|
HC MRI FETAL PELVIC IMG 1ST FETUS
|
Facility
|
OP
|
$1,551.00
|
|
|
Service Code
|
CPT 74712
|
| Hospital Charge Code |
908874712
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$280.73 |
| Max. Negotiated Rate |
$5,526.95 |
| Rate for Payer: Adventist Health Commercial |
$310.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$958.52
|
| 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 Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,526.95
|
| Rate for Payer: Blue Shield of California Commercial |
$1,865.23
|
| Rate for Payer: Blue Shield of California EPN |
$1,499.96
|
| Rate for Payer: Cash Price |
$697.95
|
| Rate for Payer: Cash Price |
$697.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,008.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$915.09
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$960.07
|
| Rate for Payer: Heritage Provider Network Senior |
$960.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$739.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$280.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$352.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$387.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$1,163.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$306.88
|
| Rate for Payer: TriValley Medical Group Senior |
$306.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$437.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$437.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC MRI FETAL PELVIC IMG 1ST FETUS
|
Facility
|
IP
|
$1,551.00
|
|
|
Service Code
|
CPT 74712
|
| Hospital Charge Code |
908874712
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$280.73 |
| Max. Negotiated Rate |
$1,163.25 |
| Rate for Payer: Adventist Health Commercial |
$310.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$998.84
|
| Rate for Payer: Cash Price |
$697.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,050.03
|
| Rate for Payer: Heritage Provider Network Senior |
$1,050.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$280.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$387.75
|
| Rate for Payer: Multiplan Commercial |
$1,163.25
|
|
|
HC MRI FETAL PELVIC IMG ADD FETUS
|
Facility
|
OP
|
$741.00
|
|
|
Service Code
|
CPT 74713
|
| Hospital Charge Code |
908874713
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$134.12 |
| Max. Negotiated Rate |
$2,368.18 |
| Rate for Payer: Adventist Health Commercial |
$148.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$457.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$629.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$407.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$555.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,368.18
|
| Rate for Payer: Blue Shield of California Commercial |
$799.30
|
| Rate for Payer: Blue Shield of California EPN |
$642.77
|
| Rate for Payer: Cash Price |
$333.45
|
| Rate for Payer: Cash Price |
$333.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$481.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$629.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$629.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$629.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$437.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$458.68
|
| Rate for Payer: Heritage Provider Network Senior |
$458.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$353.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$134.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$518.70
|
| Rate for Payer: Multiplan Commercial |
$555.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$370.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$370.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$629.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$629.85
|
| Rate for Payer: Vantage Medical Group Senior |
$629.85
|
|
|
HC MRI FETAL PELVIC IMG ADD FETUS
|
Facility
|
IP
|
$741.00
|
|
|
Service Code
|
CPT 74713
|
| Hospital Charge Code |
908874713
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$134.12 |
| Max. Negotiated Rate |
$555.75 |
| Rate for Payer: Adventist Health Commercial |
$148.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$477.20
|
| Rate for Payer: Cash Price |
$333.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$501.66
|
| Rate for Payer: Heritage Provider Network Senior |
$501.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$134.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.25
|
| Rate for Payer: Multiplan Commercial |
$555.75
|
|
|
HC MRI GUID BX/NEEDLE LOC/ASPIR
|
Facility
|
OP
|
$6,290.00
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
909002020
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$5,346.50 |
| Rate for Payer: Adventist Health Commercial |
$1,258.00
|
| Rate for Payer: Adventist Health Commercial |
