|
HC C SPINE W/FLEX AND EXT COMPLETE
|
Facility
|
OP
|
$1,850.00
|
|
|
Service Code
|
CPT 72052
|
| Hospital Charge Code |
909001303
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$86.53 |
| Max. Negotiated Rate |
$1,665.00 |
| Rate for Payer: Adventist Health Commercial |
$370.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$312.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$235.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$327.58
|
| Rate for Payer: Blue Shield of California Commercial |
$1,165.50
|
| Rate for Payer: Blue Shield of California EPN |
$734.45
|
| Rate for Payer: Cash Price |
$832.50
|
| Rate for Payer: Cash Price |
$832.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,480.00
|
| Rate for Payer: Cigna of CA HMO |
$1,184.00
|
| Rate for Payer: Cigna of CA PPO |
$1,369.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,295.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$1,572.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,110.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,665.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$86.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,174.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$95.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$370.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,387.50
|
| Rate for Payer: Networks By Design Commercial |
$1,202.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: Prime Health Services Commercial |
$1,572.50
|
| Rate for Payer: Prime Health Services Medicare |
$142.53
|
| Rate for Payer: Riverside University Health System MISP |
$147.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,110.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,110.00
|
| 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 |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC C SPINE W/FLEX AND EXT COMPLETE
|
Facility
|
IP
|
$1,850.00
|
|
|
Service Code
|
CPT 72052
|
| Hospital Charge Code |
909001303
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$370.00 |
| Max. Negotiated Rate |
$1,665.00 |
| Rate for Payer: Adventist Health Commercial |
$370.00
|
| Rate for Payer: Cash Price |
$832.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,480.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,295.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.00
|
| Rate for Payer: EPIC Health Plan Senior |
$740.00
|
| Rate for Payer: Galaxy Health WC |
$1,572.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,110.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,665.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,174.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,091.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$370.00
|
| Rate for Payer: Multiplan Commercial |
$1,387.50
|
| Rate for Payer: Networks By Design Commercial |
$1,202.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,572.50
|
|
|
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 |
$448.71 |
| Max. Negotiated Rate |
$3,570.30 |
| Rate for Payer: Adventist Health Commercial |
$793.40
|
| Rate for Payer: Adventist Health Commercial |
$1,413.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$448.71
|
| Rate for Payer: Adventist Health Medi-Cal |
$448.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,459.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,459.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,307.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,110.29
|
| Rate for Payer: Blue Shield of California Commercial |
$4,451.58
|
| Rate for Payer: Blue Shield of California Commercial |
$2,499.21
|
| Rate for Payer: Blue Shield of California EPN |
$1,574.90
|
| Rate for Payer: Blue Shield of California EPN |
$2,805.20
|
| 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: Cash Price |
$3,179.70
|
| Rate for Payer: Cash Price |
$3,179.70
|
| Rate for Payer: Cash Price |
$3,179.70
|
| Rate for Payer: Central Health Plan Commercial |
$5,652.80
|
| Rate for Payer: Central Health Plan Commercial |
$3,173.60
|
| Rate for Payer: Cigna of CA HMO |
$4,522.24
|
| Rate for Payer: Cigna of CA HMO |
$2,538.88
|
| Rate for Payer: Cigna of CA PPO |
$5,228.84
|
| Rate for Payer: Cigna of CA PPO |
$2,935.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,946.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,776.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.37
|
| Rate for Payer: EPIC Health Plan Senior |
$493.58
|
| Rate for Payer: EPIC Health Plan Senior |
$493.58
|
| Rate for Payer: Galaxy Health WC |
$3,371.95
|
| Rate for Payer: Galaxy Health WC |
$6,006.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,239.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,380.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,359.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,570.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$735.88
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$735.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$484.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$484.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,486.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,519.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$535.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$535.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$793.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,413.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$601.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$601.27
|
| Rate for Payer: Multiplan Commercial |
$5,299.50
|
| Rate for Payer: Multiplan Commercial |
$2,975.25
|
| Rate for Payer: Networks By Design Commercial |
$2,578.55
|
| Rate for Payer: Networks By Design Commercial |
$4,592.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$448.71
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$448.71
|
| Rate for Payer: Prime Health Services Commercial |
$3,371.95
|
| Rate for Payer: Prime Health Services Commercial |
$6,006.10
|
| Rate for Payer: Prime Health Services Medicare |
$475.63
|
| Rate for Payer: Prime Health Services Medicare |
$475.63
|
| Rate for Payer: Riverside University Health System MISP |
$493.58
|
| Rate for Payer: Riverside University Health System MISP |
$493.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,380.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,239.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,380.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,239.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,486.18
|
| 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 All Other HMO |
$1,486.18
|
| Rate for Payer: United Healthcare HMO Rider |
$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: United Healthcare Select/Navigate/Core |
$1,486.18
|
| Rate for Payer: Upland Medical Group Pediatric |
$448.71
|
| Rate for Payer: Upland Medical Group Pediatric |
$448.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
|
|
HC CT ABDOMEN & PELVIS W/CONTRAST
|
Facility
|
IP
|
$7,066.00
|
|
|
Service Code
|
CPT 74177
|
| Hospital Charge Code |
909202002
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,413.20 |
| Max. Negotiated Rate |
$6,359.40 |
| Rate for Payer: Adventist Health Commercial |
$1,413.20
|
