|
HC CT ANGIO NECK W/WO CONTRAST
|
Facility
|
IP
|
$3,452.00
|
|
|
Service Code
|
CPT 70498
|
| Hospital Charge Code |
909201801
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$624.81 |
| Max. Negotiated Rate |
$2,589.00 |
| Rate for Payer: Adventist Health Commercial |
$690.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,223.09
|
| Rate for Payer: Cash Price |
$1,553.40
|
| Rate for Payer: Cash Price |
$1,553.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,337.00
|
| Rate for Payer: Heritage Provider Network Senior |
$2,337.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$624.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$863.00
|
| Rate for Payer: Multiplan Commercial |
$2,589.00
|
|
|
HC CT ANGIO NECK W/WO CONTRAST
|
Facility
|
OP
|
$3,452.00
|
|
|
Service Code
|
CPT 70498
|
| Hospital Charge Code |
909201801
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$2,589.00 |
| Rate for Payer: Adventist Health Commercial |
$690.40
|
| 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 |
$2,133.34
|
| 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 |
$1,726.69
|
| 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 |
$1,553.40
|
| Rate for Payer: Cash Price |
$1,553.40
|
| Rate for Payer: Cash Price |
$1,553.40
|
| Rate for Payer: Cash Price |
$1,553.40
|
| 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 |
$1,646.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$775.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$624.81
|
| 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 |
$863.00
|
| 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 |
$2,589.00
|
| 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
|
|
|
HC CT ANGIO PELVIS W/WO CONTRAST
|
Facility
|
OP
|
$2,694.00
|
|
|
Service Code
|
CPT 72191
|
| Hospital Charge Code |
909201803
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$2,494.42 |
| Rate for Payer: Adventist Health Commercial |
$538.80
|
| Rate for Payer: Adventist Health Commercial |
$619.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,913.95
|
| 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 |
$1,549.12
|
| 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 |
$1,393.65
|
| 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 |
$1,393.65
|
| Rate for Payer: Cash Price |
$1,393.65
|
| Rate for Payer: Cash Price |
$1,393.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: 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 |
$1,477.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,285.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$560.56
|
| 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 |
$774.25
|
| 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 |
$2,020.50
|
| Rate for Payer: Multiplan Commercial |
$2,322.75
|
| 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
|
|
|
HC CT ANGIO PELVIS W/WO CONTRAST
|
Facility
|
IP
|
$2,694.00
|
|
|
Service Code
|
CPT 72191
|
| Hospital Charge Code |
909201803
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$487.61 |
| Max. Negotiated Rate |
$2,020.50 |
| Rate for Payer: Adventist Health Commercial |
$538.80
|
| Rate for Payer: 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 BIOPSY PACK-LF
|
Facility
|
IP
|
$187.46
|
|
| Hospital Charge Code |
909081734
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.93 |
| Max. Negotiated Rate |
$140.59 |
| Rate for Payer: Adventist Health Commercial |
$37.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$120.72
|
| Rate for Payer: Cash Price |
$84.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$126.91
|
| Rate for Payer: Heritage Provider Network Senior |
$126.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.87
|
| Rate for Payer: Multiplan Commercial |
$140.59
|
|
|
HC CT BIOPSY PACK-LF
|
Facility
|
OP
|
$187.46
|
|
| Hospital Charge Code |
909081734
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.93 |
| Max. Negotiated Rate |
$159.34 |
| Rate for Payer: Adventist Health Commercial |
$37.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$115.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$159.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$103.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$140.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$93.77
|
| Rate for Payer: Blue Shield of California Commercial |
$114.35
|
| Rate for Payer: Blue Shield of California EPN |
$91.48
|
| Rate for Payer: Cash Price |
$84.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$121.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$159.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$159.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$159.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$116.04
|
| Rate for Payer: Heritage Provider Network Senior |
$116.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$89.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$131.22