$598.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,887.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,849.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,346.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,544.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,646.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,459.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,717.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,244.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,497.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,146.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1,848.96
|
| Rate for Payer: Blue Shield of California Commercial |
$1,848.96
|
| Rate for Payer: Blue Shield of California EPN |
$1,486.87
|
| Rate for Payer: Blue Shield of California EPN |
$1,486.87
|
| Rate for Payer: Cash Price |
$1,346.85
|
| Rate for Payer: Cash Price |
$2,830.50
|
| Rate for Payer: Cash Price |
$1,346.85
|
| Rate for Payer: Cash Price |
$1,346.85
|
| Rate for Payer: Cash Price |
$1,346.85
|
| Rate for Payer: Cash Price |
$2,830.50
|
| Rate for Payer: Cash Price |
$2,830.50
|
| Rate for Payer: Cash Price |
$2,830.50
|
| 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 |
$2,544.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,346.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,544.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,346.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,544.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,346.50
|
| 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 |
$3,000.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,427.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$541.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,138.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,572.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$748.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,403.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,095.10
|
| Rate for Payer: Multiplan Commercial |
$4,717.50
|
| Rate for Payer: Multiplan Commercial |
$2,244.75
|
| 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 |
$1,496.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,145.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,496.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,145.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,544.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,346.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,544.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,346.50
|
| Rate for Payer: Vantage Medical Group Senior |
$5,346.50
|
| Rate for Payer: Vantage Medical Group Senior |
$2,544.05
|
|
|
HC MRI GUID BX/NEEDLE LOC/ASPIR
|
Facility
|
IP
|
$2,993.00
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
909002020
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$541.73 |
| Max. Negotiated Rate |
$2,244.75 |
| Rate for Payer: Adventist Health Commercial |
$598.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,927.49
|
| Rate for Payer: Cash Price |
$1,346.85
|
| Rate for Payer: Cash Price |
$1,346.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,026.26
|
| Rate for Payer: Heritage Provider Network Senior |
$2,026.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$541.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$748.25
|
| Rate for Payer: Multiplan Commercial |
$2,244.75
|
|
|
HC MRI INSERTABLE IMAGING COIL
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
CPT C1770
|
| Hospital Charge Code |
908801710
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$105.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$338.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$211.05
|
| Rate for Payer: Blue Shield of California EPN |
$211.05
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$241.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$283.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$243.07
|
| Rate for Payer: Heritage Provider Network Senior |
$243.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$262.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$262.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$262.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.25
|
| Rate for Payer: Multiplan Commercial |
$393.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$189.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$173.83
|
|
|
HC MRI INSERTABLE IMAGING COIL
|
Facility
|
OP
|
$525.00
|
|
|
Service Code
|
CPT C1770
|
| Hospital Charge Code |
908801710
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$105.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$324.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$446.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$288.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$393.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$211.05
|
| Rate for Payer: Blue Shield of California EPN |
$211.05
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$241.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$446.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$446.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$446.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$336.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$243.07
|
| Rate for Payer: Heritage Provider Network Senior |
