|
HC CT C SPINE W/WO CONTRAST
|
Facility
|
IP
|
$3,624.00
|
|
|
Service Code
|
CPT 72127
|
| Hospital Charge Code |
909201967
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$655.94 |
| Max. Negotiated Rate |
$2,718.00 |
| Rate for Payer: Adventist Health Commercial |
$724.80
|
| Rate for Payer: Cash Price |
$1,630.80
|
| Rate for Payer: Cash Price |
$1,630.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,453.45
|
| Rate for Payer: Heritage Provider Network Senior |
$2,453.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$655.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$906.00
|
| Rate for Payer: Multiplan Commercial |
$2,718.00
|
|
|
HC CT C SPINE W/WO CONTRAST
|
Facility
|
OP
|
$3,018.00
|
|
|
Service Code
|
CPT 72127
|
| Hospital Charge Code |
909201967
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$2,263.50 |
| Rate for Payer: Adventist Health Commercial |
$603.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,073.37
|
| 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 |
$1,860.19
|
| Rate for Payer: Blue Shield of California EPN |
$1,495.90
|
| Rate for Payer: Cash Price |
$1,358.10
|
| Rate for Payer: Cash Price |
$1,358.10
|
| Rate for Payer: Cash Price |
$1,358.10
|
| Rate for Payer: Cash Price |
$1,358.10
|
| 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 |
$311.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,439.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$546.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$260.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$754.50
|
| 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 |
$2,263.50
|
| 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 |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC CT GUID ABCESS DRAIN
|
Facility
|
OP
|
$1,995.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
909201944
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$169.32 |
| Max. Negotiated Rate |
$1,695.75 |
| Rate for Payer: Adventist Health Commercial |
$399.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,370.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,695.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,097.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,496.25
|
| Rate for Payer: Blue Shield of California Commercial |
$664.90
|
| Rate for Payer: Blue Shield of California EPN |
$534.69
|
| Rate for Payer: Cash Price |
$897.75
|
| Rate for Payer: Cash Price |
$897.75
|
| Rate for Payer: Cash Price |
$897.75
|
| Rate for Payer: Cash Price |
$897.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,695.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,695.75
|
| Rate for Payer: Dignity Health Senior |
$1,695.75
|
| 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 |
$169.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$951.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$361.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$498.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,396.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,396.50
|
| Rate for Payer: Multiplan Commercial |
$1,496.25
|
| 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 |
$997.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$997.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,695.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,695.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,695.75
|
|
|
HC CT GUID ABCESS DRAIN
|
Facility
|
IP
|
$1,995.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
909201944
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$361.10 |
| Max. Negotiated Rate |
$1,496.25 |
| Rate for Payer: Adventist Health Commercial |
$399.00
|
| Rate for Payer: Cash Price |
$897.75
|
| Rate for Payer: Cash Price |
$897.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,350.62
|
| Rate for Payer: Heritage Provider Network Senior |
$1,350.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$361.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$498.75
|
| Rate for Payer: Multiplan Commercial |
$1,496.25
|
|
|
HC CT GUIDANCE/NEEDLE PLACEMENT
|
Facility
|
IP
|
$1,930.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
909201935
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$349.33 |
| Max. Negotiated Rate |
$1,447.50 |
| Rate for Payer: Adventist Health Commercial |
$386.00
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,306.61
|
| Rate for Payer: Heritage Provider Network Senior |
$1,306.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$349.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$482.50
|
| Rate for Payer: Multiplan Commercial |
$1,447.50
|
|
|
HC CT GUIDANCE/NEEDLE PLACEMENT
|
Facility
|
OP
|
$1,930.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
909201935
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$179.90 |
| Max. Negotiated Rate |
$1,640.50 |
| Rate for Payer: Adventist Health Commercial |
$386.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,325.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,640.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,061.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,447.50
|
| Rate for Payer: Blue Shield of California Commercial |
$426.34
|
| Rate for Payer: Blue Shield of California EPN |
$342.85
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,640.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,640.50
|
| Rate for Payer: Dignity Health Senior |
$1,640.50
|
| 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 |
$179.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$920.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$349.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$482.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,351.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,351.00
|
| Rate for Payer: Multiplan Commercial |
$1,447.50
|
| 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 |
