|
HC CT COLONOGRAPHY W/O CONTRAST
|
Facility
|
IP
|
$1,492.00
|
|
|
Service Code
|
CPT 74261
|
| Hospital Charge Code |
909201811
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$270.05 |
| Max. Negotiated Rate |
$1,119.00 |
| Rate for Payer: Adventist Health Commercial |
$298.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,025.00
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,010.08
|
| Rate for Payer: Heritage Provider Network Senior |
$1,010.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$373.00
|
| Rate for Payer: Multiplan Commercial |
$1,119.00
|
|
|
HC CT COLONOGRAPHY W/O CONTRAST
|
Facility
|
OP
|
$3,707.00
|
|
|
Service Code
|
CPT 74261
|
| Hospital Charge Code |
909201811
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$2,780.25 |
| Rate for Payer: Adventist Health Commercial |
$741.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,546.71
|
| 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: Blue Shield of California Commercial |
$2,697.77
|
| Rate for Payer: Blue Shield of California EPN |
$1,534.14
|
| Rate for Payer: Cash Price |
$1,668.15
|
| Rate for Payer: Cash Price |
$1,668.15
|
| Rate for Payer: Cash Price |
$1,668.15
|
| Rate for Payer: Cash Price |
$1,668.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$645.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$670.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$926.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$2,780.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$307.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$307.02
|
| 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 CSPINE WITH CONTRAST
|
Facility
|
IP
|
$4,355.00
|
|
|
Service Code
|
CPT 72126
|
| Hospital Charge Code |
909201916
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$711.00 |
| Max. Negotiated Rate |
$3,266.25 |
| Rate for Payer: Adventist Health Commercial |
$871.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,991.88
|
| Rate for Payer: Cash Price |
$1,959.75
|
| Rate for Payer: Cash Price |
$1,959.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,948.34
|
| Rate for Payer: Heritage Provider Network Senior |
$2,948.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$788.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,088.75
|
| Rate for Payer: Multiplan Commercial |
$3,266.25
|
|
|
HC CT CSPINE WITH CONTRAST
|
Facility
|
OP
|
$3,399.00
|
|
|
Service Code
|
CPT 72126
|
| Hospital Charge Code |
909201916
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$2,549.25 |
| Rate for Payer: Adventist Health Commercial |
$679.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,335.11
|
| 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: Blue Shield of California Commercial |
$1,444.23
|
| Rate for Payer: Blue Shield of California EPN |
$821.29
|
| Rate for Payer: Cash Price |
$1,529.55
|
| Rate for Payer: Cash Price |
$1,529.55
|
| Rate for Payer: Cash Price |
$1,529.55
|
| Rate for Payer: Cash Price |
$1,529.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: Dignity Health Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$480.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Humana Medicare |
$480.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$254.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$480.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$912.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$615.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$566.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$849.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$605.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$605.43
|
| Rate for Payer: Multiplan Commercial |
$2,549.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$480.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$480.78
|
| 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 CSPINE WO CONTRAST
|
Facility
|
IP
|
$4,082.00
|
|
|
Service Code
|
CPT 72125
|
| Hospital Charge Code |
909201915
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$711.00 |
| Max. Negotiated Rate |
$3,061.50 |
| Rate for Payer: Adventist Health Commercial |
$816.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,804.33
|
| Rate for Payer: Cash Price |
$1,836.90
|
| Rate for Payer: Cash Price |
$1,836.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,763.51
|
| Rate for Payer: Heritage Provider Network Senior |
$2,763.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$738.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,020.50
|
| Rate for Payer: Multiplan Commercial |
$3,061.50
|
|
|
HC CT CSPINE WO CONTRAST
|
Facility
|
OP
|
$3,158.00
|
|
|
Service Code
|
CPT 72125
|
| Hospital Charge Code |
909201915
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$2,368.50 |
| Rate for Payer: Adventist Health Commercial |
$631.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,169.55
|
| 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: Blue Shield of California Commercial |
$1,206.38
|
| Rate for Payer: Blue Shield of California EPN |
$686.03
|
| Rate for Payer: Cash Price |
$1,421.10
|
| Rate for Payer: Cash Price |
$1,421.10
|
| Rate for Payer: Cash Price |
$1,421.10
|
| Rate for Payer: Cash Price |