$243.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$262.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$262.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$262.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$367.50
|
| Rate for Payer: Multiplan Commercial |
$393.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$189.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$173.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$446.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$446.25
|
| Rate for Payer: Vantage Medical Group Senior |
$446.25
|
|
|
HC MRI LOWER EXTREMITY W/O CON
|
Facility
|
IP
|
$3,650.00
|
|
|
Service Code
|
CPT 73718
|
| Hospital Charge Code |
908801402
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$660.65 |
| Max. Negotiated Rate |
$2,737.50 |
| Rate for Payer: Adventist Health Commercial |
$730.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,350.60
|
| Rate for Payer: Cash Price |
$1,642.50
|
| Rate for Payer: Cash Price |
$1,642.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,471.05
|
| Rate for Payer: Heritage Provider Network Senior |
$2,471.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$660.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$912.50
|
| Rate for Payer: Multiplan Commercial |
$2,737.50
|
|
|
HC MRI LOWER EXTREMITY W/O CON
|
Facility
|
OP
|
$3,650.00
|
|
|
Service Code
|
CPT 73718
|
| Hospital Charge Code |
908801402
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$306.88 |
| Max. Negotiated Rate |
$2,737.50 |
| Rate for Payer: Adventist Health Commercial |
$730.00
|
| Rate for Payer: Adventist Health Commercial |
$801.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,475.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,255.70
|
| 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 |
$2,003.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,825.73
|
| Rate for Payer: Blue Shield of California Commercial |
$2,326.75
|
| Rate for Payer: Blue Shield of California Commercial |
$2,326.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,871.10
|
| Rate for Payer: Blue Shield of California EPN |
$1,871.10
|
| Rate for Payer: Cash Price |
$1,802.25
|
| Rate for Payer: Cash Price |
$1,642.50
|
| Rate for Payer: Cash Price |
$1,642.50
|
| Rate for Payer: Cash Price |
$1,642.50
|
| Rate for Payer: Cash Price |
$1,642.50
|
| Rate for Payer: Cash Price |
$1,802.25
|
| Rate for Payer: Cash Price |
$1,802.25
|
| Rate for Payer: Cash Price |
$1,802.25
|
| 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 |
$1,910.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,741.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$724.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$660.65
|
| 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 |
$912.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,001.25
|
| 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 |
$2,737.50
|
| Rate for Payer: Multiplan Commercial |
$3,003.75
|
| 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 |
$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 LOWER EXTREM WO CONT
|
Facility
|
OP
|
$4,388.00
|
|
|
Service Code
|
CPT 73720
|
| Hospital Charge Code |
908801399
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$5,167.15 |
| Rate for Payer: Adventist Health Commercial |
$877.60
|
| Rate for Payer: Adventist Health Commercial |
$1,002.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,097.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,711.78
|
| 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 |
$2,507.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,194.88
|
| Rate for Payer: Blue Shield of California Commercial |
$5,167.15
|
| Rate for Payer: Blue Shield of California Commercial |
$5,167.15
|
| Rate for Payer: Blue Shield of California EPN |
$4,155.25
|
| Rate for Payer: Blue Shield of California EPN |
$4,155.25
|
| Rate for Payer: Cash Price |
$2,255.40
|
| Rate for Payer: Cash Price |
$1,974.60
|
| Rate for Payer: Cash Price |
$1,974.60
|
| Rate for Payer: Cash Price |
$1,974.60
|
| Rate for Payer: Cash Price |
$1,974.60
|
| Rate for Payer: Cash Price |
$2,255.40
|
| Rate for Payer: Cash Price |
$2,255.40
|
| Rate for Payer: Cash Price |
$2,255.40
|
| 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 |
$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 |
$2,390.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,093.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$907.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$794.23
|
| 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 |
$1,097.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,253.00
|
| 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 |
$3,291.00
|
| Rate for Payer: Multiplan Commercial |
$3,759.00
|
| 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 |
$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
|
|
|
HC MRI LOWER EXTREM WO CONT
|
Facility
|
IP
|
$4,388.00
|
|
|
Service Code
|
CPT 73720
|
| Hospital Charge Code |
908801399
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$794.23 |
