|
HC CRYO ABLAT LIVER TUMOR
|
Facility
|
OP
|
$15,698.00
|
|
|
Service Code
|
CPT 47381
|
| Hospital Charge Code |
909000269
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$316.98 |
| Max. Negotiated Rate |
$14,128.20 |
| Rate for Payer: Adventist Health Commercial |
$3,139.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,343.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,633.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,773.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$8,633.90
|
| Rate for Payer: Cash Price |
$8,633.90
|
| Rate for Payer: Cash Price |
$8,633.90
|
| Rate for Payer: Central Health Plan Commercial |
$12,558.40
|
| Rate for Payer: Cigna of CA HMO |
$10,046.72
|
| Rate for Payer: Cigna of CA PPO |
$11,616.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,343.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,343.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,343.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,279.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,279.20
|
| Rate for Payer: Galaxy Health WC |
$13,343.30
|
| Rate for Payer: Global Benefits Group Commercial |
$9,418.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,128.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$316.98
|
| Rate for Payer: InnovAge PACE Commercial |
$7,849.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,470.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$350.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,717.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,139.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,988.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,988.60
|
| Rate for Payer: Multiplan Commercial |
$11,773.50
|
| Rate for Payer: Networks By Design Commercial |
$10,203.70
|
| Rate for Payer: Prime Health Services Commercial |
$13,343.30
|
| Rate for Payer: Riverside University Health System MISP |
$6,279.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,418.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,343.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,343.30
|
| Rate for Payer: Vantage Medical Group Senior |
$13,343.30
|
|
|
HC CRYO ABLAT LIVER TUMOR
|
Facility
|
IP
|
$15,698.00
|
|
|
Service Code
|
CPT 47381
|
| Hospital Charge Code |
909000269
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,139.60 |
| Max. Negotiated Rate |
$14,128.20 |
| Rate for Payer: Adventist Health Commercial |
$3,139.60
|
| Rate for Payer: Cash Price |
$8,633.90
|
| Rate for Payer: Central Health Plan Commercial |
$12,558.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,279.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,279.20
|
| Rate for Payer: Galaxy Health WC |
$13,343.30
|
| Rate for Payer: Global Benefits Group Commercial |
$9,418.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,128.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,470.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,980.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,717.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,139.60
|
| Rate for Payer: Multiplan Commercial |
$11,773.50
|
| Rate for Payer: Networks By Design Commercial |
$10,203.70
|
| Rate for Payer: Prime Health Services Commercial |
$13,343.30
|
|
|
HC CRYO ABLAT RENAL TUMOR
|
Facility
|
IP
|
$19,100.00
|
|
|
Service Code
|
CPT 50593
|
| Hospital Charge Code |
909000268
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,820.00 |
| Max. Negotiated Rate |
$17,190.00 |
| Rate for Payer: Adventist Health Commercial |
$3,820.00
|
| Rate for Payer: Cash Price |
$10,505.00
|
| Rate for Payer: Central Health Plan Commercial |
$15,280.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,640.00
|
| Rate for Payer: EPIC Health Plan Senior |
$7,640.00
|
| Rate for Payer: Galaxy Health WC |
$16,235.00
|
| Rate for Payer: Global Benefits Group Commercial |
$11,460.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,190.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,739.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,277.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,822.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,820.00
|
| Rate for Payer: Multiplan Commercial |
$14,325.00
|
| Rate for Payer: Networks By Design Commercial |
$12,415.00
|
| Rate for Payer: Prime Health Services Commercial |
$16,235.00
|
|
|
HC CRYO ABLAT RENAL TUMOR
|
Facility
|
OP
|
$19,100.00
|
|
|
Service Code
|
CPT 50593
|
| Hospital Charge Code |
909000268
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,165.61 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$3,820.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$13,228.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26,109.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,842.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,551.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,228.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,764.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$21,077.25
|
| Rate for Payer: Blue Shield of California Commercial |
$4,851.77
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$10,505.00
|
| Rate for Payer: Cash Price |
$10,505.00
|
| Rate for Payer: Cash Price |
$10,505.00
|
| Rate for Payer: Central Health Plan Commercial |
$15,280.00
|
| Rate for Payer: Cigna of CA HMO |
$12,224.00
|
| Rate for Payer: Cigna of CA PPO |
$14,134.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,842.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,551.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,228.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,858.47
|
| Rate for Payer: EPIC Health Plan Senior |
$13,228.50
|
| Rate for Payer: Galaxy Health WC |
$16,235.00
|
