|
HC MRI BRAIN ASSESS WO CONTRAST
|
Facility
|
IP
|
$3,521.00
|
|
|
Service Code
|
CPT 70557
|
| Hospital Charge Code |
908870557
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$637.30 |
| Max. Negotiated Rate |
$2,640.75 |
| Rate for Payer: Adventist Health Commercial |
$704.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,267.52
|
| Rate for Payer: Cash Price |
$1,584.45
|
| Rate for Payer: Cash Price |
$1,584.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,383.72
|
| Rate for Payer: Heritage Provider Network Senior |
$2,383.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$637.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$880.25
|
| Rate for Payer: Multiplan Commercial |
$2,640.75
|
|
|
HC MRI BRAIN ASSESS WO W CONTRAST
|
Facility
|
OP
|
$4,070.00
|
|
|
Service Code
|
CPT 70559
|
| Hospital Charge Code |
908870559
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$225.59 |
| Max. Negotiated Rate |
$3,504.53 |
| Rate for Payer: Adventist Health Commercial |
$814.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,515.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,035.81
|
| Rate for Payer: Blue Shield of California Commercial |
$3,504.53
|
| Rate for Payer: Blue Shield of California EPN |
$2,818.22
|
| Rate for Payer: Cash Price |
$1,831.50
|
| Rate for Payer: Cash Price |
$1,831.50
|
| Rate for Payer: Cash Price |
$1,831.50
|
| Rate for Payer: Cash Price |
$1,831.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$225.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,941.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$736.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$259.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,017.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$3,052.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$854.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$854.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
|
HC MRI BRAIN ASSESS WO W CONTRAST
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
CPT 70559
|
| Hospital Charge Code |
908870559
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$736.67 |
| Max. Negotiated Rate |
$3,052.50 |
| Rate for Payer: Adventist Health Commercial |
$814.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,621.08
|
| Rate for Payer: Cash Price |
$1,831.50
|
| Rate for Payer: Cash Price |
$1,831.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,755.39
|
| Rate for Payer: Heritage Provider Network Senior |
$2,755.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$736.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,017.50
|
| Rate for Payer: Multiplan Commercial |
$3,052.50
|
|
|
HC MRI BRAIN WITH CONTRAST
|
Facility
|
IP
|
$11,689.00
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
908801013
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$8,766.75 |
| Rate for Payer: Adventist Health Commercial |
$2,337.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,527.72
|
| Rate for Payer: Cash Price |
$5,260.05
|
| Rate for Payer: Cash Price |
$5,260.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,913.45
|
| Rate for Payer: Heritage Provider Network Senior |
$7,913.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,115.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,922.25
|
| Rate for Payer: Multiplan Commercial |
$8,766.75
|
|
|
HC MRI BRAIN WITH CONTRAST
|
Facility
|
OP
|
$5,421.00
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
908801012
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$4,065.75 |
| Rate for Payer: Adventist Health Commercial |
$1,084.20
|
| Rate for Payer: Adventist Health Commercial |
$1,484.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,585.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,350.18
|
| 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 |
$3,711.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,711.58
|
| Rate for Payer: Blue Shield of California Commercial |
$2,826.05
|
| Rate for Payer: Blue Shield of California Commercial |
$2,826.05
|
| Rate for Payer: Blue Shield of California EPN |
$2,272.61
|
| Rate for Payer: Blue Shield of California EPN |
$2,272.61
|
| Rate for Payer: Cash Price |
$3,339.00
|
| Rate for Payer: Cash Price |
$2,439.45
|
| Rate for Payer: Cash Price |
$2,439.45
|
| Rate for Payer: Cash Price |
$2,439.45
|
| Rate for Payer: Cash Price |
$2,439.45
|
| Rate for Payer: Cash Price |
$3,339.00
|
| Rate for Payer: Cash Price |
$3,339.00
|
| Rate for Payer: Cash Price |
$3,339.00
|
| 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 |
$3,539.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,585.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,343.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$981.20
|
| 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 |
$1,355.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,855.00
|
| 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 |
$4,065.75
|
| Rate for Payer: Multiplan Commercial |
$5,565.00
|
| 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 |
$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 BRAIN WITH CONTRAST
|
Facility
|
IP
|
$7,420.00