$965.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$965.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,640.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,640.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,640.50
|
|
|
HC CT GUIDNC VISCERAL TISS ABLATN
|
Facility
|
OP
|
$6,737.00
|
|
|
Service Code
|
CPT 77013
|
| Hospital Charge Code |
909201810
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$5,726.45 |
| Rate for Payer: Adventist Health Commercial |
$1,347.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,628.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,726.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,705.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,052.75
|
| Rate for Payer: Blue Shield of California Commercial |
$4,109.57
|
| Rate for Payer: Blue Shield of California EPN |
$3,287.66
|
| Rate for Payer: Cash Price |
$3,031.65
|
| Rate for Payer: Cash Price |
$3,031.65
|
| Rate for Payer: Cash Price |
$3,031.65
|
| Rate for Payer: Cash Price |
$3,031.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,726.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,726.45
|
| Rate for Payer: Dignity Health Senior |
$5,726.45
|
| 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 |
$260.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,213.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,219.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,684.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,715.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,715.90
|
| Rate for Payer: Multiplan Commercial |
$5,052.75
|
| 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 |
$3,368.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,368.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,726.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,726.45
|
| Rate for Payer: Vantage Medical Group Senior |
$5,726.45
|
|
|
HC CT GUID RAD THERAPY
|
Facility
|
IP
|
$1,710.00
|
|
|
Service Code
|
CPT 77014
|
| Hospital Charge Code |
909100165
|
|
Hospital Revenue Code
|
359
|
| Min. Negotiated Rate |
$309.51 |
| Max. Negotiated Rate |
$1,282.50 |
| Rate for Payer: Adventist Health Commercial |
$342.00
|
| Rate for Payer: Cash Price |
$769.50
|
| Rate for Payer: Cash Price |
$769.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,157.67
|
| Rate for Payer: Heritage Provider Network Senior |
$1,157.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$309.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$427.50
|
| Rate for Payer: Multiplan Commercial |
$1,282.50
|
|
|
HC CT GUID RAD THERAPY
|
Facility
|
OP
|
$1,391.00
|
|
|
Service Code
|
CPT 77014
|
| Hospital Charge Code |
909100165
|
|
Hospital Revenue Code
|
359
|
| Min. Negotiated Rate |
$170.36 |
| Max. Negotiated Rate |
$1,182.35 |
| Rate for Payer: Adventist Health Commercial |
$278.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$955.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,182.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$765.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,043.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$708.30
|
| Rate for Payer: Blue Shield of California Commercial |
$863.42
|
| Rate for Payer: Blue Shield of California EPN |
$694.34
|
| Rate for Payer: Cash Price |
$625.95
|
| Rate for Payer: Cash Price |
$625.95
|
| Rate for Payer: Cash Price |
$625.95
|
| Rate for Payer: Cash Price |
$625.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,182.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,182.35
|
| Rate for Payer: Dignity Health Senior |
$1,182.35
|
| 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 |
$170.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$663.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$251.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$347.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$973.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$973.70
|
| Rate for Payer: Multiplan Commercial |
$1,043.25
|
| 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 |
$695.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$695.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,182.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,182.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,182.35
|
|
|
HC CT HEAD NO CONTRAST
|
Facility
|
OP
|
$2,656.00
|
|
|
Service Code
|
CPT 70450
|
| Hospital Charge Code |
909201901
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$1,992.00 |
| Rate for Payer: Adventist Health Commercial |
$531.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,824.67
|
| 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 |
$993.60
|
| Rate for Payer: Blue Shield of California EPN |
$799.02
|
| Rate for Payer: Cash Price |
$1,195.20
|
| Rate for Payer: Cash Price |
$1,195.20
|
| Rate for Payer: Cash Price |
$1,195.20
|
| Rate for Payer: Cash Price |
$1,195.20
|
| 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 |
$164.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,266.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$480.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$664.00
|
| 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 |
$1,992.00
|
| 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 |
$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 HEAD NO CONTRAST
|
Facility
|
IP
|
$2,644.00
|
|
|
Service Code
|
CPT 70450
|
| Hospital Charge Code |
909201901
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$478.56 |
| Max. Negotiated Rate |
$1,983.00 |
| Rate for Payer: Adventist Health Commercial |
$528.80
|
| Rate for Payer: Cash Price |
$1,189.80
|
| Rate for Payer: Cash Price |
$1,189.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,789.99
|
| Rate for Payer: Heritage Provider Network Senior |
$1,789.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$478.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$661.00
|
| Rate for Payer: Multiplan Commercial |
$1,983.00
|
|
|
HC CT HEAD W CONTRAST
|
Facility
|
OP
|
$2,964.00
|
|
|
Service Code
|
CPT 70460
|
| Hospital Charge Code |
909201900
