|
HC CRYOCAUTERY OF CERVIX
|
Facility
|
IP
|
$1,137.00
|
|
|
Service Code
|
CPT 57511
|
| Hospital Charge Code |
900501637
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$272.88 |
| Max. Negotiated Rate |
$966.45 |
| Rate for Payer: Cash Price |
$511.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$454.80
|
| Rate for Payer: Galaxy Health WC |
$966.45
|
| Rate for Payer: Global Benefits Group Commercial |
$682.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$758.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$433.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$272.88
|
| Rate for Payer: Multiplan Commercial |
$909.60
|
| Rate for Payer: Networks By Design Commercial |
$739.05
|
| Rate for Payer: Prime Health Services Commercial |
$966.45
|
|
|
HC CRYOCAUTERY OF CERVIX
|
Facility
|
OP
|
$1,137.00
|
|
|
Service Code
|
CPT 57511
|
| Hospital Charge Code |
900501637
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$272.88 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$400.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$682.20
|
| Rate for Payer: Cash Price |
$511.65
|
| Rate for Payer: Cash Price |
$511.65
|
| Rate for Payer: Cash Price |
$511.65
|
| Rate for Payer: Cigna of CA PPO |
$841.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$601.23
|
| Rate for Payer: Dignity Health Media |
$400.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$440.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$541.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$400.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$400.82
|
| Rate for Payer: Galaxy Health WC |
$966.45
|
| Rate for Payer: Global Benefits Group Commercial |
$682.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$852.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$657.34
|
| Rate for Payer: Heritage Provider Network Transplant |
$657.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$400.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$758.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$351.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$400.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$272.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$505.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$537.10
|
| Rate for Payer: Multiplan Commercial |
$909.60
|
| Rate for Payer: Networks By Design Commercial |
$739.05
|
| Rate for Payer: Prime Health Services Commercial |
$966.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$682.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$568.50
|
| Rate for Payer: United Healthcare All Other HMO |
$568.50
|
| Rate for Payer: United Healthcare HMO Rider |
$568.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$568.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Vantage Medical Group Senior |
$400.82
|
|
|
HC CRYOGLOBULINS QUAL
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
900910978
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.04 |
| Max. Negotiated Rate |
$57.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$47.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.49
|
| Rate for Payer: Blue Distinction Transplant |
$12.60
|
| Rate for Payer: Blue Shield of California Commercial |
$13.57
|
| Rate for Payer: Blue Shield of California EPN |
$10.75
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: Cigna of CA HMO |
$13.44
|
| Rate for Payer: Cigna of CA PPO |
$15.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.70
|
| Rate for Payer: Dignity Health Media |
$6.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.73
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.47
|
| Rate for Payer: Galaxy Health WC |
$17.85
|
| Rate for Payer: Global Benefits Group Commercial |
$12.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$15.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.61
|
| Rate for Payer: Heritage Provider Network Transplant |
$10.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$10.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.67
|
| Rate for Payer: Multiplan Commercial |
$16.80
|
| Rate for Payer: Networks By Design Commercial |
$13.65
|
| Rate for Payer: Prime Health Services Commercial |
$17.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.24
|
| Rate for Payer: United Healthcare All Other HMO |
$5.24
|
| Rate for Payer: United Healthcare HMO Rider |
$5.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
|
HC CSF LEAKAGE
|
Facility
|
IP
|
$2,072.00
|
|
|
Service Code
|
CPT 78650
|
| Hospital Charge Code |
909301416
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$497.28 |
| Max. Negotiated Rate |
$1,761.20 |
| Rate for Payer: Cash Price |
$932.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$828.80
|
| Rate for Payer: Galaxy Health WC |
$1,761.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,243.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,382.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$789.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$497.28
|
| Rate for Payer: Multiplan Commercial |
$1,657.60
|
| Rate for Payer: Networks By Design Commercial |
$1,346.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,761.20
|
|
|
HC CSF LEAKAGE
|
Facility
|
OP
|
$2,072.00
|
|
|
Service Code
|
CPT 78650
|
| Hospital Charge Code |
909301416
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$281.10 |
| Max. Negotiated Rate |
$2,909.61 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,903.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,774.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,234.50
|
| Rate for Payer: Blue Distinction Transplant |
$1,243.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,224.55
|
| Rate for Payer: Blue Shield of California EPN |
