|
HC MRI BRAIN ASSESS W CONTRAST
|
Facility
IP
|
$3,077.00
|
|
|
Service Code
|
CPT 70558
|
| Hospital Charge Code |
908870558
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$556.94 |
| Max. Negotiated Rate |
$2,307.75 |
| Rate for Payer: Adventist Health Commercial |
$615.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,113.90
|
| Rate for Payer: Cash Price |
$1,384.65
|
| Rate for Payer: Cash Price |
$1,384.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,083.13
|
| Rate for Payer: Heritage Provider Network Senior |
$2,083.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$556.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$769.25
|
| Rate for Payer: Multiplan Commercial |
$2,307.75
|
|
|
HC MRI BRAIN ASSESS WO CONTRAST
|
Facility
IP
|
$2,663.00
|
|
|
Service Code
|
CPT 70557
|
| Hospital Charge Code |
908870557
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$482.00 |
| Max. Negotiated Rate |
$1,997.25 |
| Rate for Payer: Adventist Health Commercial |
$532.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,829.48
|
| Rate for Payer: Cash Price |
$1,198.35
|
| Rate for Payer: Cash Price |
$1,198.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,802.85
|
| Rate for Payer: Heritage Provider Network Senior |
$1,802.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$482.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$665.75
|
| Rate for Payer: Multiplan Commercial |
$1,997.25
|
|
|
HC MRI BRAIN ASSESS WO CONTRAST
|
Facility
OP
|
$2,663.00
|
|
|
Service Code
|
CPT 70557
|
| Hospital Charge Code |
908870557
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$267.93 |
| Max. Negotiated Rate |
$3,062.18 |
| Rate for Payer: Adventist Health Commercial |
$532.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$814.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,829.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,033.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$689.28
|
| Rate for Payer: Blue Shield of California Commercial |
$3,062.18
|
| Rate for Payer: Blue Shield of California EPN |
$1,741.37
|
| Rate for Payer: Cash Price |
$1,198.35
|
| Rate for Payer: Cash Price |
$1,198.35
|
| Rate for Payer: Cash Price |
$1,198.35
|
| Rate for Payer: Cash Price |
$1,198.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$758.21
|
| Rate for Payer: Dignity Health Senior |
$689.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$689.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Humana Medicare |
$689.28
|
| Rate for Payer: IEHP Medi-Cal |
$267.93
|
| Rate for Payer: IEHP Medicare Advantage |
$689.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,309.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$482.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$813.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$665.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$868.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$868.49
|
| Rate for Payer: Multiplan Commercial |
$1,997.25
|
| 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 |
$1,033.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: Vantage Medical Group Senior |
$689.28
|
|
|
HC MRI BRAIN ASSESS WO W CONTRAST
|
Facility
IP
|
$3,077.00
|
|
|
Service Code
|
CPT 70559
|
| Hospital Charge Code |
908870559
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$556.94 |
| Max. Negotiated Rate |
$2,307.75 |
| Rate for Payer: Adventist Health Commercial |
$615.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,113.90
|
| Rate for Payer: Cash Price |
$1,384.65
|
| Rate for Payer: Cash Price |
$1,384.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,083.13
|
| Rate for Payer: Heritage Provider Network Senior |
$2,083.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$556.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$769.25
|
| Rate for Payer: Multiplan Commercial |
$2,307.75
|
|
|
HC MRI BRAIN ASSESS WO W CONTRAST
|
Facility
OP
|
$3,077.00
|
|
|
Service Code
|
CPT 70559
|
| Hospital Charge Code |
908870559
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$229.56 |
| Max. Negotiated Rate |
$3,402.31 |
| Rate for Payer: Adventist Health Commercial |
$615.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$814.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,113.90
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Blue Shield of California Commercial |
$3,402.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,934.79
|
| Rate for Payer: Cash Price |
$1,384.65
|
| Rate for Payer: Cash Price |
$1,384.65
|
| Rate for Payer: Cash Price |
$1,384.65
|
| Rate for Payer: Cash Price |
$1,384.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: Dignity Health Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$229.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Humana Medicare |
$229.56
|
| Rate for Payer: IEHP Medi-Cal |
$260.18
|
| Rate for Payer: IEHP Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$436.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$556.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$270.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$769.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$289.25
|
| Rate for Payer: Multiplan Commercial |
$2,307.75
|
| 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 |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC MRI BRAIN WITH CONTRAST
|
Facility
IP
|
$5,610.00
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
908801012
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$4,207.50 |
| Rate for Payer: Adventist Health Commercial |
$1,122.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,854.07
|
| Rate for Payer: Cash Price |
$2,524.50
|
| Rate for Payer: Cash Price |
$2,524.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,797.97
|
| Rate for Payer: Heritage Provider Network Senior |
$3,797.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,015.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,402.50
|
| Rate for Payer: Multiplan Commercial |
$4,207.50
|
|
|