| Rate for Payer: Global Benefits Group Commercial |
$11,460.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,190.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21,694.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,700.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,228.50
|
| Rate for Payer: InnovAge PACE Commercial |
$19,842.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,739.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,401.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,228.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,820.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,726.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,726.19
|
| Rate for Payer: Multiplan Commercial |
$14,325.00
|
| Rate for Payer: Multiplan WC |
$21,077.25
|
| Rate for Payer: Networks By Design Commercial |
$12,415.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13,228.50
|
| Rate for Payer: Preferred Health Network WC |
$21,507.40
|
| Rate for Payer: Prime Health Services Commercial |
$16,235.00
|
| Rate for Payer: Prime Health Services Medicare |
$14,022.21
|
| Rate for Payer: Prime Health Services WC |
$20,862.18
|
| Rate for Payer: Riverside University Health System MISP |
$14,551.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,460.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$13,228.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19,842.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,551.35
|
| Rate for Payer: Vantage Medical Group Senior |
$13,228.50
|
|
|
HC CRYOCAUTERY OF CERVIX
|
Facility
|
IP
|
$1,504.00
|
|
|
Service Code
|
CPT 57511
|
| Hospital Charge Code |
900501637
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$300.80 |
| Max. Negotiated Rate |
$1,353.60 |
| Rate for Payer: Adventist Health Commercial |
$300.80
|
| Rate for Payer: Cash Price |
$827.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,203.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$601.60
|
| Rate for Payer: EPIC Health Plan Senior |
$601.60
|
| Rate for Payer: Galaxy Health WC |
$1,278.40
|
| Rate for Payer: Global Benefits Group Commercial |
$902.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,353.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,003.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$573.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$930.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$300.80
|
| Rate for Payer: Multiplan Commercial |
$1,128.00
|
| Rate for Payer: Networks By Design Commercial |
$977.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,278.40
|
|
|
HC CRYOCAUTERY OF CERVIX
|
Facility
|
OP
|
$1,504.00
|
|
|
Service Code
|
CPT 57511
|
| Hospital Charge Code |
900501637
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$300.80 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$300.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$386.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$615.83
|
| Rate for Payer: Cash Price |
$827.20
|
| Rate for Payer: Cash Price |
$827.20
|
| Rate for Payer: Cash Price |
$827.20
|
| Rate for Payer: Cash Price |
$827.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,203.20
|
| Rate for Payer: Cigna of CA HMO |
$962.56
|
| Rate for Payer: Cigna of CA PPO |
$1,112.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$579.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$386.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$521.77
|
| Rate for Payer: EPIC Health Plan Senior |
$386.50
|
| Rate for Payer: Galaxy Health WC |
$1,278.40
|
| Rate for Payer: Global Benefits Group Commercial |
$902.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,353.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$633.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$386.50
|
| Rate for Payer: InnovAge PACE Commercial |
$579.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,003.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$351.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$386.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$300.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$517.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$517.91
|
| Rate for Payer: Multiplan Commercial |
$1,128.00
|
| Rate for Payer: Multiplan WC |
$615.83
|
| Rate for Payer: Networks By Design Commercial |
$977.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$386.50
|
| Rate for Payer: Preferred Health Network WC |
$628.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,278.40
|
| Rate for Payer: Prime Health Services Medicare |
$409.69
|
| Rate for Payer: Prime Health Services WC |
$609.55
|
| Rate for Payer: Riverside University Health System MISP |
$425.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$902.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$752.00
|
| Rate for Payer: United Healthcare All Other HMO |
$752.00
|
| Rate for Payer: United Healthcare HMO Rider |
$752.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$752.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$386.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Vantage Medical Group Senior |
$386.50
|
|
|
HC CRYOCAUTERY OF CERVIX
|
Facility
|
OP
|
$1,504.00
|
|
|
Service Code
|
CPT 57511
|
| Hospital Charge Code |
900501637
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$300.80 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$300.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$386.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$386.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$918.94
|
| Rate for Payer: Blue Shield of California EPN |
$600.10
|
| Rate for Payer: Cash Price |
$827.20
|
| Rate for Payer: Cash Price |
$827.20
|
| Rate for Payer: Cash Price |
