|
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: AlphaCare Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,457.08
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: IEHP Medi-Cal |
$371.89
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$371.89
|
| Rate for Payer: 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: Redlands Yucaipa Medical Group Commercial/Senior |
$250.00
|
| 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: AlphaCare Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,021.30
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: IEHP Medi-Cal |
$371.89
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$371.89
|
| Rate for Payer: 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: Redlands Yucaipa Medical Group Commercial/Senior |
$250.00
|
| 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 |
$250.00 |
| Max. Negotiated Rate |
$3,802.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,665.01
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: IEHP Medi-Cal |
$778.41
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$778.41
|
| Rate for Payer: 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: Redlands Yucaipa Medical Group Commercial/Senior |
$250.00
|
| 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
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: AlphaCare Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,726.38
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: IEHP Medi-Cal |
$371.89
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$371.89
|
| Rate for Payer: 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: Redlands Yucaipa Medical Group Commercial/Senior |
$250.00
|
| 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
|
|
|
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 CHEST W/WO CONTRAST
|
Facility
OP
|
$4,304.00
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
909201802
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$229.56 |
| Max. Negotiated Rate |
$3,658.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,564.32
|
| Rate for Payer: BCBS Transplant Transplant |
$2,582.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,543.66
|
| Rate for Payer: Blue Shield of California EPN |
$2,018.58
|
| Rate for Payer: Cash Price |
$1,936.80
|
| Rate for Payer: Cash Price |
$1,936.80
|
| Rate for Payer: Cigna of CA HMO |
$2,754.56
|
| Rate for Payer: Cigna of CA PPO |
$3,184.96
|
| 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 |
$3,658.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,582.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,228.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$376.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$376.48
|
| Rate for Payer: IEHP Medi-Cal |
$371.89
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$371.89
|
| Rate for Payer: IEHP Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,870.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$514.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,032.96
|
| 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 |
$3,443.20
|
| Rate for Payer: Networks By Design Commercial |
$2,797.60
|
| Rate for Payer: Prime Health Services Commercial |
$3,658.40
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$250.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,582.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,582.40
|
| 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 CHEST W/WO CONTRAST
|
Facility
IP
|
$6,692.00
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
909201802
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,606.08 |
| Max. Negotiated Rate |
$5,688.20 |
| Rate for Payer: Cash Price |
$3,011.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,676.80
|
| Rate for Payer: Galaxy Health WC |
$5,688.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,015.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,463.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,549.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,606.08
|
| Rate for Payer: Multiplan Commercial |
$5,353.60
|
| Rate for Payer: Networks By Design Commercial |
$4,349.80
|
| Rate for Payer: Prime Health Services Commercial |
$5,688.20
|
|
|
HC CT ANGIO HEAD W/WO CONTRAST
|
Facility
IP
|
$7,183.00
|
|
|
Service Code
|
CPT 70496
|
| Hospital Charge Code |
909201800
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,723.92 |
| Max. Negotiated Rate |
$6,105.55 |
| Rate for Payer: Cash Price |
$3,232.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,873.20
|
| Rate for Payer: Galaxy Health WC |
$6,105.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4,309.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,791.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,736.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,723.92
|
| Rate for Payer: Multiplan Commercial |
$5,746.40
|
| Rate for Payer: Networks By Design Commercial |
$4,668.95
|
| Rate for Payer: Prime Health Services Commercial |
$6,105.55
|
|
|
HC CT ANGIO HEAD W/WO CONTRAST
|
Facility
OP
|
$5,041.00
|
|
|
Service Code
|
CPT 70496
|
| Hospital Charge Code |
909201800
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$229.56 |
| Max. Negotiated Rate |
$4,284.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,003.43
|
| Rate for Payer: BCBS Transplant Transplant |
$3,024.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,979.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,364.23
|
| Rate for Payer: Cash Price |
$2,268.45
|
| Rate for Payer: Cash Price |
$2,268.45
|
| Rate for Payer: Cigna of CA HMO |
$3,226.24
|
| Rate for Payer: Cigna of CA PPO |
$3,730.34
|
| 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 |
$4,284.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,024.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,780.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$376.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$376.48
|
| Rate for Payer: IEHP Medi-Cal |
$371.89
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$371.89
|
| Rate for Payer: IEHP Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,362.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$505.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,209.84
|
| 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 |
$4,032.80
|
| Rate for Payer: Networks By Design Commercial |
$3,276.65
|
| Rate for Payer: Prime Health Services Commercial |
$4,284.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$250.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,024.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,024.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,520.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,520.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,520.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,520.50
|
| 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 LOW EXT W/WO CONT
|
Facility
OP
|
$3,219.00
|
|
|
Service Code
|
CPT 73706
|
| Hospital Charge Code |
909201807
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$229.56 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,917.88
