|
HC CRYOGLOBULINS QUAL
|
Facility
OP
|
$21.00
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
900910978
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$52.74 |
| Rate for Payer: Adventist Health Commercial |
$4.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$16.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.74
|
| Rate for Payer: Blue Shield of California Commercial |
$50.53
|
| Rate for Payer: Blue Shield of California EPN |
$39.50
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Senior |
$6.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.00
|
| Rate for Payer: Heritage Provider Network Senior |
$13.00
|
| Rate for Payer: Humana Medicare |
$6.47
|
| Rate for Payer: IEHP Medi-Cal |
$8.30
|
| Rate for Payer: IEHP Medicare Advantage |
$6.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.15
|
| Rate for Payer: Multiplan Commercial |
$15.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.47
|
| Rate for Payer: TriValley Medical Group Senior |
$6.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
|
HC CSF LEAKAGE
|
Facility
IP
|
$1,886.00
|
|
|
Service Code
|
CPT 78650
|
| Hospital Charge Code |
909301416
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$341.37 |
| Max. Negotiated Rate |
$1,414.50 |
| Rate for Payer: Adventist Health Commercial |
$377.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,295.68
|
| Rate for Payer: Cash Price |
$848.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,276.82
|
| Rate for Payer: Heritage Provider Network Senior |
$1,276.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$341.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$471.50
|
| Rate for Payer: Multiplan Commercial |
$1,414.50
|
|
|
HC CSF LEAKAGE
|
Facility
OP
|
$1,886.00
|
|
|
Service Code
|
CPT 78650
|
| Hospital Charge Code |
909301416
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$230.80 |
| Max. Negotiated Rate |
$3,370.88 |
| Rate for Payer: Adventist Health Commercial |
$377.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$666.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,295.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,774.15
|
| Rate for Payer: Blue Shield of California Commercial |
$947.52
|
| Rate for Payer: Blue Shield of California EPN |
$538.82
|
| Rate for Payer: Cash Price |
$848.70
|
| Rate for Payer: Cash Price |
$848.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,225.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,951.56
|
| Rate for Payer: Dignity Health Senior |
$1,774.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,225.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,774.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,167.43
|
| Rate for Payer: Heritage Provider Network Senior |
$1,167.43
|
| Rate for Payer: Humana Medicare |
$1,774.15
|
| Rate for Payer: IEHP Medi-Cal |
$230.80
|
| Rate for Payer: IEHP Medicare Advantage |
$1,774.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,370.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$341.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,093.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$471.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,235.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,235.43
|
| Rate for Payer: Multiplan Commercial |
$1,414.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,951.56
|
| Rate for Payer: TriValley Medical Group Senior |
$1,774.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: Vantage Medical Group Senior |
$1,774.15
|
|
|
HC C SPINE W/FLEX AND EXT COMPLETE
|
Facility
IP
|
$1,141.00
|
|
|
Service Code
|
CPT 72052
|
| Hospital Charge Code |
909001303
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$206.52 |
| Max. Negotiated Rate |
$855.75 |
| Rate for Payer: Adventist Health Commercial |
$228.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$783.87
|
| Rate for Payer: Cash Price |
$513.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$772.46
|
| Rate for Payer: Heritage Provider Network Senior |
$772.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$206.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$285.25
|
| Rate for Payer: Multiplan Commercial |
$855.75
|
|
|
HC C SPINE W/FLEX AND EXT COMPLETE
|
Facility
OP
|
$1,141.00
|
|
|
Service Code
|
CPT 72052
|
| Hospital Charge Code |
909001303
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$78.48 |
| Max. Negotiated Rate |
$855.75 |
| Rate for Payer: Adventist Health Commercial |
$228.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$109.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$783.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$271.10
|
| Rate for Payer: Blue Shield of California Commercial |
$230.02
|
| Rate for Payer: Blue Shield of California EPN |
$130.80
|
| Rate for Payer: Cash Price |
$513.45
|
| Rate for Payer: Cash Price |
$513.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$741.65