$827.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,203.20
|
| Rate for Payer: Cigna of CA HMO |
$962.56
|
| Rate for Payer: Cigna of CA PPO |
$1,112.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$579.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$386.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$521.77
|
| Rate for Payer: EPIC Health Plan Senior |
$386.50
|
| Rate for Payer: Galaxy Health WC |
$1,278.40
|
| Rate for Payer: Global Benefits Group Commercial |
$902.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,353.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$633.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$318.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$386.50
|
| Rate for Payer: InnovAge PACE Commercial |
$579.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,003.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$351.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$386.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$300.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$517.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$517.91
|
| Rate for Payer: Multiplan Commercial |
$1,128.00
|
| Rate for Payer: Networks By Design Commercial |
$977.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$386.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,278.40
|
| Rate for Payer: Prime Health Services Medicare |
$409.69
|
| Rate for Payer: Riverside University Health System MISP |
$425.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$902.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$902.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$752.00
|
| Rate for Payer: United Healthcare All Other HMO |
$752.00
|
| Rate for Payer: United Healthcare HMO Rider |
$752.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$752.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$386.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Vantage Medical Group Senior |
$386.50
|
|
|
HC CRYOCAUTERY OF CERVIX
|
Facility
|
IP
|
$1,504.00
|
|
|
Service Code
|
CPT 57511
|
| Hospital Charge Code |
900501637
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$300.80 |
| Max. Negotiated Rate |
$1,353.60 |
| Rate for Payer: Adventist Health Commercial |
$300.80
|
| Rate for Payer: Cash Price |
$827.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,203.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$601.60
|
| Rate for Payer: EPIC Health Plan Senior |
$601.60
|
| Rate for Payer: Galaxy Health WC |
$1,278.40
|
| Rate for Payer: Global Benefits Group Commercial |
$902.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,353.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,003.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$573.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$930.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$300.80
|
| Rate for Payer: Multiplan Commercial |
$1,128.00
|
| Rate for Payer: Networks By Design Commercial |
$977.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,278.40
|
|
|
HC CRYOGLOBULINS QUAL
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
900910978
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Adventist Health Commercial |
$12.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$45.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.30
|
| Rate for Payer: Blue Shield of California Commercial |
$37.63
|
| Rate for Payer: Blue Shield of California EPN |
$24.61
|
| Rate for Payer: Cash Price |
$34.10
|
| Rate for Payer: Cash Price |
$34.10
|
| Rate for Payer: Central Health Plan Commercial |
$49.60
|
| Rate for Payer: Cigna of CA HMO |
$39.68
|
| Rate for Payer: Cigna of CA PPO |
$45.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.73
|
| Rate for Payer: EPIC Health Plan Senior |
$6.47
|
| Rate for Payer: Galaxy Health WC |
$52.70
|
| Rate for Payer: Global Benefits Group Commercial |
$37.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$55.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: InnovAge PACE Commercial |
$9.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$41.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.67
|
| Rate for Payer: Multiplan Commercial |
$46.50
|
| Rate for Payer: Networks By Design Commercial |
$40.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.47
|
| Rate for Payer: Prime Health Services Commercial |
$52.70
|
| Rate for Payer: Prime Health Services Medicare |
$6.86
|
| Rate for Payer: Riverside University Health System MISP |
$7.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.24
|
| Rate for Payer: United Healthcare All Other HMO |
$5.24
|
| Rate for Payer: United Healthcare HMO Rider |
$5.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
|
HC CRYOGLOBULINS QUAL
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
900910978
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Adventist Health Commercial |
$12.40
|
| Rate for Payer: Cash Price |
$34.10
|
| Rate for Payer: Central Health Plan Commercial |
$49.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.80
|
| Rate for Payer: EPIC Health Plan Senior |
$24.80
|
| Rate for Payer: Galaxy Health WC |
$52.70
|
| Rate for Payer: Global Benefits Group Commercial |
$37.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$55.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$41.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.40
|
| Rate for Payer: Multiplan Commercial |
$46.50
|
| Rate for Payer: Networks By Design Commercial |
$40.30
|
| Rate for Payer: Prime Health Services Commercial |
$52.70
|
|
|
HC CSF LEAKAGE
|
Facility
|
OP
|
$1,590.00
|
|
|
Service Code
|
CPT 78650
|
| Hospital Charge Code |
909301416
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$254.47 |
| Max. Negotiated Rate |
$2,720.33 |