$971.77
|
| Rate for Payer: Cash Price |
$932.40
|
| Rate for Payer: Cash Price |
$932.40
|
| Rate for Payer: Cigna of CA HMO |
$1,326.08
|
| Rate for Payer: Cigna of CA PPO |
$1,533.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Dignity Health Media |
$1,774.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,951.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,395.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,774.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,774.15
|
| Rate for Payer: Galaxy Health WC |
$1,761.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,243.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,554.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,909.61
|
| Rate for Payer: Heritage Provider Network Transplant |
$2,909.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,874.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$2,874.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,774.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,382.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$281.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,774.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$497.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,235.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,377.36
|
| Rate for Payer: Multiplan Commercial |
$1,657.60
|
| Rate for Payer: Networks By Design Commercial |
$1,346.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,761.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,243.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,243.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,570.86
|
| Rate for Payer: United Healthcare All Other HMO |
$1,570.86
|
| Rate for Payer: United Healthcare HMO Rider |
$1,570.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,570.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: Vantage Medical Group Senior |
$1,774.15
|
|
|
HC C SPINE W/FLEX AND EXT COMPLETE
|
Facility
|
IP
|
$1,531.00
|
|
|
Service Code
|
CPT 72052
|
| Hospital Charge Code |
909001303
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$367.44 |
| Max. Negotiated Rate |
$1,301.35 |
| Rate for Payer: Cash Price |
$688.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.40
|
| Rate for Payer: Galaxy Health WC |
$1,301.35
|
| Rate for Payer: Global Benefits Group Commercial |
$918.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,021.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$583.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$367.44
|
| Rate for Payer: Multiplan Commercial |
$1,224.80
|
| Rate for Payer: Networks By Design Commercial |
$995.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,301.35
|
|
|
HC C SPINE W/FLEX AND EXT COMPLETE
|
Facility
|
OP
|
$1,531.00
|
|
|
Service Code
|
CPT 72052
|
| Hospital Charge Code |
909001303
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$95.59 |
| Max. Negotiated Rate |
$1,301.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$312.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$295.51
|
| Rate for Payer: Blue Distinction Transplant |
$918.60
|
| Rate for Payer: Blue Shield of California Commercial |
$904.82
|
| Rate for Payer: Blue Shield of California EPN |
$718.04
|
| Rate for Payer: Cash Price |
$688.95
|
| Rate for Payer: Cash Price |
$688.95
|
| Rate for Payer: Cigna of CA HMO |
$979.84
|
| Rate for Payer: Cigna of CA PPO |
$1,132.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,301.35
|
| Rate for Payer: Global Benefits Group Commercial |
$918.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,148.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,021.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$367.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,224.80
|
| Rate for Payer: Networks By Design Commercial |
$995.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,301.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$918.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$918.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$193.23
|
| Rate for Payer: United Healthcare All Other HMO |
$193.23
|
| Rate for Payer: United Healthcare HMO Rider |
$193.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC CT ABDOMEN & PELVIS W/CONTRAST
|
Facility
|
OP
|
$4,667.00
|
|
|
Service Code
|
CPT 74177
|
| Hospital Charge Code |
909202002
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$480.50 |
| Max. Negotiated Rate |
$3,966.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,780.60
|
| Rate for Payer: Blue Distinction Transplant |
$2,800.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,758.20
|
| Rate for Payer: Blue Shield of California EPN |
$2,188.82
|
| Rate for Payer: Cash Price |
$2,100.15
|
| Rate for Payer: Cash Price |
$2,100.15
|
| Rate for Payer: Cigna of CA HMO |
$2,986.88
|
| Rate for Payer: Cigna of CA PPO |
$3,453.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: Dignity Health Media |
$480.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$480.50
|
| Rate for Payer: Galaxy Health WC |
$3,966.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,800.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,500.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$788.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$788.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$778.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$778.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$480.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,112.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$535.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,120.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$605.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.87
|
