|
HC MRI BN MARROW(2 SEQ)
|
Facility
|
OP
|
$3,706.00
|
|
|
Service Code
|
CPT 77084
|
| Hospital Charge Code |
908801140
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$2,779.50 |
| Rate for Payer: Adventist Health Commercial |
$741.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,980.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,546.02
|
| 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 |
$2,777.86
|
| Rate for Payer: Blue Shield of California EPN |
$2,233.86
|
| Rate for Payer: Cash Price |
$1,667.70
|
| Rate for Payer: Cash Price |
$1,667.70
|
| Rate for Payer: Cash Price |
$1,667.70
|
| Rate for Payer: Cash Price |
$1,667.70
|
| 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 |
$1,767.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$670.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$353.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$926.50
|
| 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 |
$2,779.50
|
| 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 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 |
$1,698.75
|
| Rate for Payer: Cash Price |
$1,698.75
|
| 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
|
|
|
HC MRI BRAIN ASSESS W CONTRAST
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
CPT 70558
|
| Hospital Charge Code |
908870558
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$736.67 |
| Max. Negotiated Rate |
$3,052.50 |
| Rate for Payer: Adventist Health Commercial |
$814.00
|
| Rate for Payer: Cash Price |
$1,831.50
|
| Rate for Payer: Cash Price |
$1,831.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,755.39
|
| Rate for Payer: Heritage Provider Network Senior |
$2,755.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$736.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,017.50
|
| Rate for Payer: Multiplan Commercial |
$3,052.50
|
|
|
HC MRI BRAIN ASSESS W CONTRAST
|
Facility
|
OP
|
$4,070.00
|
|
|
Service Code
|
CPT 70558
|
| Hospital Charge Code |
908870558
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$3,488.35 |
| Rate for Payer: Adventist Health Commercial |
$814.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,175.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,796.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Blue Shield of California Commercial |
$3,488.35
|
| Rate for Payer: Blue Shield of California EPN |
$2,805.22
|
| Rate for Payer: Cash Price |
$1,831.50
|
| Rate for Payer: Cash Price |
$1,831.50
|
| Rate for Payer: Cash Price |
$1,831.50
|
| Rate for Payer: Cash Price |
$1,831.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Senior |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$226.19
|
| 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 |
$287.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,941.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$736.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$260.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,017.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$285.00
|
| Rate for Payer: Multiplan Commercial |
$3,052.50
|
| 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 |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC MRI BRAIN ASSESS WO CONTRAST
|
Facility
|
OP
|
$3,521.00
|
|
|
Service Code
|
CPT 70557
|
| Hospital Charge Code |
908870557
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$278.24 |
| Max. Negotiated Rate |
$3,154.18 |
| Rate for Payer: Adventist Health Commercial |
$704.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,881.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,418.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$766.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$696.67
|
| Rate for Payer: Blue Shield of California Commercial |
$3,154.18
|
| Rate for Payer: Blue Shield of California EPN |
$2,536.48
|
| Rate for Payer: Cash Price |
$1,584.45
|
| Rate for Payer: Cash Price |
$1,584.45
|
| Rate for Payer: Cash Price |
$1,584.45
|
| Rate for Payer: Cash Price |
$1,584.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$766.34
|
| Rate for Payer: Dignity Health Senior |
$696.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$696.67
|
| 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 |
$278.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$696.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,679.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$637.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$801.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$880.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$877.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$877.80
|
| Rate for Payer: Multiplan Commercial |
$2,640.75
|
| 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 |
$1,045.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$766.34
|
| Rate for Payer: Vantage Medical Group Senior |
$696.67
|
|
|
HC MRI BRAIN ASSESS WO CONTRAST
|
Facility
|
IP
|
$3,521.00
|
|
|
Service Code
|
CPT 70557
|
| Hospital Charge Code |
908870557
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$637.30 |
| Max. Negotiated Rate |
$2,640.75 |
| Rate for Payer: Adventist Health Commercial |
