HC MRI ANGIO NECK WO CONTRAST
|
Facility
|
OP
|
$5,651.00
|
|
|
Service Code
|
CPT 70547
|
| Hospital Charge Code |
908801086
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$4,238.25 |
| Rate for Payer: Adventist Health Commercial |
$1,130.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,574.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,882.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Blue Shield of California Commercial |
$2,355.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,894.37
|
| Rate for Payer: Cash Price |
$3,108.05
|
| Rate for Payer: Cash Price |
$3,108.05
|
| Rate for Payer: Cash Price |
$3,108.05
|
| Rate for Payer: Cash Price |
$3,108.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Senior |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$307.13
|
| 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 |
$342.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,695.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,022.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$353.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,412.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$386.98
|
| Rate for Payer: Multiplan Commercial |
$4,238.25
|
| 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 |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC MRI ANGIO NECK WO CONTRAST
|
Facility
|
IP
|
$5,678.00
|
|
|
Service Code
|
CPT 70547
|
| Hospital Charge Code |
908801018
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$4,258.50 |
| Rate for Payer: Adventist Health Commercial |
$1,135.60
|
| Rate for Payer: Cash Price |
$3,122.90
|
| Rate for Payer: Cash Price |
$3,122.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,844.01
|
| Rate for Payer: Heritage Provider Network Senior |
$3,844.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,027.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,419.50
|
| Rate for Payer: Multiplan Commercial |
$4,258.50
|
|
|
HC MRI ANGIO NECK WO CONTRAST
|
Facility
|
IP
|
$5,651.00
|
|
|
Service Code
|
CPT 70547
|
| Hospital Charge Code |
908801086
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$4,238.25 |
| Rate for Payer: Adventist Health Commercial |
$1,130.20
|
| Rate for Payer: Cash Price |
$3,108.05
|
| Rate for Payer: Cash Price |
$3,108.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,825.73
|
| Rate for Payer: Heritage Provider Network Senior |
$3,825.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,022.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,412.75
|
| Rate for Payer: Multiplan Commercial |
$4,238.25
|
|
|
HC MRI ANGIO NECK WO CONTRAST
|
Facility
|
OP
|
$5,678.00
|
|
|
Service Code
|
CPT 70547
|
| Hospital Charge Code |
908801018
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$4,258.50 |
| Rate for Payer: Adventist Health Commercial |
$1,135.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,574.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,900.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Blue Shield of California Commercial |
$2,355.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,894.37
|
| Rate for Payer: Cash Price |
$3,122.90
|
| Rate for Payer: Cash Price |
$3,122.90
|
| Rate for Payer: Cash Price |
$3,122.90
|
| Rate for Payer: Cash Price |
$3,122.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Senior |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$307.13
|
| 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 |
$342.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,708.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,027.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$353.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,419.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$386.98
|
| Rate for Payer: Multiplan Commercial |
$4,258.50
|
| 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 |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC MRI ANGIO NECK W WO CONTRAST
|
Facility
|
OP
|
$8,426.00
|
|
|
Service Code
|
CPT 70549
|
| Hospital Charge Code |
908801088
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$6,319.50 |
| Rate for Payer: Adventist Health Commercial |
$1,685.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,574.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,788.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Blue Shield of California Commercial |
$4,628.06
|
| Rate for Payer: Blue Shield of California EPN |
$3,721.73
|
| Rate for Payer: Cash Price |
$4,634.30
|
| Rate for Payer: Cash Price |
$4,634.30
|
| Rate for Payer: Cash Price |
$4,634.30
|
| Rate for Payer: Cash Price |
$4,634.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Senior |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$453.77
|
| 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 |
$549.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,019.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,525.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$521.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,106.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$571.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$571.75
|
| Rate for Payer: Multiplan Commercial |
$6,319.50
|
| 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 |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
HC MRI ANGIO NECK W WO CONTRAST
|
Facility
|
IP
|
$8,426.00
|
|
|
Service Code
|
CPT 70549
|
| Hospital Charge Code |
908801088
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$6,319.50 |
| Rate for Payer: Adventist Health Commercial |
$1,685.20
|
| Rate for Payer: Cash Price |
$4,634.30
|
| Rate for Payer: Cash Price |
$4,634.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,704.40
|
| Rate for Payer: Heritage Provider Network Senior |
$5,704.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,525.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,106.50
|
| Rate for Payer: Multiplan Commercial |
$6,319.50
|
|
|
HC MRI BILATERAL TMJ
|
Facility
|
IP
|
$5,787.00
|
|
|
Service Code
|
CPT 70336
|
| Hospital Charge Code |
908801055
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$4,340.25 |
| Rate for Payer: Adventist Health Commercial |
$1,157.40
|
| Rate for Payer: Cash Price |
$3,182.85
|
| Rate for Payer: Cash Price |
$3,182.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,917.80
|
| Rate for Payer: Heritage Provider Network Senior |
$3,917.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,047.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,446.75
|
| Rate for Payer: Multiplan Commercial |
$4,340.25
|
|
|
HC MRI BILATERAL TMJ
|
Facility
|
OP
|
$5,787.00
|
|
|
Service Code
|
CPT 70336
|
| Hospital Charge Code |
908801055
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$4,340.25 |
| Rate for Payer: Adventist Health Commercial |
$1,157.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,574.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,975.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Blue Shield of California Commercial |
$2,355.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,894.37
|
| Rate for Payer: Cash Price |
$3,182.85
|
| Rate for Payer: Cash Price |
$3,182.85
|
| Rate for Payer: Cash Price |
$3,182.85
|
| Rate for Payer: Cash Price |
$3,182.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Senior |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$307.13
|
| 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) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,760.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,047.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$353.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,446.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$386.98
|
| Rate for Payer: Multiplan Commercial |
$4,340.25
|
| 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 |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC MRI BN MARROW(2 SEQ)
|
Facility
|
IP
|
$3,775.00
|
|
|
Service Code
|
CPT 77084
|
| Hospital Charge Code |
908801140
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$683.27 |
| Max. Negotiated Rate |
$2,831.25 |
| Rate for Payer: Adventist Health Commercial |
$755.00
|
| Rate for Payer: Cash Price |
$2,076.25
|
| Rate for Payer: Cash Price |
$2,076.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,555.68
|
| Rate for Payer: Heritage Provider Network Senior |
$2,555.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$683.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$943.75
|
| Rate for Payer: Multiplan Commercial |
$2,831.25
|
|
