|
HC CRYOGLOBULINS QUAL
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
900910978
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$55.92 |
| Rate for Payer: Adventist Health Medi-Cal |
$6.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.70
|
| 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 |
$55.92
|
| Rate for Payer: Blue Distinction Transplant |
$12.60
|
| Rate for Payer: Blue Shield of California Commercial |
$12.98
|
| Rate for Payer: Blue Shield of California EPN |
$10.21
|
| Rate for Payer: Caremore Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: Central Health Plan Commercial |
$16.80
|
| Rate for Payer: Cigna of CA HMO |
$13.44
|
| Rate for Payer: Cigna of CA PPO |
$15.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.70
|
| Rate for Payer: Dignity Health Media |
$6.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.73
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.47
|
| Rate for Payer: Galaxy Health WC |
$17.85
|
| Rate for Payer: Global Benefits Group Commercial |
$12.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$15.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: InnovAge PACE Commercial |
$9.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.01
|
| 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 |
$4.20
|
| 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 |
$15.75
|
| Rate for Payer: Networks By Design Commercial |
$13.65
|
| Rate for Payer: Prime Health Services Commercial |
$17.85
|
| 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 |
$12.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.60
|
| 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: Vantage Medical Group Commercial/Exchange |
$9.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
|
HC CSF LEAKAGE
|
Facility
|
OP
|
$1,968.00
|
|
|
Service Code
|
CPT 78650
|
| Hospital Charge Code |
909301416
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$281.10 |
| Max. Negotiated Rate |
$2,927.35 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,774.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,680.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,774.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$953.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,162.69
|
| Rate for Payer: Blue Distinction Transplant |
$1,180.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,216.22
|
| Rate for Payer: Blue Shield of California EPN |
$956.45
|
| Rate for Payer: Caremore Medicare Advantage |
$1,774.15
|
| Rate for Payer: Cash Price |
$885.60
|
| Rate for Payer: Cash Price |
$885.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,574.40
|
| Rate for Payer: Cigna of CA HMO |
$1,259.52
|
| Rate for Payer: Cigna of CA PPO |
$1,456.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Dignity Health Media |
$1,774.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,951.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,395.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,774.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,774.15
|
| Rate for Payer: Galaxy Health WC |
$1,672.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,180.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,771.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,476.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,909.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,927.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,774.15
|
| Rate for Payer: InnovAge PACE Commercial |
$2,661.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,312.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$281.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,774.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$393.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,377.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,377.36
|
| Rate for Payer: Multiplan Commercial |
$1,476.00
|
| Rate for Payer: Networks By Design Commercial |
$1,279.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,672.80
|
| Rate for Payer: Prime Health Services Medicare |
$1,880.60
|
| Rate for Payer: Riverside University Health System MISP |
$1,951.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,180.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,180.80
|
| 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: Vantage Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: Vantage Medical Group Senior |
$1,774.15
|
|
|
HC CSF LEAKAGE
|
Facility
|
IP
|
$1,968.00
|
|
|
Service Code
|
CPT 78650
|
| Hospital Charge Code |
909301416
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$393.60 |
| Max. Negotiated Rate |
$1,771.20 |
| Rate for Payer: Cash Price |
$885.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,574.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$787.20
|
| Rate for Payer: Galaxy Health WC |
$1,672.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,180.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,771.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,312.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$749.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$393.60
|
| Rate for Payer: Multiplan Commercial |
$1,476.00
|
| Rate for Payer: Networks By Design Commercial |
$1,279.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,672.80
|
|
|
HC C SPINE W/FLEX AND EXT COMPLETE
|
Facility
|
IP
|
$1,666.00
|
|
|
Service Code
|
CPT 72052
|
| Hospital Charge Code |
909001303
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$333.20 |
| Max. Negotiated Rate |
$1,499.40 |
| Rate for Payer: Cash Price |
$749.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,332.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$666.40
|
| Rate for Payer: Galaxy Health WC |
