|
HC CT ABDOMEN W CONTRAS
|
Facility
|
OP
|
$2,996.00
|
|
|
Service Code
|
CPT 74160
|
| Hospital Charge Code |
909201928
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$2,247.00 |
| Rate for Payer: Adventist Health Commercial |
$599.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,058.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Blue Shield of California Commercial |
$1,439.71
|
| Rate for Payer: Blue Shield of California EPN |
$1,157.77
|
| Rate for Payer: Cash Price |
$1,348.20
|
| Rate for Payer: Cash Price |
$1,348.20
|
| Rate for Payer: Cash Price |
$1,348.20
|
| Rate for Payer: Cash Price |
$1,348.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Senior |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$226.19
|
| 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 |
$338.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,429.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$542.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$260.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$749.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$285.00
|
| Rate for Payer: Multiplan Commercial |
$2,247.00
|
| 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 |
$480.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$480.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC CT ABDOMEN W CONTRAS
|
Facility
|
IP
|
$2,139.00
|
|
|
Service Code
|
CPT 74160
|
| Hospital Charge Code |
909201928
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$387.16 |
| Max. Negotiated Rate |
$1,604.25 |
| Rate for Payer: Adventist Health Commercial |
$427.80
|
| Rate for Payer: Cash Price |
$962.55
|
| Rate for Payer: Cash Price |
$962.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,448.10
|
| Rate for Payer: Heritage Provider Network Senior |
$1,448.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$387.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$534.75
|
| Rate for Payer: Multiplan Commercial |
$1,604.25
|
|
|
HC CT ABDOMEN WO CONTR
|
Facility
|
OP
|
$2,665.00
|
|
|
Service Code
|
CPT 74150
|
| Hospital Charge Code |
909201927
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$1,998.75 |
| Rate for Payer: Adventist Health Commercial |
$533.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,830.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Blue Shield of California Commercial |
$1,188.67
|
| Rate for Payer: Blue Shield of California EPN |
$955.89
|
| Rate for Payer: Cash Price |
$1,199.25
|
| Rate for Payer: Cash Price |
$1,199.25
|
| Rate for Payer: Cash Price |
$1,199.25
|
| Rate for Payer: Cash Price |
$1,199.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Senior |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$135.12
|
| 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 |
$212.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,271.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$482.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$666.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.25
|
| Rate for Payer: Multiplan Commercial |
$1,998.75
|
| 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 |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC CT ABDOMEN WO CONTR
|
Facility
|
IP
|
$1,798.00
|
|
|
Service Code
|
CPT 74150
|
| Hospital Charge Code |
909201927
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$325.44 |
| Max. Negotiated Rate |
$1,348.50 |
| Rate for Payer: Adventist Health Commercial |
$359.60
|
| Rate for Payer: Cash Price |
$809.10
|
| Rate for Payer: Cash Price |
$809.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,217.25
|
| Rate for Payer: Heritage Provider Network Senior |
$1,217.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$325.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$449.50
|
| Rate for Payer: Multiplan Commercial |
$1,348.50
|
|
|
HC CT ABDOMEN W/WO CONT
|
Facility
|
IP
|
$2,451.00
|
|
|
Service Code
|
CPT 74170
|
| Hospital Charge Code |
909201929
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$443.63 |
| Max. Negotiated Rate |
$1,838.25 |
| Rate for Payer: Adventist Health Commercial |
$490.20
|
| Rate for Payer: Cash Price |
$1,102.95
|
| Rate for Payer: Cash Price |
$1,102.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,659.33
|
| Rate for Payer: Heritage Provider Network Senior |
$1,659.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$443.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$612.75
|
| Rate for Payer: Multiplan Commercial |
$1,838.25
|
|
|
HC CT ABDOMEN W/WO CONT
|
Facility
|
OP
|
$3,505.00
|
|
|
Service Code
|
CPT 74170
|
| Hospital Charge Code |
909201929
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$2,628.75 |
| Rate for Payer: Adventist Health Commercial |
$701.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,407.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Blue Shield of California Commercial |
$1,783.10
|
| Rate for Payer: Blue Shield of California EPN |
$1,433.91
|
| Rate for Payer: Cash Price |
$1,577.25
|
| Rate for Payer: Cash Price |
