|
HC 2-PIECE WITH THORACIC EXT.
|
Facility
|
OP
|
$551.00
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
915350174
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$132.24 |
| Max. Negotiated Rate |
$468.35 |
| Rate for Payer: Adventist Health Commercial |
$225.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$468.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$303.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$413.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$333.52
|
| Rate for Payer: Blue Shield of California Commercial |
$423.72
|
| Rate for Payer: Blue Shield of California Commercial |
$279.36
|
| Rate for Payer: Cash Price |
$247.95
|
| Rate for Payer: Cash Price |
$247.95
|
| Rate for Payer: Cigna of CA HMO |
$385.70
|
| Rate for Payer: Cigna of CA PPO |
$385.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$468.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$468.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$468.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$385.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.40
|
| Rate for Payer: EPIC Health Plan Senior |
$220.40
|
| Rate for Payer: Galaxy Health WC |
$468.35
|
| Rate for Payer: Global Benefits Group Commercial |
$330.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$307.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$349.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$347.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$325.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$385.70
|
| Rate for Payer: Multiplan Commercial |
$440.80
|
| Rate for Payer: Networks By Design Commercial |
$275.50
|
| Rate for Payer: Prime Health Services Commercial |
$468.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$330.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$330.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$206.79
|
| Rate for Payer: United Healthcare All Other HMO |
$201.28
|
| Rate for Payer: United Healthcare HMO Rider |
$196.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$180.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$468.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$468.35
|
| Rate for Payer: Vantage Medical Group Senior |
$468.35
|
|
|
HC 2-PIECE WITH THORACIC EXT.
|
Facility
|
IP
|
$551.00
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
915350174
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$110.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$110.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$247.95
|
| Rate for Payer: Cash Price |
$247.95
|
| Rate for Payer: Cigna of CA HMO |
$385.70
|
| Rate for Payer: Cigna of CA PPO |
$385.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$385.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.40
|
| Rate for Payer: EPIC Health Plan Senior |
$220.40
|
| Rate for Payer: Galaxy Health WC |
$468.35
|
| Rate for Payer: Global Benefits Group Commercial |
$330.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$349.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$325.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.24
|
| Rate for Payer: Multiplan Commercial |
$440.80
|
| Rate for Payer: Networks By Design Commercial |
$358.15
|
| Rate for Payer: Prime Health Services Commercial |
$468.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$206.79
|
| Rate for Payer: United Healthcare All Other HMO |
$201.28
|
| Rate for Payer: United Healthcare HMO Rider |
$196.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$180.45
|
|
|
HC 2-PIECE WITH THORACIC EXT.
|
Facility
|
OP
|
$551.00
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
905350174
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$132.24 |
| Max. Negotiated Rate |
$468.35 |
| Rate for Payer: Adventist Health Commercial |
$225.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$468.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$303.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$413.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$333.52
|
| Rate for Payer: Blue Shield of California Commercial |
$423.72
|
| Rate for Payer: Blue Shield of California Commercial |
$279.36
|
| Rate for Payer: Cash Price |
$247.95
|
| Rate for Payer: Cash Price |
$247.95
|
| Rate for Payer: Cigna of CA HMO |
$385.70
|
| Rate for Payer: Cigna of CA PPO |
$385.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$468.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$468.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$468.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$385.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.40
|
| Rate for Payer: EPIC Health Plan Senior |
$220.40
|
| Rate for Payer: Galaxy Health WC |
$468.35
|
| Rate for Payer: Global Benefits Group Commercial |
$330.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$307.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$349.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$347.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$325.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$385.70
|
| Rate for Payer: Multiplan Commercial |
$440.80
|
| Rate for Payer: Networks By Design Commercial |
$275.50
|
| Rate for Payer: Prime Health Services Commercial |
$468.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$330.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$330.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$206.79
|
| Rate for Payer: United Healthcare All Other HMO |
$201.28
|
| Rate for Payer: United Healthcare HMO Rider |
$196.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$180.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$468.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$468.35
|
| Rate for Payer: Vantage Medical Group Senior |
$468.35
|
|
|
HC 2-PIECE WITH THORACIC EXT.