| Rate for Payer: Cash Price |
$3,179.70
|
| Rate for Payer: Central Health Plan Commercial |
$5,652.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,946.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,826.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,826.40
|
| Rate for Payer: Galaxy Health WC |
$6,006.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,239.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,359.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,486.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,168.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,413.20
|
| Rate for Payer: Multiplan Commercial |
$5,299.50
|
| Rate for Payer: Networks By Design Commercial |
$4,592.90
|
| Rate for Payer: Prime Health Services Commercial |
$6,006.10
|
|
|
HC CT ABDOMEN & PELVIS W/O CONTRA
|
Facility
|
IP
|
$6,381.00
|
|
|
Service Code
|
CPT 74176
|
| Hospital Charge Code |
909202001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,276.20 |
| Max. Negotiated Rate |
$5,742.90 |
| Rate for Payer: Adventist Health Commercial |
$1,276.20
|
| Rate for Payer: Cash Price |
$2,871.45
|
| Rate for Payer: Central Health Plan Commercial |
$5,104.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,466.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,552.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,552.40
|
| Rate for Payer: Galaxy Health WC |
$5,423.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,828.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,742.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,051.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,764.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,276.20
|
| Rate for Payer: Multiplan Commercial |
$4,785.75
|
| Rate for Payer: Networks By Design Commercial |
$4,147.65
|
| Rate for Payer: Prime Health Services Commercial |
$5,423.85
|
|
|
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 |
$299.81 |
| Max. Negotiated Rate |
$3,222.90 |
| Rate for Payer: Adventist Health Commercial |
$716.20
|
| Rate for Payer: Adventist Health Commercial |
$1,276.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$306.88
|
| Rate for Payer: Adventist Health Medi-Cal |
$306.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$765.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$765.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,083.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,711.83
|
| Rate for Payer: Blue Shield of California Commercial |
$4,020.03
|
| Rate for Payer: Blue Shield of California Commercial |
$2,256.03
|
| Rate for Payer: Blue Shield of California EPN |
$1,421.66
|
| Rate for Payer: Blue Shield of California EPN |
$2,533.26
|
| 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: Cash Price |
$2,871.45
|
| Rate for Payer: Cash Price |
$2,871.45
|
| Rate for Payer: Cash Price |
$2,871.45
|
| Rate for Payer: Central Health Plan Commercial |
$5,104.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,864.80
|
| Rate for Payer: Cigna of CA HMO |
$4,083.84
|
| Rate for Payer: Cigna of CA HMO |
$2,291.84
|
| Rate for Payer: Cigna of CA PPO |
$4,721.94
|
| Rate for Payer: Cigna of CA PPO |
$2,649.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,466.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,506.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: Galaxy Health WC |
$3,043.85
|
| Rate for Payer: Galaxy Health WC |
$5,423.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,828.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,148.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,742.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,222.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.28
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$299.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$299.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,051.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,273.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$331.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$331.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$716.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,276.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$4,785.75
|
| Rate for Payer: Multiplan Commercial |
$2,685.75
|
| Rate for Payer: Networks By Design Commercial |
$2,327.65
|
| Rate for Payer: Networks By Design Commercial |
$4,147.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$306.88
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$306.88
|
| Rate for Payer: Prime Health Services Commercial |
$3,043.85
|
| Rate for Payer: Prime Health Services Commercial |
$5,423.85
|
| Rate for Payer: Prime Health Services Medicare |
$325.29
|
| Rate for Payer: Prime Health Services Medicare |
$325.29
|
| Rate for Payer: Riverside University Health System MISP |
$337.57
|
| Rate for Payer: Riverside University Health System MISP |
$337.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,148.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,828.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,148.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,828.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,037.23
|
| 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 All Other HMO |
$1,037.23
|
| Rate for Payer: United Healthcare HMO Rider |
$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: United Healthcare Select/Navigate/Core |
$1,037.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$306.88
|
| Rate for Payer: Upland Medical Group Pediatric |
$306.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC CT ABDOMEN & PELVIS W & W/O CO
|
Facility
|
IP
|
$7,670.00
|
|
|
Service Code
|
CPT 74178
|
| Hospital Charge Code |
909202003
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,534.00 |
| Max. Negotiated Rate |
$6,903.00 |
| Rate for Payer: Adventist Health Commercial |
$1,534.00
|
| Rate for Payer: Cash Price |
$3,451.50
|
| Rate for Payer: Central Health Plan Commercial |
$6,136.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,369.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,068.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,068.00
|
| Rate for Payer: Galaxy Health WC |
$6,519.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,602.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,903.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,870.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,525.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,534.00
|
| Rate for Payer: Multiplan Commercial |
$5,752.50
|
| Rate for Payer: Networks By Design Commercial |
$4,985.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,519.50
|
|
|
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 |
$448.71 |
| Max. Negotiated Rate |
$3,875.40 |
| Rate for Payer: Adventist Health Commercial |
$861.20
|
| Rate for Payer: Adventist Health Commercial |
$1,534.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$448.71
|
| Rate for Payer: Adventist Health Medi-Cal |
$448.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,929.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,929.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,504.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,461.64
|