| Max. Negotiated Rate |
$3,291.00 |
| Rate for Payer: Adventist Health Commercial |
$877.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,825.87
|
| Rate for Payer: Cash Price |
$1,974.60
|
| Rate for Payer: Cash Price |
$1,974.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,970.68
|
| Rate for Payer: Heritage Provider Network Senior |
$2,970.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$794.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,097.00
|
| Rate for Payer: Multiplan Commercial |
$3,291.00
|
|
|
HC MRI L-SPINE W & WO CONTRAST
|
Facility
|
IP
|
$6,052.00
|
|
|
Service Code
|
CPT 72158
|
| Hospital Charge Code |
908801124
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$4,539.00 |
| Rate for Payer: Adventist Health Commercial |
$1,210.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,897.49
|
| Rate for Payer: Cash Price |
$2,723.40
|
| Rate for Payer: Cash Price |
$2,723.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,097.20
|
| Rate for Payer: Heritage Provider Network Senior |
$4,097.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,095.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,513.00
|
| Rate for Payer: Multiplan Commercial |
$4,539.00
|
|
|
HC MRI L-SPINE W & WO CONTRAST
|
Facility
|
OP
|
$5,667.00
|
|
|
Service Code
|
CPT 72158
|
| Hospital Charge Code |
908801124
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$5,235.12 |
| Rate for Payer: Adventist Health Commercial |
$1,133.40
|
| Rate for Payer: Adventist Health Commercial |
$1,210.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,740.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,502.21
|
| 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 |
$3,027.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,834.63
|
| Rate for Payer: Blue Shield of California Commercial |
$5,235.12
|
| Rate for Payer: Blue Shield of California Commercial |
$5,235.12
|
| Rate for Payer: Blue Shield of California EPN |
$4,209.91
|
| Rate for Payer: Blue Shield of California EPN |
$4,209.91
|
| Rate for Payer: Cash Price |
$2,723.40
|
| Rate for Payer: Cash Price |
$2,550.15
|
| Rate for Payer: Cash Price |
$2,550.15
|
| Rate for Payer: Cash Price |
$2,550.15
|
| Rate for Payer: Cash Price |
$2,550.15
|
| Rate for Payer: Cash Price |
$2,723.40
|
| Rate for Payer: Cash Price |
$2,723.40
|
| Rate for Payer: Cash Price |
$2,723.40
|
| 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 |
$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 |
$2,886.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,703.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,095.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,025.73
|
| 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 |
$1,416.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,513.00
|
| 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 |
$4,250.25
|
| Rate for Payer: Multiplan Commercial |
$4,539.00
|
| 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 |
$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
|
|
|
HC MRI LUMBAR SPINE W CONTRAST
|
Facility
|
OP
|
$4,990.00
|
|
|
Service Code
|
CPT 72149
|
| Hospital Charge Code |
908801122
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$3,742.50 |
| Rate for Payer: Adventist Health Commercial |
$998.00
|
| Rate for Payer: Adventist Health Commercial |
$1,030.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,182.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,083.82
|
| 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 |
$2,576.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,496.00
|
| 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 |
$2,317.50
|
| Rate for Payer: Cash Price |
$2,245.50
|
| Rate for Payer: Cash Price |
$2,245.50
|
| Rate for Payer: Cash Price |
$2,245.50
|
| Rate for Payer: Cash Price |
$2,245.50
|
| Rate for Payer: Cash Price |
$2,317.50
|
| Rate for Payer: Cash Price |
$2,317.50
|
| Rate for Payer: Cash Price |
$2,317.50
|
| 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 |
$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 |
$2,456.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,380.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$932.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$903.19
|
| 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 |
$1,247.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,287.50
|
| 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 |
$3,742.50
|
| Rate for Payer: Multiplan Commercial |
$3,862.50
|
| 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 |
$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 LUMBAR SPINE W CONTRAST
|
Facility
|
IP
|
$4,990.00
|
|
|
Service Code
|
CPT 72149
|
| Hospital Charge Code |
908801122
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$903.19 |
| Max. Negotiated Rate |
$3,742.50 |
| Rate for Payer: Adventist Health Commercial |
$998.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,213.56
|
| Rate for Payer: Cash Price |
$2,245.50
|
| Rate for Payer: Cash Price |
$2,245.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,378.23