$1,416.10
|
| Rate for Payer: Global Benefits Group Commercial |
$999.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,499.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,111.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$634.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$333.20
|
| Rate for Payer: Multiplan Commercial |
$1,249.50
|
| Rate for Payer: Networks By Design Commercial |
$1,082.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,416.10
|
|
|
HC C SPINE W/FLEX AND EXT COMPLETE
|
Facility
|
OP
|
$1,666.00
|
|
|
Service Code
|
CPT 72052
|
| Hospital Charge Code |
909001303
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$95.59 |
| Max. Negotiated Rate |
$1,499.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$276.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$235.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$287.41
|
| Rate for Payer: Blue Distinction Transplant |
$999.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,029.59
|
| Rate for Payer: Blue Shield of California EPN |
$809.68
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$749.70
|
| Rate for Payer: Cash Price |
$749.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,332.80
|
| Rate for Payer: Cigna of CA HMO |
$1,066.24
|
| Rate for Payer: Cigna of CA PPO |
$1,232.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,416.10
|
| Rate for Payer: Global Benefits Group Commercial |
$999.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,499.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,249.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$226.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: InnovAge PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,111.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$333.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,249.50
|
| Rate for Payer: Networks By Design Commercial |
$1,082.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,416.10
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Riverside University Health System MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$999.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$999.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$193.23
|
| Rate for Payer: United Healthcare All Other HMO |
$193.23
|
| Rate for Payer: United Healthcare HMO Rider |
$193.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC CT ABDOMEN & PELVIS W/CONTRAST
|
Facility
|
OP
|
$4,667.00
|
|
|
Service Code
|
CPT 74177
|
| Hospital Charge Code |
909202002
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$480.50 |
| Max. Negotiated Rate |
$4,200.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$480.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,459.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,757.26
|
| Rate for Payer: Blue Distinction Transplant |
$2,800.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,884.21
|
| Rate for Payer: Blue Shield of California EPN |
$2,268.16
|
| Rate for Payer: Caremore Medicare Advantage |
$480.50
|
| Rate for Payer: Cash Price |
$2,100.15
|
| Rate for Payer: Cash Price |
$2,100.15
|
| Rate for Payer: Central Health Plan Commercial |
$3,733.60
|
| Rate for Payer: Cigna of CA HMO |
$2,986.88
|
| Rate for Payer: Cigna of CA PPO |
$3,453.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: Dignity Health Media |
$480.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$480.50
|
| Rate for Payer: Galaxy Health WC |
$3,966.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,800.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,200.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,500.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$788.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$792.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$480.50
|
| Rate for Payer: InnovAge PACE Commercial |
$720.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,112.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$535.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$933.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.87
|
| Rate for Payer: Multiplan Commercial |
$3,500.25
|
| Rate for Payer: Networks By Design Commercial |
$3,033.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,966.95
|
| Rate for Payer: Prime Health Services Medicare |
$509.33
|
| Rate for Payer: Riverside University Health System MISP |
$528.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,800.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,800.20
|
| 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: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC CT ABDOMEN & PELVIS W/CONTRAST
|
Facility
|
IP
|
$8,313.00
|
|
|
Service Code
|
CPT 74177
|
| Hospital Charge Code |
909202002
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,662.60 |
| Max. Negotiated Rate |
$7,481.70 |
| Rate for Payer: Cash Price |
$3,740.85
|
| Rate for Payer: Central Health Plan Commercial |
$6,650.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,325.20
|
| Rate for Payer: Galaxy Health WC |
$7,066.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,987.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,481.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,544.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,167.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,662.60
|
| Rate for Payer: Multiplan Commercial |
$6,234.75
|
| Rate for Payer: Networks By Design Commercial |
$5,403.45
|
| Rate for Payer: Prime Health Services Commercial |
$7,066.05
|
|
|
HC CT ABDOMEN & PELVIS W/O CONTRA
|
Facility
|
OP
|
$4,213.00
|
|
|
Service Code
|
CPT 74176
|
| Hospital Charge Code |
909202001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$306.16 |
| Max. Negotiated Rate |