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$2,223.00 |
| Rate for Payer: Adventist Health Commercial |
$592.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,036.27
|
| 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 |
$1,188.67
|
| Rate for Payer: Blue Shield of California EPN |
$955.89
|
| Rate for Payer: Cash Price |
$1,333.80
|
| Rate for Payer: Cash Price |
$1,333.80
|
| Rate for Payer: Cash Price |
$1,333.80
|
| Rate for Payer: Cash Price |
$1,333.80
|
| 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 |
$231.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,413.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$536.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$260.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$741.00
|
| 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 |
$2,223.00
|
| 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 HEAD W CONTRAST
|
Facility
|
IP
|
$2,743.00
|
|
|
Service Code
|
CPT 70460
|
| Hospital Charge Code |
909201900
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$496.48 |
| Max. Negotiated Rate |
$2,057.25 |
| Rate for Payer: Adventist Health Commercial |
$548.60
|
| Rate for Payer: Cash Price |
$1,234.35
|
| Rate for Payer: Cash Price |
$1,234.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,857.01
|
| Rate for Payer: Heritage Provider Network Senior |
$1,857.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$496.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$685.75
|
| Rate for Payer: Multiplan Commercial |
$2,057.25
|
|
|
HC CT HEAD W/WO CONTRAS
|
Facility
|
OP
|
$3,319.00
|
|
|
Service Code
|
CPT 70470
|
| Hospital Charge Code |
909201902
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$2,489.25 |
| Rate for Payer: Adventist Health Commercial |
$663.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,280.15
|
| 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 |
$1,487.62
|
| Rate for Payer: Blue Shield of California EPN |
$1,196.29
|
| Rate for Payer: Cash Price |
$1,493.55
|
| Rate for Payer: Cash Price |
$1,493.55
|
| Rate for Payer: Cash Price |
$1,493.55
|
| Rate for Payer: Cash Price |
$1,493.55
|
| 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 |
$272.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,583.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$600.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$260.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$829.75
|
| 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 |
$2,489.25
|
| 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 |
$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 HEAD W/WO CONTRAS
|
Facility
|
IP
|
$3,065.00
|
|
|
Service Code
|
CPT 70470
|
| Hospital Charge Code |
909201902
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$554.76 |
| Max. Negotiated Rate |
$2,298.75 |
| Rate for Payer: Adventist Health Commercial |
$613.00
|
| Rate for Payer: Cash Price |
$1,379.25
|
| Rate for Payer: Cash Price |
$1,379.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,075.01
|
| Rate for Payer: Heritage Provider Network Senior |
$2,075.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$554.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$766.25
|
| Rate for Payer: Multiplan Commercial |
$2,298.75
|
|
|
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 |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$1,153.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,769.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,319.14
|
| Rate for Payer: Blue Shield of California EPN |
$2,319.14
|
| 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 |
$2,671.05
|
| Rate for Payer: Heritage Provider Network Senior |
$2,671.05
|
| 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 |
$2,084.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,910.12
|
|
|
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 |
$1,442.25 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$2,365.29
|
| 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 |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,319.14
|
| Rate for Payer: Blue Shield of California EPN |
$2,319.14
|
| 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 |
$1,678.64
|
| 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: Molina Healthcare of CA Medi-Cal |
$4,038.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,038.30
|
| Rate for Payer: Multiplan Commercial |
$4,326.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,084.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,910.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,903.65
|
| 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
|
$2,625.00
|
|
|
Service Code
|
CPT 70488
|
| Hospital Charge Code |
909201950
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$475.12 |
| Max. Negotiated Rate |
$1,968.75 |
| Rate for Payer: Adventist Health Commercial |
$525.00
|
| Rate for Payer: Cash Price |
$1,181.25
|
| Rate for Payer: Cash Price |
$1,181.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,777.12
|
| Rate for Payer: Heritage Provider Network Senior |
$1,777.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$475.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$656.25
|
| Rate for Payer: Multiplan Commercial |
$1,968.75
|
|
|
HC CT MAXILLOFACIAL W/WO CONTRAST
|
Facility
|
OP
|
$3,363.00
|
|
|
Service Code
|
CPT 70488
|
| Hospital Charge Code |
909201950
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$2,522.25 |
| Rate for Payer: Adventist Health Commercial |
$672.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,310.38
|
| 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 |
$1,487.62
|
| Rate for Payer: Blue Shield of California EPN |
$1,196.29
|
| Rate for Payer: Cash Price |
$1,513.35
|
| Rate for Payer: Cash Price |
$1,513.35
|
| Rate for Payer: Cash Price |
$1,513.35
|
| Rate for Payer: Cash Price |
$1,513.35
|
| 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 |
