|
HC C SPINE W/FLEX AND EXT COMPLETE
|
Facility
|
OP
|
$1,302.00
|
|
|
Service Code
|
CPT 72052
|
| Hospital Charge Code |
909001303
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.77 |
| Max. Negotiated Rate |
$976.50 |
| Rate for Payer: Adventist Health Commercial |
$260.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$804.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$307.53
|
| Rate for Payer: Blue Shield of California Commercial |
$236.93
|
| Rate for Payer: Blue Shield of California EPN |
$190.53
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$846.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$768.18
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$805.94
|
| Rate for Payer: Heritage Provider Network Senior |
$805.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$621.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$235.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$325.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$976.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$134.46
|
| Rate for Payer: TriValley Medical Group Senior |
$134.46
|
| 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 |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC CT ABDOMEN & PELVIS W/CONTRAST
|
Facility
|
OP
|
$3,208.00
|
|
|
Service Code
|
CPT 74177
|
| Hospital Charge Code |
909202002
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$2,406.00 |
| Rate for Payer: Adventist Health Commercial |
$641.60
|
| Rate for Payer: Adventist Health Commercial |
$793.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,451.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,982.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,984.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,604.64
|
| Rate for Payer: Blue Shield of California Commercial |
$1,494.14
|
| Rate for Payer: Blue Shield of California Commercial |
$1,494.14
|
| Rate for Payer: Blue Shield of California EPN |
$1,201.54
|
| Rate for Payer: Blue Shield of California EPN |
$1,201.54
|
| Rate for Payer: Cash Price |
$1,785.15
|
| Rate for Payer: Cash Price |
$1,443.60
|
| Rate for Payer: Cash Price |
$1,443.60
|
| Rate for Payer: Cash Price |
$1,443.60
|
| Rate for Payer: Cash Price |
$1,443.60
|
| Rate for Payer: Cash Price |
$1,785.15
|
| Rate for Payer: Cash Price |
$1,785.15
|
| Rate for Payer: Cash Price |
$1,785.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$448.71
|
| Rate for Payer: EPIC Health Plan Medicare |
$448.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,892.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,530.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$718.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$580.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$516.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$516.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$802.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$991.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$601.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$601.27
|
| Rate for Payer: Multiplan Commercial |
$2,406.00
|
| Rate for Payer: Multiplan Commercial |
$2,975.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$928.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$928.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$928.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
|
|
HC CT ABDOMEN & PELVIS W/CONTRAST
|
Facility
|
IP
|
$3,208.00
|
|
|
Service Code
|
CPT 74177
|
| Hospital Charge Code |
909202002
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$580.65 |
| Max. Negotiated Rate |
$2,406.00 |
| Rate for Payer: Adventist Health Commercial |
$641.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,065.95
|
| Rate for Payer: Cash Price |
$1,443.60
|
| Rate for Payer: Cash Price |
$1,443.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,171.82
|
| Rate for Payer: Heritage Provider Network Senior |
$2,171.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$580.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$802.00
|
| Rate for Payer: Multiplan Commercial |
$2,406.00
|
|
|
HC CT ABDOMEN & PELVIS W/O CONTRA
|
Facility
|
OP
|
$2,652.00
|
|
|
Service Code
|
CPT 74176
|
| Hospital Charge Code |
909202001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$1,989.00 |
| Rate for Payer: Adventist Health Commercial |
$530.40
|
| Rate for Payer: Adventist Health Commercial |
$716.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,213.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,638.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,791.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,326.53
|
| Rate for Payer: Blue Shield of California Commercial |
$783.17
|
| Rate for Payer: Blue Shield of California Commercial |
$783.17
|
| Rate for Payer: Blue Shield of California EPN |
$629.80
|
| Rate for Payer: Blue Shield of California EPN |
$629.80
|
| Rate for Payer: Cash Price |
$1,611.45
|
| Rate for Payer: Cash Price |
$1,193.40
|
| Rate for Payer: Cash Price |
$1,193.40
|
| Rate for Payer: Cash Price |
$1,193.40
|
| Rate for Payer: Cash Price |
$1,193.40
|
| Rate for Payer: Cash Price |
$1,611.45
|
| Rate for Payer: Cash Price |
$1,611.45
|
| Rate for Payer: Cash Price |
$1,611.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.88
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,708.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,265.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$648.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$480.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$352.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$352.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$663.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$895.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$1,989.00