$1,421.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$194.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$571.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$789.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$2,368.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$307.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$307.02
|
| 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 C SPINE W/WO CONTRAST
|
Facility
|
OP
|
$3,550.00
|
|
|
Service Code
|
CPT 72127
|
| Hospital Charge Code |
909201967
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$2,662.50 |
| Rate for Payer: Adventist Health Commercial |
$710.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,438.85
|
| 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: Blue Shield of California Commercial |
$1,805.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,026.98
|
| Rate for Payer: Cash Price |
$1,597.50
|
| Rate for Payer: Cash Price |
$1,597.50
|
| Rate for Payer: Cash Price |
$1,597.50
|
| Rate for Payer: Cash Price |
$1,597.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: Dignity Health Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$229.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Humana Medicare |
$229.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$300.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$436.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$642.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$270.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$887.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$289.25
|
| Rate for Payer: Multiplan Commercial |
$2,662.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$534.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$534.54
|
| 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 C SPINE W/WO CONTRAST
|
Facility
|
IP
|
$4,487.00
|
|
|
Service Code
|
CPT 72127
|
| Hospital Charge Code |
909201967
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$711.00 |
| Max. Negotiated Rate |
$3,365.25 |
| Rate for Payer: Adventist Health Commercial |
$897.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,082.57
|
| Rate for Payer: Cash Price |
$2,019.15
|
| Rate for Payer: Cash Price |
$2,019.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,037.70
|
| Rate for Payer: Heritage Provider Network Senior |
$3,037.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$812.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,121.75
|
| Rate for Payer: Multiplan Commercial |
$3,365.25
|
|
|
HC CT GUID ABCESS DRAIN
|
Facility
|
IP
|
$1,826.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
909201944
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$330.51 |
| Max. Negotiated Rate |
$1,369.50 |
| Rate for Payer: Adventist Health Commercial |
$365.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,254.46
|
| Rate for Payer: Cash Price |
$821.70
|
| Rate for Payer: Cash Price |
$821.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,236.20
|
| Rate for Payer: Heritage Provider Network Senior |
$1,236.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$330.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$456.50
|
| Rate for Payer: Multiplan Commercial |
$1,369.50
|
|
|
HC CT GUID ABCESS DRAIN
|
Facility
|
OP
|
$1,826.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
909201944
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$163.05 |
| Max. Negotiated Rate |
$1,552.10 |
| Rate for Payer: Adventist Health Commercial |
$365.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,254.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,552.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,004.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,369.50
|
| Rate for Payer: Blue Shield of California Commercial |
$645.50
|
| Rate for Payer: Blue Shield of California EPN |
$367.08
|
| Rate for Payer: Cash Price |
$821.70
|
| Rate for Payer: Cash Price |
$821.70
|
| Rate for Payer: Cash Price |
$821.70
|
| Rate for Payer: Cash Price |
$821.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,552.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,552.10
|
| Rate for Payer: Dignity Health Senior |
$1,552.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$163.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$880.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$330.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$456.50
|
| Rate for Payer: Multiplan Commercial |
$1,369.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Senior |
$225.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,552.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,552.10
|
|
|
HC CT GUIDANCE/NEEDLE PLACEMENT
|
Facility
|
IP
|
$2,391.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
909201935
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$432.77 |
| Max. Negotiated Rate |
$1,793.25 |
| Rate for Payer: Adventist Health Commercial |
$478.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,642.62
|
| Rate for Payer: Cash Price |
$1,075.95
|
| Rate for Payer: Cash Price |
$1,075.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,618.71
|
| Rate for Payer: Heritage Provider Network Senior |