$290.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,604.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$608.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$260.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$840.75
|
| 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 |
$2,522.25
|
| 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 |
$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 MAXILLOFAC W CONT
|
Facility
|
OP
|
$2,433.00
|
|
|
Service Code
|
CPT 70487
|
| Hospital Charge Code |
909201907
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$1,824.75 |
| Rate for Payer: Adventist Health Commercial |
$486.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,671.47
|
| 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 |
$1,188.67
|
| Rate for Payer: Blue Shield of California EPN |
$955.89
|
| Rate for Payer: Cash Price |
$1,094.85
|
| Rate for Payer: Cash Price |
$1,094.85
|
| Rate for Payer: Cash Price |
$1,094.85
|
| Rate for Payer: Cash Price |
$1,094.85
|
| 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 |
$237.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,160.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$440.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$260.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$608.25
|
| 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 |
$1,824.75
|
| 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 |
$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 MAXILLOFAC W CONT
|
Facility
|
IP
|
$2,526.00
|
|
|
Service Code
|
CPT 70487
|
| Hospital Charge Code |
909201907
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$457.21 |
| Max. Negotiated Rate |
$1,894.50 |
| Rate for Payer: Adventist Health Commercial |
$505.20
|
| Rate for Payer: Cash Price |
$1,136.70
|
| Rate for Payer: Cash Price |
$1,136.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,710.10
|
| Rate for Payer: Heritage Provider Network Senior |
$1,710.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$457.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$631.50
|
| Rate for Payer: Multiplan Commercial |
$1,894.50
|
|
|
HC CT MAXILLOFAC W/O CO
|
Facility
|
IP
|
$2,140.00
|
|
|
Service Code
|
CPT 70486
|
| Hospital Charge Code |
909201906
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$387.34 |
| Max. Negotiated Rate |
$1,605.00 |
| Rate for Payer: Adventist Health Commercial |
$428.00
|
| Rate for Payer: Cash Price |
$963.00
|
| Rate for Payer: Cash Price |
$963.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,448.78
|
| Rate for Payer: Heritage Provider Network Senior |
$1,448.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$387.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$535.00
|
| Rate for Payer: Multiplan Commercial |
$1,605.00
|
|
|
HC CT MAXILLOFAC W/O CO
|
Facility
|
OP
|
$2,124.00
|
|
|
Service Code
|
CPT 70486
|
| Hospital Charge Code |
909201906
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$1,593.00 |
| Rate for Payer: Adventist Health Commercial |
$424.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,459.19
|
| 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 |
$993.60
|
| Rate for Payer: Blue Shield of California EPN |
$799.02
|
| Rate for Payer: Cash Price |
$955.80
|
| Rate for Payer: Cash Price |
$955.80
|
| Rate for Payer: Cash Price |
$955.80
|
| Rate for Payer: Cash Price |
$955.80
|
| 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 |
$199.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,013.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$384.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$531.00
|
| 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 |
$1,593.00
|
| 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 |
$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 PERFUSION W/CONTRAST, CBF
|
Facility
|
OP
|
$3,571.00
|
|
|
Service Code
|
CPT 0042T
|
| Hospital Charge Code |
909201812
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$3,035.35 |
| Rate for Payer: Adventist Health Commercial |
$714.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,453.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,035.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,964.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,678.25
|
| Rate for Payer: Blue Shield of California Commercial |
$2,178.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,742.65
|
| Rate for Payer: Cash Price |
$1,606.95
|
| Rate for Payer: Cash Price |
$1,606.95
|
| Rate for Payer: Cash Price |
$1,606.95
|
| Rate for Payer: Cash Price |
$1,606.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,035.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,035.35
|
| Rate for Payer: Dignity Health Senior |
$3,035.35
|
| 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: Kaiser Permanente of CA Commercial |
$1,703.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$646.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$892.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,499.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,499.70
|
| Rate for Payer: Multiplan Commercial |
$2,678.25
|
| 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 |
$1,785.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,785.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,035.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,035.35
|
| Rate for Payer: Vantage Medical Group Senior |
$3,035.35
|
|
|
HC CT PERFUSION W/CONTRAST, CBF
|
Facility
|
IP
|
$2,701.00
|
|
|
Service Code
|
CPT 0042T
|
| Hospital Charge Code |
909201812
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$488.88 |
| Max. Negotiated Rate |
$2,025.75 |
| Rate for Payer: Adventist Health Commercial |
$540.20
|
| Rate for Payer: Cash Price |
$1,215.45
|
| Rate for Payer: Cash Price |
$1,215.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,828.58
|
| Rate for Payer: Heritage Provider Network Senior |
$1,828.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$488.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$675.25
|
| Rate for Payer: Multiplan Commercial |
$2,025.75
|
|