|
| Rate for Payer: BCBS Transplant Transplant |
$1,931.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,902.43
|
| Rate for Payer: Blue Shield of California EPN |
$1,509.71
|
| Rate for Payer: Cash Price |
$1,448.55
|
| Rate for Payer: Cash Price |
$1,448.55
|
| Rate for Payer: Cigna of CA HMO |
$2,060.16
|
| Rate for Payer: Cigna of CA PPO |
$2,382.06
|
| 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 |
$2,736.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,931.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,414.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$376.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$376.48
|
| Rate for Payer: IEHP Medi-Cal |
$371.89
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$371.89
|
| Rate for Payer: IEHP Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,147.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$600.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$772.56
|
| 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 |
$2,575.20
|
| Rate for Payer: Networks By Design Commercial |
$2,092.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,736.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$250.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,931.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,931.40
|
| 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 LOW EXT W/WO CONT
|
Facility
IP
|
$5,733.00
|
|
|
Service Code
|
CPT 73706
|
| Hospital Charge Code |
909201807
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,375.92 |
| Max. Negotiated Rate |
$4,873.05 |
| Rate for Payer: Cash Price |
$2,579.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,293.20
|
| Rate for Payer: Galaxy Health WC |
$4,873.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,439.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,823.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,184.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,375.92
|
| Rate for Payer: Multiplan Commercial |
$4,586.40
|
| Rate for Payer: Networks By Design Commercial |
$3,726.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,873.05
|
|
|
HC CT ANGIO NECK W/WO CONTRAST
|
Facility
IP
|
$7,183.00
|
|
|
Service Code
|
CPT 70498
|
| Hospital Charge Code |
909201801
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,723.92 |
| Max. Negotiated Rate |
$6,105.55 |
| Rate for Payer: Cash Price |
$3,232.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,873.20
|
| Rate for Payer: Galaxy Health WC |
$6,105.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4,309.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,791.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,736.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,723.92
|
| Rate for Payer: Multiplan Commercial |
$5,746.40
|
| Rate for Payer: Networks By Design Commercial |
$4,668.95
|
| Rate for Payer: Prime Health Services Commercial |
$6,105.55
|
|
|
HC CT ANGIO NECK W/WO CONTRAST
|
Facility
OP
|
$5,041.00
|
|
|
Service Code
|
CPT 70498
|
| Hospital Charge Code |
909201801
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$229.56 |
| Max. Negotiated Rate |
$4,284.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,003.43
|
| Rate for Payer: BCBS Transplant Transplant |
$3,024.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,979.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,364.23
|
| Rate for Payer: Cash Price |
$2,268.45
|
| Rate for Payer: Cash Price |
$2,268.45
|
| Rate for Payer: Cigna of CA HMO |
$3,226.24
|
| Rate for Payer: Cigna of CA PPO |
$3,730.34
|
| 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 |
$4,284.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,024.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,780.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$376.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$376.48
|
| Rate for Payer: IEHP Medi-Cal |
$371.89
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$371.89
|
| Rate for Payer: IEHP Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,362.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$503.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,209.84
|
| 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 |
$4,032.80
|
| Rate for Payer: Networks By Design Commercial |
$3,276.65
|
| Rate for Payer: Prime Health Services Commercial |
$4,284.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$250.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,024.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,024.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,520.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,520.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,520.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,520.50
|
| 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 PELVIS W/WO CONTRAST
|
Facility
IP
|
$6,490.00
|
|
|
Service Code
|
CPT 72191
|
| Hospital Charge Code |
909201803
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,557.60 |
| Max. Negotiated Rate |
$5,516.50 |
| Rate for Payer: Cash Price |
$2,920.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,596.00
|
| Rate for Payer: Galaxy Health WC |
$5,516.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,894.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,328.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,472.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,557.60
|
| Rate for Payer: Multiplan Commercial |
$5,192.00
|
| Rate for Payer: Networks By Design Commercial |
$4,218.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,516.50
|
|
|
HC CT ANGIO PELVIS W/WO CONTRAST
|
Facility
OP
|
$3,643.00
|
|
|
Service Code
|
CPT 72191
|
| Hospital Charge Code |
909201803
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$229.56 |
| Max. Negotiated Rate |
$3,096.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,170.50
|
| Rate for Payer: BCBS Transplant Transplant |
$2,185.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,153.01
|
| Rate for Payer: Blue Shield of California EPN |
$1,708.57
|
| Rate for Payer: Cash Price |
$1,639.35
|
| Rate for Payer: Cash Price |
$1,639.35
|
| Rate for Payer: Cigna of CA HMO |
$2,331.52
|
| Rate for Payer: Cigna of CA PPO |
$2,695.82
|
| 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 |
$3,096.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,185.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,732.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$376.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$376.48
|
| Rate for Payer: IEHP Medi-Cal |
$371.89
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$371.89
|
| Rate for Payer: IEHP Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,429.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$522.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$874.32
|
| 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 |
$2,914.40
|
| Rate for Payer: Networks By Design Commercial |
$2,367.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,096.55