|
| Rate for Payer: Multiplan Commercial |
$2,685.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$648.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$648.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$648.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC CT ABDOMEN & PELVIS W/O CONTRA
|
Facility
|
IP
|
$2,652.00
|
|
|
Service Code
|
CPT 74176
|
| Hospital Charge Code |
909202001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$480.01 |
| Max. Negotiated Rate |
$1,989.00 |
| Rate for Payer: Adventist Health Commercial |
$530.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,707.89
|
| Rate for Payer: Cash Price |
$1,193.40
|
| Rate for Payer: Cash Price |
$1,193.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,795.40
|
| Rate for Payer: Heritage Provider Network Senior |
$1,795.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$480.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$663.00
|
| Rate for Payer: Multiplan Commercial |
$1,989.00
|
|
|
HC CT ABDOMEN & PELVIS W & W/O CO
|
Facility
|
IP
|
$3,717.00
|
|
|
Service Code
|
CPT 74178
|
| Hospital Charge Code |
909202003
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$672.78 |
| Max. Negotiated Rate |
$2,787.75 |
| Rate for Payer: Adventist Health Commercial |
$743.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,393.75
|
| Rate for Payer: Cash Price |
$1,672.65
|
| Rate for Payer: Cash Price |
$1,672.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,516.41
|
| Rate for Payer: Heritage Provider Network Senior |
$2,516.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$672.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$929.25
|
| Rate for Payer: Multiplan Commercial |
$2,787.75
|
|
|
HC CT ABDOMEN & PELVIS W & W/O CO
|
Facility
|
OP
|
$3,717.00
|
|
|
Service Code
|
CPT 74178
|
| Hospital Charge Code |
909202003
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$2,787.75 |
| Rate for Payer: Adventist Health Commercial |
$743.40
|
| Rate for Payer: Adventist Health Commercial |
$861.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,661.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,297.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,153.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,859.24
|
| Rate for Payer: Blue Shield of California Commercial |
$1,974.91
|
| Rate for Payer: Blue Shield of California Commercial |
$1,974.91
|
| Rate for Payer: Blue Shield of California EPN |
$1,588.16
|
| Rate for Payer: Blue Shield of California EPN |
$1,588.16
|
| Rate for Payer: Cash Price |
$1,937.70
|
| Rate for Payer: Cash Price |
$1,672.65
|
| Rate for Payer: Cash Price |
$1,672.65
|
| Rate for Payer: Cash Price |
$1,672.65
|
| Rate for Payer: Cash Price |
$1,672.65
|
| Rate for Payer: Cash Price |
$1,937.70
|
| Rate for Payer: Cash Price |
$1,937.70
|
| Rate for Payer: Cash Price |
$1,937.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$448.71
|
| Rate for Payer: EPIC Health Plan Medicare |
$448.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,053.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,773.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$779.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$672.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$516.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$516.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$929.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,076.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$601.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$601.27
|
| Rate for Payer: Multiplan Commercial |
$2,787.75
|
| Rate for Payer: Multiplan Commercial |
$3,229.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$928.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$928.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$928.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
|
|
HC CT ABDOMEN W CONTRAS
|
Facility
|
IP
|
$2,139.00
|
|
|
Service Code
|
CPT 74160
|
| Hospital Charge Code |
909201928
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$387.16 |
| Max. Negotiated Rate |
$1,604.25 |
| Rate for Payer: Adventist Health Commercial |
$427.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,377.52
|
| Rate for Payer: Cash Price |
$962.55
|
| Rate for Payer: Cash Price |
$962.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,448.10
|
| Rate for Payer: Heritage Provider Network Senior |
$1,448.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$387.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$534.75
|
| Rate for Payer: Multiplan Commercial |
$1,604.25
|
|
|
HC CT ABDOMEN W CONTRAS
|
Facility
|
OP
|
$2,139.00
|
|
|
Service Code
|
CPT 74160
|
| Hospital Charge Code |
909201928
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$1,604.25 |
| Rate for Payer: Adventist Health Commercial |
$427.80
|
| Rate for Payer: Adventist Health Commercial |
$599.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,851.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,321.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,498.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,069.93
|
| Rate for Payer: Blue Shield of California Commercial |
$1,439.71
|
| Rate for Payer: Blue Shield of California Commercial |
$1,439.71
|
| Rate for Payer: Blue Shield of California EPN |
$1,157.77
|
| Rate for Payer: Blue Shield of California EPN |
