|
HC CRYABLATION BONE
|
Facility
|
IP
|
$15,488.00
|
|
|
Service Code
|
CPT 20999
|
| Hospital Charge Code |
909020151
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,097.60 |
| Max. Negotiated Rate |
$13,164.80 |
| Rate for Payer: Adventist Health Commercial |
$3,097.60
|
| Rate for Payer: Cash Price |
$6,969.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,195.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,195.20
|
| Rate for Payer: Galaxy Health WC |
$13,164.80
|
| Rate for Payer: Global Benefits Group Commercial |
$9,292.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,330.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,900.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,587.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,717.12
|
| Rate for Payer: Multiplan Commercial |
$12,390.40
|
| Rate for Payer: Networks By Design Commercial |
$10,067.20
|
| Rate for Payer: Prime Health Services Commercial |
$13,164.80
|
|
|
HC CRYABLATION BONE
|
Facility
|
OP
|
$15,488.00
|
|
|
Service Code
|
CPT 20999
|
| Hospital Charge Code |
909020151
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$304.79 |
| Max. Negotiated Rate |
$13,164.80 |
| Rate for Payer: Adventist Health Commercial |
$3,097.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,511.18
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,822.94
|
| Rate for Payer: Cash Price |
$6,969.60
|
| Rate for Payer: Cash Price |
$6,969.60
|
| Rate for Payer: Cash Price |
$6,969.60
|
| Rate for Payer: Cigna of CA HMO |
$9,912.32
|
| Rate for Payer: Cigna of CA PPO |
$11,461.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$411.47
|
| Rate for Payer: EPIC Health Plan Senior |
$304.79
|
| Rate for Payer: Galaxy Health WC |
$13,164.80
|
| Rate for Payer: Global Benefits Group Commercial |
$9,292.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$499.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,330.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,717.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.42
|
| Rate for Payer: Multiplan Commercial |
$12,390.40
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$10,067.20
|
| Rate for Payer: Prime Health Services Commercial |
$13,164.80
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,292.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$304.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Vantage Medical Group Senior |
$304.79
|
|
|
HC CRYOABLATION-LUNG
|
Facility
|
IP
|
$8,155.00
|
|
|
Service Code
|
CPT 32994
|
| Hospital Charge Code |
909020150
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,631.00 |
| Max. Negotiated Rate |
$6,931.75 |
| Rate for Payer: Adventist Health Commercial |
$1,631.00
|
| Rate for Payer: Cash Price |
$3,669.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,262.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,262.00
|
| Rate for Payer: Galaxy Health WC |
$6,931.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,893.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,439.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,107.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,047.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,957.20
|
| Rate for Payer: Multiplan Commercial |
$6,524.00
|
| Rate for Payer: Networks By Design Commercial |
$5,300.75
|
| Rate for Payer: Prime Health Services Commercial |
$6,931.75
|
|
|
HC CRYOABLATION-LUNG
|
Facility
|
OP
|
$8,155.00
|
|
|
Service Code
|
CPT 32994
|
| Hospital Charge Code |
909020150
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,631.00 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$1,631.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,842.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,551.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,228.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,339.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$3,669.75
|
| Rate for Payer: Cash Price |
$3,669.75
|
| Rate for Payer: Cash Price |
$3,669.75
|
| Rate for Payer: Cigna of CA HMO |
$5,219.20
|
| Rate for Payer: Cigna of CA PPO |
$6,034.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,842.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,551.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,228.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,858.47
|
| Rate for Payer: EPIC Health Plan Senior |
$13,228.50
|
| Rate for Payer: Galaxy Health WC |
$6,931.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,893.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$21,694.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9,674.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,228.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,439.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,940.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,228.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,957.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,667.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,726.19
|
| Rate for Payer: Multiplan Commercial |
$6,524.00
|
| Rate for Payer: Multiplan WC |
$21,077.25
|
| Rate for Payer: Networks By Design Commercial |
$5,300.75
|
| Rate for Payer: Prime Health Services Commercial |
$6,931.75
|
| Rate for Payer: Prime Health Services WC |
$20,862.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,893.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$13,228.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19,842.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,551.35
