|
HC MOTOR SPEECH GOAL STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9186
|
| Hospital Charge Code |
900018222
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
HC MR ANGIO ABD W/O CONTRAST
|
Facility
|
OP
|
$3,372.00
|
|
|
Service Code
|
CPT 74185
|
| Hospital Charge Code |
908801089
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$2,866.20 |
| Rate for Payer: Adventist Health Commercial |
$674.40
|
| Rate for Payer: Adventist Health Commercial |
$1,364.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,083.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,217.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,800.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,866.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,854.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,753.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,118.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,529.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,413.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,686.67
|
| Rate for Payer: Blue Shield of California Commercial |
$2,355.70
|
| 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: Blue Shield of California EPN |
$1,894.37
|
| Rate for Payer: Cash Price |
$1,517.40
|
| Rate for Payer: Cash Price |
$3,070.80
|
| Rate for Payer: Cash Price |
$1,517.40
|
| Rate for Payer: Cash Price |
$3,070.80
|
| Rate for Payer: Cash Price |
$1,517.40
|
| Rate for Payer: Cash Price |
$1,517.40
|
| Rate for Payer: Cash Price |
$3,070.80
|
| Rate for Payer: Cash Price |
$3,070.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,866.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,800.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,800.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,866.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,866.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,800.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,608.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,255.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$610.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,235.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,706.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$843.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,360.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,776.80
|
| Rate for Payer: Multiplan Commercial |
$5,118.00
|
| Rate for Payer: Multiplan Commercial |
$2,529.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$694.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$694.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$694.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$694.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,800.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,866.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,800.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,866.20
|
| Rate for Payer: Vantage Medical Group Senior |
$5,800.40
|
| Rate for Payer: Vantage Medical Group Senior |
$2,866.20
|
|
|
HC MR ANGIO ABD W/O CONTRAST
|
Facility
|
IP
|
$3,372.00
|
|
|
Service Code
|
CPT 74185
|
| Hospital Charge Code |
908801089
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$610.33 |
| Max. Negotiated Rate |
$2,529.00 |
| Rate for Payer: Adventist Health Commercial |
$674.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,171.57
|
| Rate for Payer: Cash Price |
$1,517.40
|
| Rate for Payer: Cash Price |
$1,517.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,282.84
|
| Rate for Payer: Heritage Provider Network Senior |
$2,282.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$610.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$843.00
|
| Rate for Payer: Multiplan Commercial |
$2,529.00
|
|
|
HC MR ANGIO CHEST W CONTRAST
|
Facility
|
OP
|
$4,377.00
|
|
|
Service Code
|
CPT 71555
|
| Hospital Charge Code |
908801090
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$3,720.45 |
| Rate for Payer: Adventist Health Commercial |
$875.40
|
| Rate for Payer: Adventist Health Commercial |
$1,281.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,704.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,958.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,445.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,720.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,407.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,523.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,804.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,282.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,204.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,189.38
|
| Rate for Payer: Blue Shield of California Commercial |
$2,355.70
|
| 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: Blue Shield of California EPN |
$1,894.37
|
| Rate for Payer: Cash Price |
$1,969.65
|
| Rate for Payer: Cash Price |
$2,882.70
|
| Rate for Payer: Cash Price |
$1,969.65
|
| Rate for Payer: Cash Price |
$2,882.70
|
| Rate for Payer: Cash Price |
$1,969.65
|
| Rate for Payer: Cash Price |
$1,969.65
|
| Rate for Payer: Cash Price |
$2,882.70
|
| Rate for Payer: Cash Price |
$2,882.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,720.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,445.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,445.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,720.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,720.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,445.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,087.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,055.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$792.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,159.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,601.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,094.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,063.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,484.20
|
| Rate for Payer: Multiplan Commercial |
$4,804.50
|
| Rate for Payer: Multiplan Commercial |
$3,282.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$693.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$693.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$693.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$693.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,445.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,720.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,445.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,720.45
|
| Rate for Payer: Vantage Medical Group Senior |
$5,445.10
|
| Rate for Payer: Vantage Medical Group Senior |