|
Facility
|
IP
|
$551.00
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
905350174
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$110.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$110.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$247.95
|
| Rate for Payer: Cash Price |
$247.95
|
| Rate for Payer: Cigna of CA HMO |
$385.70
|
| Rate for Payer: Cigna of CA PPO |
$385.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$385.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.40
|
| Rate for Payer: EPIC Health Plan Senior |
$220.40
|
| Rate for Payer: Galaxy Health WC |
$468.35
|
| Rate for Payer: Global Benefits Group Commercial |
$330.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$349.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$325.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.24
|
| Rate for Payer: Multiplan Commercial |
$440.80
|
| Rate for Payer: Networks By Design Commercial |
$358.15
|
| Rate for Payer: Prime Health Services Commercial |
$468.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$206.79
|
| Rate for Payer: United Healthcare All Other HMO |
$201.28
|
| Rate for Payer: United Healthcare HMO Rider |
$196.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$180.45
|
|
|
HC 3D ECHO IMG CGEN CAR ANOMAL
|
Facility
|
IP
|
$1,871.00
|
|
|
Service Code
|
CPT 93319
|
| Hospital Charge Code |
900200319
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$374.20 |
| Max. Negotiated Rate |
$1,590.35 |
| Rate for Payer: Adventist Health Commercial |
$374.20
|
| Rate for Payer: Cash Price |
$841.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,309.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$748.40
|
| Rate for Payer: EPIC Health Plan Senior |
$748.40
|
| Rate for Payer: Galaxy Health WC |
$1,590.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,122.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,188.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,103.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$449.04
|
| Rate for Payer: Multiplan Commercial |
$1,496.80
|
| Rate for Payer: Networks By Design Commercial |
$1,216.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,590.35
|
|
|
HC 3D ECHO IMG CGEN CAR ANOMAL
|
Facility
|
OP
|
$1,871.00
|
|
|
Service Code
|
CPT 93319
|
| Hospital Charge Code |
900200319
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$92.48 |
| Max. Negotiated Rate |
$1,590.35 |
| Rate for Payer: Adventist Health Commercial |
$374.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$161.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,590.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,029.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,403.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,200.62
|
| Rate for Payer: Blue Shield of California Commercial |
$787.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,193.70
|
| Rate for Payer: Cash Price |
$841.95
|
| Rate for Payer: Cash Price |
$841.95
|
| Rate for Payer: Cash Price |
$841.95
|
| Rate for Payer: Cigna of CA HMO |
$1,197.44
|
| Rate for Payer: Cigna of CA PPO |
$1,384.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,590.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,590.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,590.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,309.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$748.40
|
| Rate for Payer: EPIC Health Plan Senior |
$748.40
|
| Rate for Payer: Galaxy Health WC |
$1,590.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,122.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$92.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,188.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$104.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,103.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$449.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,309.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,309.70
|
| Rate for Payer: Multiplan Commercial |
$1,496.80
|
| Rate for Payer: Networks By Design Commercial |
$1,216.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,590.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,122.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,122.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$968.00
|
| Rate for Payer: United Healthcare All Other HMO |
$982.00
|
| Rate for Payer: United Healthcare HMO Rider |
$832.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$762.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,590.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,590.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,590.35
|
|
|
HC 3D RENDERING W/POSTPROCESSING
|
Facility
|
OP
|
$2,311.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909201370
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$462.20 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$462.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,964.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,271.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,733.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,482.97
|
| Rate for Payer: Blue Shield of California Commercial |
$1,474.42
|
| Rate for Payer: Blue Shield of California Commercial |
$972.93
|
| Rate for Payer: Cash Price |
$1,039.95
|
| Rate for Payer: Cash Price |
$1,039.95
|
| Rate for Payer: Cigna of CA HMO |
$1,479.04
|
| Rate for Payer: Cigna of CA PPO |
$1,710.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,964.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,964.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,964.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,617.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$924.40
|
| Rate for Payer: EPIC Health Plan Senior |
$924.40
|
| Rate for Payer: Galaxy Health WC |
$1,964.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,386.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,467.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$838.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,363.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$554.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,617.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,617.70
|
| Rate for Payer: Multiplan Commercial |
$1,848.80
|
| Rate for Payer: Networks By Design Commercial |