|
| Rate for Payer: Vantage Medical Group Senior |
$13,228.50
|
|
|
HC CRYOABLATION PROBE
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C2618
|
| Hospital Charge Code |
909020059
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,558.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,394.99
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cigna of CA HMO |
$2,496.00
|
| Rate for Payer: Cigna of CA PPO |
$2,886.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$3,120.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,950.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,950.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,950.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,950.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC CRYOABLATION PROBE
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C2618
|
| Hospital Charge Code |
909020059
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| Rate for Payer: Multiplan Commercial |
$3,120.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
|
|
HC CRYO ABLAT LIVER TUMOR
|
Facility
|
OP
|
$7,918.00
|
|
|
Service Code
|
CPT 47381
|
| Hospital Charge Code |
909000269
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$309.61 |
| Max. Negotiated Rate |
$13,086.00 |
| Rate for Payer: Adventist Health Commercial |
$1,583.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13,086.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,730.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,354.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,938.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$3,563.10
|
| Rate for Payer: Cash Price |
$3,563.10
|
| Rate for Payer: Cash Price |
$3,563.10
|
| Rate for Payer: Cigna of CA HMO |
$5,067.52
|
| Rate for Payer: Cigna of CA PPO |
$5,859.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,730.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,730.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,730.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,167.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,167.20
|
| Rate for Payer: Galaxy Health WC |
$6,730.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,750.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$309.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,281.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$350.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,901.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,900.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,542.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,542.60
|
| Rate for Payer: Multiplan Commercial |
$6,334.40
|
| Rate for Payer: Networks By Design Commercial |
$5,146.70
|
| Rate for Payer: Prime Health Services Commercial |
$6,730.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,750.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,730.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,730.30
|
| Rate for Payer: Vantage Medical Group Senior |
$6,730.30
|
|
|
HC CRYO ABLAT LIVER TUMOR
|
Facility
|
IP
|
$7,918.00
|
|
|
Service Code
|
CPT 47381
|
| Hospital Charge Code |
909000269
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,583.60 |
| Max. Negotiated Rate |
$6,730.30 |
| Rate for Payer: Adventist Health Commercial |
$1,583.60
|
| Rate for Payer: Cash Price |
$3,563.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,167.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,167.20
|
| Rate for Payer: Galaxy Health WC |
$6,730.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,750.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,281.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,016.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,901.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,900.32
|
| Rate for Payer: Multiplan Commercial |
$6,334.40
|
| Rate for Payer: Networks By Design Commercial |
$5,146.70
|
| Rate for Payer: Prime Health Services Commercial |
$6,730.30
|
|
|
HC CRYO ABLAT RENAL TUMOR
|
Facility
|
IP
|
$19,652.00
|
|
|
Service Code
|
CPT 50593
|
| Hospital Charge Code |
909000268
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,930.40 |
| Max. Negotiated Rate |
$16,704.20 |
| Rate for Payer: Adventist Health Commercial |
$3,930.40
|
| Rate for Payer: Cash Price |
$8,843.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,860.80
|
| Rate for Payer: EPIC Health Plan Senior |
$7,860.80
|
| Rate for Payer: Galaxy Health WC |
$16,704.20
|
| Rate for Payer: Global Benefits Group Commercial |
$11,791.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,107.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,487.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,164.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,716.48
|
| Rate for Payer: Multiplan Commercial |
$15,721.60
|
| Rate for Payer: Networks By Design Commercial |
$12,773.80
|
| Rate for Payer: Prime Health Services Commercial |
$16,704.20
|
|
|
HC CRYO ABLAT RENAL TUMOR
|
Facility
|
OP
|
$19,652.00
|
|
|
Service Code
|
CPT 50593
|
| Hospital Charge Code |
909000268
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,822.94 |
| Max. Negotiated Rate |
$30,715.00 |
| Rate for Payer: Adventist Health Commercial |