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
908801012
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$5,565.00 |
| Rate for Payer: Adventist Health Commercial |
$1,484.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,778.48
|
| Rate for Payer: Cash Price |
$3,339.00
|
| Rate for Payer: Cash Price |
$3,339.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,023.34
|
| Rate for Payer: Heritage Provider Network Senior |
$5,023.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,343.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,855.00
|
| Rate for Payer: Multiplan Commercial |
$5,565.00
|
|
|
HC MRI BRAIN WITH CONTRAST
|
Facility
|
OP
|
$11,689.00
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
908801013
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$8,766.75 |
| Rate for Payer: Adventist Health Commercial |
$2,337.80
|
| Rate for Payer: Adventist Health Commercial |
$1,084.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,350.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,223.80
|
| 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 |
$2,711.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,846.84
|
| Rate for Payer: Blue Shield of California Commercial |
$2,826.05
|
| Rate for Payer: Blue Shield of California Commercial |
$2,826.05
|
| Rate for Payer: Blue Shield of California EPN |
$2,272.61
|
| Rate for Payer: Blue Shield of California EPN |
$2,272.61
|
| Rate for Payer: Cash Price |
$2,439.45
|
| Rate for Payer: Cash Price |
$5,260.05
|
| Rate for Payer: Cash Price |
$5,260.05
|
| Rate for Payer: Cash Price |
$5,260.05
|
| Rate for Payer: Cash Price |
$5,260.05
|
| Rate for Payer: Cash Price |
$2,439.45
|
| Rate for Payer: Cash Price |
$2,439.45
|
| Rate for Payer: Cash Price |
$2,439.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: 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 |
$2,585.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5,575.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$981.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,115.71
|
| 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 |
$2,922.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,355.25
|
| 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 |
$8,766.75
|
| Rate for Payer: Multiplan Commercial |
$4,065.75
|
| 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 |
$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 BREAST BILAT W/CONTRAST
|
Facility
|
IP
|
$5,644.00
|
|
|
Service Code
|
CPT 77059
|
| Hospital Charge Code |
908801211
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$4,233.00 |
| Rate for Payer: Adventist Health Commercial |
$1,128.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,634.74
|
| Rate for Payer: Cash Price |
$2,539.80
|
| Rate for Payer: Cash Price |
$2,539.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,820.99
|
| Rate for Payer: Heritage Provider Network Senior |
$3,820.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,021.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,411.00
|
| Rate for Payer: Multiplan Commercial |
$4,233.00
|
|
|
HC MRI BREAST BILAT W/CONTRAST
|
Facility
|
OP
|
$5,310.00
|
|
|
Service Code
|
CPT 77059
|
| Hospital Charge Code |
908801211
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$4,513.50 |
| Rate for Payer: Adventist Health Commercial |
$1,062.00
|
| Rate for Payer: Adventist Health Commercial |
$1,128.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,281.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,487.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,797.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,513.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,104.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,920.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,233.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,656.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,823.13
|
| Rate for Payer: Blue Shield of California Commercial |
$3,442.84
|
| Rate for Payer: Blue Shield of California Commercial |
$3,239.10
|
| Rate for Payer: Blue Shield of California EPN |
$2,591.28
|
| Rate for Payer: Blue Shield of California EPN |
$2,754.27
|
| Rate for Payer: Cash Price |
$2,539.80
|
| Rate for Payer: Cash Price |
$2,539.80
|
| Rate for Payer: Cash Price |
$2,389.50
|
| Rate for Payer: Cash Price |
$2,389.50
|
| Rate for Payer: Cash Price |
$2,389.50
|
| Rate for Payer: Cash Price |
$2,389.50
|
| Rate for Payer: Cash Price |
$2,539.80
|
| Rate for Payer: Cash Price |
$2,539.80
|
| 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 |
$4,797.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,513.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,797.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,513.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,513.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,797.40
|
| 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 |
$2,532.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,692.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$961.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,021.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,411.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,327.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,717.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,950.80
