|
HC CTLSO W/INTERFACE MINERVA
|
Facility
OP
|
$5,769.00
|
|
|
Service Code
|
CPT L0710
|
| Hospital Charge Code |
905350710
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,153.80 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$1,153.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,769.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,963.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,903.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,172.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,326.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,582.55
|
| Rate for Payer: Blue Shield of California EPN |
$3,386.40
|
| Rate for Payer: Cash Price |
$2,596.05
|
| Rate for Payer: Cash Price |
$2,596.05
|
| Rate for Payer: 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: IEHP Medi-Cal |
$1,616.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,884.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,884.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,884.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,442.25
|
| Rate for Payer: Multiplan Commercial |
$4,326.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,103.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,927.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,903.65
|
| Rate for Payer: Vantage Medical Group Senior |
$4,903.65
|
|
|
HC CTLSO W/INTERFACE MINERVA
|
Facility
IP
|
$5,769.00
|
|
|
Service Code
|
CPT L0710
|
| Hospital Charge Code |
905350710
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,153.80 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$1,153.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,769.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,963.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$2,596.05
|
| Rate for Payer: Cash Price |
$2,596.05
|
| Rate for Payer: Cash Price |
$2,596.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,653.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,115.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,905.61
|
| Rate for Payer: Heritage Provider Network Senior |
$7,571.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,884.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,884.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,884.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,442.25
|
| Rate for Payer: Multiplan Commercial |
$4,326.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,103.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,927.42
|
|
|
HC CT MAXILLOFACIAL W/WO CONTRAST
|
Facility
OP
|
$3,956.00
|
|
|
Service Code
|
CPT 70488
|
| Hospital Charge Code |
909201950
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$2,967.00 |
| Rate for Payer: Adventist Health Commercial |
$791.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,717.77
|
| Rate for Payer: 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 |
$1,444.23
|
| Rate for Payer: Blue Shield of California EPN |
$821.29
|
| Rate for Payer: Cash Price |
$1,780.20
|
| Rate for Payer: Cash Price |
$1,780.20
|
| Rate for Payer: Cash Price |
$1,780.20
|
| Rate for Payer: Cash Price |
$1,780.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: Dignity Health Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$229.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Humana Medicare |
$229.56
|
| Rate for Payer: IEHP Medi-Cal |
$280.08
|
| 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 |
$716.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$270.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$989.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$289.25
|
| Rate for Payer: Multiplan Commercial |
$2,967.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$534.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$534.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC CT MAXILLOFACIAL W/WO CONTRAST
|
Facility
IP
|
$3,250.00
|
|
|
Service Code
|
CPT 70488
|
| Hospital Charge Code |
909201950
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$588.25 |
| Max. Negotiated Rate |
$2,437.50 |
| Rate for Payer: Adventist Health Commercial |
$650.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,232.75
|
| Rate for Payer: Cash Price |
$1,462.50
|
| Rate for Payer: Cash Price |
$1,462.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,200.25
|
| Rate for Payer: Heritage Provider Network Senior |
$2,200.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$588.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$812.50
|
| Rate for Payer: Multiplan Commercial |
$2,437.50
|
|
|
HC CT MAXILLOFAC W CONT
|
Facility
IP
|
$3,128.00
|
|
|
Service Code
|
CPT 70487
|
| Hospital Charge Code |
909201907
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$566.17 |
| Max. Negotiated Rate |
$2,346.00 |
| Rate for Payer: Adventist Health Commercial |
$625.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,148.94
|
| Rate for Payer: Cash Price |
$1,407.60
|
| Rate for Payer: Cash Price |
$1,407.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,117.66
|
| Rate for Payer: Heritage Provider Network Senior |
$2,117.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$566.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$782.00
|
| Rate for Payer: Multiplan Commercial |
$2,346.00
|
|
|
HC CT MAXILLOFAC W CONT
|
Facility
OP
|
$2,862.00
|
|
|
Service Code
|
CPT 70487
|
| Hospital Charge Code |
909201907
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$2,146.50 |
| Rate for Payer: Adventist Health Commercial |
$572.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,966.19
|
| 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 |
$1,154.00
|
| Rate for Payer: Blue Shield of California EPN |
$656.25
|
| Rate for Payer: Cash Price |
$1,287.90
|
| Rate for Payer: Cash Price |
$1,287.90
|
| Rate for Payer: Cash Price |
$1,287.90
|
| Rate for Payer: Cash Price |
$1,287.90
|
| 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 |
$228.77
|
| 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 |