$704.20
|
| Rate for Payer: Cash Price |
$1,584.45
|
| Rate for Payer: Cash Price |
$1,584.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,383.72
|
| Rate for Payer: Heritage Provider Network Senior |
$2,383.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$637.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$880.25
|
| Rate for Payer: Multiplan Commercial |
$2,640.75
|
|
|
HC MRI BRAIN ASSESS WO W CONTRAST
|
Facility
|
OP
|
$4,070.00
|
|
|
Service Code
|
CPT 70559
|
| Hospital Charge Code |
908870559
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$3,504.53 |
| Rate for Payer: Adventist Health Commercial |
$814.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,175.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,796.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Blue Shield of California Commercial |
$3,504.53
|
| Rate for Payer: Blue Shield of California EPN |
$2,818.22
|
| Rate for Payer: Cash Price |
$1,831.50
|
| Rate for Payer: Cash Price |
$1,831.50
|
| Rate for Payer: Cash Price |
$1,831.50
|
| Rate for Payer: Cash Price |
$1,831.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Senior |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$226.19
|
| 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 |
$270.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,941.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$736.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$260.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,017.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$285.00
|
| Rate for Payer: Multiplan Commercial |
$3,052.50
|
| 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 |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC MRI BRAIN ASSESS WO W CONTRAST
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
CPT 70559
|
| Hospital Charge Code |
908870559
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$736.67 |
| Max. Negotiated Rate |
$3,052.50 |
| Rate for Payer: Adventist Health Commercial |
$814.00
|
| Rate for Payer: Cash Price |
$1,831.50
|
| Rate for Payer: Cash Price |
$1,831.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,755.39
|
| Rate for Payer: Heritage Provider Network Senior |
$2,755.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$736.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,017.50
|
| Rate for Payer: Multiplan Commercial |
$3,052.50
|
|
|
HC MRI BRAIN WITH CONTRAST
|
Facility
|
OP
|
$5,421.00
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
908801013
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$4,065.75 |
| Rate for Payer: Adventist Health Commercial |
$1,084.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,897.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,724.23
|
| 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 |
$2,826.05
|
| Rate for Payer: Blue Shield of California EPN |
$2,272.61
|
| Rate for Payer: Cash Price |
$2,439.45
|
| Rate for Payer: Cash Price |
$2,439.45
|
| Rate for Payer: Cash Price |
$2,439.45
|
| Rate for Payer: Cash Price |
$2,439.45
|
| 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 |
$428.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,585.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$981.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$521.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,355.25
|
| 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 |
$4,065.75
|
| 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 |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
HC MRI BRAIN WITH CONTRAST
|
Facility
|
IP
|
$11,689.00
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
908801013
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$8,766.75 |
| Rate for Payer: Adventist Health Commercial |
$2,337.80
|
| Rate for Payer: Cash Price |
$5,260.05
|
| Rate for Payer: Cash Price |
$5,260.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,913.45
|
| Rate for Payer: Heritage Provider Network Senior |
$7,913.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,115.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,922.25
|
| Rate for Payer: Multiplan Commercial |
$8,766.75
|
|
|
HC MRI BRAIN WITH CONTRAST
|
Facility
|
OP
|
$5,421.00
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
908801012
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$4,065.75 |
| Rate for Payer: Adventist Health Commercial |
$1,084.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,897.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,724.23
|
| 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 |
$2,826.05
|
| Rate for Payer: Blue Shield of California EPN |
$2,272.61
|
| Rate for Payer: Cash Price |
$2,439.45
|
| Rate for Payer: Cash Price |
$2,439.45
|
| Rate for Payer: Cash Price |
$2,439.45
|
| Rate for Payer: Cash Price |
$2,439.45
|
| 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 |
$428.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,585.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$981.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$521.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,355.25
|
| 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 |