$1,157.77
|
| Rate for Payer: Cash Price |
$1,348.20
|
| Rate for Payer: Cash Price |
$962.55
|
| Rate for Payer: Cash Price |
$962.55
|
| Rate for Payer: Cash Price |
$962.55
|
| Rate for Payer: Cash Price |
$962.55
|
| Rate for Payer: Cash Price |
$1,348.20
|
| Rate for Payer: Cash Price |
$1,348.20
|
| Rate for Payer: Cash Price |
$1,348.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$225.59
|
| Rate for Payer: EPIC Health Plan Medicare |
$225.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,429.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,020.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$542.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$387.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$259.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$259.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$534.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$749.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$1,604.25
|
| Rate for Payer: Multiplan Commercial |
$2,247.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$480.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$480.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$480.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
|
HC CT ABDOMEN WO CONTR
|
Facility
|
IP
|
$1,798.00
|
|
|
Service Code
|
CPT 74150
|
| Hospital Charge Code |
909201927
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$325.44 |
| Max. Negotiated Rate |
$1,348.50 |
| Rate for Payer: Adventist Health Commercial |
$359.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,157.91
|
| Rate for Payer: Cash Price |
$809.10
|
| Rate for Payer: Cash Price |
$809.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,217.25
|
| Rate for Payer: Heritage Provider Network Senior |
$1,217.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$325.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$449.50
|
| Rate for Payer: Multiplan Commercial |
$1,348.50
|
|
|
HC CT ABDOMEN WO CONTR
|
Facility
|
OP
|
$1,798.00
|
|
|
Service Code
|
CPT 74150
|
| Hospital Charge Code |
909201927
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$1,348.50 |
| Rate for Payer: Adventist Health Commercial |
$359.60
|
| Rate for Payer: Adventist Health Commercial |
$533.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,646.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,111.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,333.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$899.36
|
| Rate for Payer: Blue Shield of California Commercial |
$1,188.67
|
| Rate for Payer: Blue Shield of California Commercial |
$1,188.67
|
| Rate for Payer: Blue Shield of California EPN |
$955.89
|
| Rate for Payer: Blue Shield of California EPN |
$955.89
|
| Rate for Payer: Cash Price |
$1,199.25
|
| Rate for Payer: Cash Price |
$809.10
|
| Rate for Payer: Cash Price |
$809.10
|
| Rate for Payer: Cash Price |
$809.10
|
| Rate for Payer: Cash Price |
$809.10
|
| Rate for Payer: Cash Price |
$1,199.25
|
| Rate for Payer: Cash Price |
$1,199.25
|
| Rate for Payer: Cash Price |
$1,199.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,271.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$857.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$482.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$325.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$449.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$666.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,348.50
|
| Rate for Payer: Multiplan Commercial |
$1,998.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$307.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$307.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$307.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC CT ABDOMEN W/WO CONT
|
Facility
|
OP
|
$2,451.00
|
|
|
Service Code
|
CPT 74170
|
| Hospital Charge Code |
909201929
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$1,838.25 |
| Rate for Payer: Adventist Health Commercial |
$490.20
|
| Rate for Payer: Adventist Health Commercial |
$701.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,166.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,514.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,753.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,225.99
|
| Rate for Payer: Blue Shield of California Commercial |
$1,783.10
|
| Rate for Payer: Blue Shield of California Commercial |
$1,783.10
|
| Rate for Payer: Blue Shield of California EPN |
$1,433.91
|
| Rate for Payer: Blue Shield of California EPN |
$1,433.91
|
| Rate for Payer: Cash Price |
$1,577.25
|
| Rate for Payer: Cash Price |
$1,102.95
|
| Rate for Payer: Cash Price |
$1,102.95
|
| Rate for Payer: Cash Price |
$1,102.95
|
| Rate for Payer: Cash Price |
$1,102.95
|
| Rate for Payer: Cash Price |
$1,577.25
|
| Rate for Payer: Cash Price |
$1,577.25
|
| Rate for Payer: Cash Price |
$1,577.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$225.59
|
| Rate for Payer: EPIC Health Plan Medicare |
$225.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,671.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,169.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$634.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$443.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$259.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$259.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$612.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$876.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$1,838.25
|
| Rate for Payer: Multiplan Commercial |