$518.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$270.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$715.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$289.25
|
| Rate for Payer: Multiplan Commercial |
$2,146.50
|
| 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 |
$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 MAXILLOFAC W/O CO
|
Facility
OP
|
$2,499.00
|
|
|
Service Code
|
CPT 70486
|
| Hospital Charge Code |
909201906
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$1,874.25 |
| Rate for Payer: Adventist Health Commercial |
$499.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,716.81
|
| 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 |
$964.62
|
| Rate for Payer: Blue Shield of California EPN |
$548.55
|
| Rate for Payer: Cash Price |
$1,124.55
|
| Rate for Payer: Cash Price |
$1,124.55
|
| Rate for Payer: Cash Price |
$1,124.55
|
| Rate for Payer: Cash Price |
$1,124.55
|
| 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 |
$192.43
|
| 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 |
$452.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$624.75
|
| 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 |
$1,874.25
|
| 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 MAXILLOFAC W/O CO
|
Facility
IP
|
$2,650.00
|
|
|
Service Code
|
CPT 70486
|
| Hospital Charge Code |
909201906
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$479.65 |
| Max. Negotiated Rate |
$1,987.50 |
| Rate for Payer: Adventist Health Commercial |
$530.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,820.55
|
| Rate for Payer: Cash Price |
$1,192.50
|
| Rate for Payer: Cash Price |
$1,192.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,794.05
|
| Rate for Payer: Heritage Provider Network Senior |
$1,794.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$479.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$662.50
|
| Rate for Payer: Multiplan Commercial |
$1,987.50
|
|
|
HC CT PERFUSION W/CONTRAST, CBF
|
Facility
IP
|
$3,345.00
|
|
|
Service Code
|
CPT 0042T
|
| Hospital Charge Code |
909201812
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$605.44 |
| Max. Negotiated Rate |
$2,508.75 |
| Rate for Payer: Adventist Health Commercial |
$669.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,298.02
|
| Rate for Payer: Cash Price |
$1,505.25
|
| Rate for Payer: Cash Price |
$1,505.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,264.56
|
| Rate for Payer: Heritage Provider Network Senior |
$2,264.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$605.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$836.25
|
| Rate for Payer: Multiplan Commercial |
$2,508.75
|
|
|
HC CT PERFUSION W/CONTRAST, CBF
|
Facility
OP
|
$4,201.00
|
|
|
Service Code
|
CPT 0042T
|
| Hospital Charge Code |
909201812
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$3,570.85 |
| Rate for Payer: Adventist Health Commercial |
$840.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,886.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,570.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,310.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,150.75
|
| Rate for Payer: Blue Shield of California Commercial |
$2,608.82
|
| Rate for Payer: Blue Shield of California EPN |
$2,465.99
|
| Rate for Payer: Cash Price |
$1,890.45
|
| Rate for Payer: Cash Price |
$1,890.45
|
| Rate for Payer: Cash Price |
$1,890.45
|
| Rate for Payer: Cash Price |
$1,890.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,570.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,570.85
|
| Rate for Payer: Dignity Health Senior |
$3,570.85
|
| 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 |
$2,024.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$760.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,050.25
|
| Rate for Payer: Multiplan Commercial |
$3,150.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Senior |
$225.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,570.85
|
| Rate for Payer: Vantage Medical Group Senior |
$3,570.85
|
|
|
HC CT RECONSTRUCTION FOR TRANSPLT
|
Facility
IP
|
$2,449.00
|
|
| Hospital Charge Code |
909201983
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$443.27 |
| Max. Negotiated Rate |
$1,836.75 |
| Rate for Payer: Adventist Health Commercial |
$489.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,682.46
|
| Rate for Payer: Cash Price |
$1,102.05
|
| Rate for Payer: Cash Price |
$1,102.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,657.97
|
| Rate for Payer: Heritage Provider Network Senior |
$1,657.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$443.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$612.25
|
| Rate for Payer: Multiplan Commercial |
$1,836.75
|
|
|
HC CT RECONSTRUCTION FOR TRANSPLT
|
Facility
OP
|
$2,449.00
|
|
| Hospital Charge Code |
909201983
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$2,081.65 |
| Rate for Payer: Adventist Health Commercial |
$489.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,308.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,682.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,081.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,346.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,836.75
|
| Rate for Payer: Blue Shield of California Commercial |
$1,520.83
|
| Rate for Payer: Blue Shield of California EPN |
$1,437.56
|
| Rate for Payer: Cash Price |
$1,102.05
|
| Rate for Payer: Cash Price |
$1,102.05
|
| Rate for Payer: Cash Price |
$1,102.05
|
| Rate for Payer: Cash Price |
$1,102.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,081.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,081.65
|
| Rate for Payer: Dignity Health Senior |
$2,081.65
|
| 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 |
$1,180.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$443.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$612.25
|
| Rate for Payer: Multiplan Commercial |
$1,836.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Senior |