$1,577.25
|
| Rate for Payer: Cash Price |
$1,577.25
|
| Rate for Payer: Cash Price |
$1,577.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Senior |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$226.19
|
| 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 |
$384.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,671.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$634.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$260.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$876.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$285.00
|
| Rate for Payer: Multiplan Commercial |
$2,628.75
|
| 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 |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC CT ANGIO ABD AORTA-AIF W/WO CO
|
Facility
|
OP
|
$4,310.00
|
|
|
Service Code
|
CPT 75635
|
| Hospital Charge Code |
909201809
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$3,282.19 |
| Rate for Payer: Adventist Health Commercial |
$862.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,960.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Blue Shield of California Commercial |
$3,282.19
|
| Rate for Payer: Blue Shield of California EPN |
$2,639.43
|
| Rate for Payer: Cash Price |
$1,939.50
|
| Rate for Payer: Cash Price |
$1,939.50
|
| Rate for Payer: Cash Price |
$1,939.50
|
| Rate for Payer: Cash Price |
$1,939.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Senior |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$226.19
|
| 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 |
$554.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,055.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$780.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$260.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,077.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$285.00
|
| Rate for Payer: Multiplan Commercial |
$3,232.50
|
| 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 |
$541.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$541.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC CT ANGIO ABD AORTA-AIF W/WO CO
|
Facility
|
IP
|
$2,894.00
|
|
|
Service Code
|
CPT 75635
|
| Hospital Charge Code |
909201809
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$523.81 |
| Max. Negotiated Rate |
$2,170.50 |
| Rate for Payer: Adventist Health Commercial |
$578.80
|
| Rate for Payer: Cash Price |
$1,302.30
|
| Rate for Payer: Cash Price |
$1,302.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,959.24
|
| Rate for Payer: Heritage Provider Network Senior |
$1,959.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$523.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$723.50
|
| Rate for Payer: Multiplan Commercial |
$2,170.50
|
|
|
HC CT ANGIO ABDOMEN/PELVIS
|
Facility
|
OP
|
$3,802.00
|
|
|
Service Code
|
CPT 74174
|
| Hospital Charge Code |
909201991
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$2,851.50 |
| Rate for Payer: Adventist Health Commercial |
$760.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,611.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Blue Shield of California Commercial |
$2,708.11
|
| Rate for Payer: Blue Shield of California EPN |
$2,177.77
|
| Rate for Payer: Cash Price |
$1,710.90
|
| Rate for Payer: Cash Price |
$1,710.90
|
| Rate for Payer: Cash Price |
$1,710.90
|
| Rate for Payer: Cash Price |
$1,710.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Senior |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$453.77
|
| 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 |
$569.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,813.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$688.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$521.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$950.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$571.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$571.75
|
| Rate for Payer: Multiplan Commercial |
$2,851.50
|
| 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 |
$928.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$928.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
HC CT ANGIO ABDOMEN/PELVIS
|
Facility
|
IP
|
$2,894.00
|
|
|
Service Code
|
CPT 74174
|
| Hospital Charge Code |
909201991
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$523.81 |
| Max. Negotiated Rate |
$2,170.50 |
| Rate for Payer: Adventist Health Commercial |
$578.80
|
| Rate for Payer: Cash Price |
$1,302.30
|
| Rate for Payer: Cash Price |
$1,302.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,959.24
|
| Rate for Payer: Heritage Provider Network Senior |
$1,959.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$523.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$723.50
|
| Rate for Payer: Multiplan Commercial |
$2,170.50
|
|
|
HC CT ANGIO ABDOMEN W/WO CONTRAST
|
Facility
|
OP
|
$3,890.00
|
|
|
Service Code
|
CPT 74175
|
| Hospital Charge Code |
909201808
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$2,917.50 |
| Rate for Payer: Adventist Health Commercial |