|
| Rate for Payer: Multiplan Commercial |
$4,233.00
|
| Rate for Payer: Multiplan Commercial |
$3,982.50
|
| 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 |
$2,655.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,822.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,655.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,822.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,513.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,797.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,513.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,797.40
|
| Rate for Payer: Vantage Medical Group Senior |
$4,797.40
|
| Rate for Payer: Vantage Medical Group Senior |
$4,513.50
|
|
|
HC MRI BREAST BILAT WO CONTRAST
|
Facility
|
OP
|
$4,232.00
|
|
|
Service Code
|
CPT 77047
|
| Hospital Charge Code |
908801212
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$306.88 |
| Max. Negotiated Rate |
$3,174.00 |
| Rate for Payer: Adventist Health Commercial |
$846.40
|
| Rate for Payer: Adventist Health Commercial |
$970.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,999.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,615.38
|
| 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 |
$2,427.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,116.85
|
| Rate for Payer: Blue Shield of California Commercial |
$995.23
|
| Rate for Payer: Blue Shield of California Commercial |
$995.23
|
| Rate for Payer: Blue Shield of California EPN |
$800.33
|
| Rate for Payer: Blue Shield of California EPN |
$800.33
|
| Rate for Payer: Cash Price |
$2,183.85
|
| Rate for Payer: Cash Price |
$1,904.40
|
| Rate for Payer: Cash Price |
$1,904.40
|
| Rate for Payer: Cash Price |
$1,904.40
|
| Rate for Payer: Cash Price |
$1,904.40
|
| Rate for Payer: Cash Price |
$2,183.85
|
| Rate for Payer: Cash Price |
$2,183.85
|
| Rate for Payer: Cash Price |
$2,183.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: 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 |
$2,314.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,018.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$878.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$765.99
|
| 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 |
$1,058.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,213.25
|
| 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 |
$3,174.00
|
| Rate for Payer: Multiplan Commercial |
$3,639.75
|
| 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 |
$368.90
|
| 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: United Healthcare Navigate/Select/Select+ |
$368.90
|
| 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 BREAST BILAT WO CONTRAST
|
Facility
|
IP
|
$4,232.00
|
|
|
Service Code
|
CPT 77047
|
| Hospital Charge Code |
908801212
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$765.99 |
| Max. Negotiated Rate |
$3,174.00 |
| Rate for Payer: Adventist Health Commercial |
$846.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,725.41
|
| Rate for Payer: Cash Price |
$1,904.40
|
| Rate for Payer: Cash Price |
$1,904.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,865.06
|
| Rate for Payer: Heritage Provider Network Senior |
$2,865.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$765.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,058.00
|
| Rate for Payer: Multiplan Commercial |
$3,174.00
|
|
|
HC MRI BREAST UNI W/CONTRAST
|
Facility
|
IP
|
$5,644.00
|
|
|
Service Code
|
CPT 77058
|
| Hospital Charge Code |
908801217
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$4,233.00 |
| Rate for Payer: Adventist Health Commercial |
$1,128.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,634.74
|
| Rate for Payer: Cash Price |
$2,539.80
|
| Rate for Payer: Cash Price |
$2,539.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,820.99
|
| Rate for Payer: Heritage Provider Network Senior |
$3,820.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,021.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,411.00
|
| Rate for Payer: Multiplan Commercial |
$4,233.00
|
|
|
HC MRI BREAST UNI W/CONTRAST
|
Facility
|
OP
|
$4,998.00
|
|
|
Service Code
|
CPT 77058
|
| Hospital Charge Code |
908801217
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$4,248.30 |
| Rate for Payer: Adventist Health Commercial |
$999.60
|
| Rate for Payer: Adventist Health Commercial |
$1,128.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,088.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,487.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,797.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,248.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,104.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,748.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,748.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,233.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,500.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,823.13
|