| Rate for Payer: Blue Shield of California Commercial |
$4,832.10
|
| Rate for Payer: Blue Shield of California Commercial |
$2,712.78
|
| Rate for Payer: Blue Shield of California EPN |
$1,709.48
|
| Rate for Payer: Blue Shield of California EPN |
$3,044.99
|
| 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: Cash Price |
$3,451.50
|
| Rate for Payer: Cash Price |
$3,451.50
|
| Rate for Payer: Cash Price |
$3,451.50
|
| Rate for Payer: Central Health Plan Commercial |
$6,136.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,444.80
|
| Rate for Payer: Cigna of CA HMO |
$4,908.80
|
| Rate for Payer: Cigna of CA HMO |
$2,755.84
|
| Rate for Payer: Cigna of CA PPO |
$5,675.80
|
| Rate for Payer: Cigna of CA PPO |
$3,186.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,369.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,014.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.37
|
| Rate for Payer: EPIC Health Plan Senior |
$493.58
|
| Rate for Payer: EPIC Health Plan Senior |
$493.58
|
| Rate for Payer: Galaxy Health WC |
$3,660.10
|
| Rate for Payer: Galaxy Health WC |
$6,519.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,602.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,583.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,903.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,875.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$735.88
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$735.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$549.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$549.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,870.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,734.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$606.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$606.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$861.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,534.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$601.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$601.27
|
| Rate for Payer: Multiplan Commercial |
$5,752.50
|
| Rate for Payer: Multiplan Commercial |
$3,229.50
|
| Rate for Payer: Networks By Design Commercial |
$2,798.90
|
| Rate for Payer: Networks By Design Commercial |
$4,985.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$448.71
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$448.71
|
| Rate for Payer: Prime Health Services Commercial |
$3,660.10
|
| Rate for Payer: Prime Health Services Commercial |
$6,519.50
|
| Rate for Payer: Prime Health Services Medicare |
$475.63
|
| Rate for Payer: Prime Health Services Medicare |
$475.63
|
| Rate for Payer: Riverside University Health System MISP |
$493.58
|
| Rate for Payer: Riverside University Health System MISP |
$493.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,583.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,602.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,583.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,602.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,486.18
|
| 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 All Other HMO |
$1,486.18
|
| Rate for Payer: United Healthcare HMO Rider |
$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: United Healthcare Select/Navigate/Core |
$1,486.18
|
| Rate for Payer: Upland Medical Group Pediatric |
$448.71
|
| Rate for Payer: Upland Medical Group Pediatric |
$448.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
|
|
HC CT ABDOMEN W CONTRAS
|
Facility
|
IP
|
$5,781.00
|
|
|
Service Code
|
CPT 74160
|
| Hospital Charge Code |
909201928
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,156.20 |
| Max. Negotiated Rate |
$5,202.90 |
| Rate for Payer: Adventist Health Commercial |
$1,156.20
|
| Rate for Payer: Cash Price |
$2,601.45
|
| Rate for Payer: Central Health Plan Commercial |
$4,624.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,046.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,312.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,312.40
|
| Rate for Payer: Galaxy Health WC |
$4,913.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,468.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,202.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,670.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,410.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,156.20
|
| Rate for Payer: Multiplan Commercial |
$4,335.75
|
| Rate for Payer: Networks By Design Commercial |
$3,757.65
|
| Rate for Payer: Prime Health Services Commercial |
$4,913.85
|
|
|
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 |
$225.59 |
| Max. Negotiated Rate |
$2,696.40 |
| Rate for Payer: Adventist Health Commercial |
$599.20
|
| Rate for Payer: Adventist Health Commercial |
$1,156.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$225.59
|
| Rate for Payer: Adventist Health Medi-Cal |
$225.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,411.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,411.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,742.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,362.81
|
| Rate for Payer: Blue Shield of California Commercial |
$3,642.03
|
| Rate for Payer: Blue Shield of California Commercial |
$1,887.48
|
| Rate for Payer: Blue Shield of California EPN |
$1,189.41
|
| Rate for Payer: Blue Shield of California EPN |
$2,295.06
|
| 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: Cash Price |
$2,601.45
|
| Rate for Payer: Cash Price |
$2,601.45
|
| Rate for Payer: Cash Price |
$2,601.45
|
| Rate for Payer: Central Health Plan Commercial |
$4,624.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,396.80
|
| Rate for Payer: Cigna of CA HMO |
$3,699.84
|
| Rate for Payer: Cigna of CA HMO |
$1,917.44
|
| Rate for Payer: Cigna of CA PPO |
$4,277.94
|
| Rate for Payer: Cigna of CA PPO |
$2,217.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,046.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,097.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: Galaxy Health WC |
$2,546.60
|
| Rate for Payer: Galaxy Health WC |
$4,913.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,468.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,797.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,202.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,696.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$359.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$359.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,670.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,902.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$396.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$396.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$599.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,156.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$4,335.75
|
| Rate for Payer: Multiplan Commercial |
$2,247.00
|
| Rate for Payer: Networks By Design Commercial |
$1,947.40
|
| Rate for Payer: Networks By Design Commercial |
$3,757.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$225.59
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$225.59
|
| Rate for Payer: Prime Health Services Commercial |
$2,546.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,913.85