| Rate for Payer: Adventist Health Commercial |
$318.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,658.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$965.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,824.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,658.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$953.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$933.81
|
| Rate for Payer: Blue Shield of California Commercial |
$965.13
|
| Rate for Payer: Blue Shield of California EPN |
$631.23
|
| Rate for Payer: Cash Price |
$874.50
|
| Rate for Payer: Cash Price |
$874.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,272.00
|
| Rate for Payer: Cigna of CA HMO |
$1,017.60
|
| Rate for Payer: Cigna of CA PPO |
$1,176.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,824.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,658.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,239.30
|
| Rate for Payer: EPIC Health Plan Senior |
$1,658.74
|
| Rate for Payer: Galaxy Health WC |
$1,351.50
|
| Rate for Payer: Global Benefits Group Commercial |
$954.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,431.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,720.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$254.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,658.74
|
| Rate for Payer: InnovAge PACE Commercial |
$2,488.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,060.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$281.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,658.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$318.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,222.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,222.71
|
| Rate for Payer: Multiplan Commercial |
$1,192.50
|
| Rate for Payer: Networks By Design Commercial |
$1,033.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,658.74
|
| Rate for Payer: Prime Health Services Commercial |
$1,351.50
|
| Rate for Payer: Prime Health Services Medicare |
$1,758.26
|
| Rate for Payer: Riverside University Health System MISP |
$1,824.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$954.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$954.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,570.86
|
| Rate for Payer: United Healthcare All Other HMO |
$1,570.86
|
| Rate for Payer: United Healthcare HMO Rider |
$1,570.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,570.86
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,658.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,824.61
|
| Rate for Payer: Vantage Medical Group Senior |
$1,658.74
|
|
|
HC CSF LEAKAGE
|
Facility
|
IP
|
$1,590.00
|
|
|
Service Code
|
CPT 78650
|
| Hospital Charge Code |
909301416
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$318.00 |
| Max. Negotiated Rate |
$1,431.00 |
| Rate for Payer: Adventist Health Commercial |
$318.00
|
| Rate for Payer: Cash Price |
$874.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,272.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$636.00
|
| Rate for Payer: EPIC Health Plan Senior |
$636.00
|
| Rate for Payer: Galaxy Health WC |
$1,351.50
|
| Rate for Payer: Global Benefits Group Commercial |
$954.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,431.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,060.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$605.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$984.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$318.00
|
| Rate for Payer: Multiplan Commercial |
$1,192.50
|
| Rate for Payer: Networks By Design Commercial |
$1,033.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,351.50
|
|
|
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 |
$1,017.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,480.00
|
| 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 Permanente of CA Commercial/Self Funded |
$1,233.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$704.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,145.15
|
| 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 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 |
$47.82 |
| Max. Negotiated Rate |
$1,665.00 |
| Rate for Payer: Adventist Health Commercial |
$370.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,123.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$235.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.82
|
| Rate for Payer: Blue Shield of California Commercial |
$1,122.95
|
| Rate for Payer: Blue Shield of California EPN |
$734.45
|
| Rate for Payer: Cash Price |
$1,017.50
|
| Rate for Payer: Cash Price |
$1,017.50
|
| 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 |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$1,572.50
|
| 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 |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$86.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: InnovAge PACE Commercial |
$202.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,233.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$370.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| 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 |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,572.50
|
| Rate for Payer: Prime Health Services Medicare |
$143.23
|
| Rate for Payer: Riverside University Health System MISP |
$148.63
|
| 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 |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC CT ABDOMEN & PELVIS W/CONTRAST
|
Facility
|
OP
|
$3,967.00
|
|
|
Service Code
|
CPT 74177
|
| Hospital Charge Code |
909202002
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$453.77 |
| Max. Negotiated Rate |
$3,570.30 |
| Rate for Payer: Adventist Health Commercial |