$3,791.70 |
| Rate for Payer: Adventist Health Medi-Cal |
$306.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$765.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,489.04
|
| Rate for Payer: Blue Distinction Transplant |
$2,527.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,603.63
|
| Rate for Payer: Blue Shield of California EPN |
$2,047.52
|
| Rate for Payer: Caremore Medicare Advantage |
$306.16
|
| Rate for Payer: Cash Price |
$1,895.85
|
| Rate for Payer: Cash Price |
$1,895.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,370.40
|
| Rate for Payer: Cigna of CA HMO |
$2,696.32
|
| Rate for Payer: Cigna of CA PPO |
$3,117.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Media |
$306.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$306.16
|
| Rate for Payer: Galaxy Health WC |
$3,581.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,527.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,791.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,159.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$502.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$505.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.16
|
| Rate for Payer: InnovAge PACE Commercial |
$459.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,810.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$331.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$842.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$410.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410.25
|
| Rate for Payer: Multiplan Commercial |
$3,159.75
|
| Rate for Payer: Networks By Design Commercial |
$2,738.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,581.05
|
| Rate for Payer: Prime Health Services Medicare |
$324.53
|
| Rate for Payer: Riverside University Health System MISP |
$336.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,527.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,527.80
|
| 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: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC CT ABDOMEN & PELVIS W/O CONTRA
|
Facility
|
IP
|
$7,507.00
|
|
|
Service Code
|
CPT 74176
|
| Hospital Charge Code |
909202001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,501.40 |
| Max. Negotiated Rate |
$6,756.30 |
| Rate for Payer: Cash Price |
$3,378.15
|
| Rate for Payer: Central Health Plan Commercial |
$6,005.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,002.80
|
| Rate for Payer: Galaxy Health WC |
$6,380.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,504.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,756.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,007.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,860.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,501.40
|
| Rate for Payer: Multiplan Commercial |
$5,630.25
|
| Rate for Payer: Networks By Design Commercial |
$4,879.55
|
| Rate for Payer: Prime Health Services Commercial |
$6,380.95
|
|
|
HC CT ABDOMEN & PELVIS W & W/O CO
|
Facility
|
OP
|
$5,066.00
|
|
|
Service Code
|
CPT 74178
|
| Hospital Charge Code |
909202003
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$480.50 |
| Max. Negotiated Rate |
$4,559.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$480.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,929.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,992.99
|
| Rate for Payer: Blue Distinction Transplant |
$3,039.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,130.79
|
| Rate for Payer: Blue Shield of California EPN |
$2,462.08
|
| Rate for Payer: Caremore Medicare Advantage |
$480.50
|
| Rate for Payer: Cash Price |
$2,279.70
|
| Rate for Payer: Cash Price |
$2,279.70
|
| Rate for Payer: Central Health Plan Commercial |
$4,052.80
|
| Rate for Payer: Cigna of CA HMO |
$3,242.24
|
| Rate for Payer: Cigna of CA PPO |
$3,748.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: Dignity Health Media |
$480.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$480.50
|
| Rate for Payer: Galaxy Health WC |
$4,306.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,039.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,559.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,799.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$788.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$792.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$480.50
|
| Rate for Payer: InnovAge PACE Commercial |
$720.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,379.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$606.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,013.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.87
|
| Rate for Payer: Multiplan Commercial |
$3,799.50
|
| Rate for Payer: Networks By Design Commercial |
$3,292.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,306.10
|
| Rate for Payer: Prime Health Services Medicare |
$509.33
|
| Rate for Payer: Riverside University Health System MISP |
$528.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,039.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,039.60
|
| 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: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC CT ABDOMEN & PELVIS W & W/O CO
|
Facility
|
IP
|
$9,023.00
|
|
|
Service Code
|
CPT 74178
|
| Hospital Charge Code |
909202003
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,804.60 |
| Max. Negotiated Rate |
$8,120.70 |
| Rate for Payer: Cash Price |
$4,060.35
|
| Rate for Payer: Central Health Plan Commercial |
$7,218.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,609.20
|
| Rate for Payer: Galaxy Health WC |
$7,669.55
|
| Rate for Payer: Global Benefits Group Commercial |