|
| 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 |
$741.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$706.28
|
| Rate for Payer: Heritage Provider Network Senior |
$706.28
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: IEHP Medi-Cal |
$78.48
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$206.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$285.25
|
| 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 |
$855.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$120.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$120.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC CT ABDOMEN & PELVIS W/CONTRAST
|
Facility
IP
|
$3,973.00
|
|
|
Service Code
|
CPT 74177
|
| Hospital Charge Code |
909202002
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$711.00 |
| Max. Negotiated Rate |
$2,979.75 |
| Rate for Payer: Adventist Health Commercial |
$794.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,729.45
|
| Rate for Payer: Cash Price |
$1,787.85
|
| Rate for Payer: Cash Price |
$1,787.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,689.72
|
| Rate for Payer: Heritage Provider Network Senior |
$2,689.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$719.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$993.25
|
| Rate for Payer: Multiplan Commercial |
$2,979.75
|
|
|
HC CT ABDOMEN & PELVIS W/CONTRAST
|
Facility
OP
|
$4,667.00
|
|
|
Service Code
|
CPT 74177
|
| Hospital Charge Code |
909202002
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$3,500.25 |
| Rate for Payer: Adventist Health Commercial |
$933.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,206.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Blue Shield of California Commercial |
$1,450.56
|
| Rate for Payer: Blue Shield of California EPN |
$824.89
|
| Rate for Payer: Cash Price |
$2,100.15
|
| Rate for Payer: Cash Price |
$2,100.15
|
| Rate for Payer: Cash Price |
$2,100.15
|
| Rate for Payer: Cash Price |
$2,100.15
|
| 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: IEHP Medi-Cal |
$439.61
|
| Rate for Payer: IEHP Medicare Advantage |
$480.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$912.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$844.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$566.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,166.75
|
| 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 |
$3,500.25
|
| 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 |
$928.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$928.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC CT ABDOMEN & PELVIS W/O CONTRA
|
Facility
OP
|
$4,213.00
|
|
|
Service Code
|
CPT 74176
|
| Hospital Charge Code |
909202001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$3,159.75 |
| Rate for Payer: Adventist Health Commercial |
$842.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,894.33
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Blue Shield of California Commercial |
$760.33
|
| Rate for Payer: Blue Shield of California EPN |
$432.37
|
| Rate for Payer: Cash Price |
$1,895.85
|
| Rate for Payer: Cash Price |
$1,895.85
|
| Rate for Payer: Cash Price |
$1,895.85
|
| Rate for Payer: Cash Price |
$1,895.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: Dignity Health Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Humana Medicare |
$306.16
|
| Rate for Payer: IEHP Medi-Cal |
$271.92
|
| Rate for Payer: IEHP Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$581.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$762.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,053.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$385.76
|
| Rate for Payer: Multiplan Commercial |
$3,159.75
|
| 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 |
$648.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$648.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC CT ABDOMEN & PELVIS W/O CONTRA
|
Facility
IP
|
$3,284.00
|
|
|
Service Code
|
CPT 74176
|
| Hospital Charge Code |
909202001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$594.40 |
| Max. Negotiated Rate |
$2,463.00 |
| Rate for Payer: Adventist Health Commercial |
$656.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,256.11
|
| Rate for Payer: Cash Price |
$1,477.80
|
| Rate for Payer: Cash Price |
$1,477.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,223.27
|
| Rate for Payer: Heritage Provider Network Senior |
$2,223.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$594.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$821.00
|
| Rate for Payer: Multiplan Commercial |
$2,463.00
|
|
|
HC CT ABDOMEN & PELVIS W & W/O CO
|
Facility
OP
|
$5,066.00
|
|
|
Service Code
|
CPT 74178
|
| Hospital Charge Code |
909202003
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$3,799.50 |
| Rate for Payer: Adventist Health Commercial |