$1,618.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$432.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$597.75
|
| Rate for Payer: Multiplan Commercial |
$1,793.25
|
|
|
HC CT GUIDANCE/NEEDLE PLACEMENT
|
Facility
|
OP
|
$2,391.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
909201935
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$173.24 |
| Max. Negotiated Rate |
$2,032.35 |
| Rate for Payer: Adventist Health Commercial |
$478.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,642.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,032.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,315.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,793.25
|
| Rate for Payer: Blue Shield of California Commercial |
$413.90
|
| Rate for Payer: Blue Shield of California EPN |
$235.37
|
| Rate for Payer: Cash Price |
$1,075.95
|
| Rate for Payer: Cash Price |
$1,075.95
|
| Rate for Payer: Cash Price |
$1,075.95
|
| Rate for Payer: Cash Price |
$1,075.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,032.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,032.35
|
| Rate for Payer: Dignity Health Senior |
$2,032.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$173.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,152.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$432.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$597.75
|
| Rate for Payer: Multiplan Commercial |
$1,793.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Senior |
$225.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,032.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,032.35
|
|
|
HC CT GUID RAD THERAPY
|
Facility
|
OP
|
$1,637.00
|
|
|
Service Code
|
CPT 77014
|
| Hospital Charge Code |
909100165
|
|
Hospital Revenue Code
|
359
|
| Min. Negotiated Rate |
$164.05 |
| Max. Negotiated Rate |
$1,391.45 |
| Rate for Payer: Adventist Health Commercial |
$327.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,124.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,391.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$900.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,227.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$649.39
|
| Rate for Payer: Blue Shield of California Commercial |
$1,016.58
|
| Rate for Payer: Blue Shield of California EPN |
$960.92
|
| Rate for Payer: Cash Price |
$736.65
|
| Rate for Payer: Cash Price |
$736.65
|
| Rate for Payer: Cash Price |
$736.65
|
| Rate for Payer: Cash Price |
$736.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,391.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,391.45
|
| Rate for Payer: Dignity Health Senior |
$1,391.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$164.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$789.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$296.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$409.25
|
| Rate for Payer: Multiplan Commercial |
$1,227.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Senior |
$225.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,391.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,391.45
|
|
|
HC CT GUID RAD THERAPY
|
Facility
|
IP
|
$2,118.00
|
|
|
Service Code
|
CPT 77014
|
| Hospital Charge Code |
909100165
|
|
Hospital Revenue Code
|
359
|
| Min. Negotiated Rate |
$383.36 |
| Max. Negotiated Rate |
$1,588.50 |
| Rate for Payer: Adventist Health Commercial |
$423.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,455.07
|
| Rate for Payer: Cash Price |
$953.10
|
| Rate for Payer: Cash Price |
$953.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,433.89
|
| Rate for Payer: Heritage Provider Network Senior |
$1,433.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$383.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$529.50
|
| Rate for Payer: Multiplan Commercial |
$1,588.50
|
|
|
HC CT HEAD NO CONTRAST
|
Facility
|
IP
|
$3,274.00
|
|
|
Service Code
|
CPT 70450
|
| Hospital Charge Code |
909201901
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$592.59 |
| Max. Negotiated Rate |
$2,455.50 |
| Rate for Payer: Adventist Health Commercial |
$654.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,249.24
|
| Rate for Payer: Cash Price |
$1,473.30
|
| Rate for Payer: Cash Price |
$1,473.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,216.50
|
| Rate for Payer: Heritage Provider Network Senior |
$2,216.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$592.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$818.50
|
| Rate for Payer: Multiplan Commercial |
$2,455.50
|
|
|
HC CT HEAD NO CONTRAST
|
Facility
|
OP
|
$3,125.00
|
|
|
Service Code
|
CPT 70450
|
| Hospital Charge Code |
909201901
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$2,343.75 |
| Rate for Payer: Adventist Health Commercial |
$625.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,146.88
|
| 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: Blue Shield of California Commercial |
$964.62
|
| Rate for Payer: Blue Shield of California EPN |
$548.55
|
| Rate for Payer: Cash Price |
$1,406.25
|
| Rate for Payer: Cash Price |
$1,406.25
|
| Rate for Payer: Cash Price |
$1,406.25
|
| Rate for Payer: Cash Price |