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$250.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,185.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,185.80
|
| 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 UPP EXT W/WO CON
|
Facility
OP
|
$3,534.00
|
|
|
Service Code
|
CPT 73206
|
| Hospital Charge Code |
909201804
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$229.56 |
| Max. Negotiated Rate |
$3,003.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,105.56
|
| Rate for Payer: BCBS Transplant Transplant |
$2,120.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,088.59
|
| Rate for Payer: Blue Shield of California EPN |
$1,657.45
|
| Rate for Payer: Cash Price |
$1,590.30
|
| Rate for Payer: Cash Price |
$1,590.30
|
| Rate for Payer: Cigna of CA HMO |
$2,261.76
|
| Rate for Payer: Cigna of CA PPO |
$2,615.16
|
| 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 |
$3,003.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,120.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,650.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$376.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$376.48
|
| Rate for Payer: IEHP Medi-Cal |
$371.89
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$371.89
|
| Rate for Payer: IEHP Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,357.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$553.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$848.16
|
| 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 |
$2,827.20
|
| Rate for Payer: Networks By Design Commercial |
$2,297.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,003.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$250.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,120.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,120.40
|
| 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 UPP EXT W/WO CON
|
Facility
IP
|
$6,294.00
|
|
|
Service Code
|
CPT 73206
|
| Hospital Charge Code |
909201804
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,510.56 |
| Max. Negotiated Rate |
$5,349.90 |
| Rate for Payer: Cash Price |
$2,832.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,517.60
|
| Rate for Payer: Galaxy Health WC |
$5,349.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,776.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,198.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,398.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,510.56
|
| Rate for Payer: Multiplan Commercial |
$5,035.20
|
| Rate for Payer: Networks By Design Commercial |
$4,091.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,349.90
|
|
|
HC CT BONE L-SPINE W CONTRAST
|
Facility
OP
|
$3,219.00
|
|
|
Service Code
|
CPT 72132
|
| Hospital Charge Code |
909201008
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,917.88
|
| Rate for Payer: BCBS Transplant Transplant |
$1,931.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,902.43
|
| Rate for Payer: Blue Shield of California EPN |
$1,509.71
|
| Rate for Payer: Cash Price |
$1,448.55
|
| Rate for Payer: Cash Price |
$1,448.55
|
| Rate for Payer: Cigna of CA HMO |
$2,060.16
|
| Rate for Payer: Cigna of CA PPO |
$2,382.06
|
| 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 |
$2,736.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,931.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,414.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$788.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$788.02
|
| Rate for Payer: IEHP Medi-Cal |
$778.41
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$778.41
|
| Rate for Payer: IEHP Medicare Advantage |
$480.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,147.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$309.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$772.56
|
| 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 |
$2,575.20
|
| Rate for Payer: Networks By Design Commercial |
$2,092.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,736.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$250.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,931.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,931.40
|
| 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 |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC CT BONE L-SPINE W CONTRAST
|
Facility
IP
|
$5,733.00
|
|
|
Service Code
|
CPT 72132
|
| Hospital Charge Code |
909201008
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,375.92 |
| Max. Negotiated Rate |
$4,873.05 |
| Rate for Payer: Cash Price |
$2,579.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,293.20
|
| Rate for Payer: Galaxy Health WC |
$4,873.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,439.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,823.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,184.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,375.92
|
| Rate for Payer: Multiplan Commercial |
$4,586.40
|
| Rate for Payer: Networks By Design Commercial |
$3,726.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,873.05
|
|
|
HC CT BONE L-SPINE W/O CONTRAST
|
Facility
OP
|
$3,000.00
|
|
|
Service Code
|
CPT 72131
|
| Hospital Charge Code |
909201007
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,787.40
|
| Rate for Payer: BCBS Transplant Transplant |
$1,800.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,773.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,407.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna of CA HMO |
$1,920.00
|
| Rate for Payer: Cigna of CA PPO |
$2,220.00
|
| 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 |
$2,550.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,800.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,250.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: IEHP Medi-Cal |
$222.52
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$222.52
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,001.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$236.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$720.00
|
| 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 |
$2,400.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,550.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$250.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,800.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| 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 BONE L-SPINE W/O CONTRAST
|
Facility
IP
|
$5,345.00
|
|
|
Service Code
|
CPT 72131
|
| Hospital Charge Code |
909201007
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,282.80 |
| Max. Negotiated Rate |
$4,543.25 |
| Rate for Payer: Cash Price |
$2,405.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,138.00
|
| Rate for Payer: Galaxy Health WC |
$4,543.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,207.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,565.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,036.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,282.80
|
| Rate for Payer: Multiplan Commercial |
$4,276.00
|
| Rate for Payer: Networks By Design Commercial |
$3,474.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,543.25
|
|