$3,720.45
|
|
|
HC MR ANGIO CHEST W CONTRAST
|
Facility
|
IP
|
$4,377.00
|
|
|
Service Code
|
CPT 71555
|
| Hospital Charge Code |
908801090
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$792.24 |
| Max. Negotiated Rate |
$3,282.75 |
| Rate for Payer: Adventist Health Commercial |
$875.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,818.79
|
| Rate for Payer: Cash Price |
$1,969.65
|
| Rate for Payer: Cash Price |
$1,969.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,963.23
|
| Rate for Payer: Heritage Provider Network Senior |
$2,963.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$792.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,094.25
|
| Rate for Payer: Multiplan Commercial |
$3,282.75
|
|
|
HC MR ANGIO CHEST W/O CONTRAST
|
Facility
|
OP
|
$3,283.00
|
|
|
Service Code
|
CPT 71555
|
| Hospital Charge Code |
908801091
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$2,790.55 |
| Rate for Payer: Adventist Health Commercial |
$656.60
|
| Rate for Payer: Adventist Health Commercial |
$1,190.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,028.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,678.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,059.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,790.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,805.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,273.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,464.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,462.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,977.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,642.16
|
| Rate for Payer: Blue Shield of California Commercial |
$2,355.70
|
| 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: Blue Shield of California EPN |
$1,894.37
|
| Rate for Payer: Cash Price |
$1,477.35
|
| Rate for Payer: Cash Price |
$2,678.40
|
| Rate for Payer: Cash Price |
$1,477.35
|
| Rate for Payer: Cash Price |
$2,678.40
|
| Rate for Payer: Cash Price |
$1,477.35
|
| Rate for Payer: Cash Price |
$1,477.35
|
| Rate for Payer: Cash Price |
$2,678.40
|
| Rate for Payer: Cash Price |
$2,678.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,790.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,059.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,059.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,790.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,790.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,059.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,565.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,839.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$594.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,077.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,488.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$820.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,298.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,166.40
|
| Rate for Payer: Multiplan Commercial |
$4,464.00
|
| Rate for Payer: Multiplan Commercial |
$2,462.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$693.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$693.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$693.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$693.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,059.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,790.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,059.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,790.55
|
| Rate for Payer: Vantage Medical Group Senior |
$5,059.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,790.55
|
|
|
HC MR ANGIO CHEST W/O CONTRAST
|
Facility
|
IP
|
$3,283.00
|
|
|
Service Code
|
CPT 71555
|
| Hospital Charge Code |
908801091
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$594.22 |
| Max. Negotiated Rate |
$2,462.25 |
| Rate for Payer: Adventist Health Commercial |
$656.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,114.25
|
| Rate for Payer: Cash Price |
$1,477.35
|
| Rate for Payer: Cash Price |
$1,477.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,222.59
|
| Rate for Payer: Heritage Provider Network Senior |
$2,222.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$594.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$820.75
|
| Rate for Payer: Multiplan Commercial |
$2,462.25
|
|
|
HC MR ANGIO LOW EXT W CONTRAST
|
Facility
|
IP
|
$5,697.00
|
|
|
Service Code
|
CPT 73725
|
| Hospital Charge Code |
908801092
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$4,272.75 |
| Rate for Payer: Adventist Health Commercial |
$1,139.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,668.87
|
| Rate for Payer: Cash Price |
$2,563.65
|
| Rate for Payer: Cash Price |
$2,563.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,856.87
|
| Rate for Payer: Heritage Provider Network Senior |
$3,856.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,031.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,424.25
|
| Rate for Payer: Multiplan Commercial |
$4,272.75
|
|
|
HC MR ANGIO LOW EXT W CONTRAST
|
Facility
|
OP
|
$5,356.00
|
|
|
Service Code
|
CPT 73725
|
| Hospital Charge Code |
908801092
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$4,552.60 |
| Rate for Payer: Adventist Health Commercial |
$1,071.20
|
| Rate for Payer: Adventist Health Commercial |
$1,139.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,310.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,520.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,842.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,552.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,945.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,133.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,272.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,017.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,849.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,679.07
|
| Rate for Payer: Blue Shield of California Commercial |
$2,355.70
|
| 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: Blue Shield of California EPN |
$1,894.37
|
| Rate for Payer: Cash Price |
$2,410.20
|
| Rate for Payer: Cash Price |
$2,563.65
|
| Rate for Payer: Cash Price |
$2,410.20
|
| Rate for Payer: Cash Price |
$2,563.65
|
| Rate for Payer: Cash Price |
$2,410.20
|
| Rate for Payer: Cash Price |
$2,410.20
|
| Rate for Payer: Cash Price |
$2,563.65
|
| Rate for Payer: Cash Price |