HC MRI BRAIN WITH CONTRAST
|
Facility
OP
|
$4,480.00
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
908801012
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$3,360.00 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Blue Shield of California Commercial |
$2,743.62
|
| Rate for Payer: Blue Shield of California EPN |
$1,560.21
|
| 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: IEHP Medi-Cal |
$412.20
|
| Rate for Payer: 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 |
$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 BRAIN WITH CONTRAST
|
Facility
IP
|
$9,660.00
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
908801013
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$7,245.00 |
| Rate for Payer: Adventist Health Commercial |
$1,932.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,636.42
|
| Rate for Payer: Cash Price |
$4,347.00
|
| Rate for Payer: Cash Price |
$4,347.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,539.82
|
| Rate for Payer: Heritage Provider Network Senior |
$6,539.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,748.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,415.00
|
| Rate for Payer: Multiplan Commercial |
$7,245.00
|
|
|
HC MRI BRAIN WITH CONTRAST
|
Facility
OP
|
$4,480.00
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
908801013
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$3,360.00 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Blue Shield of California Commercial |
$2,743.62
|
| Rate for Payer: Blue Shield of California EPN |
$1,560.21
|
| 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: IEHP Medi-Cal |
$412.20
|
| Rate for Payer: 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 |
$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 BREAST BILAT WO CONTRAST
|
Facility
IP
|
$5,241.00
|
|
|
Service Code
|
CPT 77047
|
| Hospital Charge Code |
908801212
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$3,930.75 |
| Rate for Payer: Adventist Health Commercial |
$1,048.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,600.57
|
| Rate for Payer: Cash Price |
$2,358.45
|
| Rate for Payer: Cash Price |
$2,358.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,548.16
|
| Rate for Payer: Heritage Provider Network Senior |
$3,548.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$948.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,310.25
|
| Rate for Payer: Multiplan Commercial |
$3,930.75
|
|
|
HC MRI BREAST BILAT WO CONTRAST
|
Facility
OP
|
$4,011.00
|
|
|
Service Code
|
CPT 77047
|
| Hospital Charge Code |
908801212
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$306.16 |
| Max. Negotiated Rate |
$3,008.25 |
| Rate for Payer: Adventist Health Commercial |
$802.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$814.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,755.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Blue Shield of California Commercial |
$966.20
|
| Rate for Payer: Blue Shield of California EPN |
$549.45
|
| Rate for Payer: Cash Price |
$1,804.95
|
| Rate for Payer: Cash Price |
$1,804.95
|
| Rate for Payer: Cash Price |
$1,804.95
|
| Rate for Payer: Cash Price |
$1,804.95
|
| 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: IEHP Medi-Cal |
$333.95
|
| Rate for Payer: IEHP Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$581.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$725.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,002.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$385.76
|
| Rate for Payer: Multiplan Commercial |
$3,008.25
|
| 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 |
$368.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$368.90
|
| 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 BREAST UNI WO CONTRAST
|
Facility
IP
|
$5,454.00
|
|
|
Service Code
|
CPT 77046
|
| Hospital Charge Code |
908801219
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$4,090.50 |
| Rate for Payer: Adventist Health Commercial |
$1,090.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,746.90
|
| Rate for Payer: Cash Price |
$2,454.30
|
| Rate for Payer: Cash Price |
$2,454.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,692.36
|
| Rate for Payer: Heritage Provider Network Senior |
$3,692.36
|
| 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: Multiplan Commercial |
$4,090.50
|
|
|
HC MRI BREAST UNI WO CONTRAST
|
Facility
OP
|
$3,562.00
|
|
|
Service Code
|
CPT 77046
|
| Hospital Charge Code |
908801219
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$306.16 |
| Max. Negotiated Rate |
$2,671.50 |
| Rate for Payer: Adventist Health Commercial |
$712.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$814.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,447.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Blue Shield of California Commercial |
$972.08
|
| Rate for Payer: Blue Shield of California EPN |
$552.79
|
| Rate for Payer: Cash Price |
$1,602.90
|
| Rate for Payer: Cash Price |
$1,602.90
|
| Rate for Payer: Cash Price |
$1,602.90
|
| Rate for Payer: Cash Price |
$1,602.90
|
| 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: IEHP Medi-Cal |
$325.73
|
| Rate for Payer: IEHP Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$581.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$644.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$890.50
|
| 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 |
$2,671.50
|
| 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 |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC MRI BRST BI W WO CNTRST W CAD
|
Facility
IP
|
$5,241.00
|
|
|
Service Code
|
CPT 77049
|
| Hospital Charge Code |
908801210
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$3,930.75 |
| Rate for Payer: Adventist Health Commercial |
$1,048.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,600.57
|
| Rate for Payer: Cash Price |
$2,358.45
|
| Rate for Payer: Cash Price |
$2,358.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,548.16
|
| Rate for Payer: Heritage Provider Network Senior |