$1,013.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,480.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Blue Shield of California Commercial |
$1,917.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,090.32
|
| Rate for Payer: Cash Price |
$2,279.70
|
| Rate for Payer: Cash Price |
$2,279.70
|
| Rate for Payer: Cash Price |
$2,279.70
|
| Rate for Payer: Cash Price |
$2,279.70
|
| 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: IEHP Medi-Cal |
$498.01
|
| Rate for Payer: IEHP Medicare Advantage |
$480.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$912.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$916.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$566.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,266.50
|
| 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 |
$3,799.50
|
| 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 |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC CT ABDOMEN & PELVIS W & W/O CO
|
Facility
IP
|
$4,603.00
|
|
|
Service Code
|
CPT 74178
|
| Hospital Charge Code |
909202003
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$711.00 |
| Max. Negotiated Rate |
$3,452.25 |
| Rate for Payer: Adventist Health Commercial |
$920.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,162.26
|
| Rate for Payer: Cash Price |
$2,071.35
|
| Rate for Payer: Cash Price |
$2,071.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,116.23
|
| Rate for Payer: Heritage Provider Network Senior |
$3,116.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$833.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,150.75
|
| Rate for Payer: Multiplan Commercial |
$3,452.25
|
|
|
HC CT ABDOMEN W CONTRAS
|
Facility
IP
|
$2,648.00
|
|
|
Service Code
|
CPT 74160
|
| Hospital Charge Code |
909201928
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$479.29 |
| Max. Negotiated Rate |
$1,986.00 |
| Rate for Payer: Adventist Health Commercial |
$529.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,819.18
|
| Rate for Payer: Cash Price |
$1,191.60
|
| Rate for Payer: Cash Price |
$1,191.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,792.70
|
| Rate for Payer: Heritage Provider Network Senior |
$1,792.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$479.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$662.00
|
| Rate for Payer: Multiplan Commercial |
$1,986.00
|
|
|
HC CT ABDOMEN W CONTRAS
|
Facility
OP
|
$3,525.00
|
|
|
Service Code
|
CPT 74160
|
| Hospital Charge Code |
909201928
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$2,643.75 |
| Rate for Payer: Adventist Health Commercial |
$705.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,421.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Blue Shield of California Commercial |
$1,397.72
|
| Rate for Payer: Blue Shield of California EPN |
$794.84
|
| Rate for Payer: Cash Price |
$1,586.25
|
| Rate for Payer: Cash Price |
$1,586.25
|
| Rate for Payer: Cash Price |
$1,586.25
|
| Rate for Payer: Cash Price |
$1,586.25
|
| 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: IEHP Medi-Cal |
$325.67
|
| Rate for Payer: IEHP Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$436.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$638.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$270.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$881.25
|
| 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 |
$2,643.75
|
| 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 |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC CT ABDOMEN WO CONTR
|
Facility
IP
|
$2,226.00
|
|
|
Service Code
|
CPT 74150
|
| Hospital Charge Code |
909201927
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$402.91 |
| Max. Negotiated Rate |
$1,669.50 |
| Rate for Payer: Adventist Health Commercial |
$445.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,529.26
|
| Rate for Payer: Cash Price |
$1,001.70
|
| Rate for Payer: Cash Price |
$1,001.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,507.00
|
| Rate for Payer: Heritage Provider Network Senior |
$1,507.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$402.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$556.50
|
| Rate for Payer: Multiplan Commercial |
$1,669.50
|
|
|
HC CT ABDOMEN WO CONTR
|
Facility
OP
|
$3,135.00
|
|
|
Service Code
|
CPT 74150
|
| Hospital Charge Code |
909201927
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$2,351.25 |
| Rate for Payer: Adventist Health Commercial |
$627.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,153.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| 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 |
$1,410.75
|
| Rate for Payer: Cash Price |
$1,410.75
|
| Rate for Payer: Cash Price |
$1,410.75
|
| Rate for Payer: Cash Price |
$1,410.75
|
| 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: IEHP Medi-Cal |
$204.64
