|
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
|
|
|
HC CT ABDOMEN WO CONTR
|
Facility
|
IP
|
$5,018.00
|
|
|
Service Code
|
CPT 74150
|
| Hospital Charge Code |
909201927
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,003.60 |
| Max. Negotiated Rate |
$4,265.30 |
| Rate for Payer: Adventist Health Commercial |
$1,003.60
|
| Rate for Payer: Cash Price |
$2,258.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,007.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,007.20
|
| Rate for Payer: Galaxy Health WC |
$4,265.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,010.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,347.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,911.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,106.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,204.32
|
| Rate for Payer: Multiplan Commercial |
$4,014.40
|
| Rate for Payer: Networks By Design Commercial |
$3,261.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,265.30
|
|
|
HC CT ABDOMEN WO CONTR
|
Facility
|
OP
|
$2,665.00
|
|
|
Service Code
|
CPT 74150
|
| Hospital Charge Code |
909201927
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$533.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| 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 |
$1,636.58
|
| Rate for Payer: Blue Shield of California Commercial |
$1,630.98
|
| Rate for Payer: Blue Shield of California EPN |
$1,076.66
|
| Rate for Payer: Cash Price |
$1,199.25
|
| Rate for Payer: Cash Price |
$1,199.25
|
| Rate for Payer: Cash Price |
$1,199.25
|
| Rate for Payer: Cigna of CA HMO |
$1,705.60
|
| Rate for Payer: Cigna of CA PPO |
$1,972.10
|
| 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 |
$2,265.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,599.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$220.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,777.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$249.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$639.60
|
| 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 |
$2,132.00
|
| Rate for Payer: Networks By Design Commercial |
$1,732.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,265.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,599.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,599.00
|
| 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: 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 CT ABDOMEN W/WO CONT
|
Facility
|
OP
|
$3,505.00
|
|
|
Service Code
|
CPT 74170
|
| Hospital Charge Code |
909201929
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$2,979.25 |
| Rate for Payer: Adventist Health Commercial |
$701.00
|
| 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 |
$2,152.42
|
| Rate for Payer: Blue Shield of California Commercial |
$2,145.06
|
| Rate for Payer: Blue Shield of California EPN |
$1,416.02
|
| Rate for Payer: Cash Price |
$1,577.25
|
| Rate for Payer: Cash Price |
$1,577.25
|
| Rate for Payer: Cash Price |
$1,577.25
|
| Rate for Payer: Cigna of CA HMO |
$2,243.20
|
| Rate for Payer: Cigna of CA PPO |
$2,593.70
|
| 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 |
$2,979.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,103.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$399.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,337.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$451.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$841.20
|
| 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 |
$2,804.00
|
| Rate for Payer: Networks By Design Commercial |
$2,278.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,979.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,103.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,103.00
|
| 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: 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
|
|
|
HC CT ABDOMEN W/WO CONT
|
Facility
|
IP
|
$6,539.00
|
|
|
Service Code
|
CPT 74170
|
| Hospital Charge Code |
909201929
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,307.80 |
| Max. Negotiated Rate |
$5,558.15 |
| Rate for Payer: Adventist Health Commercial |
$1,307.80
|
| Rate for Payer: Cash Price |
$2,942.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,615.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,615.60
|
| Rate for Payer: Galaxy Health WC |
$5,558.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,923.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,361.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,491.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,047.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,569.36
|
| Rate for Payer: Multiplan Commercial |
$5,231.20
|
| Rate for Payer: Networks By Design Commercial |
$4,250.35
|
| Rate for Payer: Prime Health Services Commercial |
$5,558.15
|
|
|
HC CT ANGIO ABD AORTA-AIF W/WO CO
|
Facility
|
OP
|
$4,310.00
|
|
|
Service Code
|
CPT 75635
|
| Hospital Charge Code |
909201809
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$3,663.50 |
| Rate for Payer: Adventist Health Commercial |
$862.00
|
| 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 |
$2,646.77
|
| Rate for Payer: Blue Shield of California Commercial |
$2,637.72
|
| Rate for Payer: Blue Shield of California EPN |
$1,741.24
|
| Rate for Payer: Cash Price |
$1,939.50
|
| Rate for Payer: Cash Price |
$1,939.50
|
| Rate for Payer: Cash Price |
$1,939.50
|
| Rate for Payer: Cigna of CA HMO |
$2,758.40
|
| Rate for Payer: Cigna of CA PPO |
$3,189.40
|
| 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 |
$3,663.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,586.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$575.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,874.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$650.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,034.40