$2,563.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,552.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,842.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,842.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,552.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,552.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,842.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,554.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,717.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$969.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,031.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,424.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,339.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,749.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,987.90
|
| Rate for Payer: Multiplan Commercial |
$4,272.75
|
| Rate for Payer: Multiplan Commercial |
$4,017.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$696.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$696.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$696.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$696.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,842.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,552.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,842.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,552.60
|
| Rate for Payer: Vantage Medical Group Senior |
$4,842.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,552.60
|
|
|
HC MR ANGIO LOW EXT WO CONT
|
Facility
|
IP
|
$5,697.00
|
|
|
Service Code
|
CPT 73725
|
| Hospital Charge Code |
908801094
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$4,272.75 |
| Rate for Payer: Adventist Health Commercial |
$1,139.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,668.87
|
| Rate for Payer: Cash Price |
$2,563.65
|
| Rate for Payer: Cash Price |
$2,563.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,856.87
|
| Rate for Payer: Heritage Provider Network Senior |
$3,856.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,031.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,424.25
|
| Rate for Payer: Multiplan Commercial |
$4,272.75
|
|
|
HC MR ANGIO LOW EXT WO CONT
|
Facility
|
OP
|
$4,898.00
|
|
|
Service Code
|
CPT 73725
|
| Hospital Charge Code |
908801094
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$4,163.30 |
| Rate for Payer: Adventist Health Commercial |
$979.60
|
| Rate for Payer: Adventist Health Commercial |
$1,139.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,026.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,520.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,842.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,163.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,693.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,133.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,272.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,673.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,849.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,449.98
|
| Rate for Payer: Blue Shield of California Commercial |
$2,355.70
|
| 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: Blue Shield of California EPN |
$1,894.37
|
| Rate for Payer: Cash Price |
$2,204.10
|
| Rate for Payer: Cash Price |
$2,563.65
|
| Rate for Payer: Cash Price |
$2,204.10
|
| Rate for Payer: Cash Price |
$2,563.65
|
| Rate for Payer: Cash Price |
$2,204.10
|
| Rate for Payer: Cash Price |
$2,204.10
|
| Rate for Payer: Cash Price |
$2,563.65
|
| Rate for Payer: Cash Price |
$2,563.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,163.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,842.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,842.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,163.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,163.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,842.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,336.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,717.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$886.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,031.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,424.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,224.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,428.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,987.90
|
| Rate for Payer: Multiplan Commercial |
$4,272.75
|
| Rate for Payer: Multiplan Commercial |
$3,673.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$696.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$696.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$696.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$696.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,842.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,163.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,842.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,163.30
|
| Rate for Payer: Vantage Medical Group Senior |
$4,842.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,163.30
|
|
|
HC MR ANGIO PELVIS W/CONT
|
Facility
|
IP
|
$5,590.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801097
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$4,192.50 |
| Rate for Payer: Adventist Health Commercial |
$1,118.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,599.96
|
| Rate for Payer: Cash Price |
$2,515.50
|
| Rate for Payer: Cash Price |
$2,515.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,784.43
|
| Rate for Payer: Heritage Provider Network Senior |
$3,784.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,011.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,397.50
|
| Rate for Payer: Multiplan Commercial |
$4,192.50
|
|
|
HC MR ANGIO PELVIS W/CONT
|
Facility
|
OP
|
$3,752.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801097
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$3,189.20 |
| Rate for Payer: Adventist Health Commercial |
$750.40
|
| Rate for Payer: Adventist Health Commercial |
$1,118.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,318.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,454.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,751.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,189.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,063.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,074.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,814.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,796.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,876.75
|
| Rate for Payer: Blue Shield of California Commercial |
$2,355.70
|
| 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: Blue Shield of California EPN |
$1,894.37
|
| Rate for Payer: Cash Price |
$1,688.40
|
| Rate for Payer: Cash Price |
$2,515.50
|
| Rate for Payer: Cash Price |
$1,688.40
|
| Rate for Payer: Cash Price |
$2,515.50
|