| Rate for Payer: Blue Shield of California Commercial |
$3,442.84
|
| Rate for Payer: Blue Shield of California Commercial |
$3,048.78
|
| Rate for Payer: Blue Shield of California EPN |
$2,439.02
|
| Rate for Payer: Blue Shield of California EPN |
$2,754.27
|
| Rate for Payer: Cash Price |
$2,539.80
|
| Rate for Payer: Cash Price |
$2,539.80
|
| Rate for Payer: Cash Price |
$2,249.10
|
| Rate for Payer: Cash Price |
$2,249.10
|
| Rate for Payer: Cash Price |
$2,249.10
|
| Rate for Payer: Cash Price |
$2,249.10
|
| Rate for Payer: Cash Price |
$2,539.80
|
| Rate for Payer: Cash Price |
$2,539.80
|
| 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 |
$4,797.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,248.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,797.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,248.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,248.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,797.40
|
| 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 |
$2,384.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,692.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$904.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,021.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,411.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,249.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,498.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,950.80
|
| Rate for Payer: Multiplan Commercial |
$4,233.00
|
| Rate for Payer: Multiplan Commercial |
$3,748.50
|
| 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 |
$2,499.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,822.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,499.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,822.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,248.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,797.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,248.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,797.40
|
| Rate for Payer: Vantage Medical Group Senior |
$4,797.40
|
| Rate for Payer: Vantage Medical Group Senior |
$4,248.30
|
|
|
HC MRI BREAST UNI WO CONTRAST
|
Facility
|
OP
|
$4,310.00
|
|
|
Service Code
|
CPT 77046
|
| Hospital Charge Code |
908801219
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$306.88 |
| Max. Negotiated Rate |
$3,232.50 |
| Rate for Payer: Adventist Health Commercial |
$862.00
|
| Rate for Payer: Adventist Health Commercial |
$880.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,721.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,663.58
|
| 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 |
$2,202.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,155.86
|
| Rate for Payer: Blue Shield of California Commercial |
$1,001.28
|
| Rate for Payer: Blue Shield of California Commercial |
$1,001.28
|
| Rate for Payer: Blue Shield of California EPN |
$805.20
|
| Rate for Payer: Blue Shield of California EPN |
$805.20
|
| Rate for Payer: Cash Price |
$1,981.80
|
| Rate for Payer: Cash Price |
$1,939.50
|
| Rate for Payer: Cash Price |
$1,939.50
|
| Rate for Payer: Cash Price |
$1,939.50
|
| Rate for Payer: Cash Price |
$1,939.50
|
| Rate for Payer: Cash Price |
$1,981.80
|
| Rate for Payer: Cash Price |
$1,981.80
|
| Rate for Payer: Cash Price |
$1,981.80
|
| 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 |
$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 |
$2,100.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,055.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$797.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$780.11
|
| 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 |
$1,077.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,101.00
|
| 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 |
$3,232.50
|
| Rate for Payer: Multiplan Commercial |
$3,303.00
|
| 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 |
$368.90
|
| 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: United Healthcare Navigate/Select/Select+ |
$368.90
|
| 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 BREAST UNI WO CONTRAST
|
Facility
|
IP
|
$4,404.00
|
|
|
Service Code
|
CPT 77046
|
| Hospital Charge Code |
908801219
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$797.12 |
| Max. Negotiated Rate |
$3,303.00 |
| Rate for Payer: Adventist Health Commercial |
$880.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,836.18
|
| Rate for Payer: Cash Price |
$1,981.80
|
| Rate for Payer: Cash Price |
$1,981.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,981.51
|
| Rate for Payer: Heritage Provider Network Senior |
$2,981.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$797.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,101.00
|
| Rate for Payer: Multiplan Commercial |
$3,303.00
|
|
|
HC MRI BRST BI W WO CNTRST W CAD
|
Facility
|
IP
|
$4,232.00
|
|
|
Service Code
|
CPT 77049
|
| Hospital Charge Code |
908801210
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$765.99 |
| Max. Negotiated Rate |
$3,174.00 |
| Rate for Payer: Adventist Health Commercial |
$846.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,725.41
|
| Rate for Payer: Cash Price |