$1,406.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$157.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$565.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$781.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$2,343.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$307.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$307.02
|
| 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 HEAD W CONTRAST
|
Facility
|
OP
|
$3,487.00
|
|
|
Service Code
|
CPT 70460
|
| Hospital Charge Code |
909201900
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$222.81 |
| Max. Negotiated Rate |
$2,615.25 |
| Rate for Payer: Adventist Health Commercial |
$697.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,395.57
|
| 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: Blue Shield of California Commercial |
$1,154.00
|
| Rate for Payer: Blue Shield of California EPN |
$656.25
|
| Rate for Payer: Cash Price |
$1,569.15
|
| Rate for Payer: Cash Price |
$1,569.15
|
| Rate for Payer: Cash Price |
$1,569.15
|
| Rate for Payer: Cash Price |
$1,569.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: Dignity Health Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$229.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Humana Medicare |
$229.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$222.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$436.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$631.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$270.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$871.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$289.25
|
| Rate for Payer: Multiplan Commercial |
$2,615.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$480.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$480.78
|
| 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 HEAD W CONTRAST
|
Facility
|
IP
|
$3,397.00
|
|
|
Service Code
|
CPT 70460
|
| Hospital Charge Code |
909201900
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$614.86 |
| Max. Negotiated Rate |
$2,547.75 |
| Rate for Payer: Adventist Health Commercial |
$679.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,333.74
|
| Rate for Payer: Cash Price |
$1,528.65
|
| Rate for Payer: Cash Price |
$1,528.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,299.77
|
| Rate for Payer: Heritage Provider Network Senior |
$2,299.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$614.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$849.25
|
| Rate for Payer: Multiplan Commercial |
$2,547.75
|
|
|
HC CT HEAD W/WO CONTRAS
|
Facility
|
IP
|
$3,796.00
|
|
|
Service Code
|
CPT 70470
|
| Hospital Charge Code |
909201902
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$687.08 |
| Max. Negotiated Rate |
$2,847.00 |
| Rate for Payer: Adventist Health Commercial |
$759.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,607.85
|
| Rate for Payer: Cash Price |
$1,708.20
|
| Rate for Payer: Cash Price |
$1,708.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,569.89
|
| Rate for Payer: Heritage Provider Network Senior |
$2,569.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$687.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$949.00
|
| Rate for Payer: Multiplan Commercial |
$2,847.00
|
|
|
HC CT HEAD W/WO CONTRAS
|
Facility
|
OP
|
$3,905.00
|
|
|
Service Code
|
CPT 70470
|
| Hospital Charge Code |
909201902
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$2,928.75 |
| Rate for Payer: Adventist Health Commercial |
$781.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,682.74
|
| 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: Blue Shield of California Commercial |
$1,444.23
|
| Rate for Payer: Blue Shield of California EPN |
$821.29
|
| Rate for Payer: Cash Price |
$1,757.25
|
| Rate for Payer: Cash Price |
$1,757.25
|
| Rate for Payer: Cash Price |
$1,757.25
|
| Rate for Payer: Cash Price |
$1,757.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: Dignity Health Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$229.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Humana Medicare |
$229.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$262.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$436.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$706.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$270.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$976.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$289.25
|
| Rate for Payer: Multiplan Commercial |
$2,928.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$534.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$534.54
|
| 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 CTLSO W/INTERFACE MINERVA
|
Facility
|
IP
|
$5,769.00
|
|
|
Service Code
|
CPT L0710
|
| Hospital Charge Code |
905350710
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,153.80 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$1,153.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,769.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,963.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$2,596.05
|
| Rate for Payer: Cash Price |