|
| Rate for Payer: Prime Health Services Medicare |
$239.13
|
| Rate for Payer: Prime Health Services Medicare |
$239.13
|
| Rate for Payer: Riverside University Health System MISP |
$248.15
|
| Rate for Payer: Riverside University Health System MISP |
$248.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,797.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,468.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,797.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,468.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$769.25
|
| 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 All Other HMO |
$769.25
|
| Rate for Payer: United Healthcare HMO Rider |
$769.25
|
| Rate for Payer: United Healthcare HMO Rider |
$769.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$769.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$769.25
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
|
HC CT ABDOMEN WO CONTR
|
Facility
|
IP
|
$4,791.00
|
|
|
Service Code
|
CPT 74150
|
| Hospital Charge Code |
909201927
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$958.20 |
| Max. Negotiated Rate |
$4,311.90 |
| Rate for Payer: Adventist Health Commercial |
$958.20
|
| Rate for Payer: Cash Price |
$2,155.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,832.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,353.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,916.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,916.40
|
| Rate for Payer: Galaxy Health WC |
$4,072.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,874.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,311.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,042.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,826.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$958.20
|
| Rate for Payer: Multiplan Commercial |
$3,593.25
|
| Rate for Payer: Networks By Design Commercial |
$3,114.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,072.35
|
|
|
HC CT ABDOMEN WO CONTR
|
Facility
|
OP
|
$4,791.00
|
|
|
Service Code
|
CPT 74150
|
| Hospital Charge Code |
909201927
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$4,311.90 |
| Rate for Payer: Adventist Health Commercial |
$958.20
|
| Rate for Payer: Adventist Health Commercial |
$533.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,170.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,170.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,786.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,550.23
|
| Rate for Payer: Blue Shield of California Commercial |
$1,678.95
|
| Rate for Payer: Blue Shield of California Commercial |
$3,018.33
|
| Rate for Payer: Blue Shield of California EPN |
$1,902.03
|
| Rate for Payer: Blue Shield of California EPN |
$1,058.01
|
| Rate for Payer: Cash Price |
$1,199.25
|
| Rate for Payer: Cash Price |
$2,155.95
|
| Rate for Payer: Cash Price |
$2,155.95
|
| Rate for Payer: Cash Price |
$1,199.25
|
| Rate for Payer: Cash Price |
$1,199.25
|
| Rate for Payer: Cash Price |
$2,155.95
|
| Rate for Payer: Center for Health Promotion Commercial |
$145.00
|
| Rate for Payer: Center for Health Promotion Commercial |
$145.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,132.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,832.80
|
| Rate for Payer: Cigna of CA HMO |
$3,066.24
|
| Rate for Payer: Cigna of CA HMO |
$1,705.60
|
| Rate for Payer: Cigna of CA PPO |
$3,545.34
|
| Rate for Payer: Cigna of CA PPO |
$1,972.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,353.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,865.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$2,265.25
|
| Rate for Payer: Galaxy Health WC |
$4,072.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,599.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,874.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,398.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,311.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$225.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$225.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,692.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,042.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$249.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$249.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$533.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$958.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$3,593.25
|
| Rate for Payer: Multiplan Commercial |
$1,998.75
|
| Rate for Payer: Networks By Design Commercial |
$1,732.25
|
| Rate for Payer: Networks By Design Commercial |
$3,114.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: Prime Health Services Commercial |
$2,265.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,072.35
|
| Rate for Payer: Prime Health Services Medicare |
$142.53
|
| Rate for Payer: Prime Health Services Medicare |
$142.53
|
| Rate for Payer: Riverside University Health System MISP |
$147.91
|
| Rate for Payer: Riverside University Health System MISP |
$147.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,599.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,874.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,599.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,874.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$491.23
|
| 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 All Other HMO |
$491.23
|
| Rate for Payer: United Healthcare HMO Rider |
$491.23
|
| Rate for Payer: United Healthcare HMO Rider |
$491.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$491.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$491.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
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 |
$225.59 |
| Max. Negotiated Rate |
$3,154.50 |
| Rate for Payer: Adventist Health Commercial |
$701.00
|
| Rate for Payer: Adventist Health Commercial |
$1,248.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$225.59
|
| Rate for Payer: Adventist Health Medi-Cal |
$225.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,747.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,747.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,038.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,631.55
|
| Rate for Payer: Blue Shield of California Commercial |
$3,933.09
|
| Rate for Payer: Blue Shield of California Commercial |
$2,208.15
|
| Rate for Payer: Blue Shield of California EPN |
$1,391.48
|
| Rate for Payer: Blue Shield of California EPN |
$2,478.47
|
| 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: Cash Price |
$2,809.35
|
| Rate for Payer: Cash Price |
$2,809.35
|
| Rate for Payer: Cash Price |
$2,809.35
|
| Rate for Payer: Central Health Plan Commercial |
$4,994.40
|
| Rate for Payer: Central Health Plan Commercial |
$2,804.00
|
| Rate for Payer: Cigna of CA HMO |
$3,995.52
|
| Rate for Payer: Cigna of CA HMO |
$2,243.20
|
| Rate for Payer: Cigna of CA PPO |
$4,619.82
|
| Rate for Payer: Cigna of CA PPO |
$2,593.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,370.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,453.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: Galaxy Health WC |
$2,979.25
|
| Rate for Payer: Galaxy Health WC |