$5,413.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,120.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,018.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,437.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,804.60
|
| Rate for Payer: Multiplan Commercial |
$6,767.25
|
| Rate for Payer: Networks By Design Commercial |
$5,864.95
|
| Rate for Payer: Prime Health Services Commercial |
$7,669.55
|
|
|
HC CT ABDOMEN W CONTRAS
|
Facility
|
IP
|
$6,801.00
|
|
|
Service Code
|
CPT 74160
|
| Hospital Charge Code |
909201928
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,360.20 |
| Max. Negotiated Rate |
$6,120.90 |
| Rate for Payer: Cash Price |
$3,060.45
|
| Rate for Payer: Central Health Plan Commercial |
$5,440.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,720.40
|
| Rate for Payer: Galaxy Health WC |
$5,780.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,080.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,120.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,536.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,591.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,360.20
|
| Rate for Payer: Multiplan Commercial |
$5,100.75
|
| Rate for Payer: Networks By Design Commercial |
$4,420.65
|
| Rate for Payer: Prime Health Services Commercial |
$5,780.85
|
|
|
HC CT ABDOMEN W CONTRAS
|
Facility
|
OP
|
$3,525.00
|
|
|
Service Code
|
CPT 74160
|
| Hospital Charge Code |
909201928
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$229.56 |
| Max. Negotiated Rate |
$3,172.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$229.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,411.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,082.57
|
| Rate for Payer: Blue Distinction Transplant |
$2,115.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,178.45
|
| Rate for Payer: Blue Shield of California EPN |
$1,713.15
|
| Rate for Payer: Caremore Medicare Advantage |
$229.56
|
| Rate for Payer: Cash Price |
$1,586.25
|
| Rate for Payer: Cash Price |
$1,586.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,820.00
|
| Rate for Payer: Cigna of CA HMO |
$2,256.00
|
| Rate for Payer: Cigna of CA PPO |
$2,608.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Media |
$229.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$229.56
|
| Rate for Payer: Galaxy Health WC |
$2,996.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,115.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,172.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,643.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$376.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$378.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: InnovAge PACE Commercial |
$344.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,351.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$396.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$705.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$307.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$307.61
|
| Rate for Payer: Multiplan Commercial |
$2,643.75
|
| Rate for Payer: Networks By Design Commercial |
$2,291.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,996.25
|
| Rate for Payer: Prime Health Services Medicare |
$243.33
|
| Rate for Payer: Riverside University Health System MISP |
$252.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,115.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,115.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$769.25
|
| Rate for Payer: United Healthcare All Other HMO |
$769.25
|
| Rate for Payer: United Healthcare HMO Rider |
$769.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$769.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC CT ABDOMEN WO CONTR
|
Facility
|
IP
|
$5,637.00
|
|
|
Service Code
|
CPT 74150
|
| Hospital Charge Code |
909201927
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,127.40 |
| Max. Negotiated Rate |
$5,073.30 |
| Rate for Payer: Cash Price |
$2,536.65
|
| Rate for Payer: Central Health Plan Commercial |
$4,509.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,254.80
|
| Rate for Payer: Galaxy Health WC |
$4,791.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,382.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,073.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,759.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,147.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,127.40
|
| Rate for Payer: Multiplan Commercial |
$4,227.75
|
| Rate for Payer: Networks By Design Commercial |
$3,664.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,791.45
|
|
|
HC CT ABDOMEN WO CONTR
|
Facility
|
OP
|
$3,135.00
|
|
|
Service Code
|
CPT 74150
|
| Hospital Charge Code |
909201927
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$2,821.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,170.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,852.16
|
| Rate for Payer: Blue Distinction Transplant |
$1,881.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,937.43
|
| Rate for Payer: Blue Shield of California EPN |
$1,523.61
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$1,410.75
|
| Rate for Payer: Cash Price |
$1,410.75
|
| Rate for Payer: Center for Health Promotion Commercial |
$145.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,508.00
|
| Rate for Payer: Cigna of CA HMO |
$2,006.40
|
| Rate for Payer: Cigna of CA PPO |
$2,319.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$2,664.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,881.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,821.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,351.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$226.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: InnovAge PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,091.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$249.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$627.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$2,351.25