| Rate for Payer: Multiplan Commercial |
$3,733.60
|
| Rate for Payer: Networks By Design Commercial |
$3,033.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,966.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,800.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,800.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,486.18
|
| Rate for Payer: United Healthcare All Other HMO |
$1,486.18
|
| Rate for Payer: United Healthcare HMO Rider |
$1,486.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,486.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC CT ABDOMEN & PELVIS W/CONTRAST
|
Facility
|
IP
|
$8,313.00
|
|
|
Service Code
|
CPT 74177
|
| Hospital Charge Code |
909202002
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,995.12 |
| Max. Negotiated Rate |
$7,066.05 |
| Rate for Payer: Cash Price |
$3,740.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,325.20
|
| Rate for Payer: Galaxy Health WC |
$7,066.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,987.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,544.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,167.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,995.12
|
| Rate for Payer: Multiplan Commercial |
$6,650.40
|
| Rate for Payer: Networks By Design Commercial |
$5,403.45
|
| Rate for Payer: Prime Health Services Commercial |
$7,066.05
|
|
|
HC CT ABDOMEN & PELVIS W/O CONTRA
|
Facility
|
IP
|
$7,507.00
|
|
|
Service Code
|
CPT 74176
|
| Hospital Charge Code |
909202001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,801.68 |
| Max. Negotiated Rate |
$6,380.95 |
| Rate for Payer: Cash Price |
$3,378.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,002.80
|
| Rate for Payer: Galaxy Health WC |
$6,380.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,504.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,007.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,860.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,801.68
|
| Rate for Payer: Multiplan Commercial |
$6,005.60
|
| Rate for Payer: Networks By Design Commercial |
$4,879.55
|
| Rate for Payer: Prime Health Services Commercial |
$6,380.95
|
|
|
HC CT ABDOMEN & PELVIS W/O CONTRA
|
Facility
|
OP
|
$4,213.00
|
|
|
Service Code
|
CPT 74176
|
| Hospital Charge Code |
909202001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$306.16 |
| Max. Negotiated Rate |
$3,581.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,510.11
|
| Rate for Payer: Blue Distinction Transplant |
$2,527.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,489.88
|
| Rate for Payer: Blue Shield of California EPN |
$1,975.90
|
| Rate for Payer: Cash Price |
$1,895.85
|
| Rate for Payer: Cash Price |
$1,895.85
|
| Rate for Payer: Cigna of CA HMO |
$2,696.32
|
| Rate for Payer: Cigna of CA PPO |
$3,117.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Media |
$306.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$306.16
|
| Rate for Payer: Galaxy Health WC |
$3,581.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,527.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,159.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$502.10
|
| Rate for Payer: Heritage Provider Network Transplant |
$502.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$495.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$495.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,810.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$331.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,011.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410.25
|
| Rate for Payer: Multiplan Commercial |
$3,370.40
|
| Rate for Payer: Networks By Design Commercial |
$2,738.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,581.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,527.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,527.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,037.23
|
| Rate for Payer: United Healthcare All Other HMO |
$1,037.23
|
| Rate for Payer: United Healthcare HMO Rider |
$1,037.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,037.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC CT ABDOMEN & PELVIS W & W/O CO
|
Facility
|
IP
|
$9,023.00
|
|
|
Service Code
|
CPT 74178
|
| Hospital Charge Code |
909202003
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,165.52 |
| Max. Negotiated Rate |
$7,669.55 |
| Rate for Payer: Cash Price |
$4,060.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,609.20
|
| Rate for Payer: Galaxy Health WC |
$7,669.55
|
| Rate for Payer: Global Benefits Group Commercial |
$5,413.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,018.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,437.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,165.52
|
| Rate for Payer: Multiplan Commercial |
$7,218.40
|
| Rate for Payer: Networks By Design Commercial |
$5,864.95
|
| Rate for Payer: Prime Health Services Commercial |
$7,669.55
|
|
|
HC CT ABDOMEN & PELVIS W & W/O CO
|
Facility
|
OP
|
$5,066.00
|
|
|
Service Code
|
CPT 74178
|
| Hospital Charge Code |
909202003
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$480.50 |
| Max. Negotiated Rate |
$4,306.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,018.32
|
| Rate for Payer: Blue Distinction Transplant |
$3,039.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,994.01
|
| Rate for Payer: Blue Shield of California EPN |
$2,375.95
|
| Rate for Payer: Cash Price |
$2,279.70
|
| Rate for Payer: Cash Price |
$2,279.70
|
| Rate for Payer: Cigna of CA HMO |
$3,242.24
|
| Rate for Payer: Cigna of CA PPO |
$3,748.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: Dignity Health Media |
$480.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$480.50
|
| Rate for Payer: Galaxy Health WC |