$1,502.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,964.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,386.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,386.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,155.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,155.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,155.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,155.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,964.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,964.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,964.35
|
|
|
HC 3D RENDERING W/POSTPROCESSING
|
Facility
|
IP
|
$2,311.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909201370
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$462.20 |
| Max. Negotiated Rate |
$1,964.35 |
| Rate for Payer: Adventist Health Commercial |
$462.20
|
| Rate for Payer: Cash Price |
$1,039.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,617.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$924.40
|
| Rate for Payer: EPIC Health Plan Senior |
$924.40
|
| Rate for Payer: Galaxy Health WC |
$1,964.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,386.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,467.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,363.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$554.64
|
| Rate for Payer: Multiplan Commercial |
$1,848.80
|
| Rate for Payer: Networks By Design Commercial |
$1,502.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,964.35
|
|
|
HC 3-PHASE BONE SCAN
|
Facility
|
OP
|
$3,154.00
|
|
|
Service Code
|
CPT 78315
|
| Hospital Charge Code |
909301372
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$220.25 |
| Max. Negotiated Rate |
$2,680.90 |
| Rate for Payer: Adventist Health Commercial |
$630.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,761.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$514.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,023.92
|
| Rate for Payer: Blue Shield of California Commercial |
$2,012.25
|
| Rate for Payer: Blue Shield of California Commercial |
$1,327.83
|
| Rate for Payer: Cash Price |
$1,419.30
|
| Rate for Payer: Cash Price |
$1,419.30
|
| Rate for Payer: Cigna of CA HMO |
$2,018.56
|
| Rate for Payer: Cigna of CA PPO |
$2,333.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$771.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,207.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$848.38
|
| Rate for Payer: EPIC Health Plan Senior |
$565.59
|
| Rate for Payer: Galaxy Health WC |
$2,680.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,892.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$843.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$220.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$514.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,002.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$249.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$719.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$756.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$647.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$688.99
|
| Rate for Payer: Multiplan Commercial |
$2,523.20
|
| Rate for Payer: Networks By Design Commercial |
$2,050.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,680.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,892.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,892.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$632.16
|
| Rate for Payer: United Healthcare All Other HMO |
$632.16
|
| Rate for Payer: United Healthcare HMO Rider |
$632.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$632.16
|
| Rate for Payer: Upland Medical Group Pediatric |
$514.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Vantage Medical Group Senior |
$514.17
|
|
|
HC 3-PHASE BONE SCAN
|
Facility
|
IP
|
$3,154.00
|
|
|
Service Code
|
CPT 78315
|
| Hospital Charge Code |
909301372
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$630.80 |
| Max. Negotiated Rate |
$2,680.90 |
| Rate for Payer: Adventist Health Commercial |
$630.80
|
| Rate for Payer: Cash Price |
$1,419.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,207.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,261.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,261.60
|
| Rate for Payer: Galaxy Health WC |
$2,680.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,892.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,002.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,860.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$756.96
|
| Rate for Payer: Multiplan Commercial |
$2,523.20
|
| Rate for Payer: Networks By Design Commercial |
$2,050.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,680.90
|
|
|
HC 59 FE CHLORIDE
|
Facility
|
IP
|
$1,217.00
|
|
|
Service Code
|
CPT A4641
|
| Hospital Charge Code |
909301497
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$243.40 |
| Max. Negotiated Rate |
$1,034.45 |
| Rate for Payer: Adventist Health Commercial |
$243.40
|
| Rate for Payer: Blue Shield of California Commercial |
$617.02
|
| Rate for Payer: Blue Shield of California Commercial |
$935.87
|
| Rate for Payer: Cash Price |
$547.65
|
| Rate for Payer: Cigna of CA HMO |
$851.90
|
| Rate for Payer: Cigna of CA PPO |
$851.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$851.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$486.80
|
| Rate for Payer: EPIC Health Plan Senior |
$486.80
|
| Rate for Payer: Galaxy Health WC |
$1,034.45
|
| Rate for Payer: Global Benefits Group Commercial |
$730.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$772.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$718.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.08
|
| Rate for Payer: Multiplan Commercial |
$973.60
|
| Rate for Payer: Networks By Design Commercial |
$608.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,034.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$456.74
|
| Rate for Payer: United Healthcare All Other HMO |
$444.57
|
| Rate for Payer: United Healthcare HMO Rider |
$434.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$398.57
|
|
|
HC 59 FE CHLORIDE
|
Facility
|
OP
|
$1,217.00
|
|
|
Service Code
|
CPT A4641
|
| Hospital Charge Code |
909301497
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$243.40 |
| Max. Negotiated Rate |
$1,034.45 |
| Rate for Payer: Adventist Health Commercial |