|
| Rate for Payer: Multiplan Commercial |
$140.59
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$93.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$93.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$159.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$159.34
|
| Rate for Payer: Vantage Medical Group Senior |
$159.34
|
|
|
HC CT BONE L-SPINE W CONTRAST
|
Facility
|
IP
|
$2,714.00
|
|
|
Service Code
|
CPT 72132
|
| Hospital Charge Code |
909201008
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$491.23 |
| Max. Negotiated Rate |
$2,035.50 |
| Rate for Payer: Adventist Health Commercial |
$542.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,747.82
|
| Rate for Payer: Cash Price |
$1,221.30
|
| Rate for Payer: Cash Price |
$1,221.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,837.38
|
| Rate for Payer: Heritage Provider Network Senior |
$1,837.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$491.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$678.50
|
| Rate for Payer: Multiplan Commercial |
$2,035.50
|
|
|
HC CT BONE L-SPINE W CONTRAST
|
Facility
|
OP
|
$2,714.00
|
|
|
Service Code
|
CPT 72132
|
| Hospital Charge Code |
909201008
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$2,035.50 |
| Rate for Payer: Adventist Health Commercial |
$542.80
|
| Rate for Payer: Adventist Health Commercial |
$547.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,690.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,677.25
|
| 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 |
$1,368.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,357.54
|
| Rate for Payer: Blue Shield of California Commercial |
$1,487.62
|
| Rate for Payer: Blue Shield of California Commercial |
$1,487.62
|
| Rate for Payer: Blue Shield of California EPN |
$1,196.29
|
| Rate for Payer: Blue Shield of California EPN |
$1,196.29
|
| Rate for Payer: Cash Price |
$1,231.20
|
| Rate for Payer: Cash Price |
$1,221.30
|
| Rate for Payer: Cash Price |
$1,221.30
|
| Rate for Payer: Cash Price |
$1,221.30
|
| Rate for Payer: Cash Price |
$1,221.30
|
| Rate for Payer: Cash Price |
$1,231.20
|
| Rate for Payer: Cash Price |
$1,231.20
|
| Rate for Payer: Cash Price |
$1,231.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: 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 |
$1,305.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,294.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$495.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$491.23
|
| 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 |
$678.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$684.00
|
| 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 |
$2,035.50
|
| Rate for Payer: Multiplan Commercial |
$2,052.00
|
| 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 |
$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 BONE L-SPINE W/O CONTRAST
|
Facility
|
OP
|
$2,499.00
|
|
|
Service Code
|
CPT 72131
|
| Hospital Charge Code |
909201007
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$1,874.25 |
| Rate for Payer: Adventist Health Commercial |
$499.80
|
| Rate for Payer: Adventist Health Commercial |
$510.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,575.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,544.38
|
| 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 |
$1,275.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,250.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,242.62
|
| Rate for Payer: Blue Shield of California Commercial |
$1,242.62
|
| Rate for Payer: Blue Shield of California EPN |
$999.28
|
| Rate for Payer: Blue Shield of California EPN |
$999.28
|
| Rate for Payer: Cash Price |
$1,147.50
|
| 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: Cash Price |
$1,147.50
|
| Rate for Payer: Cash Price |
$1,147.50
|
| Rate for Payer: Cash Price |
$1,147.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: 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 |
$1,216.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,192.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$461.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$452.32
|
| 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 |
$624.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$637.50
|
| 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 |
$1,874.25
|
| Rate for Payer: Multiplan Commercial |
$1,912.50
|
| 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 |
$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 BONE L-SPINE W/O CONTRAST
|
Facility
|
IP
|
$2,499.00
|
|
|
Service Code
|
CPT 72131
|
| Hospital Charge Code |
909201007
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$452.32 |
| Max. Negotiated Rate |
$1,874.25 |
| Rate for Payer: Adventist Health Commercial |