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$567.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$783.75
|
| 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 |
$2,351.25
|
| 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 ABDOMEN W/WO CONT
|
Facility
IP
|
$3,035.00
|
|
|
Service Code
|
CPT 74170
|
| Hospital Charge Code |
909201929
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$549.34 |
| Max. Negotiated Rate |
$2,276.25 |
| Rate for Payer: Adventist Health Commercial |
$607.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,085.04
|
| Rate for Payer: Cash Price |
$1,365.75
|
| Rate for Payer: Cash Price |
$1,365.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,054.70
|
| Rate for Payer: Heritage Provider Network Senior |
$2,054.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$549.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$758.75
|
| Rate for Payer: Multiplan Commercial |
$2,276.25
|
|
|
HC CT ABDOMEN W/WO CONT
|
Facility
OP
|
$4,124.00
|
|
|
Service Code
|
CPT 74170
|
| Hospital Charge Code |
909201929
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$3,093.00 |
| Rate for Payer: Adventist Health Commercial |
$824.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,833.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Blue Shield of California Commercial |
$1,731.10
|
| Rate for Payer: Blue Shield of California EPN |
$984.42
|
| Rate for Payer: Cash Price |
$1,855.80
|
| Rate for Payer: Cash Price |
$1,855.80
|
| Rate for Payer: Cash Price |
$1,855.80
|
| Rate for Payer: Cash Price |
$1,855.80
|
| 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: IEHP Medi-Cal |
$370.72
|
| Rate for Payer: IEHP Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$436.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$746.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$270.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,031.00
|
| 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 |
$3,093.00
|
| 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 ANGIO ABD AORTA-AIF W/WO CO
|
Facility
OP
|
$5,071.00
|
|
|
Service Code
|
CPT 75635
|
| Hospital Charge Code |
909201809
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$3,803.25 |
| Rate for Payer: Adventist Health Commercial |
$1,014.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,483.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Blue Shield of California Commercial |
$3,186.46
|
| Rate for Payer: Blue Shield of California EPN |
$1,812.04
|
| Rate for Payer: Cash Price |
$2,281.95
|
| Rate for Payer: Cash Price |
$2,281.95
|
| Rate for Payer: Cash Price |
$2,281.95
|
| Rate for Payer: Cash Price |
$2,281.95
|
| 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: IEHP Medi-Cal |
$534.36
|
| Rate for Payer: IEHP Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$436.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$917.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$270.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,267.75
|
| 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 |
$3,803.25
|
| 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 |
$541.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$541.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC CT ANGIO ABD AORTA-AIF W/WO CO
|
Facility
IP
|
$3,584.00
|
|
|
Service Code
|
CPT 75635
|
| Hospital Charge Code |
909201809
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$648.70 |
| Max. Negotiated Rate |
$2,688.00 |
| Rate for Payer: Adventist Health Commercial |
$716.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,462.21
|
| Rate for Payer: Cash Price |
$1,612.80
|
| Rate for Payer: Cash Price |
$1,612.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,426.37
|
| Rate for Payer: Heritage Provider Network Senior |
$2,426.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$648.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$896.00
|
| Rate for Payer: Multiplan Commercial |
$2,688.00
|
|
|
HC CT ANGIO ABDOMEN/PELVIS
|
Facility
OP
|
$4,473.00
|
|
|
Service Code
|
CPT 74174
|
| Hospital Charge Code |
909201991
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$3,354.75 |
| Rate for Payer: Adventist Health Commercial |
$894.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,072.95
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Blue Shield of California Commercial |
$2,629.13
|
| Rate for Payer: Blue Shield of California EPN |
$1,495.10
|
| Rate for Payer: Cash Price |
$2,012.85
|
| Rate for Payer: Cash Price |
$2,012.85
|
| Rate for Payer: Cash Price |
$2,012.85
|
| Rate for Payer: Cash Price |
$2,012.85
|
| 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: IEHP Medi-Cal |
$548.76
|
| Rate for Payer: IEHP Medicare Advantage |
$480.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$912.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$809.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$566.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,118.25