$4,065.75
|
| 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 |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
HC MRI BRAIN WITH CONTRAST
|
Facility
|
IP
|
$7,420.00
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
908801012
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$5,565.00 |
| Rate for Payer: Adventist Health Commercial |
$1,484.00
|
| Rate for Payer: Cash Price |
$3,339.00
|
| Rate for Payer: Cash Price |
$3,339.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,023.34
|
| Rate for Payer: Heritage Provider Network Senior |
$5,023.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,343.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,855.00
|
| Rate for Payer: Multiplan Commercial |
$5,565.00
|
|
|
HC MRI BREAST BILAT W/CONTRAST
|
Facility
|
IP
|
$5,644.00
|
|
|
Service Code
|
CPT 77059
|
| Hospital Charge Code |
908801211
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$4,233.00 |
| Rate for Payer: Adventist Health Commercial |
$1,128.80
|
| Rate for Payer: Cash Price |
$2,539.80
|
| Rate for Payer: Cash Price |
$2,539.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,820.99
|
| Rate for Payer: Heritage Provider Network Senior |
$3,820.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,021.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,411.00
|
| Rate for Payer: Multiplan Commercial |
$4,233.00
|
|
|
HC MRI BREAST BILAT W/CONTRAST
|
Facility
|
OP
|
$5,310.00
|
|
|
Service Code
|
CPT 77059
|
| Hospital Charge Code |
908801211
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$4,513.50 |
| Rate for Payer: Adventist Health Commercial |
$1,062.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,574.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,647.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,513.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,920.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.50
|
| Rate for Payer: Blue Shield of California Commercial |
$3,239.10
|
| Rate for Payer: Blue Shield of California EPN |
$2,591.28
|
| Rate for Payer: Cash Price |
$2,389.50
|
| Rate for Payer: Cash Price |
$2,389.50
|
| Rate for Payer: Cash Price |
$2,389.50
|
| Rate for Payer: Cash Price |
$2,389.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,513.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,513.50
|
| Rate for Payer: Dignity Health Senior |
$4,513.50
|
| 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: Kaiser Permanente of CA Commercial |
$2,532.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$961.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,327.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,717.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,717.00
|
| Rate for Payer: Multiplan Commercial |
$3,982.50
|
| 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 |
$2,655.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,655.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,513.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,513.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,513.50
|
|
|
HC MRI BREAST BILAT WO CONTRAST
|
Facility
|
IP
|
$4,232.00
|
|
|
Service Code
|
CPT 77047
|
| Hospital Charge Code |
908801212
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$765.99 |
| Max. Negotiated Rate |
$3,174.00 |
| Rate for Payer: Adventist Health Commercial |
$846.40
|
| Rate for Payer: Cash Price |
$1,904.40
|
| Rate for Payer: Cash Price |
$1,904.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,865.06
|
| Rate for Payer: Heritage Provider Network Senior |
$2,865.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$765.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,058.00
|
| Rate for Payer: Multiplan Commercial |
$3,174.00
|
|
|
HC MRI BREAST BILAT WO CONTRAST
|
Facility
|
OP
|
$4,853.00
|
|
|
Service Code
|
CPT 77047
|
| Hospital Charge Code |
908801212
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$3,639.75 |
| Rate for Payer: Adventist Health Commercial |
$970.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,593.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,334.01
|
| 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 |
$995.23
|
| Rate for Payer: Blue Shield of California EPN |
$800.33
|
| Rate for Payer: Cash Price |
$2,183.85
|
| Rate for Payer: Cash Price |
$2,183.85
|
| Rate for Payer: Cash Price |
$2,183.85
|
| Rate for Payer: Cash Price |
$2,183.85
|
| 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) Medi-Cal |
$346.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,314.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$878.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$353.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,213.25
|
| 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 |
$3,639.75
|
| 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 |
$368.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$368.90
|
| 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 BREAST UNI W/CONTRAST
|
Facility
|
IP
|
$5,644.00
|
|
|
Service Code
|
CPT 77058
|
| Hospital Charge Code |
908801217
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$4,233.00 |