|
| Rate for Payer: Networks By Design Commercial |
$2,037.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,664.75
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Riverside University Health System MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,881.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,881.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$491.23
|
| Rate for Payer: United Healthcare All Other HMO |
$491.23
|
| Rate for Payer: United Healthcare HMO Rider |
$491.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$491.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC CT ABDOMEN W/WO CONT
|
Facility
|
OP
|
$4,124.00
|
|
|
Service Code
|
CPT 74170
|
| Hospital Charge Code |
909201929
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$229.56 |
| Max. Negotiated Rate |
$3,711.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$229.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,747.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,436.46
|
| Rate for Payer: Blue Distinction Transplant |
$2,474.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,548.63
|
| Rate for Payer: Blue Shield of California EPN |
$2,004.26
|
| Rate for Payer: Caremore Medicare Advantage |
$229.56
|
| Rate for Payer: Cash Price |
$1,855.80
|
| Rate for Payer: Cash Price |
$1,855.80
|
| Rate for Payer: Central Health Plan Commercial |
$3,299.20
|
| Rate for Payer: Cigna of CA HMO |
$2,639.36
|
| Rate for Payer: Cigna of CA PPO |
$3,051.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Media |
$229.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$229.56
|
| Rate for Payer: Galaxy Health WC |
$3,505.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,474.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,711.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,093.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$376.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$378.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: InnovAge PACE Commercial |
$344.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,750.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$451.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$824.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$307.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$307.61
|
| Rate for Payer: Multiplan Commercial |
$3,093.00
|
| Rate for Payer: Networks By Design Commercial |
$2,680.60
|
| Rate for Payer: Prime Health Services Commercial |
$3,505.40
|
| Rate for Payer: Prime Health Services Medicare |
$243.33
|
| Rate for Payer: Riverside University Health System MISP |
$252.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,474.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,474.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$855.26
|
| Rate for Payer: United Healthcare All Other HMO |
$855.26
|
| Rate for Payer: United Healthcare HMO Rider |
$855.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$855.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC CT ABDOMEN W/WO CONT
|
Facility
|
IP
|
$7,345.00
|
|
|
Service Code
|
CPT 74170
|
| Hospital Charge Code |
909201929
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,469.00 |
| Max. Negotiated Rate |
$6,610.50 |
| Rate for Payer: Cash Price |
$3,305.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,876.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,938.00
|
| Rate for Payer: Galaxy Health WC |
$6,243.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,407.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,610.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,899.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,798.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,469.00
|
| Rate for Payer: Multiplan Commercial |
$5,508.75
|
| Rate for Payer: Networks By Design Commercial |
$4,774.25
|
| Rate for Payer: Prime Health Services Commercial |
$6,243.25
|
|
|
HC CT ANGIO ABD AORTA-AIF W/WO CO
|
Facility
|
IP
|
$7,606.00
|
|
|
Service Code
|
CPT 75635
|
| Hospital Charge Code |
909201809
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,521.20 |
| Max. Negotiated Rate |
$6,845.40 |
| Rate for Payer: Cash Price |
$3,422.70
|
| Rate for Payer: Central Health Plan Commercial |
$6,084.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,042.40
|
| Rate for Payer: Galaxy Health WC |
$6,465.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,563.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,845.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,073.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,897.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,521.20
|
| Rate for Payer: Multiplan Commercial |
$5,704.50
|
| Rate for Payer: Networks By Design Commercial |
$4,943.90
|
| Rate for Payer: Prime Health Services Commercial |
$6,465.10
|
|
|
HC CT ANGIO ABD AORTA-AIF W/WO CO
|
Facility
|
OP
|
$5,071.00
|
|
|
Service Code
|
CPT 75635
|
| Hospital Charge Code |
909201809
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$229.56 |
| Max. Negotiated Rate |
$4,563.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$229.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,786.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,995.95
|
| Rate for Payer: Blue Distinction Transplant |
$3,042.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,133.88
|
| Rate for Payer: Blue Shield of California EPN |
$2,464.51
|
| Rate for Payer: Caremore Medicare Advantage |
$229.56
|
| Rate for Payer: Cash Price |
$2,281.95
|