$1,904.40
|
| Rate for Payer: Cash Price |
$1,904.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,865.06
|
| Rate for Payer: Heritage Provider Network Senior |
$2,865.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$765.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,058.00
|
| Rate for Payer: Multiplan Commercial |
$3,174.00
|
|
|
HC MRI BRST BI W WO CNTRST W CAD
|
Facility
|
OP
|
$4,232.00
|
|
|
Service Code
|
CPT 77049
|
| Hospital Charge Code |
908801210
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$3,597.20 |
| Rate for Payer: Adventist Health Commercial |
$846.40
|
| Rate for Payer: Adventist Health Commercial |
$1,182.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,615.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,653.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,024.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,597.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,327.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,251.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,433.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,174.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,956.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,116.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1,641.02
|
| Rate for Payer: Blue Shield of California Commercial |
$1,641.02
|
| Rate for Payer: Blue Shield of California EPN |
$1,319.66
|
| Rate for Payer: Blue Shield of California EPN |
$1,319.66
|
| Rate for Payer: Cash Price |
$1,904.40
|
| Rate for Payer: Cash Price |
$2,659.95
|
| Rate for Payer: Cash Price |
$1,904.40
|
| Rate for Payer: Cash Price |
$2,659.95
|
| Rate for Payer: Cash Price |
$1,904.40
|
| Rate for Payer: Cash Price |
$1,904.40
|
| Rate for Payer: Cash Price |
$2,659.95
|
| Rate for Payer: Cash Price |
$2,659.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,597.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,024.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,024.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,597.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,597.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,024.35
|
| 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 |
$2,018.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,819.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$765.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,069.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,477.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,058.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,962.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,137.70
|
| Rate for Payer: Multiplan Commercial |
$4,433.25
|
| Rate for Payer: Multiplan Commercial |
$3,174.00
|
| 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 |
$468.80
|
| 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: United Healthcare Navigate/Select/Select+ |
$468.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,024.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,597.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,024.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,597.20
|
| Rate for Payer: Vantage Medical Group Senior |
$5,024.35
|
| Rate for Payer: Vantage Medical Group Senior |
$3,597.20
|
|
|
HC MRI BRST UNI W WO CTRST W CAD
|
Facility
|
OP
|
$4,404.00
|
|
|
Service Code
|
CPT 77048
|
| Hospital Charge Code |
908801215
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$3,743.40 |
| Rate for Payer: Adventist Health Commercial |
$880.80
|
| Rate for Payer: Adventist Health Commercial |
$1,090.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,721.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,370.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,635.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,743.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,422.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,999.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,090.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,303.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,728.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,202.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1,649.14
|
| Rate for Payer: Blue Shield of California Commercial |
$1,649.14
|
| Rate for Payer: Blue Shield of California EPN |
$1,326.18
|
| Rate for Payer: Blue Shield of California EPN |
$1,326.18
|
| Rate for Payer: Cash Price |
$1,981.80
|
| Rate for Payer: Cash Price |
$2,454.30
|
| Rate for Payer: Cash Price |
$1,981.80
|
| Rate for Payer: Cash Price |
$2,454.30
|
| Rate for Payer: Cash Price |
$1,981.80
|
| Rate for Payer: Cash Price |
$1,981.80
|
| Rate for Payer: Cash Price |
$2,454.30
|
| Rate for Payer: Cash Price |
$2,454.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,743.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,635.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,635.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,743.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,743.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,635.90
|
| 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 |