$3,930.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30,715.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,842.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,551.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,228.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,922.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,822.94
|
| Rate for Payer: Cash Price |
$8,843.40
|
| Rate for Payer: Cash Price |
$8,843.40
|
| Rate for Payer: Cash Price |
$8,843.40
|
| Rate for Payer: Cigna of CA HMO |
$12,577.28
|
| Rate for Payer: Cigna of CA PPO |
$14,542.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,842.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,551.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,228.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,858.47
|
| Rate for Payer: EPIC Health Plan Senior |
$13,228.50
|
| Rate for Payer: Galaxy Health WC |
$16,704.20
|
| Rate for Payer: Global Benefits Group Commercial |
$11,791.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$21,694.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,544.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,228.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,107.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,401.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,228.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,716.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,667.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,726.19
|
| Rate for Payer: Multiplan Commercial |
$15,721.60
|
| Rate for Payer: Multiplan WC |
$21,077.25
|
| Rate for Payer: Networks By Design Commercial |
$12,773.80
|
| Rate for Payer: Prime Health Services Commercial |
$16,704.20
|
| Rate for Payer: Prime Health Services WC |
$20,862.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,791.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$13,228.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19,842.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,551.35
|
| Rate for Payer: Vantage Medical Group Senior |
$13,228.50
|
|
|
HC CRYOCAUTERY OF CERVIX
|
Facility
|
OP
|
$1,111.00
|
|
|
Service Code
|
CPT 57511
|
| Hospital Charge Code |
900501637
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$222.20 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$222.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$386.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$499.95
|
| Rate for Payer: Cash Price |
$499.95
|
| Rate for Payer: Cash Price |
$499.95
|
| Rate for Payer: Cigna of CA HMO |
$711.04
|
| Rate for Payer: Cigna of CA PPO |
$822.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$579.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$386.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$521.77
|
| Rate for Payer: EPIC Health Plan Senior |
$386.50
|
| Rate for Payer: Galaxy Health WC |
$944.35
|
| Rate for Payer: Global Benefits Group Commercial |
$666.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$633.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$386.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$741.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$351.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$386.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$266.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$486.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$517.91
|
| Rate for Payer: Multiplan Commercial |
$888.80
|
| Rate for Payer: Multiplan WC |
$615.83
|
| Rate for Payer: Networks By Design Commercial |
$722.15
|
| Rate for Payer: Prime Health Services Commercial |
$944.35
|
| Rate for Payer: Prime Health Services WC |
$609.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$666.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$555.50
|
| Rate for Payer: United Healthcare All Other HMO |
$555.50
|
| Rate for Payer: United Healthcare HMO Rider |
$555.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$555.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$386.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Vantage Medical Group Senior |
$386.50
|
|
|
HC CRYOCAUTERY OF CERVIX
|
Facility
|
IP
|
$1,111.00
|
|
|
Service Code
|
CPT 57511
|
| Hospital Charge Code |
900501637
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$222.20 |
| Max. Negotiated Rate |
$944.35 |
| Rate for Payer: Adventist Health Commercial |
$222.20
|
| Rate for Payer: Cash Price |
$499.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$444.40
|
| Rate for Payer: EPIC Health Plan Senior |
$444.40
|
| Rate for Payer: Galaxy Health WC |
$944.35
|
| Rate for Payer: Global Benefits Group Commercial |
$666.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$741.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$423.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$687.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$266.64
|
| Rate for Payer: Multiplan Commercial |
$888.80
|
| Rate for Payer: Networks By Design Commercial |
$722.15
|
| Rate for Payer: Prime Health Services Commercial |
$944.35
|
|
|
HC CRYOGLOBULINS QUAL
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
900910978
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$62.24 |
| Rate for Payer: Adventist Health Commercial |
$12.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.71
|
| 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 |
$62.24
|
| Rate for Payer: Blue Shield of California Commercial |
$41.48
|
| Rate for Payer: Blue Shield of California EPN |
$27.40
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna of CA HMO |