$243.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,034.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$669.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$912.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$780.95
|
| Rate for Payer: Cash Price |
$547.65
|
| Rate for Payer: Cigna of CA HMO |
$851.90
|
| Rate for Payer: Cigna of CA PPO |
$851.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,034.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,034.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,034.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$851.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$486.80
|
| Rate for Payer: EPIC Health Plan Senior |
$486.80
|
| Rate for Payer: Galaxy Health WC |
$1,034.45
|
| Rate for Payer: Global Benefits Group Commercial |
$730.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$772.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$718.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$851.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$851.90
|
| Rate for Payer: Multiplan Commercial |
$973.60
|
| Rate for Payer: Networks By Design Commercial |
$608.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,034.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$730.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$730.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$456.74
|
| Rate for Payer: United Healthcare All Other HMO |
$444.57
|
| Rate for Payer: United Healthcare HMO Rider |
$434.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$398.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,034.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,034.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,034.45
|
|
|
HC 5-HIAA BY HPLC
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT 83497
|
| Hospital Charge Code |
900910535
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$133.14 |
| Rate for Payer: Adventist Health Commercial |
$7.60
|
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.14
|
| Rate for Payer: Blue Shield of California Commercial |
$19.36
|
| Rate for Payer: Blue Shield of California Commercial |
$17.52
|
| Rate for Payer: Blue Shield of California Commercial |
$29.27
|
| Rate for Payer: Blue Shield of California Commercial |
$26.49
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna of CA HMO |
$26.88
|
| Rate for Payer: Cigna of CA HMO |
$24.32
|
| Rate for Payer: Cigna of CA PPO |
$28.12
|
| Rate for Payer: Cigna of CA PPO |
$31.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.29
|
| Rate for Payer: EPIC Health Plan Senior |
$14.19
|
| Rate for Payer: EPIC Health Plan Senior |
$14.19
|
| Rate for Payer: Galaxy Health WC |
$32.30
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Global Benefits Group Commercial |
$22.80
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.16
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.29
|
| Rate for Payer: Multiplan Commercial |
$33.60
|
| Rate for Payer: Multiplan Commercial |
$30.40
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: Networks By Design Commercial |
$24.70
|
| Rate for Payer: Prime Health Services Commercial |
$32.30
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.45
|
| Rate for Payer: United Healthcare All Other HMO |
$10.45
|
| Rate for Payer: United Healthcare All Other HMO |
$10.45
|
| Rate for Payer: United Healthcare HMO Rider |
$10.45
|
| Rate for Payer: United Healthcare HMO Rider |
$10.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.45
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.90
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.19
|
| Rate for Payer: Vantage Medical Group Senior |
$12.90
|
| Rate for Payer: Vantage Medical Group Senior |
$12.90
|
|
|
HC 5-HIAA BY HPLC
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 83497
|
| Hospital Charge Code |
900910535
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$35.70 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16.80
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.08
|
| Rate for Payer: Multiplan Commercial |
$33.60
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
|
|
HC ABCESS CATH EXCHANGE
|
Facility
|
OP
|
$2,408.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
909001859
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$175.59 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$481.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,046.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,324.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$925.04
|
| Rate for Payer: Blue Shield of California Commercial |
$1,536.30
|
| Rate for Payer: Blue Shield of California Commercial |
$1,013.77
|
| Rate for Payer: Cash Price |
$1,083.60
|
| Rate for Payer: Cash Price |
$1,083.60
|
| Rate for Payer: Cash Price |
$1,083.60
|
| Rate for Payer: Cigna of CA HMO |
$1,541.12
|
| Rate for Payer: Cigna of CA PPO |
$1,781.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,046.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,046.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,046.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,685.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$963.20
|
| Rate for Payer: EPIC Health Plan Senior |
$963.20
|
| Rate for Payer: Galaxy Health WC |
$2,046.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,444.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$175.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,529.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$198.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,420.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$577.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,685.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,685.60
|
| Rate for Payer: Multiplan Commercial |
$1,926.40
|
| Rate for Payer: Networks By Design Commercial |
$1,565.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,046.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,444.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,444.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,204.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,204.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,204.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,204.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,046.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,046.80