$2,100.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,601.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$797.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$987.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,363.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,101.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,082.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,817.80
|
| Rate for Payer: Multiplan Commercial |
$4,090.50
|
| Rate for Payer: Multiplan Commercial |
$3,303.00
|
| 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 |
$471.10
|
| 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: United Healthcare Navigate/Select/Select+ |
$471.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,635.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,743.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,635.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,743.40
|
| Rate for Payer: Vantage Medical Group Senior |
$4,635.90
|
| Rate for Payer: Vantage Medical Group Senior |
$3,743.40
|
|
|
HC MRI BRST UNI W WO CTRST W CAD
|
Facility
|
IP
|
$4,404.00
|
|
|
Service Code
|
CPT 77048
|
| Hospital Charge Code |
908801215
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$797.12 |
| Max. Negotiated Rate |
$3,303.00 |
| Rate for Payer: Adventist Health Commercial |
$880.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,836.18
|
| Rate for Payer: Cash Price |
$1,981.80
|
| Rate for Payer: Cash Price |
$1,981.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,981.51
|
| Rate for Payer: Heritage Provider Network Senior |
$2,981.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$797.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,101.00
|
| Rate for Payer: Multiplan Commercial |
$3,303.00
|
|
|
HC MRI CHEST W/ CONTRAST
|
Facility
|
IP
|
$5,186.00
|
|
|
Service Code
|
CPT 71551
|
| Hospital Charge Code |
908801201
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$3,889.50 |
| Rate for Payer: Adventist Health Commercial |
$1,037.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,339.78
|
| Rate for Payer: Cash Price |
$2,333.70
|
| Rate for Payer: Cash Price |
$2,333.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,510.92
|
| Rate for Payer: Heritage Provider Network Senior |
$3,510.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$938.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,296.50
|
| Rate for Payer: Multiplan Commercial |
$3,889.50
|
|
|
HC MRI CHEST W/ CONTRAST
|
Facility
|
OP
|
$4,965.00
|
|
|
Service Code
|
CPT 71551
|
| Hospital Charge Code |
908801201
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$3,723.75 |
| Rate for Payer: Adventist Health Commercial |
$993.00
|
| Rate for Payer: Adventist Health Commercial |
$1,037.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,204.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,068.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,512.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,512.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,109.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,109.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,008.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,008.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,594.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,483.49
|
| 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 |
$2,333.70
|
| Rate for Payer: Cash Price |
$2,234.25
|
| Rate for Payer: Cash Price |
$2,234.25
|
| Rate for Payer: Cash Price |
$2,234.25
|
| Rate for Payer: Cash Price |
$2,234.25
|
| Rate for Payer: Cash Price |
$2,333.70
|
| Rate for Payer: Cash Price |
$2,333.70
|
| Rate for Payer: Cash Price |
$2,333.70
|
| 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 |
$1,512.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,512.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,109.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,109.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,008.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,008.25
|
| 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 |
$1,008.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,008.25
|
| 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 |
$1,008.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,008.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,473.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$938.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$898.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,159.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,159.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,241.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,296.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,351.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,351.06
|
| Rate for Payer: Multiplan Commercial |
$3,723.75
|
| Rate for Payer: Multiplan Commercial |
$3,889.50
|
| 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 |
$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 |