$2,628.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$534.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$534.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$534.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
|
HC CT ABDOMEN W/WO CONT
|
Facility
|
IP
|
$2,451.00
|
|
|
Service Code
|
CPT 74170
|
| Hospital Charge Code |
909201929
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$443.63 |
| Max. Negotiated Rate |
$1,838.25 |
| Rate for Payer: Adventist Health Commercial |
$490.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,578.44
|
| Rate for Payer: Cash Price |
$1,102.95
|
| Rate for Payer: Cash Price |
$1,102.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,659.33
|
| Rate for Payer: Heritage Provider Network Senior |
$1,659.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$443.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$612.75
|
| Rate for Payer: Multiplan Commercial |
$1,838.25
|
|
|
HC CT ANGIO ABD AORTA-AIF W/WO CO
|
Facility
|
IP
|
$2,894.00
|
|
|
Service Code
|
CPT 75635
|
| Hospital Charge Code |
909201809
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$523.81 |
| Max. Negotiated Rate |
$2,170.50 |
| Rate for Payer: Adventist Health Commercial |
$578.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,863.74
|
| Rate for Payer: Cash Price |
$1,302.30
|
| Rate for Payer: Cash Price |
$1,302.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,959.24
|
| Rate for Payer: Heritage Provider Network Senior |
$1,959.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$523.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$723.50
|
| Rate for Payer: Multiplan Commercial |
$2,170.50
|
|
|
HC CT ANGIO ABD AORTA-AIF W/WO CO
|
Facility
|
OP
|
$2,894.00
|
|
|
Service Code
|
CPT 75635
|
| Hospital Charge Code |
909201809
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$3,282.19 |
| Rate for Payer: Adventist Health Commercial |
$578.80
|
| Rate for Payer: Adventist Health Commercial |
$862.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,663.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,788.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,155.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,447.58
|
| Rate for Payer: Blue Shield of California Commercial |
$3,282.19
|
| Rate for Payer: Blue Shield of California Commercial |
$3,282.19
|
| Rate for Payer: Blue Shield of California EPN |
$2,639.43
|
| Rate for Payer: Blue Shield of California EPN |
$2,639.43
|
| Rate for Payer: Cash Price |
$1,939.50
|
| Rate for Payer: Cash Price |
$1,302.30
|
| Rate for Payer: Cash Price |
$1,302.30
|
| Rate for Payer: Cash Price |
$1,302.30
|
| Rate for Payer: Cash Price |
$1,302.30
|
| Rate for Payer: Cash Price |
$1,939.50
|
| Rate for Payer: Cash Price |
$1,939.50
|
| Rate for Payer: Cash Price |
$1,939.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$225.59
|
| Rate for Payer: EPIC Health Plan Medicare |
$225.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,055.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,380.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$780.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$523.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$259.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$259.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$723.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,077.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$2,170.50
|
| Rate for Payer: Multiplan Commercial |
$3,232.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$541.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$541.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$541.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
|
HC CT ANGIO ABDOMEN/PELVIS
|
Facility
|
IP
|
$2,894.00
|
|
|
Service Code
|
CPT 74174
|
| Hospital Charge Code |
909201991
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$523.81 |
| Max. Negotiated Rate |
$2,170.50 |
| Rate for Payer: Adventist Health Commercial |
$578.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,863.74
|
| Rate for Payer: Cash Price |
$1,302.30
|
| Rate for Payer: Cash Price |
$1,302.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,959.24
|
| Rate for Payer: Heritage Provider Network Senior |
$1,959.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$523.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$723.50
|
| Rate for Payer: Multiplan Commercial |
$2,170.50
|
|
|
HC CT ANGIO ABDOMEN/PELVIS
|
Facility
|
OP
|
$2,894.00
|
|
|
Service Code
|
CPT 74174
|
| Hospital Charge Code |
909201991
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$2,708.11 |
| Rate for Payer: Adventist Health Commercial |
$578.80
|
| Rate for Payer: Adventist Health Commercial |
$760.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,349.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,788.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,901.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,447.58
|
| Rate for Payer: Blue Shield of California Commercial |
$2,708.11
|
| Rate for Payer: Blue Shield of California Commercial |
$2,708.11
|
| Rate for Payer: Blue Shield of California EPN |
$2,177.77
|
| Rate for Payer: Blue Shield of California EPN |
$2,177.77
|
| Rate for Payer: Cash Price |
$1,710.90
|
| Rate for Payer: Cash Price |
$1,302.30
|
| Rate for Payer: Cash Price |
$1,302.30
|
| Rate for Payer: Cash Price |
$1,302.30
|
| Rate for Payer: Cash Price |
$1,302.30
|
| Rate for Payer: Cash Price |
$1,710.90
|
| Rate for Payer: Cash Price |
$1,710.90
|
| Rate for Payer: Cash Price |