|
| 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 |
$3,448.00
|
| Rate for Payer: Networks By Design Commercial |
$2,801.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,663.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,586.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,586.00
|
| 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: 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
|
|
|
HC CT ANGIO ABD AORTA-AIF W/WO CO
|
Facility
|
IP
|
$6,772.00
|
|
|
Service Code
|
CPT 75635
|
| Hospital Charge Code |
909201809
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,354.40 |
| Max. Negotiated Rate |
$5,756.20 |
| Rate for Payer: Adventist Health Commercial |
$1,354.40
|
| Rate for Payer: Cash Price |
$3,047.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,708.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,708.80
|
| Rate for Payer: Galaxy Health WC |
$5,756.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,063.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,516.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,580.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,191.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,625.28
|
| Rate for Payer: Multiplan Commercial |
$5,417.60
|
| Rate for Payer: Networks By Design Commercial |
$4,401.80
|
| Rate for Payer: Prime Health Services Commercial |
$5,756.20
|
|
|
HC CT ANGIO ABDOMEN/PELVIS
|
Facility
|
IP
|
$7,096.00
|
|
|
Service Code
|
CPT 74174
|
| Hospital Charge Code |
909201991
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,419.20 |
| Max. Negotiated Rate |
$6,031.60 |
| Rate for Payer: Adventist Health Commercial |
$1,419.20
|
| Rate for Payer: Cash Price |
$3,193.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,838.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,838.40
|
| Rate for Payer: Galaxy Health WC |
$6,031.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,257.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,733.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,703.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,392.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,703.04
|
| Rate for Payer: Multiplan Commercial |
$5,676.80
|
| Rate for Payer: Networks By Design Commercial |
$4,612.40
|
| Rate for Payer: Prime Health Services Commercial |
$6,031.60
|
|
|
HC CT ANGIO ABDOMEN/PELVIS
|
Facility
|
OP
|
$3,802.00
|
|
|
Service Code
|
CPT 74174
|
| Hospital Charge Code |
909201991
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$453.77 |
| Max. Negotiated Rate |
$3,231.70 |
| Rate for Payer: Adventist Health Commercial |
$760.40
|
| 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 |
$2,334.81
|
| Rate for Payer: Blue Shield of California Commercial |
$2,326.82
|
| Rate for Payer: Blue Shield of California EPN |
$1,536.01
|
| Rate for Payer: Cash Price |
$1,710.90
|
| Rate for Payer: Cash Price |
$1,710.90
|
| Rate for Payer: Cash Price |
$1,710.90
|
| Rate for Payer: Cigna of CA HMO |
$2,433.28
|
| Rate for Payer: Cigna of CA PPO |
$2,813.48
|
| 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 |
$3,231.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,281.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$590.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,535.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$668.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$912.48
|
| 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 |
$3,041.60
|
| Rate for Payer: Networks By Design Commercial |
$2,471.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,231.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,281.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,281.20
|
| 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 ANGIO ABDOMEN W/WO CONTRAST
|
Facility
|
OP
|
$3,890.00
|
|
|
Service Code
|
CPT 74175
|
| Hospital Charge Code |
909201808
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$3,306.50 |
| Rate for Payer: Adventist Health Commercial |
$778.00
|
| 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 |
$2,388.85
|
| Rate for Payer: Blue Shield of California Commercial |
$2,380.68
|
| Rate for Payer: Blue Shield of California EPN |
$1,571.56
|
| Rate for Payer: Cash Price |
$1,750.50
|
| Rate for Payer: Cash Price |
$1,750.50
|
| Rate for Payer: Cash Price |
$1,750.50
|
| Rate for Payer: Cigna of CA HMO |
$2,489.60
|
| Rate for Payer: Cigna of CA PPO |
$2,878.60
|
| 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 |
$3,306.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,334.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$465.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,594.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$526.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$933.60
|
| 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 |
$3,112.00
|
| Rate for Payer: Networks By Design Commercial |
$2,528.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,306.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,334.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,334.00
|
| 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: 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
|
|
|
HC CT ANGIO ABDOMEN W/WO CONTRAST
|
Facility
|
IP
|
$5,806.00
|
|
|
Service Code
|
CPT 74175
|
| Hospital Charge Code |
909201808
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,161.20 |
| Max. Negotiated Rate |
$4,935.10 |
| Rate for Payer: Adventist Health Commercial |
$1,161.20
|
| Rate for Payer: Cash Price |
$2,612.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,322.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,322.40
|
| Rate for Payer: Galaxy Health WC |