$5,306.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,745.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,103.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,618.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,154.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$408.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$408.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,964.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,225.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$451.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$451.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$701.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,248.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$4,682.25
|
| Rate for Payer: Multiplan Commercial |
$2,628.75
|
| Rate for Payer: Networks By Design Commercial |
$2,278.25
|
| Rate for Payer: Networks By Design Commercial |
$4,057.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$225.59
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$225.59
|
| Rate for Payer: Prime Health Services Commercial |
$2,979.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,306.55
|
| Rate for Payer: Prime Health Services Medicare |
$239.13
|
| Rate for Payer: Prime Health Services Medicare |
$239.13
|
| Rate for Payer: Riverside University Health System MISP |
$248.15
|
| Rate for Payer: Riverside University Health System MISP |
$248.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,103.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,745.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,103.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,745.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$855.26
|
| 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 All Other HMO |
$855.26
|
| Rate for Payer: United Healthcare HMO Rider |
$855.26
|
| Rate for Payer: United Healthcare HMO Rider |
$855.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$855.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$855.26
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
|
HC CT ABDOMEN W/WO CONT
|
Facility
|
IP
|
$6,243.00
|
|
|
Service Code
|
CPT 74170
|
| Hospital Charge Code |
909201929
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,248.60 |
| Max. Negotiated Rate |
$5,618.70 |
| Rate for Payer: Adventist Health Commercial |
$1,248.60
|
| Rate for Payer: Cash Price |
$2,809.35
|
| Rate for Payer: Central Health Plan Commercial |
$4,994.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,370.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,497.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,497.20
|
| Rate for Payer: Galaxy Health WC |
$5,306.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,745.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,618.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,964.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,683.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,248.60
|
| Rate for Payer: Multiplan Commercial |
$4,682.25
|
| Rate for Payer: Networks By Design Commercial |
$4,057.95
|
| Rate for Payer: Prime Health Services Commercial |
$5,306.55
|
|
|
HC CT ANGIO ABD AORTA-AIF W/WO CO
|
Facility
|
IP
|
$6,465.00
|
|
|
Service Code
|
CPT 75635
|
| Hospital Charge Code |
909201809
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,293.00 |
| Max. Negotiated Rate |
$5,818.50 |
| Rate for Payer: Adventist Health Commercial |
$1,293.00
|
| Rate for Payer: Cash Price |
$2,909.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,172.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,525.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,586.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,586.00
|
| Rate for Payer: Galaxy Health WC |
$5,495.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,879.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,818.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,105.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,814.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,293.00
|
| Rate for Payer: Multiplan Commercial |
$4,848.75
|
| Rate for Payer: Networks By Design Commercial |
$4,202.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,495.25
|
|
|
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 |
$225.59 |
| Max. Negotiated Rate |
$3,879.00 |
| Rate for Payer: Adventist Health Commercial |
$862.00
|
| Rate for Payer: Adventist Health Commercial |
$1,293.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$225.59
|
| Rate for Payer: Adventist Health Medi-Cal |
$225.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,786.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,786.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,507.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,760.69
|
| Rate for Payer: Blue Shield of California Commercial |
$4,072.95
|
| Rate for Payer: Blue Shield of California Commercial |
$2,715.30
|
| Rate for Payer: Blue Shield of California EPN |
$1,711.07
|
| Rate for Payer: Blue Shield of California EPN |
$2,566.61
|
| 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: Cash Price |
$2,909.25
|
| Rate for Payer: Cash Price |
$2,909.25
|
| Rate for Payer: Cash Price |
$2,909.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,172.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,448.00
|
| Rate for Payer: Cigna of CA HMO |
$4,137.60
|
| Rate for Payer: Cigna of CA HMO |
$2,758.40
|
| Rate for Payer: Cigna of CA PPO |
$4,784.10
|
| Rate for Payer: Cigna of CA PPO |
$3,189.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,525.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,017.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: Galaxy Health WC |
$3,663.50
|
| Rate for Payer: Galaxy Health WC |
$5,495.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,879.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,586.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,818.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,879.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$589.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$589.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,105.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,736.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$650.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$650.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$862.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,293.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$4,848.75
|
| Rate for Payer: Multiplan Commercial |
$3,232.50
|
| Rate for Payer: Networks By Design Commercial |
$2,801.50
|
| Rate for Payer: Networks By Design Commercial |
$4,202.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$225.59
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$225.59
|
| Rate for Payer: Prime Health Services Commercial |
$3,663.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,495.25
|
| Rate for Payer: Prime Health Services Medicare |
$239.13
|
| Rate for Payer: Prime Health Services Medicare |
$239.13
|
| Rate for Payer: Riverside University Health System MISP |
$248.15
|
| Rate for Payer: Riverside University Health System MISP |