$793.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$453.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,459.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,329.82
|
| Rate for Payer: Blue Shield of California Commercial |
$2,407.97
|
| Rate for Payer: Blue Shield of California EPN |
$1,574.90
|
| Rate for Payer: Cash Price |
$2,181.85
|
| Rate for Payer: Cash Price |
$2,181.85
|
| Rate for Payer: Cash Price |
$2,181.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,173.60
|
| Rate for Payer: Cigna of CA HMO |
$2,538.88
|
| Rate for Payer: Cigna of CA PPO |
$2,935.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.59
|
| Rate for Payer: EPIC Health Plan Senior |
$453.77
|
| Rate for Payer: Galaxy Health WC |
$3,371.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,380.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,570.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$484.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: InnovAge PACE Commercial |
$680.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,645.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$535.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$793.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$608.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$608.05
|
| Rate for Payer: Multiplan Commercial |
$2,975.25
|
| Rate for Payer: Networks By Design Commercial |
$2,578.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$453.77
|
| Rate for Payer: Prime Health Services Commercial |
$3,371.95
|
| Rate for Payer: Prime Health Services Medicare |
$481.00
|
| Rate for Payer: Riverside University Health System MISP |
$499.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,380.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,380.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,486.18
|
| Rate for Payer: United Healthcare All Other HMO |
$1,486.18
|
| Rate for Payer: United Healthcare HMO Rider |
$1,486.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,486.18
|
| Rate for Payer: Upland Medical Group Pediatric |
$453.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
HC CT ABDOMEN & PELVIS W/CONTRAST
|
Facility
|
IP
|
$3,967.00
|
|
|
Service Code
|
CPT 74177
|
| Hospital Charge Code |
909202002
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$793.40 |
| Max. Negotiated Rate |
$3,570.30 |
| Rate for Payer: Adventist Health Commercial |
$793.40
|
| Rate for Payer: Cash Price |
$2,181.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,173.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,586.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,586.80
|
| Rate for Payer: Galaxy Health WC |
$3,371.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,380.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,570.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,645.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,511.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,455.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$793.40
|
| Rate for Payer: Multiplan Commercial |
$2,975.25
|
| Rate for Payer: Networks By Design Commercial |
$2,578.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,371.95
|
|
|
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 Medi-Cal |
$307.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$765.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,103.12
|
| Rate for Payer: Blue Shield of California Commercial |
$2,173.67
|
| Rate for Payer: Blue Shield of California EPN |
$1,421.66
|
| Rate for Payer: Cash Price |
$1,969.55
|
| Rate for Payer: Cash Price |
$1,969.55
|
| Rate for Payer: Cash Price |
$1,969.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,864.80
|
| Rate for Payer: Cigna of CA HMO |
$2,291.84
|
| Rate for Payer: Cigna of CA PPO |
$2,649.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$3,043.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,148.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,222.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$299.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: InnovAge PACE Commercial |
$460.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,388.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$331.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$716.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$411.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$2,685.75
|
| Rate for Payer: Networks By Design Commercial |
$2,327.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$307.13
|
| Rate for Payer: Prime Health Services Commercial |
$3,043.85
|
| Rate for Payer: Prime Health Services Medicare |
$325.56
|
| Rate for Payer: Riverside University Health System MISP |
$337.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,148.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,148.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,037.23
|
| Rate for Payer: United Healthcare All Other HMO |
$1,037.23
|
| Rate for Payer: United Healthcare HMO Rider |
$1,037.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,037.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC CT ABDOMEN & PELVIS W/O CONTRA
|
Facility
|
IP
|
$3,581.00
|
|
|
Service Code
|
CPT 74176
|
| Hospital Charge Code |
909202001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$716.20 |
| Max. Negotiated Rate |
$3,222.90 |
| Rate for Payer: Adventist Health Commercial |
$716.20
|
| Rate for Payer: Cash Price |
$1,969.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,864.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,432.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,432.40
|
| Rate for Payer: Galaxy Health WC |