$499.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,609.36
|
| Rate for Payer: Cash Price |
$1,124.55
|
| Rate for Payer: Cash Price |
$1,124.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,691.82
|
| Rate for Payer: Heritage Provider Network Senior |
$1,691.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$452.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$624.75
|
| Rate for Payer: Multiplan Commercial |
$1,874.25
|
|
|
HC CT BONE L-SPINE W/WO CONTRAST
|
Facility
|
IP
|
$2,905.00
|
|
|
Service Code
|
CPT 72133
|
| Hospital Charge Code |
909201009
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$525.80 |
| Max. Negotiated Rate |
$2,178.75 |
| Rate for Payer: Adventist Health Commercial |
$581.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,870.82
|
| Rate for Payer: Cash Price |
$1,307.25
|
| Rate for Payer: Cash Price |
$1,307.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,966.68
|
| Rate for Payer: Heritage Provider Network Senior |
$1,966.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$525.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$726.25
|
| Rate for Payer: Multiplan Commercial |
$2,178.75
|
|
|
HC CT BONE L-SPINE W/WO CONTRAST
|
Facility
|
OP
|
$2,905.00
|
|
|
Service Code
|
CPT 72133
|
| Hospital Charge Code |
909201009
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$2,178.75 |
| Rate for Payer: Adventist Health Commercial |
$581.00
|
| Rate for Payer: Adventist Health Commercial |
$600.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,856.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,795.29
|
| 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 |
$1,502.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,453.08
|
| Rate for Payer: Blue Shield of California Commercial |
$1,860.19
|
| Rate for Payer: Blue Shield of California Commercial |
$1,860.19
|
| Rate for Payer: Blue Shield of California EPN |
$1,495.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,495.90
|
| Rate for Payer: Cash Price |
$1,351.80
|
| Rate for Payer: Cash Price |
$1,307.25
|
| Rate for Payer: Cash Price |
$1,307.25
|
| Rate for Payer: Cash Price |
$1,307.25
|
| Rate for Payer: Cash Price |
$1,307.25
|
| Rate for Payer: Cash Price |
$1,351.80
|
| Rate for Payer: Cash Price |
$1,351.80
|
| Rate for Payer: Cash Price |
$1,351.80
|
| 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 |
$1,432.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,385.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$543.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$525.80
|
| 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 |
$726.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$751.00
|
| 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 |
$2,178.75
|
| Rate for Payer: Multiplan Commercial |
$2,253.00
|
| 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 |
$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 BONE PELVIS W CONTRAST
|
Facility
|
OP
|
$2,213.00
|
|
|
Service Code
|
CPT 72193
|
| Hospital Charge Code |
909201931
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$1,659.75 |
| Rate for Payer: Adventist Health Commercial |
$442.60
|
| Rate for Payer: Adventist Health Commercial |
$552.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,706.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,367.63
|
| 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 |
$1,381.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,106.94
|
| 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 |
$1,242.45
|
| Rate for Payer: Cash Price |
$995.85
|
| Rate for Payer: Cash Price |
$995.85
|
| Rate for Payer: Cash Price |
$995.85
|
| Rate for Payer: Cash Price |
$995.85
|
| Rate for Payer: Cash Price |
$1,242.45
|
| Rate for Payer: Cash Price |
$1,242.45
|
| Rate for Payer: Cash Price |
$1,242.45
|
| 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 |
$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 |
$1,317.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,055.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$499.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$400.55
|
| 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 |
$553.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$690.25
|
| 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 |
$1,659.75
|
| Rate for Payer: Multiplan Commercial |
$2,070.75
|
| 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 |
$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 BONE PELVIS W CONTRAST
|
Facility
|
IP
|
$2,213.00
|
|
|
Service Code
|
CPT 72193
|
| Hospital Charge Code |
909201931
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$400.55 |
| Max. Negotiated Rate |
$1,659.75 |
| Rate for Payer: Adventist Health Commercial |
$442.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,425.17
|
| Rate for Payer: Cash Price |
$995.85
|