$1,512.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,512.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,109.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,109.08
|
| Rate for Payer: Vantage Medical Group Senior |
$1,008.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,008.25
|
|
|
HC MRI CHEST, W/O CONT
|
Facility
|
OP
|
$3,497.00
|
|
|
Service Code
|
CPT 71550
|
| Hospital Charge Code |
908801200
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$306.88 |
| Max. Negotiated Rate |
$2,622.75 |
| Rate for Payer: Adventist Health Commercial |
$699.40
|
| Rate for Payer: Adventist Health Commercial |
$888.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,745.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,161.15
|
| 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 |
$2,221.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,749.20
|
| 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 |
$1,998.90
|
| Rate for Payer: Cash Price |
$1,573.65
|
| Rate for Payer: Cash Price |
$1,573.65
|
| Rate for Payer: Cash Price |
$1,573.65
|
| Rate for Payer: Cash Price |
$1,573.65
|
| Rate for Payer: Cash Price |
$1,998.90
|
| Rate for Payer: Cash Price |
$1,998.90
|
| Rate for Payer: Cash Price |
$1,998.90
|
| 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 |
$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 |
$2,118.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,668.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$804.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$632.96
|
| 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 |
$874.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,110.50
|
| 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 |
$2,622.75
|
| Rate for Payer: Multiplan Commercial |
$3,331.50
|
| 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 |
$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 CHEST, W/O CONT
|
Facility
|
IP
|
$3,497.00
|
|
|
Service Code
|
CPT 71550
|
| Hospital Charge Code |
908801200
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$632.96 |
| Max. Negotiated Rate |
$2,622.75 |
| Rate for Payer: Adventist Health Commercial |
$699.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,252.07
|
| Rate for Payer: Cash Price |
$1,573.65
|
| Rate for Payer: Cash Price |
$1,573.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,367.47
|
| Rate for Payer: Heritage Provider Network Senior |
$2,367.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$632.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$874.25
|
| Rate for Payer: Multiplan Commercial |
$2,622.75
|
|
|
HC MRI CHEST W WO CONTRAST
|
Facility
|
IP
|
$5,578.00
|
|
|
Service Code
|
CPT 71552
|
| Hospital Charge Code |
908801202
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$4,183.50 |
| Rate for Payer: Adventist Health Commercial |
$1,115.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,592.23
|
| Rate for Payer: Cash Price |
$2,510.10
|
| Rate for Payer: Cash Price |
$2,510.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,776.31
|
| Rate for Payer: Heritage Provider Network Senior |
$3,776.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,009.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,394.50
|
| Rate for Payer: Multiplan Commercial |
$4,183.50
|
|
|
HC MRI CHEST W WO CONTRAST
|
Facility
|
OP
|
$5,578.00
|
|
|
Service Code
|
CPT 71552
|
| Hospital Charge Code |
908801202
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$5,144.06 |
| Rate for Payer: Adventist Health Commercial |
$1,115.60
|
| Rate for Payer: Adventist Health Commercial |
$1,229.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,798.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,447.20
|
| 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 |
$3,074.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,790.12
|
| Rate for Payer: Blue Shield of California Commercial |
$5,144.06
|
| Rate for Payer: Blue Shield of California Commercial |
$5,144.06
|
| Rate for Payer: Blue Shield of California EPN |
$4,136.68
|
| Rate for Payer: Blue Shield of California EPN |
$4,136.68
|
| Rate for Payer: Cash Price |
$2,766.15
|
| Rate for Payer: Cash Price |
$2,510.10
|
| Rate for Payer: Cash Price |
$2,510.10
|
| Rate for Payer: Cash Price |
$2,510.10
|
| Rate for Payer: Cash Price |
$2,510.10
|
| Rate for Payer: Cash Price |
$2,766.15
|
| Rate for Payer: Cash Price |
$2,766.15
|
| Rate for Payer: Cash Price |
$2,766.15
|
| 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 |
$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 |
$2,932.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,660.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,112.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,009.62
|
| 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 |
$1,394.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,536.75
|
| 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 |
$4,183.50
|
| Rate for Payer: Multiplan Commercial |
$4,610.25
|
| 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 |
$854.45
|
| 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: United Healthcare Navigate/Select/Select+ |
$854.45
|
| 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
|
|