$778.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,672.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Blue Shield of California Commercial |
$2,494.42
|
| Rate for Payer: Blue Shield of California EPN |
$2,005.93
|
| Rate for Payer: Cash Price |
$1,750.50
|
| Rate for Payer: Cash Price |
$1,750.50
|
| Rate for Payer: Cash Price |
$1,750.50
|
| Rate for Payer: Cash Price |
$1,750.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Senior |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$226.19
|
| 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 |
$449.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,855.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$704.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$260.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$972.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$285.00
|
| Rate for Payer: Multiplan Commercial |
$2,917.50
|
| 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 |
$541.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$541.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC CT ANGIO ABDOMEN W/WO CONTRAST
|
Facility
|
IP
|
$2,694.00
|
|
|
Service Code
|
CPT 74175
|
| Hospital Charge Code |
909201808
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$487.61 |
| Max. Negotiated Rate |
$2,020.50 |
| Rate for Payer: Adventist Health Commercial |
$538.80
|
| Rate for Payer: Cash Price |
$1,212.30
|
| Rate for Payer: Cash Price |
$1,212.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,823.84
|
| Rate for Payer: Heritage Provider Network Senior |
$1,823.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$487.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$673.50
|
| Rate for Payer: Multiplan Commercial |
$2,020.50
|
|
|
HC CT ANGIO CHEST W/WO CONTRAST
|
Facility
|
OP
|
$3,658.00
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
909201802
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$2,743.50 |
| Rate for Payer: Adventist Health Commercial |
$731.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,513.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Blue Shield of California Commercial |
$2,565.12
|
| Rate for Payer: Blue Shield of California EPN |
$2,062.78
|
| Rate for Payer: Cash Price |
$1,646.10
|
| Rate for Payer: Cash Price |
$1,646.10
|
| Rate for Payer: Cash Price |
$1,646.10
|
| Rate for Payer: Cash Price |
$1,646.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Senior |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$226.19
|
| 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 |
$438.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,744.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$662.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$260.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$914.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$285.00
|
| Rate for Payer: Multiplan Commercial |
$2,743.50
|
| 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 |
$541.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$541.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC CT ANGIO CHEST W/WO CONTRAST
|
Facility
|
IP
|
$2,643.00
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
909201802
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$478.38 |
| Max. Negotiated Rate |
$1,982.25 |
| Rate for Payer: Adventist Health Commercial |
$528.60
|
| Rate for Payer: Cash Price |
$1,189.35
|
| Rate for Payer: Cash Price |
$1,189.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,789.31
|
| Rate for Payer: Heritage Provider Network Senior |
$1,789.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$478.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$660.75
|
| Rate for Payer: Multiplan Commercial |
$1,982.25
|
|
|
HC CT ANGIO HEAD W/WO CONTRAST
|
Facility
|
IP
|
$3,215.00
|
|
|
Service Code
|
CPT 70496
|
| Hospital Charge Code |
909201800
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$581.91 |
| Max. Negotiated Rate |
$2,411.25 |
| Rate for Payer: Adventist Health Commercial |
$643.00
|
| Rate for Payer: Cash Price |
$1,446.75
|
| Rate for Payer: Cash Price |
$1,446.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,176.55
|
| Rate for Payer: Heritage Provider Network Senior |
$2,176.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$581.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$803.75
|
| Rate for Payer: Multiplan Commercial |
$2,411.25
|
|
|
HC CT ANGIO HEAD W/WO CONTRAST
|
Facility
|
OP
|
$4,285.00
|
|
|
Service Code
|
CPT 70496
|
| Hospital Charge Code |
909201800
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$3,213.75 |
| Rate for Payer: Adventist Health Commercial |
$857.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,943.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Blue Shield of California Commercial |
$2,235.07
|
| Rate for Payer: Blue Shield of California EPN |
$1,797.37
|
| Rate for Payer: Cash Price |
$1,928.25
|
| Rate for Payer: Cash Price |
$1,928.25
|
| Rate for Payer: Cash Price |
$1,928.25
|