| Rate for Payer: Cash Price |
$2,281.95
|
| Rate for Payer: Central Health Plan Commercial |
$4,056.80
|
| Rate for Payer: Cigna of CA HMO |
$3,245.44
|
| Rate for Payer: Cigna of CA PPO |
$3,752.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Media |
$229.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$229.56
|
| Rate for Payer: Galaxy Health WC |
$4,310.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,042.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,563.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,803.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$376.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$378.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: InnovAge PACE Commercial |
$344.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,382.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$650.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,014.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$307.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$307.61
|
| Rate for Payer: Multiplan Commercial |
$3,803.25
|
| Rate for Payer: Networks By Design Commercial |
$3,296.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,310.35
|
| Rate for Payer: Prime Health Services Medicare |
$243.33
|
| Rate for Payer: Riverside University Health System MISP |
$252.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,042.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,042.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.48
|
| Rate for Payer: United Healthcare All Other HMO |
$866.48
|
| Rate for Payer: United Healthcare HMO Rider |
$866.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC CT ANGIO ABDOMEN/PELVIS
|
Facility
|
IP
|
$7,970.00
|
|
|
Service Code
|
CPT 74174
|
| Hospital Charge Code |
909201991
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,594.00 |
| Max. Negotiated Rate |
$7,173.00 |
| Rate for Payer: Cash Price |
$3,586.50
|
| Rate for Payer: Central Health Plan Commercial |
$6,376.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,188.00
|
| Rate for Payer: Galaxy Health WC |
$6,774.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,782.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,173.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,315.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,036.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,594.00
|
| Rate for Payer: Multiplan Commercial |
$5,977.50
|
| Rate for Payer: Networks By Design Commercial |
$5,180.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,774.50
|
|
|
HC CT ANGIO ABDOMEN/PELVIS
|
Facility
|
OP
|
$4,473.00
|
|
|
Service Code
|
CPT 74174
|
| Hospital Charge Code |
909201991
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$480.50 |
| Max. Negotiated Rate |
$4,025.70 |
| Rate for Payer: Adventist Health Medi-Cal |
$480.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,754.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,642.65
|
| Rate for Payer: Blue Distinction Transplant |
$2,683.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,764.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,173.88
|
| Rate for Payer: Caremore Medicare Advantage |
$480.50
|
| Rate for Payer: Cash Price |
$2,012.85
|
| Rate for Payer: Cash Price |
$2,012.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,578.40
|
| Rate for Payer: Cigna of CA HMO |
$2,862.72
|
| Rate for Payer: Cigna of CA PPO |
$3,310.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: Dignity Health Media |
$480.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$480.50
|
| Rate for Payer: Galaxy Health WC |
$3,802.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,683.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,025.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,354.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$788.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$792.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$480.50
|
| Rate for Payer: InnovAge PACE Commercial |
$720.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,983.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$668.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$894.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.87
|
| Rate for Payer: Multiplan Commercial |
$3,354.75
|
| Rate for Payer: Networks By Design Commercial |
$2,907.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,802.05
|
| Rate for Payer: Prime Health Services Medicare |
$509.33
|
| Rate for Payer: Riverside University Health System MISP |
$528.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,683.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,683.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,486.18
|
| Rate for Payer: United Healthcare All Other HMO |
$1,486.18
|
| Rate for Payer: United Healthcare HMO Rider |
$1,486.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,486.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC CT ANGIO ABDOMEN W/WO CONTRAST
|
Facility
|
OP
|
$4,576.00
|
|
|
Service Code
|
CPT 74175
|
| Hospital Charge Code |
909201808
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$229.56 |
| Max. Negotiated Rate |
$4,118.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$229.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,786.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,703.50
|
| Rate for Payer: Blue Distinction Transplant |
$2,745.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,827.97
|
| Rate for Payer: Blue Shield of California EPN |
$2,223.94
|
| Rate for Payer: Caremore Medicare Advantage |
$229.56
|
| Rate for Payer: Cash Price |
$2,059.20
|
| Rate for Payer: Cash Price |
$2,059.20
|
| Rate for Payer: Central Health Plan Commercial |
$3,660.80
|