$39.68
|
| Rate for Payer: Cigna of CA PPO |
$45.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.73
|
| Rate for Payer: EPIC Health Plan Senior |
$6.47
|
| Rate for Payer: Galaxy Health WC |
$52.70
|
| Rate for Payer: Global Benefits Group Commercial |
$37.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$41.35
|
| 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 |
$14.88
|
| 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 |
$49.60
|
| Rate for Payer: Networks By Design Commercial |
$40.30
|
| Rate for Payer: Prime Health Services Commercial |
$52.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.20
|
| 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: Upland Medical Group Pediatric |
$6.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
|
HC CRYOGLOBULINS QUAL
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
900910978
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$130.05 |
| Rate for Payer: Adventist Health Commercial |
$30.60
|
| Rate for Payer: Cash Price |
$68.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.20
|
| Rate for Payer: EPIC Health Plan Senior |
$61.20
|
| Rate for Payer: Galaxy Health WC |
$130.05
|
| Rate for Payer: Global Benefits Group Commercial |
$91.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$102.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$94.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.72
|
| Rate for Payer: Multiplan Commercial |
$122.40
|
| Rate for Payer: Networks By Design Commercial |
$99.45
|
| Rate for Payer: Prime Health Services Commercial |
$130.05
|
|
|
HC CSF LEAKAGE
|
Facility
|
IP
|
$1,761.00
|
|
|
Service Code
|
CPT 78650
|
| Hospital Charge Code |
909301416
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$352.20 |
| Max. Negotiated Rate |
$1,496.85 |
| Rate for Payer: Adventist Health Commercial |
$352.20
|
| Rate for Payer: Cash Price |
$792.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$704.40
|
| Rate for Payer: EPIC Health Plan Senior |
$704.40
|
| Rate for Payer: Galaxy Health WC |
$1,496.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,056.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,174.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$670.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,090.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$422.64
|
| Rate for Payer: Multiplan Commercial |
$1,408.80
|
| Rate for Payer: Networks By Design Commercial |
$1,144.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,496.85
|
|
|
HC CSF LEAKAGE
|
Facility
|
OP
|
$1,761.00
|
|
|
Service Code
|
CPT 78650
|
| Hospital Charge Code |
909301416
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$248.56 |
| Max. Negotiated Rate |
$2,720.33 |
| Rate for Payer: Adventist Health Commercial |
$352.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,155.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,824.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,658.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,081.43
|
| Rate for Payer: Blue Shield of California Commercial |
$1,077.73
|
| Rate for Payer: Blue Shield of California EPN |
$711.44
|
| Rate for Payer: Cash Price |
$792.45
|
| Rate for Payer: Cash Price |
$792.45
|
| Rate for Payer: Cigna of CA HMO |
$1,127.04
|
| Rate for Payer: Cigna of CA PPO |
$1,303.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,824.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,658.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,239.30
|
| Rate for Payer: EPIC Health Plan Senior |
$1,658.74
|
| Rate for Payer: Galaxy Health WC |
$1,496.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,056.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,720.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$248.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,658.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,174.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$281.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,658.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$422.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,090.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,222.71
|
| Rate for Payer: Multiplan Commercial |
$1,408.80
|
| Rate for Payer: Networks By Design Commercial |
$1,144.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,496.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,056.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,056.60
|
| 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: Upland Medical Group Pediatric |
$1,658.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,824.61
|
| Rate for Payer: Vantage Medical Group Senior |
$1,658.74
|
|
|
HC C SPINE W/FLEX AND EXT COMPLETE
|
Facility
|
OP
|
$1,301.00
|
|
|
Service Code
|
CPT 72052
|
| Hospital Charge Code |
909001303
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$84.52 |
| Max. Negotiated Rate |
$1,105.85 |
| Rate for Payer: Adventist Health Commercial |
$260.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$853.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$319.92
|
| Rate for Payer: Blue Shield of California Commercial |
$796.21
|
| Rate for Payer: Blue Shield of California EPN |
$525.60
|
| Rate for Payer: Cash Price |
$585.45
|
| Rate for Payer: Cash Price |
$585.45
|
| Rate for Payer: Cigna of CA HMO |
$832.64
|
| Rate for Payer: Cigna of CA PPO |
$962.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$1,105.85