| Rate for Payer: Cash Price |
$1,688.40
|
| Rate for Payer: Cash Price |
$1,688.40
|
| Rate for Payer: Cash Price |
$2,515.50
|
| Rate for Payer: Cash Price |
$2,515.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,189.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,751.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,751.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,189.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,189.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,751.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,789.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,666.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$679.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,011.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,397.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$938.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,626.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,913.00
|
| Rate for Payer: Multiplan Commercial |
$4,192.50
|
| Rate for Payer: Multiplan Commercial |
$2,814.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$696.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$696.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,751.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,189.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,751.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,189.20
|
| Rate for Payer: Vantage Medical Group Senior |
$4,751.50
|
| Rate for Payer: Vantage Medical Group Senior |
$3,189.20
|
|
|
HC MR ANGIO PELVIS WO CONT
|
Facility
|
IP
|
$4,642.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801098
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$840.20 |
| Max. Negotiated Rate |
$3,481.50 |
| Rate for Payer: Adventist Health Commercial |
$928.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,989.45
|
| Rate for Payer: Cash Price |
$2,088.90
|
| Rate for Payer: Cash Price |
$2,088.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,142.63
|
| Rate for Payer: Heritage Provider Network Senior |
$3,142.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$840.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,160.50
|
| Rate for Payer: Multiplan Commercial |
$3,481.50
|
|
|
HC MR ANGIO PELVIS WO CONT
|
Facility
|
OP
|
$3,298.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801098
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$2,803.30 |
| Rate for Payer: Adventist Health Commercial |
$659.60
|
| Rate for Payer: Adventist Health Commercial |
$928.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,038.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,868.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,945.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,803.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,813.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,553.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,481.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,473.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,321.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,649.66
|
| Rate for Payer: Blue Shield of California Commercial |
$2,355.70
|
| 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: Blue Shield of California EPN |
$1,894.37
|
| Rate for Payer: Cash Price |
$1,484.10
|
| Rate for Payer: Cash Price |
$2,088.90
|
| Rate for Payer: Cash Price |
$1,484.10
|
| Rate for Payer: Cash Price |
$2,088.90
|
| Rate for Payer: Cash Price |
$1,484.10
|
| Rate for Payer: Cash Price |
$1,484.10
|
| Rate for Payer: Cash Price |
$2,088.90
|
| Rate for Payer: Cash Price |
$2,088.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,803.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,945.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,945.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,803.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,803.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,945.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,573.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,214.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$596.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$840.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,160.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$824.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,308.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,249.40
|
| Rate for Payer: Multiplan Commercial |
$3,481.50
|
| Rate for Payer: Multiplan Commercial |
$2,473.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$696.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$696.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,945.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,803.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,945.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,803.30
|
| Rate for Payer: Vantage Medical Group Senior |
$3,945.70
|
| Rate for Payer: Vantage Medical Group Senior |
$2,803.30
|
|
|
HC MR ANGIO PELVIS WO FOL W CONT
|
Facility
|
OP
|
$4,211.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801034
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$3,579.35 |
| Rate for Payer: Adventist Health Commercial |
$842.20
|
| Rate for Payer: Adventist Health Commercial |
$1,174.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,602.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,627.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,989.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,579.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,316.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,228.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,402.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,158.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,936.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,106.34
|
| Rate for Payer: Blue Shield of California Commercial |
$2,355.70
|
| 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: Blue Shield of California EPN |
$1,894.37
|
| Rate for Payer: Cash Price |
$1,894.95
|
| Rate for Payer: Cash Price |
$2,641.50
|
| Rate for Payer: Cash Price |
$1,894.95
|
| Rate for Payer: Cash Price |
$2,641.50
|
| Rate for Payer: Cash Price |
$1,894.95
|
| Rate for Payer: Cash Price |
$1,894.95
|
| Rate for Payer: Cash Price |
$2,641.50
|
| Rate for Payer: Cash Price |