$225.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,081.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,081.65
|
|
|
HC CT SOFT TIS NCK W CONTR
|
Facility
IP
|
$3,349.00
|
|
|
Service Code
|
CPT 70491
|
| Hospital Charge Code |
909201910
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$606.17 |
| Max. Negotiated Rate |
$2,511.75 |
| Rate for Payer: Adventist Health Commercial |
$669.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,300.76
|
| Rate for Payer: Cash Price |
$1,507.05
|
| Rate for Payer: Cash Price |
$1,507.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,267.27
|
| Rate for Payer: Heritage Provider Network Senior |
$2,267.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$606.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$837.25
|
| Rate for Payer: Multiplan Commercial |
$2,511.75
|
|
|
HC CT SOFT TIS NCK W CONTR
|
Facility
OP
|
$3,224.00
|
|
|
Service Code
|
CPT 70491
|
| Hospital Charge Code |
909201910
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$2,418.00 |
| Rate for Payer: Adventist Health Commercial |
$644.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,214.89
|
| 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 |
$1,154.00
|
| Rate for Payer: Blue Shield of California EPN |
$656.25
|
| Rate for Payer: Cash Price |
$1,450.80
|
| Rate for Payer: Cash Price |
$1,450.80
|
| Rate for Payer: Cash Price |
$1,450.80
|
| Rate for Payer: Cash Price |
$1,450.80
|
| 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 |
$278.54
|
| 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 |
$583.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$270.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$806.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$289.25
|
| Rate for Payer: Multiplan Commercial |
$2,418.00
|
| 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 |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC CT SOFT TIS NCK WO CONTR
|
Facility
OP
|
$2,862.00
|
|
|
Service Code
|
CPT 70490
|
| Hospital Charge Code |
909201909
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$2,146.50 |
| Rate for Payer: Adventist Health Commercial |
$572.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,966.19
|
| 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 |
$964.62
|
| Rate for Payer: Blue Shield of California EPN |
$548.55
|
| Rate for Payer: Cash Price |
$1,287.90
|
| Rate for Payer: Cash Price |
$1,287.90
|
| Rate for Payer: Cash Price |
$1,287.90
|
| Rate for Payer: Cash Price |
$1,287.90
|
| 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 |
$224.66
|
| 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 |
$518.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$715.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$2,146.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$307.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$307.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC CT SOFT TIS NCK WO CONTR
|
Facility
IP
|
$3,111.00
|
|
|
Service Code
|
CPT 70490
|
| Hospital Charge Code |
909201909
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$563.09 |
| Max. Negotiated Rate |
$2,333.25 |
| Rate for Payer: Adventist Health Commercial |
$622.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,137.26
|
| Rate for Payer: Cash Price |
$1,399.95
|
| Rate for Payer: Cash Price |
$1,399.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,106.15
|
| Rate for Payer: Heritage Provider Network Senior |
$2,106.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$563.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$777.75
|
| Rate for Payer: Multiplan Commercial |
$2,333.25
|
|
|
HC CT SOFT TISSUE NECK W/WO CNTRST
|
Facility
IP
|
$3,709.00
|
|
|
Service Code
|
CPT 70492
|
| Hospital Charge Code |
909201911
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$671.33 |
| Max. Negotiated Rate |
$2,781.75 |
| Rate for Payer: Adventist Health Commercial |
$741.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,548.08
|
| Rate for Payer: Cash Price |
$1,669.05
|
| Rate for Payer: Cash Price |
$1,669.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,510.99
|
| Rate for Payer: Heritage Provider Network Senior |
$2,510.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$671.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$927.25
|
| Rate for Payer: Multiplan Commercial |
$2,781.75
|
|
|
HC CT SOFT TISSUE NECK W/WO CNTRST
|
Facility
OP
|
$3,842.00
|
|
|
Service Code
|
CPT 70492
|
| Hospital Charge Code |
909201911
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$2,881.50 |
| Rate for Payer: Adventist Health Commercial |
$768.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,639.45
|
| 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 |
$1,444.23
|
| Rate for Payer: Blue Shield of California EPN |
$821.29
|
| Rate for Payer: Cash Price |
$1,728.90
|
| Rate for Payer: Cash Price |
$1,728.90
|
| Rate for Payer: Cash Price |
$1,728.90
|
| Rate for Payer: Cash Price |
$1,728.90
|
| 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 |
$335.15
|
| 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 |
$695.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$270.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$960.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$289.25
|
| Rate for Payer: Multiplan Commercial |
$2,881.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$534.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$534.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC CT STEREOTACTIC LOCALIZATION
|
Facility
OP
|
$1,856.00
|
|
|
Service Code
|
CPT 77011
|
| Hospital Charge Code |
909001159
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$3,816.21 |
| Rate for Payer: Adventist Health Commercial |
$371.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,275.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,577.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,020.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,392.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,816.21