|
| Rate for Payer: Global Benefits Group Commercial |
$780.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$84.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$867.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$312.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$1,040.80
|
| Rate for Payer: Networks By Design Commercial |
$845.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,105.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$780.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$780.60
|
| 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: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC C SPINE W/FLEX AND EXT COMPLETE
|
Facility
|
IP
|
$1,301.00
|
|
|
Service Code
|
CPT 72052
|
| Hospital Charge Code |
909001303
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$260.20 |
| Max. Negotiated Rate |
$1,105.85 |
| Rate for Payer: Adventist Health Commercial |
$260.20
|
| Rate for Payer: Cash Price |
$585.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$520.40
|
| Rate for Payer: EPIC Health Plan Senior |
$520.40
|
| Rate for Payer: Galaxy Health WC |
$1,105.85
|
| Rate for Payer: Global Benefits Group Commercial |
$780.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$867.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$495.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$805.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$312.24
|
| Rate for Payer: Multiplan Commercial |
$1,040.80
|
| Rate for Payer: Networks By Design Commercial |
$845.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,105.85
|
|
|
HC CT ABDOMEN & PELVIS W/CONTRAST
|
Facility
|
OP
|
$3,967.00
|
|
|
Service Code
|
CPT 74177
|
| Hospital Charge Code |
909202002
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$453.77 |
| Max. Negotiated Rate |
$3,371.95 |
| Rate for Payer: Adventist Health Commercial |
$793.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,436.13
|
| Rate for Payer: Blue Shield of California Commercial |
$2,427.80
|
| Rate for Payer: Blue Shield of California EPN |
$1,602.67
|
| Rate for Payer: Cash Price |
$1,785.15
|
| Rate for Payer: Cash Price |
$1,785.15
|
| Rate for Payer: Cash Price |
$1,785.15
|
| Rate for Payer: Cigna of CA HMO |
$2,538.88
|
| Rate for Payer: Cigna of CA PPO |
$2,935.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.59
|
| Rate for Payer: EPIC Health Plan Senior |
$453.77
|
| Rate for Payer: Galaxy Health WC |
$3,371.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,380.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$473.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,645.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$535.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$952.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$571.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$608.05
|
| Rate for Payer: Multiplan Commercial |
$3,173.60
|
| Rate for Payer: Networks By Design Commercial |
$2,578.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,371.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,380.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,380.20
|
| 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: Upland Medical Group Pediatric |
$453.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
HC CT ABDOMEN & PELVIS W/CONTRAST
|
Facility
|
IP
|
$7,401.00
|
|
|
Service Code
|
CPT 74177
|
| Hospital Charge Code |
909202002
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,480.20 |
| Max. Negotiated Rate |
$6,290.85 |
| Rate for Payer: Adventist Health Commercial |
$1,480.20
|
| Rate for Payer: Cash Price |
$3,330.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,960.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,960.40
|
| Rate for Payer: Galaxy Health WC |
$6,290.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,440.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,936.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,819.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,581.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,776.24
|
| Rate for Payer: Multiplan Commercial |
$5,920.80
|
| Rate for Payer: Networks By Design Commercial |
$4,810.65
|
| Rate for Payer: Prime Health Services Commercial |
$6,290.85
|
|
|
HC CT ABDOMEN & PELVIS W/O CONTRA
|
Facility
|
IP
|
$6,684.00
|
|
|
Service Code
|
CPT 74176
|
| Hospital Charge Code |
909202001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,336.80 |
| Max. Negotiated Rate |
$5,681.40 |
| Rate for Payer: Adventist Health Commercial |
$1,336.80
|
| Rate for Payer: Cash Price |
$3,007.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,673.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,673.60
|
| Rate for Payer: Galaxy Health WC |
$5,681.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,010.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,458.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,546.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,137.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,604.16
|
| Rate for Payer: Multiplan Commercial |
$5,347.20
|
| Rate for Payer: Networks By Design Commercial |
$4,344.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,681.40
|
|
|
HC CT ABDOMEN & PELVIS W/O CONTRA
|
Facility
|
OP
|
$3,581.00
|
|
|
Service Code
|
CPT 74176
|
| Hospital Charge Code |
909202001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$292.84 |