$4,306.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,039.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,799.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$788.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$788.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$778.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$778.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$480.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,379.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$606.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,215.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$605.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.87
|
| Rate for Payer: Multiplan Commercial |
$4,052.80
|
| Rate for Payer: Networks By Design Commercial |
$3,292.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,306.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,039.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,039.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,486.18
|
| Rate for Payer: United Healthcare All Other HMO |
$1,486.18
|
| Rate for Payer: United Healthcare HMO Rider |
$1,486.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,486.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC CT ABDOMEN W CONTRAS
|
Facility
|
IP
|
$6,801.00
|
|
|
Service Code
|
CPT 74160
|
| Hospital Charge Code |
909201928
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,632.24 |
| Max. Negotiated Rate |
$5,780.85 |
| Rate for Payer: Cash Price |
$3,060.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,720.40
|
| Rate for Payer: Galaxy Health WC |
$5,780.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,080.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,536.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,591.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,632.24
|
| Rate for Payer: Multiplan Commercial |
$5,440.80
|
| Rate for Payer: Networks By Design Commercial |
$4,420.65
|
| Rate for Payer: Prime Health Services Commercial |
$5,780.85
|
|
|
HC CT ABDOMEN W CONTRAS
|
Facility
|
OP
|
$3,525.00
|
|
|
Service Code
|
CPT 74160
|
| Hospital Charge Code |
909201928
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$229.56 |
| Max. Negotiated Rate |
$2,996.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,100.20
|
| Rate for Payer: Blue Distinction Transplant |
$2,115.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,083.28
|
| Rate for Payer: Blue Shield of California EPN |
$1,653.22
|
| Rate for Payer: Cash Price |
$1,586.25
|
| Rate for Payer: Cash Price |
$1,586.25
|
| Rate for Payer: Cigna of CA HMO |
$2,256.00
|
| Rate for Payer: Cigna of CA PPO |
$2,608.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Media |
$229.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$229.56
|
| Rate for Payer: Galaxy Health WC |
$2,996.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,115.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,643.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$376.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$376.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$371.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$371.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,351.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$396.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$846.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$307.61
|
| Rate for Payer: Multiplan Commercial |
$2,820.00
|
| Rate for Payer: Networks By Design Commercial |
$2,291.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,996.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,115.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,115.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$769.25
|
| Rate for Payer: United Healthcare All Other HMO |
$769.25
|
| Rate for Payer: United Healthcare HMO Rider |
$769.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$769.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC CT ABDOMEN WO CONTR
|
Facility
|
OP
|
$3,135.00
|
|
|
Service Code
|
CPT 74150
|
| Hospital Charge Code |
909201927
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,867.83
|
| Rate for Payer: Blue Distinction Transplant |
$1,881.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,852.78
|
| Rate for Payer: Blue Shield of California EPN |
$1,470.32
|
| Rate for Payer: Cash Price |
$1,410.75
|
| Rate for Payer: Cash Price |
$1,410.75
|
| Rate for Payer: Cigna of CA HMO |
$2,006.40
|
| Rate for Payer: Cigna of CA PPO |
$2,319.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$2,664.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,881.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,351.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,091.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$249.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$752.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$2,508.00
|
| Rate for Payer: Networks By Design Commercial |
$2,037.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,664.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,881.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,881.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$491.23
|
| Rate for Payer: United Healthcare All Other HMO |
$491.23
|
| Rate for Payer: United Healthcare HMO Rider |
$491.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$491.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC CT ABDOMEN WO CONTR
|
Facility
|
IP
|
$5,637.00
|
|
|
Service Code
|
CPT 74150
|
| Hospital Charge Code |
909201927
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,352.88 |
| Max. Negotiated Rate |
$4,791.45 |
| Rate for Payer: Cash Price |