$248.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,586.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,879.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,586.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,879.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.48
|
| 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 All Other HMO |
$866.48
|
| Rate for Payer: United Healthcare HMO Rider |
$866.48
|
| Rate for Payer: United Healthcare HMO Rider |
$866.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.48
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
|
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 |
$448.71 |
| Max. Negotiated Rate |
$3,421.80 |
| Rate for Payer: Adventist Health Commercial |
$760.40
|
| Rate for Payer: Adventist Health Commercial |
$1,354.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$448.71
|
| Rate for Payer: Adventist Health Medi-Cal |
$448.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,754.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,754.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,211.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,940.44
|
| Rate for Payer: Blue Shield of California Commercial |
$4,267.62
|
| Rate for Payer: Blue Shield of California Commercial |
$2,395.26
|
| Rate for Payer: Blue Shield of California EPN |
$1,509.39
|
| Rate for Payer: Blue Shield of California EPN |
$2,689.28
|
| 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: Cash Price |
$3,048.30
|
| Rate for Payer: Cash Price |
$3,048.30
|
| Rate for Payer: Cash Price |
$3,048.30
|
| Rate for Payer: Central Health Plan Commercial |
$5,419.20
|
| Rate for Payer: Central Health Plan Commercial |
$3,041.60
|
| Rate for Payer: Cigna of CA HMO |
$4,335.36
|
| Rate for Payer: Cigna of CA HMO |
$2,433.28
|
| Rate for Payer: Cigna of CA PPO |
$5,012.76
|
| Rate for Payer: Cigna of CA PPO |
$2,813.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,741.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,661.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.37
|
| Rate for Payer: EPIC Health Plan Senior |
$493.58
|
| Rate for Payer: EPIC Health Plan Senior |
$493.58
|
| Rate for Payer: Galaxy Health WC |
$3,231.70
|
| Rate for Payer: Galaxy Health WC |
$5,757.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,064.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,281.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,096.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,421.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$735.88
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$735.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$605.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$605.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,301.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,414.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$668.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$668.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$760.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,354.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$601.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$601.27
|
| Rate for Payer: Multiplan Commercial |
$5,080.50
|
| Rate for Payer: Multiplan Commercial |
$2,851.50
|
| Rate for Payer: Networks By Design Commercial |
$2,471.30
|
| Rate for Payer: Networks By Design Commercial |
$4,403.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$448.71
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$448.71
|
| Rate for Payer: Prime Health Services Commercial |
$3,231.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,757.90
|
| Rate for Payer: Prime Health Services Medicare |
$475.63
|
| Rate for Payer: Prime Health Services Medicare |
$475.63
|
| Rate for Payer: Riverside University Health System MISP |
$493.58
|
| Rate for Payer: Riverside University Health System MISP |
$493.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,281.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,064.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,281.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,064.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,486.18
|
| 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 All Other HMO |
$1,486.18
|
| Rate for Payer: United Healthcare HMO Rider |
$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: United Healthcare Select/Navigate/Core |
$1,486.18
|
| Rate for Payer: Upland Medical Group Pediatric |
$448.71
|
| Rate for Payer: Upland Medical Group Pediatric |
$448.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
|
|
HC CT ANGIO ABDOMEN/PELVIS
|
Facility
|
IP
|
$6,774.00
|
|
|
Service Code
|
CPT 74174
|
| Hospital Charge Code |
909201991
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,354.80 |
| Max. Negotiated Rate |
$6,096.60 |
| Rate for Payer: Adventist Health Commercial |
$1,354.80
|
| Rate for Payer: Cash Price |
$3,048.30
|
| Rate for Payer: Central Health Plan Commercial |
$5,419.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,741.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,709.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,709.60
|
| Rate for Payer: Galaxy Health WC |
$5,757.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,064.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,096.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,301.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,996.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,354.80
|
| Rate for Payer: Multiplan Commercial |
$5,080.50
|
| Rate for Payer: Networks By Design Commercial |
$4,403.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,757.90
|
|
|
HC CT ANGIO ABDOMEN W/WO CONTRAST
|
Facility
|
IP
|
$5,543.00
|
|
|
Service Code
|
CPT 74175
|
| Hospital Charge Code |
909201808
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,108.60 |
| Max. Negotiated Rate |
$4,988.70 |
| Rate for Payer: Adventist Health Commercial |
$1,108.60
|
| Rate for Payer: Cash Price |
$2,494.35
|
| Rate for Payer: Central Health Plan Commercial |
$4,434.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,880.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,217.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,217.20
|
| Rate for Payer: Galaxy Health WC |
$4,711.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,325.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,988.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,519.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,270.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,108.60
|
| Rate for Payer: Multiplan Commercial |
$4,157.25
|
| Rate for Payer: Networks By Design Commercial |
$3,602.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,711.55
|
|
|
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 |
$225.59 |
| Max. Negotiated Rate |
$3,501.00 |
| Rate for Payer: Adventist Health Commercial |
$778.00
|
| Rate for Payer: Adventist Health Commercial |
$1,108.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$225.59
|
| Rate for Payer: Adventist Health Medi-Cal |
$225.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,786.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,786.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,262.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,224.36