$4,935.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,483.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,872.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,212.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,593.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,393.44
|
| Rate for Payer: Multiplan Commercial |
$4,644.80
|
| Rate for Payer: Networks By Design Commercial |
$3,773.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,935.10
|
|
|
HC CT ANGIO CHEST W/WO CONTRAST
|
Facility
|
OP
|
$3,658.00
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
909201802
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$3,109.30 |
| Rate for Payer: Adventist Health Commercial |
$731.60
|
| 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 |
$2,246.38
|
| Rate for Payer: Blue Shield of California Commercial |
$2,238.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,477.83
|
| Rate for Payer: Cash Price |
$1,646.10
|
| Rate for Payer: Cash Price |
$1,646.10
|
| Rate for Payer: Cash Price |
$1,646.10
|
| Rate for Payer: Cigna of CA HMO |
$2,341.12
|
| Rate for Payer: Cigna of CA PPO |
$2,706.92
|
| 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 |
$3,109.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,194.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$455.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,439.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$514.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$877.92
|
| 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 |
$2,926.40
|
| Rate for Payer: Networks By Design Commercial |
$2,377.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,109.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,194.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,194.80
|
| 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: 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
|
|
|
HC CT ANGIO CHEST W/WO CONTRAST
|
Facility
|
IP
|
$5,958.00
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
909201802
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,191.60 |
| Max. Negotiated Rate |
$5,064.30 |
| Rate for Payer: Adventist Health Commercial |
$1,191.60
|
| Rate for Payer: Cash Price |
$2,681.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,383.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,383.20
|
| Rate for Payer: Galaxy Health WC |
$5,064.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,574.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,973.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,270.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,688.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,429.92
|
| Rate for Payer: Multiplan Commercial |
$4,766.40
|
| Rate for Payer: Networks By Design Commercial |
$3,872.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,064.30
|
|
|
HC CT ANGIO HEAD W/WO CONTRAST
|
Facility
|
OP
|
$4,285.00
|
|
|
Service Code
|
CPT 70496
|
| Hospital Charge Code |
909201800
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$3,642.25 |
| Rate for Payer: Adventist Health Commercial |
$857.00
|
| 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 |
$2,631.42
|
| Rate for Payer: Blue Shield of California Commercial |
$2,622.42
|
| Rate for Payer: Blue Shield of California EPN |
$1,731.14
|
| Rate for Payer: Cash Price |
$1,928.25
|
| Rate for Payer: Cash Price |
$1,928.25
|
| Rate for Payer: Cash Price |
$1,928.25
|
| Rate for Payer: Cigna of CA HMO |
$2,742.40
|
| Rate for Payer: Cigna of CA PPO |
$3,170.90
|
| 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 |
$3,642.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,571.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$446.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,858.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$505.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,028.40
|
| 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 |
$3,428.00
|
| Rate for Payer: Networks By Design Commercial |
$2,785.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,642.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,571.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,571.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,142.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,142.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,142.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,142.50
|
| 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
|
|
|
HC CT ANGIO HEAD W/WO CONTRAST
|
Facility
|
IP
|
$7,722.00
|
|
|
Service Code
|
CPT 70496
|
| Hospital Charge Code |
909201800
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,544.40 |
| Max. Negotiated Rate |
$6,563.70 |
| Rate for Payer: Adventist Health Commercial |
$1,544.40
|
| Rate for Payer: Cash Price |
$3,474.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,088.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,088.80
|
| Rate for Payer: Galaxy Health WC |
$6,563.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,633.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,150.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,942.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,779.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,853.28
|
| Rate for Payer: Multiplan Commercial |
$6,177.60
|
| Rate for Payer: Networks By Design Commercial |
$5,019.30
|
| Rate for Payer: Prime Health Services Commercial |
$6,563.70
|
|
|
HC CT ANGIO LOW EXT W/WO CONT
|
Facility
|
IP
|
$4,873.00
|
|
|
Service Code
|
CPT 73706
|
| Hospital Charge Code |
909201807
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$974.60 |
| Max. Negotiated Rate |
$4,142.05 |
| Rate for Payer: Adventist Health Commercial |
$974.60
|
| Rate for Payer: Cash Price |