$2,641.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,579.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,989.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,989.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,579.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,579.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,989.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,008.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,799.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$762.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,062.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,467.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,052.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,947.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,109.00
|
| Rate for Payer: Multiplan Commercial |
$4,402.50
|
| Rate for Payer: Multiplan Commercial |
$3,158.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$696.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$696.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,989.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,579.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,989.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,579.35
|
| Rate for Payer: Vantage Medical Group Senior |
$4,989.50
|
| Rate for Payer: Vantage Medical Group Senior |
$3,579.35
|
|
|
HC MR ANGIO PELVIS WO FOL W CONT
|
Facility
|
IP
|
$5,870.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801034
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$4,402.50 |
| Rate for Payer: Adventist Health Commercial |
$1,174.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,780.28
|
| Rate for Payer: Cash Price |
$2,641.50
|
| Rate for Payer: Cash Price |
$2,641.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,973.99
|
| Rate for Payer: Heritage Provider Network Senior |
$3,973.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,062.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,467.50
|
| Rate for Payer: Multiplan Commercial |
$4,402.50
|
|
|
HC MR ANGIO PELVIS WO FOL W CONT
|
Facility
|
IP
|
$8,568.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801099
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$6,426.00 |
| Rate for Payer: Adventist Health Commercial |
$1,713.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,517.79
|
| Rate for Payer: Cash Price |
$3,855.60
|
| Rate for Payer: Cash Price |
$3,855.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,800.54
|
| Rate for Payer: Heritage Provider Network Senior |
$5,800.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,550.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,142.00
|
| Rate for Payer: Multiplan Commercial |
$6,426.00
|
|
|
HC MR ANGIO PELVIS WO FOL W CONT
|
Facility
|
OP
|
$4,211.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801099
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$3,579.35 |
| Rate for Payer: Adventist Health Commercial |
$842.20
|
| Rate for Payer: Adventist Health Commercial |
$1,713.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,602.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,295.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,282.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,579.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,316.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,712.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,426.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,158.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,285.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,106.34
|
| Rate for Payer: Blue Shield of California Commercial |
$2,355.70
|
| 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: Blue Shield of California EPN |
$1,894.37
|
| Rate for Payer: Cash Price |
$1,894.95
|
| Rate for Payer: Cash Price |
$3,855.60
|
| Rate for Payer: Cash Price |
$1,894.95
|
| Rate for Payer: Cash Price |
$3,855.60
|
| Rate for Payer: Cash Price |
$1,894.95
|
| Rate for Payer: Cash Price |
$1,894.95
|
| Rate for Payer: Cash Price |
$3,855.60
|
| Rate for Payer: Cash Price |
$3,855.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,579.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,282.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,282.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,579.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,579.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,282.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,008.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,086.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$762.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,550.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,142.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,052.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,947.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,997.60
|
| Rate for Payer: Multiplan Commercial |
$6,426.00
|
| Rate for Payer: Multiplan Commercial |
$3,158.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$696.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$696.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,282.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,579.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,282.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,579.35
|
| Rate for Payer: Vantage Medical Group Senior |
$7,282.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,579.35
|
|
|
HC MR ANGIO W/O FOL W/CONT, ABD
|
Facility
|
OP
|
$3,372.00
|
|
|
Service Code
|
CPT 74185
|
| Hospital Charge Code |
908801096
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$2,866.20 |
| Rate for Payer: Adventist Health Commercial |
$674.40
|
| Rate for Payer: Adventist Health Commercial |
$1,543.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,083.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,769.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,560.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,866.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,854.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,244.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,788.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,529.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,860.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,686.67
|
| Rate for Payer: Blue Shield of California Commercial |
$2,355.70
|
| 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: Blue Shield of California EPN |
$1,894.37
|
| Rate for Payer: Cash Price |
$1,517.40
|
| Rate for Payer: Cash Price |
$3,473.10
|
| Rate for Payer: Cash Price |
$1,517.40
|
| Rate for Payer: Cash Price |
$3,473.10
|
| Rate for Payer: Cash Price |
$1,517.40
|
| Rate for Payer: Cash Price |
$1,517.40
|
| Rate for Payer: Cash Price |
$3,473.10
|
| Rate for Payer: Cash Price |