|
| 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 |
$3,354.75
|
| 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 |
$928.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$928.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC CT ANGIO ABDOMEN/PELVIS
|
Facility
IP
|
$3,584.00
|
|
|
Service Code
|
CPT 74174
|
| Hospital Charge Code |
909201991
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$648.70 |
| Max. Negotiated Rate |
$2,688.00 |
| Rate for Payer: Adventist Health Commercial |
$716.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,462.21
|
| Rate for Payer: Cash Price |
$1,612.80
|
| Rate for Payer: Cash Price |
$1,612.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,426.37
|
| Rate for Payer: Heritage Provider Network Senior |
$2,426.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$648.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$896.00
|
| Rate for Payer: Multiplan Commercial |
$2,688.00
|
|
|
HC CT ANGIO ABDOMEN W/WO CONTRAST
|
Facility
OP
|
$4,576.00
|
|
|
Service Code
|
CPT 74175
|
| Hospital Charge Code |
909201808
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$3,432.00 |
| Rate for Payer: Adventist Health Commercial |
$915.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,143.71
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Blue Shield of California Commercial |
$2,421.66
|
| Rate for Payer: Blue Shield of California EPN |
$1,377.13
|
| Rate for Payer: Cash Price |
$2,059.20
|
| Rate for Payer: Cash Price |
$2,059.20
|
| Rate for Payer: Cash Price |
$2,059.20
|
| Rate for Payer: Cash Price |
$2,059.20
|
| 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: IEHP Medi-Cal |
$432.40
|
| Rate for Payer: IEHP Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$436.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$828.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$270.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,144.00
|
| 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 |
$3,432.00
|
| 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 |
$541.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$541.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC CT ANGIO ABDOMEN W/WO CONTRAST
|
Facility
IP
|
$3,336.00
|
|
|
Service Code
|
CPT 74175
|
| Hospital Charge Code |
909201808
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$603.82 |
| Max. Negotiated Rate |
$2,502.00 |
| Rate for Payer: Adventist Health Commercial |
$667.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,291.83
|
| Rate for Payer: Cash Price |
$1,501.20
|
| Rate for Payer: Cash Price |
$1,501.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,258.47
|
| Rate for Payer: Heritage Provider Network Senior |
$2,258.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$603.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$834.00
|
| Rate for Payer: Multiplan Commercial |
$2,502.00
|
|
|
HC CT ANGIO CHEST W/WO CONTRAST
|
Facility
OP
|
$4,304.00
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
909201802
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$3,228.00 |
| Rate for Payer: Adventist Health Commercial |
$860.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,956.85
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Blue Shield of California Commercial |
$2,490.30
|
| Rate for Payer: Blue Shield of California EPN |
$1,416.16
|
| Rate for Payer: Cash Price |
$1,936.80
|
| Rate for Payer: Cash Price |
$1,936.80
|
| Rate for Payer: Cash Price |
$1,936.80
|
| Rate for Payer: Cash Price |
$1,936.80
|
| 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: IEHP Medi-Cal |
$422.62
|
| Rate for Payer: IEHP Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$436.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$779.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$270.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,076.00
|
| 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 |
$3,228.00
|
| 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 |
$541.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$541.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC CT ANGIO CHEST W/WO CONTRAST
|
Facility
IP
|
$3,273.00
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
909201802
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$592.41 |
| Max. Negotiated Rate |
$2,454.75 |
| Rate for Payer: Adventist Health Commercial |
$654.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,248.55
|
| Rate for Payer: Cash Price |
$1,472.85
|
| Rate for Payer: Cash Price |
$1,472.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,215.82
|
| Rate for Payer: Heritage Provider Network Senior |
$2,215.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$592.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$818.25
|
| Rate for Payer: Multiplan Commercial |
$2,454.75
|
|