$2,192.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,949.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,949.20
|
| Rate for Payer: Galaxy Health WC |
$4,142.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,923.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,250.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,856.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,016.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,169.52
|
| Rate for Payer: Multiplan Commercial |
$3,898.40
|
| Rate for Payer: Networks By Design Commercial |
$3,167.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,142.05
|
|
|
HC CT ANGIO LOW EXT W/WO CONT
|
Facility
|
OP
|
$2,736.00
|
|
|
Service Code
|
CPT 73706
|
| Hospital Charge Code |
909201807
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$547.20
|
| 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 |
$1,680.18
|
| Rate for Payer: Blue Shield of California Commercial |
$1,674.43
|
| Rate for Payer: Blue Shield of California EPN |
$1,105.34
|
| Rate for Payer: Cash Price |
$1,231.20
|
| Rate for Payer: Cash Price |
$1,231.20
|
| Rate for Payer: Cash Price |
$1,231.20
|
| Rate for Payer: Cigna of CA HMO |
$1,751.04
|
| Rate for Payer: Cigna of CA PPO |
$2,024.64
|
| 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 |
$2,325.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,641.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$530.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,824.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$600.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$656.64
|
| 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 |
$2,188.80
|
| Rate for Payer: Networks By Design Commercial |
$1,778.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,325.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,641.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,641.60
|
| 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: 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
|
|
|
HC CT ANGIO NECK W/WO CONTRAST
|
Facility
|
OP
|
$4,285.00
|
|
|
Service Code
|
CPT 70498
|
| Hospital Charge Code |
909201801
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$3,642.25 |
| Rate for Payer: Adventist Health Commercial |
$857.00
|
| 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 |
$2,631.42
|
| Rate for Payer: Blue Shield of California Commercial |
$2,622.42
|
| Rate for Payer: Blue Shield of California EPN |
$1,731.14
|
| Rate for Payer: Cash Price |
$1,928.25
|
| Rate for Payer: Cash Price |
$1,928.25
|
| Rate for Payer: Cash Price |
$1,928.25
|
| Rate for Payer: Cigna of CA HMO |
$2,742.40
|
| Rate for Payer: Cigna of CA PPO |
$3,170.90
|
| 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 |
$3,642.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,571.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$445.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,858.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$503.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,028.40
|
| 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 |
$3,428.00
|
| Rate for Payer: Networks By Design Commercial |
$2,785.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,642.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,571.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,571.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,142.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,142.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,142.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,142.50
|
| 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
|
|
|
HC CT ANGIO NECK W/WO CONTRAST
|
Facility
|
IP
|
$7,722.00
|
|
|
Service Code
|
CPT 70498
|
| Hospital Charge Code |
909201801
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,544.40 |
| Max. Negotiated Rate |
$6,563.70 |
| Rate for Payer: Adventist Health Commercial |
$1,544.40
|
| Rate for Payer: Cash Price |
$3,474.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,088.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,088.80
|
| Rate for Payer: Galaxy Health WC |
$6,563.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,633.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,150.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,942.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,779.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,853.28
|
| Rate for Payer: Multiplan Commercial |
$6,177.60
|
| Rate for Payer: Networks By Design Commercial |
$5,019.30
|
| Rate for Payer: Prime Health Services Commercial |
$6,563.70
|
|
|
HC CT ANGIO PELVIS W/WO CONTRAST
|
Facility
|
IP
|
$5,778.00
|
|
|
Service Code
|
CPT 72191
|
| Hospital Charge Code |
909201803
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,155.60 |
| Max. Negotiated Rate |
$4,911.30 |
| Rate for Payer: Adventist Health Commercial |
$1,155.60
|
| Rate for Payer: Cash Price |
$2,600.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,311.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,311.20
|
| Rate for Payer: Galaxy Health WC |
$4,911.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,466.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,853.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,201.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,576.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,386.72
|
| Rate for Payer: Multiplan Commercial |
$4,622.40
|
| Rate for Payer: Networks By Design Commercial |
$3,755.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,911.30
|
|
|
HC CT ANGIO PELVIS W/WO CONTRAST
|
Facility
|
OP
|
$3,097.00
|
|
|
Service Code
|
CPT 72191
|
| Hospital Charge Code |
909201803
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$619.40
|
| 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 |
$1,901.87
|