|
| Rate for Payer: Vantage Medical Group Senior |
$2,046.80
|
|
|
HC ABCESS CATH EXCHANGE
|
Facility
|
IP
|
$2,408.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
909001859
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$481.60 |
| Max. Negotiated Rate |
$2,046.80 |
| Rate for Payer: Adventist Health Commercial |
$481.60
|
| Rate for Payer: Cash Price |
$1,083.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,685.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$963.20
|
| Rate for Payer: EPIC Health Plan Senior |
$963.20
|
| Rate for Payer: Galaxy Health WC |
$2,046.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,444.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,529.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,420.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$577.92
|
| Rate for Payer: Multiplan Commercial |
$1,926.40
|
| Rate for Payer: Networks By Design Commercial |
$1,565.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,046.80
|
|
|
HC ABDOMEN KUB SUPINE
|
Facility
|
IP
|
$592.00
|
|
|
Service Code
|
CPT 74018
|
| Hospital Charge Code |
909001702
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$118.40 |
| Max. Negotiated Rate |
$503.20 |
| Rate for Payer: Adventist Health Commercial |
$118.40
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$414.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$236.80
|
| Rate for Payer: EPIC Health Plan Senior |
$236.80
|
| Rate for Payer: Galaxy Health WC |
$503.20
|
| Rate for Payer: Global Benefits Group Commercial |
$355.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$375.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$349.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.08
|
| Rate for Payer: Multiplan Commercial |
$473.60
|
| Rate for Payer: Networks By Design Commercial |
$384.80
|
| Rate for Payer: Prime Health Services Commercial |
$503.20
|
|
|
HC ABDOMEN KUB SUPINE
|
Facility
|
OP
|
$592.00
|
|
|
Service Code
|
CPT 74018
|
| Hospital Charge Code |
909001702
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$41.33 |
| Max. Negotiated Rate |
$503.20 |
| Rate for Payer: Adventist Health Commercial |
$118.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$126.67
|
| 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 Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$203.26
|
| Rate for Payer: Blue Shield of California Commercial |
$249.23
|
| Rate for Payer: Blue Shield of California Commercial |
$377.70
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cigna of CA HMO |
$378.88
|
| Rate for Payer: Cigna of CA PPO |
$438.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$414.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$503.20
|
| Rate for Payer: Global Benefits Group Commercial |
$355.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$41.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$375.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$141.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$473.60
|
| Rate for Payer: Networks By Design Commercial |
$384.80
|
| Rate for Payer: Prime Health Services Commercial |
$503.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$355.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$355.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$159.01
|
| Rate for Payer: United Healthcare All Other HMO |
$159.01
|
| Rate for Payer: United Healthcare HMO Rider |
$159.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.93
|
| 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 Senior |
$111.93
|
|
|
HC ABDOMEN/RETROPERIT PERC BIO
|
Facility
|
IP
|
$4,137.00
|
|
|
Service Code
|
CPT 49180
|
| Hospital Charge Code |
909000161
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$827.40 |
| Max. Negotiated Rate |
$3,516.45 |
| Rate for Payer: Adventist Health Commercial |
$827.40
|
| Rate for Payer: Cash Price |
$1,861.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,895.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,654.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,654.80
|
| Rate for Payer: Galaxy Health WC |
$3,516.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,482.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,626.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,440.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$992.88
|
| Rate for Payer: Multiplan Commercial |
$3,309.60
|
| Rate for Payer: Networks By Design Commercial |
$2,689.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,516.45
|
|
|
HC ABDOMEN/RETROPERIT PERC BIO
|
Facility
|
OP
|
$4,137.00
|
|
|
Service Code
|
CPT 49180
|
| Hospital Charge Code |
909000161
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$419.68 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$827.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$1,861.65
|
| Rate for Payer: Cash Price |
$1,861.65
|
| Rate for Payer: Cash Price |
$1,861.65
|
| Rate for Payer: Cigna of CA HMO |
$2,647.68
|
| Rate for Payer: Cigna of CA PPO |
$3,061.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,895.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,504.98
|
| Rate for Payer: EPIC Health Plan Senior |
$2,336.65
|
| Rate for Payer: Galaxy Health WC |
$3,516.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,482.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,483.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$419.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,626.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$474.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,973.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$992.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,676.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$3,309.60
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$2,689.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,516.45
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,482.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,068.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,124.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
HC ABDOMEN SINGLE AP VIEW
|
Facility
|
OP
|
$592.00
|
|
|
Service Code
|
CPT 74018
|
| Hospital Charge Code |
909001175
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$41.33 |
| Max. Negotiated Rate |
$503.20 |
| Rate for Payer: Adventist Health Commercial |
$118.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$126.67