| Rate for Payer: Adventist Health Commercial |
$1,128.80
|
| Rate for Payer: Cash Price |
$2,539.80
|
| Rate for Payer: Cash Price |
$2,539.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,820.99
|
| Rate for Payer: Heritage Provider Network Senior |
$3,820.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,021.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,411.00
|
| Rate for Payer: Multiplan Commercial |
$4,233.00
|
|
|
HC MRI BREAST UNI W/CONTRAST
|
Facility
|
OP
|
$4,998.00
|
|
|
Service Code
|
CPT 77058
|
| Hospital Charge Code |
908801217
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$4,248.30 |
| Rate for Payer: Adventist Health Commercial |
$999.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,574.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,433.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,248.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,748.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,748.50
|
| Rate for Payer: Blue Shield of California Commercial |
$3,048.78
|
| Rate for Payer: Blue Shield of California EPN |
$2,439.02
|
| Rate for Payer: Cash Price |
$2,249.10
|
| Rate for Payer: Cash Price |
$2,249.10
|
| Rate for Payer: Cash Price |
$2,249.10
|
| Rate for Payer: Cash Price |
$2,249.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,248.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,248.30
|
| Rate for Payer: Dignity Health Senior |
$4,248.30
|
| 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: Kaiser Permanente of CA Commercial |
$2,384.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$904.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,249.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,498.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,498.60
|
| Rate for Payer: Multiplan Commercial |
$3,748.50
|
| 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 |
$2,499.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,499.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,248.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,248.30
|
| Rate for Payer: Vantage Medical Group Senior |
$4,248.30
|
|
|
HC MRI BREAST UNI WO CONTRAST
|
Facility
|
IP
|
$4,404.00
|
|
|
Service Code
|
CPT 77046
|
| Hospital Charge Code |
908801219
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$797.12 |
| Max. Negotiated Rate |
$3,303.00 |
| Rate for Payer: Adventist Health Commercial |
$880.80
|
| Rate for Payer: Cash Price |
$1,981.80
|
| Rate for Payer: Cash Price |
$1,981.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,981.51
|
| Rate for Payer: Heritage Provider Network Senior |
$2,981.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$797.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,101.00
|
| Rate for Payer: Multiplan Commercial |
$3,303.00
|
|
|
HC MRI BREAST UNI WO CONTRAST
|
Facility
|
OP
|
$4,310.00
|
|
|
Service Code
|
CPT 77046
|
| Hospital Charge Code |
908801219
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$3,232.50 |
| Rate for Payer: Adventist Health Commercial |
$862.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,303.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,960.97
|
| 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 |
$1,001.28
|
| Rate for Payer: Blue Shield of California EPN |
$805.20
|
| Rate for Payer: Cash Price |
$1,939.50
|
| Rate for Payer: Cash Price |
$1,939.50
|
| Rate for Payer: Cash Price |
$1,939.50
|
| Rate for Payer: Cash Price |
$1,939.50
|
| 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 |
$338.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,055.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$780.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$353.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,077.50
|
| 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 |
$3,232.50
|
| 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 |
$368.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$368.90
|
| 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 BRST BI W WO CNTRST W CAD
|
Facility
|
OP
|
$5,911.00
|
|
|
Service Code
|
CPT 77049
|
| Hospital Charge Code |
908801210
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$5,024.35 |
| Rate for Payer: Adventist Health Commercial |
$1,182.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,159.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,060.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,024.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,251.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,433.25
|
| Rate for Payer: Blue Shield of California Commercial |
$1,641.02
|
| Rate for Payer: Blue Shield of California EPN |
$1,319.66
|
| Rate for Payer: Cash Price |
$2,659.95
|
| Rate for Payer: Cash Price |
$2,659.95
|
| Rate for Payer: Cash Price |
$2,659.95
|
| Rate for Payer: Cash Price |
$2,659.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,024.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,024.35
|
| Rate for Payer: Dignity Health Senior |
$5,024.35
|
| 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 |