$1,710.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$448.71
|
| Rate for Payer: EPIC Health Plan Medicare |
$448.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,813.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,380.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$688.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$523.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$516.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$516.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$723.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$950.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$601.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$601.27
|
| Rate for Payer: Multiplan Commercial |
$2,170.50
|
| Rate for Payer: Multiplan Commercial |
$2,851.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$928.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$928.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$928.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
|
|
HC CT ANGIO ABDOMEN W/WO CONTRAST
|
Facility
|
OP
|
$2,694.00
|
|
|
Service Code
|
CPT 74175
|
| Hospital Charge Code |
909201808
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$2,494.42 |
| Rate for Payer: Adventist Health Commercial |
$538.80
|
| Rate for Payer: Adventist Health Commercial |
$778.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,404.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,664.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,945.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,347.54
|
| Rate for Payer: Blue Shield of California Commercial |
$2,494.42
|
| Rate for Payer: Blue Shield of California Commercial |
$2,494.42
|
| Rate for Payer: Blue Shield of California EPN |
$2,005.93
|
| Rate for Payer: Blue Shield of California EPN |
$2,005.93
|
| Rate for Payer: Cash Price |
$1,750.50
|
| Rate for Payer: Cash Price |
$1,212.30
|
| Rate for Payer: Cash Price |
$1,212.30
|
| Rate for Payer: Cash Price |
$1,212.30
|
| Rate for Payer: Cash Price |
$1,212.30
|
| Rate for Payer: Cash Price |
$1,750.50
|
| Rate for Payer: Cash Price |
$1,750.50
|
| Rate for Payer: Cash Price |
$1,750.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$225.59
|
| Rate for Payer: EPIC Health Plan Medicare |
$225.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,855.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,285.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$704.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$487.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$259.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$259.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$673.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$972.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$2,020.50
|
| Rate for Payer: Multiplan Commercial |
$2,917.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$541.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$541.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$541.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
|
HC CT ANGIO ABDOMEN W/WO CONTRAST
|
Facility
|
IP
|
$2,694.00
|
|
|
Service Code
|
CPT 74175
|
| Hospital Charge Code |
909201808
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$487.61 |
| Max. Negotiated Rate |
$2,020.50 |
| Rate for Payer: Adventist Health Commercial |
$538.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,734.94
|
| Rate for Payer: Cash Price |
$1,212.30
|
| Rate for Payer: Cash Price |
$1,212.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,823.84
|
| Rate for Payer: Heritage Provider Network Senior |
$1,823.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$487.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$673.50
|
| Rate for Payer: Multiplan Commercial |
$2,020.50
|
|
|
HC CT ANGIO CHEST W/WO CONTRAST
|
Facility
|
IP
|
$2,643.00
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
909201802
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$478.38 |
| Max. Negotiated Rate |
$1,982.25 |
| Rate for Payer: Adventist Health Commercial |
$528.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,702.09
|
| Rate for Payer: Cash Price |
$1,189.35
|
| Rate for Payer: Cash Price |
$1,189.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,789.31
|
| Rate for Payer: Heritage Provider Network Senior |
$1,789.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$478.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$660.75
|
| Rate for Payer: Multiplan Commercial |
$1,982.25
|
|
|
HC CT ANGIO CHEST W/WO CONTRAST
|
Facility
|
OP
|
$2,643.00
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
909201802
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$2,565.12 |
| Rate for Payer: Adventist Health Commercial |
$528.60
|
| Rate for Payer: Adventist Health Commercial |
$731.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,260.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,633.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,829.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,322.03
|
| Rate for Payer: Blue Shield of California Commercial |
$2,565.12
|
| Rate for Payer: Blue Shield of California Commercial |
$2,565.12
|
| Rate for Payer: Blue Shield of California EPN |
$2,062.78
|
| Rate for Payer: Blue Shield of California EPN |
$2,062.78
|
| Rate for Payer: Cash Price |
$1,646.10
|
| Rate for Payer: Cash Price |
$1,189.35
|
| Rate for Payer: Cash Price |
$1,189.35
|
| Rate for Payer: Cash Price |
$1,189.35
|
| Rate for Payer: Cash Price |
$1,189.35
|
| Rate for Payer: Cash Price |
$1,646.10
|
| Rate for Payer: Cash Price |