| Rate for Payer: Cash Price |
$1,928.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Senior |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$226.19
|
| 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 |
$430.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,043.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$775.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$260.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,071.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$285.00
|
| Rate for Payer: Multiplan Commercial |
$3,213.75
|
| 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 |
$541.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$541.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC CT ANGIO NECK W/WO CONTRAST
|
Facility
|
IP
|
$3,452.00
|
|
|
Service Code
|
CPT 70498
|
| Hospital Charge Code |
909201801
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$624.81 |
| Max. Negotiated Rate |
$2,589.00 |
| Rate for Payer: Adventist Health Commercial |
$690.40
|
| Rate for Payer: Cash Price |
$1,553.40
|
| Rate for Payer: Cash Price |
$1,553.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,337.00
|
| Rate for Payer: Heritage Provider Network Senior |
$2,337.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$624.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$863.00
|
| Rate for Payer: Multiplan Commercial |
$2,589.00
|
|
|
HC CT ANGIO NECK W/WO CONTRAST
|
Facility
|
OP
|
$4,285.00
|
|
|
Service Code
|
CPT 70498
|
| Hospital Charge Code |
909201801
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$3,213.75 |
| Rate for Payer: Adventist Health Commercial |
$857.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,943.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Blue Shield of California Commercial |
$2,235.07
|
| Rate for Payer: Blue Shield of California EPN |
$1,797.37
|
| Rate for Payer: Cash Price |
$1,928.25
|
| Rate for Payer: Cash Price |
$1,928.25
|
| Rate for Payer: Cash Price |
$1,928.25
|
| Rate for Payer: Cash Price |
$1,928.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Senior |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$226.19
|
| 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 |
$429.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,043.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$775.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$260.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,071.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$285.00
|
| Rate for Payer: Multiplan Commercial |
$3,213.75
|
| 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 |
$541.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$541.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC CT ANGIO PELVIS W/WO CONTRAST
|
Facility
|
OP
|
$3,097.00
|
|
|
Service Code
|
CPT 72191
|
| Hospital Charge Code |
909201803
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$2,494.42 |
| Rate for Payer: Adventist Health Commercial |
$619.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,127.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Blue Shield of California Commercial |
$2,494.42
|
| Rate for Payer: Blue Shield of California EPN |
$2,005.93
|
| Rate for Payer: Cash Price |
$1,393.65
|
| Rate for Payer: Cash Price |
$1,393.65
|
| Rate for Payer: Cash Price |
$1,393.65
|
| Rate for Payer: Cash Price |
$1,393.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Senior |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$226.19
|
| 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 |
$445.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,477.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$560.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$260.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$774.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$285.00
|
| Rate for Payer: Multiplan Commercial |
$2,322.75
|
| 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 |
$541.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$541.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC CT ANGIO PELVIS W/WO CONTRAST
|
Facility
|
IP
|
$2,694.00
|
|
|
Service Code
|
CPT 72191
|
| Hospital Charge Code |
909201803
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$487.61 |
| Max. Negotiated Rate |
$2,020.50 |
| Rate for Payer: Adventist Health Commercial |
$538.80
|
| Rate for Payer: Cash Price |
$1,212.30
|
| Rate for Payer: Cash Price |
$1,212.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,823.84
|
| Rate for Payer: Heritage Provider Network Senior |
$1,823.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$487.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$673.50
|
| Rate for Payer: Multiplan Commercial |
$2,020.50
|
|
|
HC CT BIOPSY PACK-LF
|
Facility
|
IP
|
$187.46
|
|
| Hospital Charge Code |
909081734
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.93 |
| Max. Negotiated Rate |
$140.59 |
| Rate for Payer: Adventist Health Commercial |
$37.49
|
| Rate for Payer: Cash Price |