| Rate for Payer: Blue Shield of California Commercial |
$1,895.36
|
| Rate for Payer: Blue Shield of California EPN |
$1,251.19
|
| Rate for Payer: Cash Price |
$1,393.65
|
| Rate for Payer: Cash Price |
$1,393.65
|
| Rate for Payer: Cash Price |
$1,393.65
|
| Rate for Payer: Cigna of CA HMO |
$1,982.08
|
| Rate for Payer: Cigna of CA PPO |
$2,291.78
|
| 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 |
$2,632.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,858.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$461.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,065.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$522.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$743.28
|
| 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 |
$2,477.60
|
| Rate for Payer: Networks By Design Commercial |
$2,013.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,632.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,858.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,858.20
|
| 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: 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
|
|
|
HC CT ANGIO UPP EXT W/WO CON
|
Facility
|
OP
|
$3,004.00
|
|
|
Service Code
|
CPT 73206
|
| Hospital Charge Code |
909201804
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$600.80
|
| 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 |
$1,844.76
|
| Rate for Payer: Blue Shield of California Commercial |
$1,838.45
|
| Rate for Payer: Blue Shield of California EPN |
$1,213.62
|
| Rate for Payer: Cash Price |
$1,351.80
|
| Rate for Payer: Cash Price |
$1,351.80
|
| Rate for Payer: Cash Price |
$1,351.80
|
| Rate for Payer: Cigna of CA HMO |
$1,922.56
|
| Rate for Payer: Cigna of CA PPO |
$2,222.96
|
| 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 |
$2,553.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,802.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$488.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,003.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$553.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$720.96
|
| 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 |
$2,403.20
|
| Rate for Payer: Networks By Design Commercial |
$1,952.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,553.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,802.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,802.40
|
| 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: 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
|
|
|
HC CT ANGIO UPP EXT W/WO CON
|
Facility
|
IP
|
$5,350.00
|
|
|
Service Code
|
CPT 73206
|
| Hospital Charge Code |
909201804
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,070.00 |
| Max. Negotiated Rate |
$4,547.50 |
| Rate for Payer: Adventist Health Commercial |
$1,070.00
|
| Rate for Payer: Cash Price |
$2,407.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,140.00
|
| Rate for Payer: Galaxy Health WC |
$4,547.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,210.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,568.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,038.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,311.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,284.00
|
| Rate for Payer: Multiplan Commercial |
$4,280.00
|
| Rate for Payer: Networks By Design Commercial |
$3,477.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,547.50
|
|
|
HC CT BONE L-SPINE W CONTRAST
|
Facility
|
IP
|
$5,104.00
|
|
|
Service Code
|
CPT 72132
|
| Hospital Charge Code |
909201008
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,020.80 |
| Max. Negotiated Rate |
$4,338.40 |
| Rate for Payer: Adventist Health Commercial |
$1,020.80
|
| Rate for Payer: Cash Price |
$2,296.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,041.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,041.60
|
| Rate for Payer: Galaxy Health WC |
$4,338.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,062.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,404.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,944.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,159.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,224.96
|
| Rate for Payer: Multiplan Commercial |
$4,083.20
|
| Rate for Payer: Networks By Design Commercial |
$3,317.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,338.40
|
|
|
HC CT BONE L-SPINE W CONTRAST
|
Facility
|
OP
|
$2,736.00
|
|
|
Service Code
|
CPT 72132
|
| Hospital Charge Code |
909201008
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$273.97 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$547.20
|
| 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 |
$1,680.18
|
| Rate for Payer: Blue Shield of California Commercial |
$1,674.43
|
| Rate for Payer: Blue Shield of California EPN |
$1,105.34
|
| Rate for Payer: Cash Price |
$1,231.20
|
| Rate for Payer: Cash Price |
$1,231.20
|
| Rate for Payer: Cash Price |
$1,231.20
|
| Rate for Payer: Cigna of CA HMO |
$1,751.04
|
| Rate for Payer: Cigna of CA PPO |
$2,024.64
|
| 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 |
$2,325.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,641.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$273.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,824.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$309.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$656.64
|
| 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 |
$2,188.80
|
| Rate for Payer: Networks By Design Commercial |
$1,778.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,325.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,641.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,641.60
|
| 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 |
$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
|
|