| Max. Negotiated Rate |
$3,043.85 |
| Rate for Payer: Adventist Health Commercial |
$716.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,199.09
|
| Rate for Payer: Blue Shield of California Commercial |
$2,191.57
|
| Rate for Payer: Blue Shield of California EPN |
$1,446.72
|
| Rate for Payer: Cash Price |
$1,611.45
|
| Rate for Payer: Cash Price |
$1,611.45
|
| Rate for Payer: Cash Price |
$1,611.45
|
| Rate for Payer: Cigna of CA HMO |
$2,291.84
|
| Rate for Payer: Cigna of CA PPO |
$2,649.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$3,043.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,148.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$292.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,388.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$331.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$859.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$2,864.80
|
| Rate for Payer: Networks By Design Commercial |
$2,327.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,043.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,148.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,148.60
|
| 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: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC CT ABDOMEN & PELVIS W & W/O CO
|
Facility
|
IP
|
$8,033.00
|
|
|
Service Code
|
CPT 74178
|
| Hospital Charge Code |
909202003
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,606.60 |
| Max. Negotiated Rate |
$6,828.05 |
| Rate for Payer: Adventist Health Commercial |
$1,606.60
|
| Rate for Payer: Cash Price |
$3,614.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,213.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,213.20
|
| Rate for Payer: Galaxy Health WC |
$6,828.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,819.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,358.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,060.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,972.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,927.92
|
| Rate for Payer: Multiplan Commercial |
$6,426.40
|
| Rate for Payer: Networks By Design Commercial |
$5,221.45
|
| Rate for Payer: Prime Health Services Commercial |
$6,828.05
|
|
|
HC CT ABDOMEN & PELVIS W & W/O CO
|
Facility
|
OP
|
$4,306.00
|
|
|
Service Code
|
CPT 74178
|
| Hospital Charge Code |
909202003
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$453.77 |
| Max. Negotiated Rate |
$3,660.10 |
| Rate for Payer: Adventist Health Commercial |
$861.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,644.31
|
| Rate for Payer: Blue Shield of California Commercial |
$2,635.27
|
| Rate for Payer: Blue Shield of California EPN |
$1,739.62
|
| Rate for Payer: Cash Price |
$1,937.70
|
| Rate for Payer: Cash Price |
$1,937.70
|
| Rate for Payer: Cash Price |
$1,937.70
|
| Rate for Payer: Cigna of CA HMO |
$2,755.84
|
| Rate for Payer: Cigna of CA PPO |
$3,186.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.59
|
| Rate for Payer: EPIC Health Plan Senior |
$453.77
|
| Rate for Payer: Galaxy Health WC |
$3,660.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,583.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$536.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,872.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$606.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,033.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$571.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$608.05
|
| Rate for Payer: Multiplan Commercial |
$3,444.80
|
| Rate for Payer: Networks By Design Commercial |
$2,798.90
|
| Rate for Payer: Prime Health Services Commercial |
$3,660.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,583.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,583.60
|
| 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: Upland Medical Group Pediatric |
$453.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
HC CT ABDOMEN W CONTRAS
|
Facility
|
OP
|
$2,996.00
|
|
|
Service Code
|
CPT 74160
|
| Hospital Charge Code |
909201928
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$599.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,839.84
|
| Rate for Payer: Blue Shield of California Commercial |
$1,833.55
|
| Rate for Payer: Blue Shield of California EPN |
$1,210.38
|
| Rate for Payer: Cash Price |
$1,348.20
|
| Rate for Payer: Cash Price |
$1,348.20
|
| Rate for Payer: Cash Price |
$1,348.20
|
| Rate for Payer: Cigna of CA HMO |
$1,917.44
|
| Rate for Payer: Cigna of CA PPO |
$2,217.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.36
|
| Rate for Payer: EPIC Health Plan Senior |
$226.19
|
| Rate for Payer: Galaxy Health WC |
$2,546.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,797.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$350.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,998.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$396.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$719.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.09
|
| Rate for Payer: Multiplan Commercial |
$2,396.80
|
| Rate for Payer: Networks By Design Commercial |
$1,947.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,546.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,797.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,797.60
|
| 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: Upland Medical Group Pediatric |
$226.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