$3,043.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,148.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,222.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,388.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,364.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,216.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$716.20
|
| Rate for Payer: Multiplan Commercial |
$2,685.75
|
| Rate for Payer: Networks By Design Commercial |
$2,327.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,043.85
|
|
|
HC CT ABDOMEN & PELVIS W & W/O CO
|
Facility
|
OP
|
$4,306.00
|
|
|
Service Code
|
CPT 74178
|
| Hospital Charge Code |
909202003
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$453.77 |
| Max. Negotiated Rate |
$3,875.40 |
| Rate for Payer: Adventist Health Commercial |
$861.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$453.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,929.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,528.91
|
| Rate for Payer: Blue Shield of California Commercial |
$2,613.74
|
| Rate for Payer: Blue Shield of California EPN |
$1,709.48
|
| Rate for Payer: Cash Price |
$2,368.30
|
| Rate for Payer: Cash Price |
$2,368.30
|
| Rate for Payer: Cash Price |
$2,368.30
|
| Rate for Payer: Central Health Plan Commercial |
$3,444.80
|
| Rate for Payer: Cigna of CA HMO |
$2,755.84
|
| Rate for Payer: Cigna of CA PPO |
$3,186.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.59
|
| Rate for Payer: EPIC Health Plan Senior |
$453.77
|
| Rate for Payer: Galaxy Health WC |
$3,660.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,583.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,875.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$549.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: InnovAge PACE Commercial |
$680.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,872.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$606.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$861.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$608.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$608.05
|
| Rate for Payer: Multiplan Commercial |
$3,229.50
|
| Rate for Payer: Networks By Design Commercial |
$2,798.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$453.77
|
| Rate for Payer: Prime Health Services Commercial |
$3,660.10
|
| Rate for Payer: Prime Health Services Medicare |
$481.00
|
| Rate for Payer: Riverside University Health System MISP |
$499.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,583.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,583.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,486.18
|
| Rate for Payer: United Healthcare All Other HMO |
$1,486.18
|
| Rate for Payer: United Healthcare HMO Rider |
$1,486.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,486.18
|
| Rate for Payer: Upland Medical Group Pediatric |
$453.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
HC CT ABDOMEN & PELVIS W & W/O CO
|
Facility
|
IP
|
$4,306.00
|
|
|
Service Code
|
CPT 74178
|
| Hospital Charge Code |
909202003
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$861.20 |
| Max. Negotiated Rate |
$3,875.40 |
| Rate for Payer: Adventist Health Commercial |
$861.20
|
| Rate for Payer: Cash Price |
$2,368.30
|
| Rate for Payer: Central Health Plan Commercial |
$3,444.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,722.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,722.40
|
| Rate for Payer: Galaxy Health WC |
$3,660.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,583.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,875.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,872.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,640.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,665.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$861.20
|
| Rate for Payer: Multiplan Commercial |
$3,229.50
|
| Rate for Payer: Networks By Design Commercial |
$2,798.90
|
| Rate for Payer: Prime Health Services Commercial |
$3,660.10
|
|
|
HC CT ABDOMEN W CONTRAS
|
Facility
|
OP
|
$2,996.00
|
|
|
Service Code
|
CPT 74160
|
| Hospital Charge Code |
909201928
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$2,696.40 |
| Rate for Payer: Adventist Health Commercial |
$599.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$226.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,411.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,759.55
|
| Rate for Payer: Blue Shield of California Commercial |
$1,818.57
|
| Rate for Payer: Blue Shield of California EPN |
$1,189.41
|
| Rate for Payer: Cash Price |
$1,647.80
|
| Rate for Payer: Cash Price |
$1,647.80
|
| Rate for Payer: Cash Price |
$1,647.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,396.80
|
| Rate for Payer: Cigna of CA HMO |
$1,917.44
|
| Rate for Payer: Cigna of CA PPO |
$2,217.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.36
|
| Rate for Payer: EPIC Health Plan Senior |
$226.19
|
| Rate for Payer: Galaxy Health WC |
$2,546.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,797.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,696.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$359.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: InnovAge PACE Commercial |
$339.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,998.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$396.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$599.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$303.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.09
|
| Rate for Payer: Multiplan Commercial |
$2,247.00
|
| Rate for Payer: Networks By Design Commercial |
$1,947.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$226.19
|
| Rate for Payer: Prime Health Services Commercial |
$2,546.60
|
| Rate for Payer: Prime Health Services Medicare |