|
| Rate for Payer: Heritage Provider Network Senior |
$3,378.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$903.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,247.50
|
| Rate for Payer: Multiplan Commercial |
$3,742.50
|
|
|
HC MRI PELVIS W/CONTRAST
|
Facility
|
IP
|
$3,705.00
|
|
|
Service Code
|
CPT 72196
|
| Hospital Charge Code |
908801350
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$670.61 |
| Max. Negotiated Rate |
$2,778.75 |
| Rate for Payer: Adventist Health Commercial |
$741.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,386.02
|
| Rate for Payer: Cash Price |
$1,667.25
|
| Rate for Payer: Cash Price |
$1,667.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,508.28
|
| Rate for Payer: Heritage Provider Network Senior |
$2,508.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$670.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$926.25
|
| Rate for Payer: Multiplan Commercial |
$2,778.75
|
|
|
HC MRI PELVIS W/CONTRAST
|
Facility
|
OP
|
$3,705.00
|
|
|
Service Code
|
CPT 72196
|
| Hospital Charge Code |
908801350
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$2,800.03 |
| Rate for Payer: Adventist Health Commercial |
$741.00
|
| Rate for Payer: Adventist Health Commercial |
$1,030.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,182.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,289.69
|
| 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 |
$2,576.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,853.24
|
| 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 |
$2,317.50
|
| Rate for Payer: Cash Price |
$1,667.25
|
| Rate for Payer: Cash Price |
$1,667.25
|
| Rate for Payer: Cash Price |
$1,667.25
|
| Rate for Payer: Cash Price |
$1,667.25
|
| Rate for Payer: Cash Price |
$2,317.50
|
| Rate for Payer: Cash Price |
$2,317.50
|
| Rate for Payer: Cash Price |
$2,317.50
|
| 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 |
$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 |
$2,456.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,767.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$932.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$670.61
|
| 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 |
$926.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,287.50
|
| 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 |
$2,778.75
|
| Rate for Payer: Multiplan Commercial |
$3,862.50
|
| 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 |
$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 PELVIS W/O CONTRAST
|
Facility
|
IP
|
$3,705.00
|
|
|
Service Code
|
CPT 72195
|
| Hospital Charge Code |
908801351
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$670.61 |
| Max. Negotiated Rate |
$2,778.75 |
| Rate for Payer: Adventist Health Commercial |
$741.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,386.02
|
| Rate for Payer: Cash Price |
$1,667.25
|
| Rate for Payer: Cash Price |
$1,667.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,508.28
|
| Rate for Payer: Heritage Provider Network Senior |
$2,508.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$670.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$926.25
|
| Rate for Payer: Multiplan Commercial |
$2,778.75
|
|
|
HC MRI PELVIS W/O CONTRAST
|
Facility
|
OP
|
$3,705.00
|
|
|
Service Code
|
CPT 72195
|
| Hospital Charge Code |
908801351
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$306.88 |
| Max. Negotiated Rate |
$2,778.75 |
| Rate for Payer: Adventist Health Commercial |
$741.00
|
| 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 |
$2,289.69
|
| 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 |
$1,853.24
|
| 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 |
$1,667.25
|
| Rate for Payer: Cash Price |
$1,667.25
|
| Rate for Payer: Cash Price |
$1,667.25
|
| Rate for Payer: Cash Price |
$1,667.25
|
| 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 |
$1,767.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$848.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$670.61
|
| 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 |
$926.25
|
| 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 |
$2,778.75
|
| 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 PELVIS W & WO CONTRAST
|
Facility
|
OP
|
$5,607.00
|
|
|
Service Code
|
CPT 72197
|
| Hospital Charge Code |
908801352
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$5,178.72 |
| Rate for Payer: Adventist Health Commercial |
$1,121.40
|
| Rate for Payer: Adventist Health Commercial |
$1,236.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,819.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,465.13
|
| 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 |
$3,091.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,804.62
|
| Rate for Payer: Blue Shield of California Commercial |
$5,178.72
|
| Rate for Payer: Blue Shield of California Commercial |
$5,178.72
|
| Rate for Payer: Blue Shield of California EPN |
$4,164.55
|
| Rate for Payer: Blue Shield of California EPN |
$4,164.55
|
| Rate for Payer: Cash Price |
$2,781.00
|