$3,548.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$948.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,310.25
|
| Rate for Payer: Multiplan Commercial |
$3,930.75
|
|
|
HC MRI BRST BI W WO CNTRST W CAD
|
Facility
OP
|
$4,885.00
|
|
|
Service Code
|
CPT 77049
|
| Hospital Charge Code |
908801210
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$4,152.25 |
| Rate for Payer: Adventist Health Commercial |
$977.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$814.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,356.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,152.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,686.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,663.75
|
| Rate for Payer: Blue Shield of California Commercial |
$1,593.16
|
| Rate for Payer: Blue Shield of California EPN |
$905.98
|
| 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 |
$4,152.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,152.25
|
| Rate for Payer: Dignity Health Senior |
$4,152.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: IEHP Medi-Cal |
$527.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,354.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$884.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,221.25
|
| 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 |
$468.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$468.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,152.25
|
| Rate for Payer: Vantage Medical Group Senior |
$4,152.25
|
|
|
HC MRI BRST UNI W WO CTRST W CAD
|
Facility
OP
|
$4,507.00
|
|
|
Service Code
|
CPT 77048
|
| Hospital Charge Code |
908801215
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$3,830.95 |
| Rate for Payer: Adventist Health Commercial |
$901.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$814.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,096.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,830.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,478.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,380.25
|
| Rate for Payer: Blue Shield of California Commercial |
$1,601.04
|
| Rate for Payer: Blue Shield of California EPN |
$910.46
|
| Rate for Payer: Cash Price |
$2,028.15
|
| Rate for Payer: Cash Price |
$2,028.15
|
| Rate for Payer: Cash Price |
$2,028.15
|
| Rate for Payer: Cash Price |
$2,028.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,830.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,830.95
|
| Rate for Payer: Dignity Health Senior |
$3,830.95
|
| 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: IEHP Medi-Cal |
$517.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,172.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$815.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,126.75
|
| Rate for Payer: Multiplan Commercial |
$3,380.25
|
| 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 |
$471.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$471.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,830.95
|
| Rate for Payer: Vantage Medical Group Senior |
$3,830.95
|
|
|
HC MRI BRST UNI W WO CTRST W CAD
|
Facility
IP
|
$5,454.00
|
|
|
Service Code
|
CPT 77048
|
| Hospital Charge Code |
908801215
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$4,090.50 |
| Rate for Payer: Adventist Health Commercial |
$1,090.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,746.90
|
| Rate for Payer: Cash Price |
$2,454.30
|
| Rate for Payer: Cash Price |
$2,454.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,692.36
|
| Rate for Payer: Heritage Provider Network Senior |
$3,692.36
|
| 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: Multiplan Commercial |
$4,090.50
|
|
|
HC MRI CHEST W/ CONTRAST
|
Facility
OP
|
$4,104.00
|
|
|
Service Code
|
CPT 71551
|
| Hospital Charge Code |
908801201
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$3,078.00 |
| Rate for Payer: Adventist Health Commercial |
$820.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,574.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,819.45
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,500.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,000.40
|
| 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 |
$1,846.80
|
| Rate for Payer: Cash Price |
$1,846.80
|
| Rate for Payer: Cash Price |
$1,846.80
|
| Rate for Payer: Cash Price |
$1,846.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,100.44
|
| Rate for Payer: Dignity Health Senior |
$1,000.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,000.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Humana Medicare |
$1,000.40
|
| Rate for Payer: IEHP Medi-Cal |
$583.64
|
| Rate for Payer: IEHP Medicare Advantage |
$1,000.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,900.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$742.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,180.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,026.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,260.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,260.50
|
| Rate for Payer: Multiplan Commercial |
$3,078.00
|
| 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 |
$1,500.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: Vantage Medical Group Senior |
$1,000.40
|
|
|
HC MRI CHEST W/ CONTRAST
|
Facility
IP
|
$6,422.00
|
|
|
Service Code
|
CPT 71551
|
| Hospital Charge Code |
908801201
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$4,816.50 |
| Rate for Payer: Adventist Health Commercial |
$1,284.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,411.91
|
| Rate for Payer: Cash Price |
$2,889.90
|
| Rate for Payer: Cash Price |
$2,889.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,347.69
|
| Rate for Payer: Heritage Provider Network Senior |
$4,347.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,162.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,605.50
|
| Rate for Payer: Multiplan Commercial |
$4,816.50
|
|
|
HC MRI CHEST, W/O CONT
|
Facility