$239.76
|
| Rate for Payer: Riverside University Health System MISP |
$248.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,797.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,797.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$769.25
|
| Rate for Payer: United Healthcare All Other HMO |
$769.25
|
| Rate for Payer: United Healthcare HMO Rider |
$769.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$769.25
|
| Rate for Payer: Upland Medical Group Pediatric |
$226.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC CT ABDOMEN W CONTRAS
|
Facility
|
IP
|
$2,996.00
|
|
|
Service Code
|
CPT 74160
|
| Hospital Charge Code |
909201928
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$599.20 |
| Max. Negotiated Rate |
$2,696.40 |
| Rate for Payer: Adventist Health Commercial |
$599.20
|
| Rate for Payer: Cash Price |
$1,647.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,396.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,198.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,198.40
|
| Rate for Payer: Galaxy Health WC |
$2,546.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,797.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,696.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,998.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,141.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,854.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$599.20
|
| Rate for Payer: Multiplan Commercial |
$2,247.00
|
| Rate for Payer: Networks By Design Commercial |
$1,947.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,546.60
|
|
|
HC CT ABDOMEN WO CONTR
|
Facility
|
OP
|
$2,665.00
|
|
|
Service Code
|
CPT 74150
|
| Hospital Charge Code |
909201927
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$2,398.50 |
| Rate for Payer: Adventist Health Commercial |
$533.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,170.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,565.15
|
| Rate for Payer: Blue Shield of California Commercial |
$1,617.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,058.01
|
| Rate for Payer: Cash Price |
$1,465.75
|
| Rate for Payer: Cash Price |
$1,465.75
|
| Rate for Payer: Cash Price |
$1,465.75
|
| Rate for Payer: Center for Health Promotion Commercial |
$145.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,132.00
|
| Rate for Payer: Cigna of CA HMO |
$1,705.60
|
| Rate for Payer: Cigna of CA PPO |
$1,972.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$2,265.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,599.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,398.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$225.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: InnovAge PACE Commercial |
$202.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,777.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$249.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$533.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$1,998.75
|
| Rate for Payer: Networks By Design Commercial |
$1,732.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$2,265.25
|
| Rate for Payer: Prime Health Services Medicare |
$143.23
|
| Rate for Payer: Riverside University Health System MISP |
$148.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,599.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,599.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$491.23
|
| Rate for Payer: United Healthcare All Other HMO |
$491.23
|
| Rate for Payer: United Healthcare HMO Rider |
$491.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$491.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC CT ABDOMEN WO CONTR
|
Facility
|
IP
|
$2,665.00
|
|
|
Service Code
|
CPT 74150
|
| Hospital Charge Code |
909201927
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$533.00 |
| Max. Negotiated Rate |
$2,398.50 |
| Rate for Payer: Adventist Health Commercial |
$533.00
|
| Rate for Payer: Cash Price |
$1,465.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,132.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,066.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,066.00
|
| Rate for Payer: Galaxy Health WC |
$2,265.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,599.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,398.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,777.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,015.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,649.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$533.00
|
| Rate for Payer: Multiplan Commercial |
$1,998.75
|
| Rate for Payer: Networks By Design Commercial |
$1,732.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,265.25
|
|
|
HC CT ABDOMEN W/WO CONT
|
Facility
|
IP
|
$3,505.00
|
|
|
Service Code
|
CPT 74170
|
| Hospital Charge Code |
909201929
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$701.00 |
| Max. Negotiated Rate |
$3,154.50 |
| Rate for Payer: Adventist Health Commercial |
$701.00
|
| Rate for Payer: Cash Price |
$1,927.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,804.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,402.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,402.00
|
| Rate for Payer: Galaxy Health WC |
$2,979.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,103.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,154.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,337.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,335.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,169.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$701.00
|
| Rate for Payer: Multiplan Commercial |
$2,628.75
|
| Rate for Payer: Networks By Design Commercial |
$2,278.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,979.25
|
|