$2,536.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,254.80
|
| Rate for Payer: Galaxy Health WC |
$4,791.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,382.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,759.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,147.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,352.88
|
| Rate for Payer: Multiplan Commercial |
$4,509.60
|
| Rate for Payer: Networks By Design Commercial |
$3,664.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,791.45
|
|
|
HC CT ABDOMEN W/WO CONT
|
Facility
|
OP
|
$4,124.00
|
|
|
Service Code
|
CPT 74170
|
| Hospital Charge Code |
909201929
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$229.56 |
| Max. Negotiated Rate |
$3,505.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,457.08
|
| Rate for Payer: Blue Distinction Transplant |
$2,474.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,437.28
|
| Rate for Payer: Blue Shield of California EPN |
$1,934.16
|
| Rate for Payer: Cash Price |
$1,855.80
|
| Rate for Payer: Cash Price |
$1,855.80
|
| Rate for Payer: Cigna of CA HMO |
$2,639.36
|
| Rate for Payer: Cigna of CA PPO |
$3,051.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Media |
$229.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$229.56
|
| Rate for Payer: Galaxy Health WC |
$3,505.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,474.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,093.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$376.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$376.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$371.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$371.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,750.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$451.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$989.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$307.61
|
| Rate for Payer: Multiplan Commercial |
$3,299.20
|
| Rate for Payer: Networks By Design Commercial |
$2,680.60
|
| Rate for Payer: Prime Health Services Commercial |
$3,505.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,474.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,474.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$855.26
|
| Rate for Payer: United Healthcare All Other HMO |
$855.26
|
| Rate for Payer: United Healthcare HMO Rider |
$855.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$855.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC CT ABDOMEN W/WO CONT
|
Facility
|
IP
|
$7,345.00
|
|
|
Service Code
|
CPT 74170
|
| Hospital Charge Code |
909201929
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,762.80 |
| Max. Negotiated Rate |
$6,243.25 |
| Rate for Payer: Cash Price |
$3,305.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,938.00
|
| Rate for Payer: Galaxy Health WC |
$6,243.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,407.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,899.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,798.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,762.80
|
| Rate for Payer: Multiplan Commercial |
$5,876.00
|
| Rate for Payer: Networks By Design Commercial |
$4,774.25
|
| Rate for Payer: Prime Health Services Commercial |
$6,243.25
|
|
|
HC CT ANGIO ABD AORTA-AIF W/WO CO
|
Facility
|
OP
|
$5,071.00
|
|
|
Service Code
|
CPT 75635
|
| Hospital Charge Code |
909201809
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$229.56 |
| Max. Negotiated Rate |
$4,310.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,021.30
|
| Rate for Payer: Blue Distinction Transplant |
$3,042.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,996.96
|
| Rate for Payer: Blue Shield of California EPN |
$2,378.30
|
| Rate for Payer: Cash Price |
$2,281.95
|
| Rate for Payer: Cash Price |
$2,281.95
|
| Rate for Payer: Cigna of CA HMO |
$3,245.44
|
| Rate for Payer: Cigna of CA PPO |
$3,752.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Media |
$229.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$229.56
|
| Rate for Payer: Galaxy Health WC |
$4,310.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,042.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,803.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$376.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$376.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$371.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$371.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,382.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$650.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,217.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$307.61
|
| Rate for Payer: Multiplan Commercial |
$4,056.80
|
| Rate for Payer: Networks By Design Commercial |
$3,296.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,310.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,042.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,042.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.48
|
| Rate for Payer: United Healthcare All Other HMO |
$866.48
|
| Rate for Payer: United Healthcare HMO Rider |
$866.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC CT ANGIO ABD AORTA-AIF W/WO CO
|
Facility
|
IP
|
$7,606.00
|
|
|
Service Code
|
CPT 75635
|
| Hospital Charge Code |
909201809
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,825.44 |
| Max. Negotiated Rate |
$6,465.10 |
| Rate for Payer: Cash Price |
$3,422.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,042.40
|
| Rate for Payer: Galaxy Health WC |
$6,465.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,563.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,073.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,897.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,825.44