$84.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$126.91
|
| Rate for Payer: Heritage Provider Network Senior |
$126.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.87
|
| Rate for Payer: Multiplan Commercial |
$140.59
|
|
|
HC CT BIOPSY PACK-LF
|
Facility
|
OP
|
$187.46
|
|
| Hospital Charge Code |
909081734
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.93 |
| Max. Negotiated Rate |
$159.34 |
| Rate for Payer: Adventist Health Commercial |
$37.49
|
| Rate for Payer: Aetna of CA Gatekeeper |
$100.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$128.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$159.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$103.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$140.59
|
| Rate for Payer: Blue Shield of California Commercial |
$114.35
|
| Rate for Payer: Blue Shield of California EPN |
$91.48
|
| Rate for Payer: Cash Price |
$84.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$121.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$159.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$159.34
|
| Rate for Payer: Dignity Health Senior |
$159.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$116.04
|
| Rate for Payer: Heritage Provider Network Senior |
$116.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$89.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$131.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$131.22
|
| Rate for Payer: Multiplan Commercial |
$140.59
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$93.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$93.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$159.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$159.34
|
| Rate for Payer: Vantage Medical Group Senior |
$159.34
|
|
|
HC CT BONE L-SPINE W CONTRAST
|
Facility
|
OP
|
$2,736.00
|
|
|
Service Code
|
CPT 72132
|
| Hospital Charge Code |
909201008
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$2,052.00 |
| Rate for Payer: Adventist Health Commercial |
$547.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,879.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Blue Shield of California Commercial |
$1,487.62
|
| Rate for Payer: Blue Shield of California EPN |
$1,196.29
|
| Rate for Payer: Cash Price |
$1,231.20
|
| Rate for Payer: Cash Price |
$1,231.20
|
| Rate for Payer: Cash Price |
$1,231.20
|
| Rate for Payer: Cash Price |
$1,231.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Senior |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$453.77
|
| 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 |
$264.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,305.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$495.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$521.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$684.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$571.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$571.75
|
| Rate for Payer: Multiplan Commercial |
$2,052.00
|
| 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 |
$480.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$480.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
HC CT BONE L-SPINE W CONTRAST
|
Facility
|
IP
|
$2,714.00
|
|
|
Service Code
|
CPT 72132
|
| Hospital Charge Code |
909201008
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$491.23 |
| Max. Negotiated Rate |
$2,035.50 |
| Rate for Payer: Adventist Health Commercial |
$542.80
|
| Rate for Payer: Cash Price |
$1,221.30
|
| Rate for Payer: Cash Price |
$1,221.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,837.38
|
| Rate for Payer: Heritage Provider Network Senior |
$1,837.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$491.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$678.50
|
| Rate for Payer: Multiplan Commercial |
$2,035.50
|
|
|
HC CT BONE L-SPINE W/O CONTRAST
|
Facility
|
OP
|
$2,550.00
|
|
|
Service Code
|
CPT 72131
|
| Hospital Charge Code |
909201007
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$1,912.50 |
| Rate for Payer: Adventist Health Commercial |
$510.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,751.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Blue Shield of California Commercial |
$1,242.62
|
| Rate for Payer: Blue Shield of California EPN |
$999.28
|
| Rate for Payer: Cash Price |
$1,147.50
|
| Rate for Payer: Cash Price |
$1,147.50
|
| Rate for Payer: Cash Price |
$1,147.50
|
| Rate for Payer: Cash Price |
$1,147.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Senior |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$135.12
|
| 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 |
$201.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,216.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$461.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$637.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.25
|
| Rate for Payer: Multiplan Commercial |
$1,912.50
|
| 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 |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