|
| Rate for Payer: Blue Shield of California Commercial |
$3,492.09
|
| Rate for Payer: Blue Shield of California Commercial |
$2,450.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,544.33
|
| Rate for Payer: Blue Shield of California EPN |
$2,200.57
|
| 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: Cash Price |
$2,494.35
|
| Rate for Payer: Cash Price |
$2,494.35
|
| Rate for Payer: Cash Price |
$2,494.35
|
| Rate for Payer: Central Health Plan Commercial |
$4,434.40
|
| Rate for Payer: Central Health Plan Commercial |
$3,112.00
|
| Rate for Payer: Cigna of CA HMO |
$3,547.52
|
| Rate for Payer: Cigna of CA HMO |
$2,489.60
|
| Rate for Payer: Cigna of CA PPO |
$4,101.82
|
| Rate for Payer: Cigna of CA PPO |
$2,878.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,880.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,723.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: Galaxy Health WC |
$3,306.50
|
| Rate for Payer: Galaxy Health WC |
$4,711.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,325.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,334.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,988.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,501.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$476.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$476.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,519.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,470.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$526.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$526.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$778.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,108.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$4,157.25
|
| Rate for Payer: Multiplan Commercial |
$2,917.50
|
| Rate for Payer: Networks By Design Commercial |
$2,528.50
|
| Rate for Payer: Networks By Design Commercial |
$3,602.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$225.59
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$225.59
|
| Rate for Payer: Prime Health Services Commercial |
$3,306.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,711.55
|
| Rate for Payer: Prime Health Services Medicare |
$239.13
|
| Rate for Payer: Prime Health Services Medicare |
$239.13
|
| Rate for Payer: Riverside University Health System MISP |
$248.15
|
| Rate for Payer: Riverside University Health System MISP |
$248.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,334.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,325.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,334.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,325.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.48
|
| 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 All Other HMO |
$866.48
|
| Rate for Payer: United Healthcare HMO Rider |
$866.48
|
| Rate for Payer: United Healthcare HMO Rider |
$866.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.48
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
|
HC CT ANGIO CHEST W/WO CONTRAST
|
Facility
|
IP
|
$5,688.00
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
909201802
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,137.60 |
| Max. Negotiated Rate |
$5,119.20 |
| Rate for Payer: Adventist Health Commercial |
$1,137.60
|
| Rate for Payer: Cash Price |
$2,559.60
|
| Rate for Payer: Central Health Plan Commercial |
$4,550.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,981.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,275.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,275.20
|
| Rate for Payer: Galaxy Health WC |
$4,834.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,412.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,119.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,611.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,355.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,137.60
|
| Rate for Payer: Multiplan Commercial |
$4,266.00
|
| Rate for Payer: Networks By Design Commercial |
$3,697.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,834.80
|
|
|
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 |
$225.59 |
| Max. Negotiated Rate |
$3,292.20 |
| Rate for Payer: Adventist Health Commercial |
$731.60
|
| Rate for Payer: Adventist Health Commercial |
$1,137.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$225.59
|
| Rate for Payer: Adventist Health Medi-Cal |
$225.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,858.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,858.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,127.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,308.71
|
| Rate for Payer: Blue Shield of California Commercial |
$3,583.44
|
| Rate for Payer: Blue Shield of California Commercial |
$2,304.54
|
| Rate for Payer: Blue Shield of California EPN |
$1,452.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,258.14
|
| 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: Cash Price |
$2,559.60
|
| Rate for Payer: Cash Price |
$2,559.60
|
| Rate for Payer: Cash Price |
$2,559.60
|
| Rate for Payer: Central Health Plan Commercial |
$4,550.40
|
| Rate for Payer: Central Health Plan Commercial |
$2,926.40
|
| Rate for Payer: Cigna of CA HMO |
$3,640.32
|
| Rate for Payer: Cigna of CA HMO |
$2,341.12
|
| Rate for Payer: Cigna of CA PPO |
$4,209.12
|
| Rate for Payer: Cigna of CA PPO |
$2,706.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,981.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,560.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: Galaxy Health WC |
$3,109.30
|
| Rate for Payer: Galaxy Health WC |
$4,834.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,412.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,194.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,119.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,292.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$465.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$465.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,611.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,322.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$514.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$514.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$731.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,137.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$4,266.00
|
| Rate for Payer: Multiplan Commercial |
$2,743.50
|
| Rate for Payer: Networks By Design Commercial |
$2,377.70
|
| Rate for Payer: Networks By Design Commercial |
$3,697.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$225.59
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$225.59
|
| Rate for Payer: Prime Health Services Commercial |
$3,109.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,834.80
|
| Rate for Payer: Prime Health Services Medicare |
$239.13
|
| Rate for Payer: Prime Health Services Medicare |
$239.13
|
| Rate for Payer: Riverside University Health System MISP |
$248.15
|
| Rate for Payer: Riverside University Health System MISP |
$248.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,194.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,412.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,194.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,412.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.48