|
| Rate for Payer: Blue Shield of California EPN |
$2,170.16
|
| Rate for Payer: Cash Price |
$835.20
|
| Rate for Payer: Cash Price |
$835.20
|
| Rate for Payer: Cash Price |
$835.20
|
| Rate for Payer: Cash Price |
$835.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,577.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,577.60
|
| Rate for Payer: Dignity Health Senior |
$1,577.60
|
| 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: IEHP Medi-Cal |
$311.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$894.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$335.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$464.00
|
| Rate for Payer: Multiplan Commercial |
$1,392.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Senior |
$225.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,577.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,577.60
|
|
|
HC CT STEREOTACTIC LOCALIZATION
|
Facility
IP
|
$2,332.00
|
|
|
Service Code
|
CPT 77011
|
| Hospital Charge Code |
909001159
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$422.09 |
| Max. Negotiated Rate |
$1,749.00 |
| Rate for Payer: Adventist Health Commercial |
$466.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,602.08
|
| Rate for Payer: Cash Price |
$1,049.40
|
| Rate for Payer: Cash Price |
$1,049.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,578.76
|
| Rate for Payer: Heritage Provider Network Senior |
$1,578.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$422.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$583.00
|
| Rate for Payer: Multiplan Commercial |
$1,749.00
|
|
|
HC CT, THX, LD FOR LC SCRN WO CON
|
Facility
IP
|
$299.00
|
|
|
Service Code
|
CPT 71271
|
| Hospital Charge Code |
909201271
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$54.12 |
| Max. Negotiated Rate |
$711.00 |
| Rate for Payer: Adventist Health Commercial |
$59.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$205.41
|
| Rate for Payer: Cash Price |
$134.55
|
| Rate for Payer: Cash Price |
$134.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$202.42
|
| Rate for Payer: Heritage Provider Network Senior |
$202.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.75
|
| Rate for Payer: Multiplan Commercial |
$224.25
|
|
|
HC CT, THX, LD FOR LC SCRN WO CON
|
Facility
OP
|
$299.00
|
|
|
Service Code
|
CPT 71271
|
| Hospital Charge Code |
909201271
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$54.12 |
| Max. Negotiated Rate |
$1,024.00 |
| Rate for Payer: Adventist Health Commercial |
$59.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$205.41
|
| 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 |
$548.53
|
| Rate for Payer: Blue Shield of California EPN |
$311.93
|
| Rate for Payer: Cash Price |
$134.55
|
| Rate for Payer: Cash Price |
$134.55
|
| Rate for Payer: Cash Price |
$134.55
|
| Rate for Payer: Cash Price |
$134.55
|
| 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 |
$205.59
|
| 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 |
$54.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.75
|
| 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 |
$224.25
|
| 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 |
$129.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$129.44
|
| 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 TSPINE W CONTRAST
|
Facility
IP
|
$3,362.00
|
|
|
Service Code
|
CPT 72129
|
| Hospital Charge Code |
909201918
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$608.52 |
| Max. Negotiated Rate |
$2,521.50 |
| Rate for Payer: Adventist Health Commercial |
$672.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,309.69
|
| Rate for Payer: Cash Price |
$1,512.90
|
| Rate for Payer: Cash Price |
$1,512.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,276.07
|
| Rate for Payer: Heritage Provider Network Senior |
$2,276.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$608.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$840.50
|
| Rate for Payer: Multiplan Commercial |
$2,521.50
|
|
|
HC CT TSPINE W CONTRAST
|
Facility
OP
|
$2,968.00
|
|
|
Service Code
|
CPT 72129
|
| Hospital Charge Code |
909201918
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$2,226.00 |
| Rate for Payer: Adventist Health Commercial |
$593.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,039.02
|
| 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 |
$1,444.23
|
| Rate for Payer: Blue Shield of California EPN |
$821.29
|
| Rate for Payer: Cash Price |
$1,335.60
|
| Rate for Payer: Cash Price |
$1,335.60
|
| Rate for Payer: Cash Price |
$1,335.60
|
| Rate for Payer: Cash Price |
$1,335.60
|
| 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 |
$256.37
|
| 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 |
$537.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$270.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$742.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$289.25
|
| Rate for Payer: Multiplan Commercial |
$2,226.00
|
| 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 |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC CT TSPINE WO CONTRAST
|
Facility
OP
|
$3,000.00
|
|
|
Service Code
|
CPT 72128
|
| Hospital Charge Code |
909201917
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$2,250.00 |
| Rate for Payer: Adventist Health Commercial |
$600.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,061.00
|
| 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 |
$1,206.38
|
| Rate for Payer: Blue Shield of California EPN |
$686.03
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| 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 |
$194.50
|
| 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 |
$543.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$750.00
|
| 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 |
$2,250.00
|
| 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 |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