$547.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,819.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,069.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,477.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,137.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,137.70
|
| Rate for Payer: Multiplan Commercial |
$4,433.25
|
| 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 |
$468.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$468.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,024.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,024.35
|
| Rate for Payer: Vantage Medical Group Senior |
$5,024.35
|
|
|
HC MRI BRST BI W WO CNTRST W CAD
|
Facility
|
IP
|
$4,232.00
|
|
|
Service Code
|
CPT 77049
|
| Hospital Charge Code |
908801210
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$765.99 |
| Max. Negotiated Rate |
$3,174.00 |
| Rate for Payer: Adventist Health Commercial |
$846.40
|
| Rate for Payer: Cash Price |
$1,904.40
|
| Rate for Payer: Cash Price |
$1,904.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,865.06
|
| Rate for Payer: Heritage Provider Network Senior |
$2,865.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$765.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,058.00
|
| Rate for Payer: Multiplan Commercial |
$3,174.00
|
|
|
HC MRI BRST UNI W WO CTRST W CAD
|
Facility
|
IP
|
$4,404.00
|
|
|
Service Code
|
CPT 77048
|
| Hospital Charge Code |
908801215
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$797.12 |
| Max. Negotiated Rate |
$3,303.00 |
| Rate for Payer: Adventist Health Commercial |
$880.80
|
| Rate for Payer: Cash Price |
$1,981.80
|
| Rate for Payer: Cash Price |
$1,981.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,981.51
|
| Rate for Payer: Heritage Provider Network Senior |
$2,981.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$797.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,101.00
|
| Rate for Payer: Multiplan Commercial |
$3,303.00
|
|
|
HC MRI BRST UNI W WO CTRST W CAD
|
Facility
|
OP
|
$5,454.00
|
|
|
Service Code
|
CPT 77048
|
| Hospital Charge Code |
908801215
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$4,635.90 |
| Rate for Payer: Adventist Health Commercial |
$1,090.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,915.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,746.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,635.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,999.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,090.50
|
| Rate for Payer: Blue Shield of California Commercial |
$1,649.14
|
| Rate for Payer: Blue Shield of California EPN |
$1,326.18
|
| Rate for Payer: Cash Price |
$2,454.30
|
| Rate for Payer: Cash Price |
$2,454.30
|
| Rate for Payer: Cash Price |
$2,454.30
|
| Rate for Payer: Cash Price |
$2,454.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,635.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,635.90
|
| Rate for Payer: Dignity Health Senior |
$4,635.90
|
| 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 |
$537.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,601.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$987.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,363.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,817.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,817.80
|
| Rate for Payer: Multiplan Commercial |
$4,090.50
|
| 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 |
$471.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$471.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,635.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,635.90
|
| Rate for Payer: Vantage Medical Group Senior |
$4,635.90
|
|
|
HC MRI CHEST W/ CONTRAST
|
Facility
|
OP
|
$4,965.00
|
|
|
Service Code
|
CPT 71551
|
| Hospital Charge Code |
908801201
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$3,723.75 |
| Rate for Payer: Adventist Health Commercial |
$993.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,574.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,410.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,104.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,003.85
|
| 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 |
$2,234.25
|
| Rate for Payer: Cash Price |
$2,234.25
|
| Rate for Payer: Cash Price |
$2,234.25
|
| Rate for Payer: Cash Price |
$2,234.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,104.23
|
| Rate for Payer: Dignity Health Senior |
$1,003.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,003.85
|
| 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 |
$606.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,003.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,368.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$898.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,154.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,241.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,264.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,264.85
|
| Rate for Payer: Multiplan Commercial |
$3,723.75
|
| 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 |
$1,505.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,104.23
|
| Rate for Payer: Vantage Medical Group Senior |
$1,003.85
|
|