IP
|
$4,331.00
|
|
|
Service Code
|
CPT 71550
|
| Hospital Charge Code |
908801200
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$783.91 |
| Max. Negotiated Rate |
$3,248.25 |
| Rate for Payer: Adventist Health Commercial |
$866.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,975.40
|
| Rate for Payer: Cash Price |
$1,948.95
|
| Rate for Payer: Cash Price |
$1,948.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,932.09
|
| Rate for Payer: Heritage Provider Network Senior |
$2,932.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$783.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,082.75
|
| Rate for Payer: Multiplan Commercial |
$3,248.25
|
|
|
HC MRI CHEST, W/O CONT
|
Facility
OP
|
$3,671.00
|
|
|
Service Code
|
CPT 71550
|
| Hospital Charge Code |
908801200
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$306.16 |
| Max. Negotiated Rate |
$2,753.25 |
| Rate for Payer: Adventist Health Commercial |
$734.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,574.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,521.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: AlphaCare 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 |
$1,651.95
|
| Rate for Payer: Cash Price |
$1,651.95
|
| Rate for Payer: Cash Price |
$1,651.95
|
| Rate for Payer: Cash Price |
$1,651.95
|
| 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: IEHP Medi-Cal |
$528.22
|
| Rate for Payer: IEHP Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$581.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$664.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$917.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$385.76
|
| Rate for Payer: Multiplan Commercial |
$2,753.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$541.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$541.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC MRI CHEST W WO CONTRAST
|
Facility
IP
|
$6,907.00
|
|
|
Service Code
|
CPT 71552
|
| Hospital Charge Code |
908801202
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$5,180.25 |
| Rate for Payer: Adventist Health Commercial |
$1,381.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,745.11
|
| Rate for Payer: Cash Price |
$3,108.15
|
| Rate for Payer: Cash Price |
$3,108.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,676.04
|
| Rate for Payer: Heritage Provider Network Senior |
$4,676.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,250.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,726.75
|
| Rate for Payer: Multiplan Commercial |
$5,180.25
|
|
|
HC MRI CHEST W WO CONTRAST
|
Facility
OP
|
$4,859.00
|
|
|
Service Code
|
CPT 71552
|
| Hospital Charge Code |
908801202
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$4,994.03 |
| Rate for Payer: Adventist Health Commercial |
$971.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,574.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,338.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Blue Shield of California Commercial |
$4,994.03
|
| Rate for Payer: Blue Shield of California EPN |
$2,839.95
|
| Rate for Payer: Cash Price |
$2,186.55
|
| Rate for Payer: Cash Price |
$2,186.55
|
| Rate for Payer: Cash Price |
$2,186.55
|
| Rate for Payer: Cash Price |
$2,186.55
|
| 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: IEHP Medi-Cal |
$736.98
|
| Rate for Payer: IEHP Medicare Advantage |
$480.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$912.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$879.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$566.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,214.75
|
| 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 |
$3,644.25
|
| 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 |
$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 FETAL PELVIC IMG 1ST FETUS
|
Facility
OP
|
$1,226.00
|
|
|
Service Code
|
CPT 74712
|
| Hospital Charge Code |
908874712
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$221.91 |
| Max. Negotiated Rate |
$4,872.33 |
| Rate for Payer: Adventist Health Commercial |
$245.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$814.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$842.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,872.33
|
| Rate for Payer: Blue Shield of California Commercial |
$1,810.83
|
| Rate for Payer: Blue Shield of California EPN |
$1,029.76
|
| Rate for Payer: Cash Price |
$551.70
|
| Rate for Payer: Cash Price |
$551.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$796.90
|
| 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 |
$796.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$758.89
|
| Rate for Payer: Heritage Provider Network Senior |
$758.89
|
| Rate for Payer: Humana Medicare |
$306.16
|
| Rate for Payer: IEHP Medi-Cal |
$625.84
|
| Rate for Payer: IEHP Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$581.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$221.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$306.50
|
| 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 |
$919.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$306.16
|
| Rate for Payer: TriValley Medical Group Senior |
$306.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$437.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$437.66
|
| 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 FETAL PELVIC IMG 1ST FETUS
|
Facility
IP
|
$1,226.00
|
|
|
Service Code
|
CPT 74712
|
| Hospital Charge Code |
908874712
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$221.91 |
| Max. Negotiated Rate |
$919.50 |
| Rate for Payer: Adventist Health Commercial |
$245.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$842.26
|
| Rate for Payer: Cash Price |
$551.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$830.00
|
| Rate for Payer: Heritage Provider Network Senior |
$830.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$221.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$306.50
|
| Rate for Payer: Multiplan Commercial |
$919.50
|
|