|
| Rate for Payer: Multiplan Commercial |
$6,084.80
|
| Rate for Payer: Networks By Design Commercial |
$4,943.90
|
| Rate for Payer: Prime Health Services Commercial |
$6,465.10
|
|
|
HC CT ANGIO ABDOMEN/PELVIS
|
Facility
|
IP
|
$7,970.00
|
|
|
Service Code
|
CPT 74174
|
| Hospital Charge Code |
909201991
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,912.80 |
| Max. Negotiated Rate |
$6,774.50 |
| Rate for Payer: Cash Price |
$3,586.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,188.00
|
| Rate for Payer: Galaxy Health WC |
$6,774.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,782.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,315.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,036.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,912.80
|
| Rate for Payer: Multiplan Commercial |
$6,376.00
|
| Rate for Payer: Networks By Design Commercial |
$5,180.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,774.50
|
|
|
HC CT ANGIO ABDOMEN/PELVIS
|
Facility
|
OP
|
$4,473.00
|
|
|
Service Code
|
CPT 74174
|
| Hospital Charge Code |
909201991
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$480.50 |
| Max. Negotiated Rate |
$3,802.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,665.01
|
| Rate for Payer: Blue Distinction Transplant |
$2,683.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,643.54
|
| Rate for Payer: Blue Shield of California EPN |
$2,097.84
|
| Rate for Payer: Cash Price |
$2,012.85
|
| Rate for Payer: Cash Price |
$2,012.85
|
| Rate for Payer: Cigna of CA HMO |
$2,862.72
|
| Rate for Payer: Cigna of CA PPO |
$3,310.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: Dignity Health Media |
$480.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$480.50
|
| Rate for Payer: Galaxy Health WC |
$3,802.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,683.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,354.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$788.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$788.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$778.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$778.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$480.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,983.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$668.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,073.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$605.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.87
|
| Rate for Payer: Multiplan Commercial |
$3,578.40
|
| Rate for Payer: Networks By Design Commercial |
$2,907.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,802.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,683.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,683.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,486.18
|
| Rate for Payer: United Healthcare All Other HMO |
$1,486.18
|
| Rate for Payer: United Healthcare HMO Rider |
$1,486.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,486.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC CT ANGIO ABDOMEN W/WO CONTRAST
|
Facility
|
IP
|
$6,521.00
|
|
|
Service Code
|
CPT 74175
|
| Hospital Charge Code |
909201808
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,565.04 |
| Max. Negotiated Rate |
$5,542.85 |
| Rate for Payer: Cash Price |
$2,934.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,608.40
|
| Rate for Payer: Galaxy Health WC |
$5,542.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,912.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,349.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,484.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,565.04
|
| Rate for Payer: Multiplan Commercial |
$5,216.80
|
| Rate for Payer: Networks By Design Commercial |
$4,238.65
|
| Rate for Payer: Prime Health Services Commercial |
$5,542.85
|
|
|
HC CT ANGIO ABDOMEN W/WO CONTRAST
|
Facility
|
OP
|
$4,576.00
|
|
|
Service Code
|
CPT 74175
|
| Hospital Charge Code |
909201808
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$229.56 |
| Max. Negotiated Rate |
$3,889.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,726.38
|
| Rate for Payer: Blue Distinction Transplant |
$2,745.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,704.42
|
| Rate for Payer: Blue Shield of California EPN |
$2,146.14
|
| Rate for Payer: Cash Price |
$2,059.20
|
| Rate for Payer: Cash Price |
$2,059.20
|
| Rate for Payer: Cigna of CA HMO |
$2,928.64
|
| Rate for Payer: Cigna of CA PPO |
$3,386.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Media |
$229.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$229.56
|
| Rate for Payer: Galaxy Health WC |
$3,889.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,745.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,432.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$376.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$376.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$371.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$371.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,052.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$526.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,098.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$307.61
|
| Rate for Payer: Multiplan Commercial |
$3,660.80
|
| Rate for Payer: Networks By Design Commercial |
$2,974.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,889.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,745.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,745.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.48
|
| Rate for Payer: United Healthcare All Other HMO |
$866.48
|
| Rate for Payer: United Healthcare HMO Rider |
$866.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