$1,646.10
|
| Rate for Payer: Cash Price |
$1,646.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$225.59
|
| Rate for Payer: EPIC Health Plan Medicare |
$225.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,744.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,260.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$662.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$478.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$259.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$259.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$660.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$914.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$1,982.25
|
| Rate for Payer: Multiplan Commercial |
$2,743.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$541.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$541.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$541.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
|
HC CT ANGIO HEAD AND NECK W WO CONTRAST
|
Facility
|
OP
|
$1,128.00
|
|
|
Service Code
|
CPT 70471
|
| Hospital Charge Code |
909201820
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$204.17 |
| Max. Negotiated Rate |
$910.00 |
| Rate for Payer: Adventist Health Commercial |
$225.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$697.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$564.23
|
| Rate for Payer: Blue Shield of California Commercial |
$688.08
|
| Rate for Payer: Blue Shield of California EPN |
$550.46
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$448.71
|
| 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) Medicare Advantage |
$448.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$538.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$204.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$516.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$282.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$601.27
|
| Rate for Payer: Multiplan Commercial |
$846.00
|
| 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 |
$564.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$564.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
|
|
HC CT ANGIO HEAD AND NECK W WO CONTRAST
|
Facility
|
IP
|
$1,128.00
|
|
|
Service Code
|
CPT 70471
|
| Hospital Charge Code |
909201820
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$204.17 |
| Max. Negotiated Rate |
$846.00 |
| Rate for Payer: Adventist Health Commercial |
$225.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$726.43
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$763.66
|
| Rate for Payer: Heritage Provider Network Senior |
$763.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$204.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$282.00
|
| Rate for Payer: Multiplan Commercial |
$846.00
|
|
|
HC CT ANGIO HEAD W/WO CONTRAST
|
Facility
|
IP
|
$3,215.00
|
|
|
Service Code
|
CPT 70496
|
| Hospital Charge Code |
909201800
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$581.91 |
| Max. Negotiated Rate |
$2,411.25 |
| Rate for Payer: Adventist Health Commercial |
$643.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,070.46
|
| Rate for Payer: Cash Price |
$1,446.75
|
| Rate for Payer: Cash Price |
$1,446.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,176.55
|
| Rate for Payer: Heritage Provider Network Senior |
$2,176.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$581.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$803.75
|
| Rate for Payer: Multiplan Commercial |
$2,411.25
|
|
|
HC CT ANGIO HEAD W/WO CONTRAST
|
Facility
|
OP
|
$3,215.00
|
|
|
Service Code
|
CPT 70496
|
| Hospital Charge Code |
909201800
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$2,411.25 |
| Rate for Payer: Adventist Health Commercial |
$643.00
|
| Rate for Payer: Adventist Health Commercial |
$857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,648.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,986.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,143.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,608.14
|
| Rate for Payer: Blue Shield of California Commercial |
$2,235.07
|
| Rate for Payer: Blue Shield of California Commercial |
$2,235.07
|
| Rate for Payer: Blue Shield of California EPN |
$1,797.37
|
| Rate for Payer: Blue Shield of California EPN |
$1,797.37
|
| Rate for Payer: Cash Price |
$1,928.25
|
| Rate for Payer: Cash Price |
$1,446.75
|
| Rate for Payer: Cash Price |
$1,446.75
|
| Rate for Payer: Cash Price |
$1,446.75
|
| Rate for Payer: Cash Price |
$1,446.75
|
| Rate for Payer: Cash Price |
$1,928.25
|
| Rate for Payer: Cash Price |
$1,928.25
|
| Rate for Payer: Cash Price |
$1,928.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$225.59
|
| Rate for Payer: EPIC Health Plan Medicare |
$225.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,043.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,533.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$775.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$581.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$259.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$259.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$803.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,071.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$2,411.25
|
| Rate for Payer: Multiplan Commercial |
$3,213.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$541.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$541.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$541.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