|
| 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 All Other HMO |
$866.48
|
| Rate for Payer: United Healthcare HMO Rider |
$866.48
|
| Rate for Payer: United Healthcare HMO Rider |
$866.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.48
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
|
HC CT ANGIO HEAD AND NECK W WO CONTRAST
|
Facility
|
OP
|
$1,093.00
|
|
|
Service Code
|
CPT 70471
|
| Hospital Charge Code |
909201820
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$218.60 |
| Max. Negotiated Rate |
$2,364.00 |
| Rate for Payer: Adventist Health Commercial |
$218.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$448.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,119.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$635.80
|
| Rate for Payer: Blue Shield of California Commercial |
$688.59
|
| Rate for Payer: Blue Shield of California EPN |
$433.92
|
| Rate for Payer: Cash Price |
$491.85
|
| Rate for Payer: Cash Price |
$491.85
|
| Rate for Payer: Cash Price |
$491.85
|
| Rate for Payer: Central Health Plan Commercial |
$874.40
|
| Rate for Payer: Cigna of CA HMO |
$699.52
|
| Rate for Payer: Cigna of CA PPO |
$808.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$765.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.37
|
| Rate for Payer: EPIC Health Plan Senior |
$493.58
|
| Rate for Payer: Galaxy Health WC |
$929.05
|
| Rate for Payer: Global Benefits Group Commercial |
$655.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$983.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$735.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$694.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$601.27
|
| Rate for Payer: Multiplan Commercial |
$819.75
|
| Rate for Payer: Networks By Design Commercial |
$710.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$448.71
|
| Rate for Payer: Prime Health Services Commercial |
$929.05
|
| Rate for Payer: Prime Health Services Medicare |
$475.63
|
| Rate for Payer: Riverside University Health System MISP |
$493.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$655.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$655.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$546.50
|
| Rate for Payer: United Healthcare All Other HMO |
$546.50
|
| Rate for Payer: United Healthcare HMO Rider |
$546.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$546.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$448.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
|
|
HC CT ANGIO HEAD AND NECK W WO CONTRAST
|
Facility
|
IP
|
$1,093.00
|
|
|
Service Code
|
CPT 70471
|
| Hospital Charge Code |
909201820
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$218.60 |
| Max. Negotiated Rate |
$983.70 |
| Rate for Payer: Adventist Health Commercial |
$218.60
|
| Rate for Payer: Cash Price |
$491.85
|
| Rate for Payer: Central Health Plan Commercial |
$874.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$765.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$437.20
|
| Rate for Payer: EPIC Health Plan Senior |
$437.20
|
| Rate for Payer: Galaxy Health WC |
$929.05
|
| Rate for Payer: Global Benefits Group Commercial |
$655.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$983.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$694.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$644.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.60
|
| Rate for Payer: Multiplan Commercial |
$819.75
|
| Rate for Payer: Networks By Design Commercial |
$710.45
|
| Rate for Payer: Prime Health Services Commercial |
$929.05
|
|
|
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 |
$225.59 |
| Max. Negotiated Rate |
$3,856.50 |
| Rate for Payer: Adventist Health Commercial |
$857.00
|
| Rate for Payer: Adventist Health Commercial |
$1,221.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$225.59
|
| Rate for Payer: Adventist Health Medi-Cal |
$225.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,519.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,519.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,551.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,492.58
|
| Rate for Payer: Blue Shield of California Commercial |
$3,846.78
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.55
|
| Rate for Payer: Blue Shield of California EPN |
$1,701.14
|
| Rate for Payer: Blue Shield of California EPN |
$2,424.08
|
| 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: Cash Price |
$2,747.70
|
| Rate for Payer: Cash Price |
$2,747.70
|
| Rate for Payer: Cash Price |
$2,747.70
|
| Rate for Payer: Central Health Plan Commercial |
$3,428.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,884.80
|
| Rate for Payer: Cigna of CA HMO |
$3,907.84
|
| Rate for Payer: Cigna of CA HMO |
$2,742.40
|
| Rate for Payer: Cigna of CA PPO |
$4,518.44
|
| Rate for Payer: Cigna of CA PPO |
$3,170.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,999.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,274.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: Galaxy Health WC |
$5,190.10
|
| Rate for Payer: Galaxy Health WC |
$3,642.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,571.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,663.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,856.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,495.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$457.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$457.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,720.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,877.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$505.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$505.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,221.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$857.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$4,579.50
|
| Rate for Payer: Multiplan Commercial |
$3,213.75
|
| Rate for Payer: Networks By Design Commercial |
$2,785.25
|
| Rate for Payer: Networks By Design Commercial |
$3,968.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$225.59
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$225.59
|
| Rate for Payer: Prime Health Services Commercial |
$5,190.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,642.25
|
| Rate for Payer: Prime Health Services Medicare |
$239.13
|
| Rate for Payer: Prime Health Services Medicare |
$239.13
|
| Rate for Payer: Riverside University Health System MISP |
$248.15
|
| Rate for Payer: Riverside University Health System MISP |
$248.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,663.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,571.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,663.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,571.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,053.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,142.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,053.00
|
| 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 HMO Rider |
$3,053.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,053.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,142.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