$2,596.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,653.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,115.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,905.61
|
| Rate for Payer: Heritage Provider Network Senior |
$7,571.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,884.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,884.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,884.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,442.25
|
| Rate for Payer: Multiplan Commercial |
$4,326.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,103.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,927.42
|
|
|
HC CTLSO W/INTERFACE MINERVA
|
Facility
|
OP
|
$5,769.00
|
|
|
Service Code
|
CPT L0710
|
| Hospital Charge Code |
905350710
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,153.80 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$1,153.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,769.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,963.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,903.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,172.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,326.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,582.55
|
| Rate for Payer: Blue Shield of California EPN |
$3,386.40
|
| Rate for Payer: Cash Price |
$2,596.05
|
| Rate for Payer: Cash Price |
$2,596.05
|
| Rate for Payer: Cash Price |
$2,596.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,653.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,903.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,903.65
|
| Rate for Payer: Dignity Health Senior |
$4,903.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,692.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,671.05
|
| Rate for Payer: Heritage Provider Network Senior |
$2,671.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,616.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,884.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,884.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,884.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,442.25
|
| Rate for Payer: Multiplan Commercial |
$4,326.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,103.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,927.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,903.65
|
| Rate for Payer: Vantage Medical Group Senior |
$4,903.65
|
|
|
HC CT MAXILLOFACIAL W/WO CONTRAST
|
Facility
|
IP
|
$3,250.00
|
|
|
Service Code
|
CPT 70488
|
| Hospital Charge Code |
909201950
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$588.25 |
| Max. Negotiated Rate |
$2,437.50 |
| Rate for Payer: Adventist Health Commercial |
$650.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,232.75
|
| Rate for Payer: Cash Price |
$1,462.50
|
| Rate for Payer: Cash Price |
$1,462.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,200.25
|
| Rate for Payer: Heritage Provider Network Senior |
$2,200.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$588.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$812.50
|
| Rate for Payer: Multiplan Commercial |
$2,437.50
|
|
|
HC CT MAXILLOFACIAL W/WO CONTRAST
|
Facility
|
OP
|
$3,956.00
|
|
|
Service Code
|
CPT 70488
|
| Hospital Charge Code |
909201950
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$2,967.00 |
| Rate for Payer: Adventist Health Commercial |
$791.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,717.77
|
| 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: Blue Shield of California Commercial |
$1,444.23
|
| Rate for Payer: Blue Shield of California EPN |
$821.29
|
| Rate for Payer: Cash Price |
$1,780.20
|
| Rate for Payer: Cash Price |
$1,780.20
|
| Rate for Payer: Cash Price |
$1,780.20
|
| Rate for Payer: Cash Price |
$1,780.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: Dignity Health Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$229.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Humana Medicare |
$229.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$280.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$436.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$716.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$270.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$989.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$289.25
|
| Rate for Payer: Multiplan Commercial |
$2,967.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$534.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$534.54
|
| 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 MAXILLOFAC W CONT
|
Facility
|
IP
|
$3,128.00
|
|
|
Service Code
|
CPT 70487
|
| Hospital Charge Code |
909201907
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$566.17 |
| Max. Negotiated Rate |
$2,346.00 |
| Rate for Payer: Adventist Health Commercial |
$625.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,148.94
|
| Rate for Payer: Cash Price |
$1,407.60
|
| Rate for Payer: Cash Price |
$1,407.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,117.66
|
| Rate for Payer: Heritage Provider Network Senior |
$2,117.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$566.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$782.00
|
| Rate for Payer: Multiplan Commercial |
$2,346.00
|
|