| Rate for Payer: Cash Price |
$2,523.15
|
| Rate for Payer: Cash Price |
$2,523.15
|
| Rate for Payer: Cash Price |
$2,523.15
|
| Rate for Payer: Cash Price |
$2,523.15
|
| Rate for Payer: Cash Price |
$2,781.00
|
| Rate for Payer: Cash Price |
$2,781.00
|
| Rate for Payer: Cash Price |
$2,781.00
|
| 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 |
$2,947.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,674.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,118.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,014.87
|
| 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 |
$1,401.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,545.00
|
| 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 |
$4,205.25
|
| Rate for Payer: Multiplan Commercial |
$4,635.00
|
| 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 |
$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
|
|
|
HC MRI PELVIS W & WO CONTRAST
|
Facility
|
IP
|
$5,607.00
|
|
|
Service Code
|
CPT 72197
|
| Hospital Charge Code |
908801352
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$4,205.25 |
| Rate for Payer: Adventist Health Commercial |
$1,121.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,610.91
|
| Rate for Payer: Cash Price |
$2,523.15
|
| Rate for Payer: Cash Price |
$2,523.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,795.94
|
| Rate for Payer: Heritage Provider Network Senior |
$3,795.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,014.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,401.75
|
| Rate for Payer: Multiplan Commercial |
$4,205.25
|
|
|
HC MRI PROCEDURE
|
Facility
|
IP
|
$2,672.00
|
|
|
Service Code
|
CPT 76498
|
| Hospital Charge Code |
908801008
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$483.63 |
| Max. Negotiated Rate |
$2,004.00 |
| Rate for Payer: Adventist Health Commercial |
$534.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,720.77
|
| Rate for Payer: Cash Price |
$1,202.40
|
| Rate for Payer: Cash Price |
$1,202.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,808.94
|
| Rate for Payer: Heritage Provider Network Senior |
$1,808.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$483.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$668.00
|
| Rate for Payer: Multiplan Commercial |
$2,004.00
|
|
|
HC MRI PROCEDURE
|
Facility
|
OP
|
$2,672.00
|
|
|
Service Code
|
CPT 76498
|
| Hospital Charge Code |
908801008
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$111.93 |
| Max. Negotiated Rate |
$2,004.00 |
| Rate for Payer: Adventist Health Commercial |
$534.40
|
| Rate for Payer: Adventist Health Commercial |
$632.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,955.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,651.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,582.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,336.53
|
| Rate for Payer: Blue Shield of California Commercial |
$1,930.04
|
| Rate for Payer: Blue Shield of California Commercial |
$1,629.92
|
| Rate for Payer: Blue Shield of California EPN |
$1,303.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,544.03
|
| Rate for Payer: Cash Price |
$1,423.80
|
| Rate for Payer: Cash Price |
$1,202.40
|
| Rate for Payer: Cash Price |
$1,202.40
|
| Rate for Payer: Cash Price |
$1,423.80
|
| Rate for Payer: Cash Price |
$1,423.80
|
| Rate for Payer: Cash Price |
$1,202.40
|
| Rate for Payer: Cash Price |
$1,423.80
|
| Rate for Payer: Cash Price |
$1,202.40
|
| 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 |
$167.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| 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 |
$111.93
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.93
|
| 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 |
$111.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,274.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,509.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$483.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$572.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$668.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$791.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$2,004.00
|
| Rate for Payer: Multiplan Commercial |
$2,373.00
|
| 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 |
$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 |
$167.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC MRI SPECTROSCOPY
|
Facility
|
IP
|
$3,474.00
|
|
|
Service Code
|
CPT 76390
|
| Hospital Charge Code |
908801255
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$628.79 |
| Max. Negotiated Rate |
$2,605.50 |
| Rate for Payer: Adventist Health Commercial |
$694.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,237.26
|
| Rate for Payer: Cash Price |
$1,563.30
|
| Rate for Payer: Cash Price |
$1,563.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,351.90
|
| Rate for Payer: Heritage Provider Network Senior |
$2,351.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$628.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$868.50
|
| Rate for Payer: Multiplan Commercial |
$2,605.50
|
|