| Rate for Payer: Cigna of CA HMO |
$2,928.64
|
| Rate for Payer: Cigna of CA PPO |
$3,386.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Media |
$229.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$229.56
|
| Rate for Payer: Galaxy Health WC |
$3,889.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,745.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,118.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,432.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$376.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$378.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: InnovAge PACE Commercial |
$344.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,052.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$526.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$915.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$307.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$307.61
|
| Rate for Payer: Multiplan Commercial |
$3,432.00
|
| Rate for Payer: Networks By Design Commercial |
$2,974.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,889.60
|
| Rate for Payer: Prime Health Services Medicare |
$243.33
|
| Rate for Payer: Riverside University Health System MISP |
$252.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,745.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,745.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.48
|
| Rate for Payer: United Healthcare All Other HMO |
$866.48
|
| Rate for Payer: United Healthcare HMO Rider |
$866.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC CT ANGIO ABDOMEN W/WO CONTRAST
|
Facility
|
IP
|
$6,521.00
|
|
|
Service Code
|
CPT 74175
|
| Hospital Charge Code |
909201808
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,304.20 |
| Max. Negotiated Rate |
$5,868.90 |
| Rate for Payer: Cash Price |
$2,934.45
|
| Rate for Payer: Central Health Plan Commercial |
$5,216.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,608.40
|
| Rate for Payer: Galaxy Health WC |
$5,542.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,912.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,868.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,349.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,484.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,304.20
|
| Rate for Payer: Multiplan Commercial |
$4,890.75
|
| Rate for Payer: Networks By Design Commercial |
$4,238.65
|
| Rate for Payer: Prime Health Services Commercial |
$5,542.85
|
|
|
HC CT ANGIO CHEST W/WO CONTRAST
|
Facility
|
IP
|
$6,692.00
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
909201802
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,338.40 |
| Max. Negotiated Rate |
$6,022.80 |
| Rate for Payer: Cash Price |
$3,011.40
|
| Rate for Payer: Central Health Plan Commercial |
$5,353.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,676.80
|
| Rate for Payer: Galaxy Health WC |
$5,688.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,015.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,022.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,463.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,549.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,338.40
|
| Rate for Payer: Multiplan Commercial |
$5,019.00
|
| Rate for Payer: Networks By Design Commercial |
$4,349.80
|
| Rate for Payer: Prime Health Services Commercial |
$5,688.20
|
|
|
HC CT ANGIO CHEST W/WO CONTRAST
|
Facility
|
OP
|
$4,304.00
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
909201802
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$229.56 |
| Max. Negotiated Rate |
$3,873.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$229.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,858.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,542.80
|
| Rate for Payer: Blue Distinction Transplant |
$2,582.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,659.87
|
| Rate for Payer: Blue Shield of California EPN |
$2,091.74
|
| Rate for Payer: Caremore Medicare Advantage |
$229.56
|
| Rate for Payer: Cash Price |
$1,936.80
|
| Rate for Payer: Cash Price |
$1,936.80
|
| Rate for Payer: Central Health Plan Commercial |
$3,443.20
|
| Rate for Payer: Cigna of CA HMO |
$2,754.56
|
| Rate for Payer: Cigna of CA PPO |
$3,184.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Media |
$229.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$229.56
|
| Rate for Payer: Galaxy Health WC |
$3,658.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,582.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,873.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,228.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$376.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$378.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: InnovAge PACE Commercial |
$344.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,870.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$514.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$860.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$307.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$307.61
|
| Rate for Payer: Multiplan Commercial |
$3,228.00
|
| Rate for Payer: Networks By Design Commercial |
$2,797.60
|
| Rate for Payer: Prime Health Services Commercial |
$3,658.40
|
| Rate for Payer: Prime Health Services Medicare |
$243.33
|
| Rate for Payer: Riverside University Health System MISP |
$252.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,582.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,582.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.48
|
| Rate for Payer: United Healthcare All Other HMO |
$866.48
|
| Rate for Payer: United Healthcare HMO Rider |
$866.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