$3,473.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,866.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,560.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,560.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,866.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,866.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,560.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,608.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,681.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$610.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,396.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,929.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$843.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,360.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,402.60
|
| Rate for Payer: Multiplan Commercial |
$5,788.50
|
| Rate for Payer: Multiplan Commercial |
$2,529.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$694.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$694.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$694.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$694.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,560.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,866.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,560.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,866.20
|
| Rate for Payer: Vantage Medical Group Senior |
$6,560.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,866.20
|
|
|
HC MR ANGIO W/O FOL W/CONT, ABD
|
Facility
|
IP
|
$3,372.00
|
|
|
Service Code
|
CPT 74185
|
| Hospital Charge Code |
908801096
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$610.33 |
| Max. Negotiated Rate |
$2,529.00 |
| Rate for Payer: Adventist Health Commercial |
$674.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,171.57
|
| Rate for Payer: Cash Price |
$1,517.40
|
| Rate for Payer: Cash Price |
$1,517.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,282.84
|
| Rate for Payer: Heritage Provider Network Senior |
$2,282.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$610.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$843.00
|
| Rate for Payer: Multiplan Commercial |
$2,529.00
|
|
|
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: Adventist Health Commercial |
$1,075.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,321.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,644.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,688.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,140.36
|
| Rate for Payer: Blue Shield of California Commercial |
$2,800.03
|
| 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: Blue Shield of California EPN |
$2,251.69
|
| Rate for Payer: Cash Price |
$2,418.75
|
| Rate for Payer: Cash Price |
$1,925.55
|
| Rate for Payer: Cash Price |
$1,925.55
|
| Rate for Payer: Cash Price |
$1,925.55
|
| Rate for Payer: Cash Price |
$1,925.55
|
| Rate for Payer: Cash Price |
$2,418.75
|
| Rate for Payer: Cash Price |
$2,418.75
|
| Rate for Payer: Cash Price |
$2,418.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$448.71
|
| Rate for Payer: EPIC Health Plan Medicare |
$448.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,563.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,041.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$972.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$774.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$516.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$516.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,069.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,343.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$601.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$601.27
|
| Rate for Payer: Multiplan Commercial |
$3,209.25
|
| Rate for Payer: Multiplan Commercial |
$4,031.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$697.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$697.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$697.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
|
|
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: Aetna of CA Non-Gatekeeper |
$2,755.68
|
| Rate for Payer: Cash Price |
$1,925.55
|
| Rate for Payer: Cash Price |
$1,925.55
|
| 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 Foundation Hospitals 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/O CONTRAST
|
Facility
|
OP
|
$3,864.00
|
|
|
Service Code
|
CPT 74181
|
| Hospital Charge Code |
908801300
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$306.88 |
| Max. Negotiated Rate |
$2,898.00 |
| Rate for Payer: Adventist Health Commercial |
$772.80
|
| Rate for Payer: Adventist Health Commercial |
$937.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,896.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,387.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,344.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,932.77
|
| Rate for Payer: Blue Shield of California Commercial |
$2,335.44
|
| 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: Blue Shield of California EPN |
$1,878.08
|
| Rate for Payer: Cash Price |
$2,109.15
|
| Rate for Payer: Cash Price |
$1,738.80
|
| Rate for Payer: Cash Price |
$1,738.80
|
| Rate for Payer: Cash Price |
$1,738.80
|
| Rate for Payer: Cash Price |
$1,738.80
|
| Rate for Payer: Cash Price |
$2,109.15
|
| Rate for Payer: Cash Price |
$2,109.15
|
| Rate for Payer: Cash Price |
$2,109.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.88
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,235.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,843.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$848.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$699.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$352.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$352.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$966.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,171.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$2,898.00
|
| Rate for Payer: Multiplan Commercial |
$3,515.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$541.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$541.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$541.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
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: Aetna of CA Non-Gatekeeper |
$2,488.42
|
| Rate for Payer: Cash Price |
$1,738.80
|
| Rate for Payer: Cash Price |
$1,738.80
|
| 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 Foundation Hospitals Medi-Cal |
$699.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$966.00
|
| Rate for Payer: Multiplan Commercial |
$2,898.00
|
|