|
| 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 Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$203.26
|
| Rate for Payer: Blue Shield of California Commercial |
$249.23
|
| Rate for Payer: Blue Shield of California Commercial |
$377.70
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cigna of CA HMO |
$378.88
|
| Rate for Payer: Cigna of CA PPO |
$438.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$414.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$503.20
|
| Rate for Payer: Global Benefits Group Commercial |
$355.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$41.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$375.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$141.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$473.60
|
| Rate for Payer: Networks By Design Commercial |
$384.80
|
| Rate for Payer: Prime Health Services Commercial |
$503.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$355.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$355.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$159.01
|
| Rate for Payer: United Healthcare All Other HMO |
$159.01
|
| Rate for Payer: United Healthcare HMO Rider |
$159.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.93
|
| 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 Senior |
$111.93
|
|
|
HC ABDOMEN SINGLE AP VIEW
|
Facility
|
IP
|
$592.00
|
|
|
Service Code
|
CPT 74018
|
| Hospital Charge Code |
909001175
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$118.40 |
| Max. Negotiated Rate |
$503.20 |
| Rate for Payer: Adventist Health Commercial |
$118.40
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$414.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$236.80
|
| Rate for Payer: EPIC Health Plan Senior |
$236.80
|
| Rate for Payer: Galaxy Health WC |
$503.20
|
| Rate for Payer: Global Benefits Group Commercial |
$355.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$375.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$349.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.08
|
| Rate for Payer: Multiplan Commercial |
$473.60
|
| Rate for Payer: Networks By Design Commercial |
$384.80
|
| Rate for Payer: Prime Health Services Commercial |
$503.20
|
|
|
HC ABDOMEN THREE OR MORE VIEWS
|
Facility
|
IP
|
$926.00
|
|
|
Service Code
|
CPT 74021
|
| Hospital Charge Code |
909074021
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$185.20 |
| Max. Negotiated Rate |
$787.10 |
| Rate for Payer: Adventist Health Commercial |
$185.20
|
| Rate for Payer: Cash Price |
$416.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$648.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$370.40
|
| Rate for Payer: EPIC Health Plan Senior |
$370.40
|
| Rate for Payer: Galaxy Health WC |
$787.10
|
| Rate for Payer: Global Benefits Group Commercial |
$555.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$588.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$546.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.24
|
| Rate for Payer: Multiplan Commercial |
$740.80
|
| Rate for Payer: Networks By Design Commercial |
$601.90
|
| Rate for Payer: Prime Health Services Commercial |
$787.10
|
|
|
HC ABDOMEN THREE OR MORE VIEWS
|
Facility
|
OP
|
$926.00
|
|
|
Service Code
|
CPT 74021
|
| Hospital Charge Code |
909074021
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$62.83 |
| Max. Negotiated Rate |
$787.10 |
| Rate for Payer: Adventist Health Commercial |
$185.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$176.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$284.21
|
| Rate for Payer: Blue Shield of California Commercial |
$389.85
|
| Rate for Payer: Blue Shield of California Commercial |
$590.79
|
| Rate for Payer: Cash Price |
$416.70
|
| Rate for Payer: Cash Price |
$416.70
|
| Rate for Payer: Cigna of CA HMO |
$592.64
|
| Rate for Payer: Cigna of CA PPO |
$685.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$648.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$787.10
|
| Rate for Payer: Global Benefits Group Commercial |
$555.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$62.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$588.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$71.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$740.80
|
| Rate for Payer: Networks By Design Commercial |
$601.90
|
| Rate for Payer: Prime Health Services Commercial |
$787.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$555.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$555.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$303.97
|
| Rate for Payer: United Healthcare All Other HMO |
$303.97
|
| Rate for Payer: United Healthcare HMO Rider |
$303.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$303.97
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC ABDOMEN TWO VIEWS
|
Facility
|
OP
|
$741.00
|
|
|
Service Code
|
CPT 74019
|
| Hospital Charge Code |
909074019
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$50.50 |
| Max. Negotiated Rate |
$629.85 |
| Rate for Payer: Adventist Health Commercial |
$148.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$151.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$243.70
|
| Rate for Payer: Blue Shield of California Commercial |
$311.96
|
| Rate for Payer: Blue Shield of California Commercial |
$472.76
|
| Rate for Payer: Cash Price |
$333.45
|
| Rate for Payer: Cash Price |
$333.45
|
| Rate for Payer: Cigna of CA HMO |
$474.24
|
| Rate for Payer: Cigna of CA PPO |
$548.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$518.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$629.85
|
| Rate for Payer: Global Benefits Group Commercial |
$444.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$50.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$470.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$592.80
|
| Rate for Payer: Networks By Design Commercial |
$481.65
|
| Rate for Payer: Prime Health Services Commercial |
$629.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$444.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$444.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$303.97
|
| Rate for Payer: United Healthcare All Other HMO |
$303.97
|
| Rate for Payer: United Healthcare HMO Rider |
$303.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$303.97
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