| Rate for Payer: Cash Price |
$995.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,498.20
|
| Rate for Payer: Heritage Provider Network Senior |
$1,498.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$400.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$553.25
|
| Rate for Payer: Multiplan Commercial |
$1,659.75
|
|
|
HC CT BONE PELVIS W/O CONTRAST
|
Facility
|
IP
|
$2,088.00
|
|
|
Service Code
|
CPT 72192
|
| Hospital Charge Code |
909201930
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$377.93 |
| Max. Negotiated Rate |
$1,566.00 |
| Rate for Payer: Adventist Health Commercial |
$417.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,344.67
|
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,413.58
|
| Rate for Payer: Heritage Provider Network Senior |
$1,413.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$377.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$522.00
|
| Rate for Payer: Multiplan Commercial |
$1,566.00
|
|
|
HC CT BONE PELVIS W/O CONTRAST
|
Facility
|
OP
|
$2,088.00
|
|
|
Service Code
|
CPT 72192
|
| Hospital Charge Code |
909201930
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$1,566.00 |
| Rate for Payer: Adventist Health Commercial |
$417.60
|
| Rate for Payer: Adventist Health Commercial |
$508.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,570.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,290.38
|
| 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 |
$1,271.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,044.42
|
| Rate for Payer: Blue Shield of California Commercial |
$1,242.62
|
| Rate for Payer: Blue Shield of California Commercial |
$1,242.62
|
| Rate for Payer: Blue Shield of California EPN |
$999.28
|
| Rate for Payer: Blue Shield of California EPN |
$999.28
|
| Rate for Payer: Cash Price |
$1,143.45
|
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Cash Price |
$1,143.45
|
| Rate for Payer: Cash Price |
$1,143.45
|
| Rate for Payer: Cash Price |
$1,143.45
|
| 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 |
$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 |
$1,212.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$995.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$459.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$377.93
|
| 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 |
$522.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$635.25
|
| 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 |
$1,566.00
|
| Rate for Payer: Multiplan Commercial |
$1,905.75
|
| 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 BONE PELVIS W/WO CONTRAST
|
Facility
|
OP
|
$2,480.00
|
|
|
Service Code
|
CPT 72194
|
| Hospital Charge Code |
909201932
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$1,860.00 |
| Rate for Payer: Adventist Health Commercial |
$496.00
|
| Rate for Payer: Adventist Health Commercial |
$603.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,865.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,532.64
|
| 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 |
$1,509.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,240.50
|
| 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 |
$1,358.10
|
| Rate for Payer: Cash Price |
$1,116.00
|
| Rate for Payer: Cash Price |
$1,116.00
|
| Rate for Payer: Cash Price |
$1,116.00
|
| Rate for Payer: Cash Price |
$1,116.00
|
| Rate for Payer: Cash Price |
$1,358.10
|
| Rate for Payer: Cash Price |
$1,358.10
|
| Rate for Payer: Cash Price |
$1,358.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: 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 |
$1,439.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,182.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$546.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$448.88
|
| 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 |
$620.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$754.50
|
| 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 |
$1,860.00
|
| Rate for Payer: Multiplan Commercial |
$2,263.50
|
| 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 |
$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 BONE PELVIS W/WO CONTRAST
|
Facility
|
IP
|
$2,480.00
|
|
|
Service Code
|
CPT 72194
|
| Hospital Charge Code |
909201932
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$448.88 |
| Max. Negotiated Rate |
$1,860.00 |
| Rate for Payer: Adventist Health Commercial |
$496.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,597.12
|
| Rate for Payer: Cash Price |
$1,116.00
|
| Rate for Payer: Cash Price |
$1,116.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,678.96
|
| Rate for Payer: Heritage Provider Network Senior |
$1,678.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$448.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$620.00
|
| Rate for Payer: Multiplan Commercial |
$1,860.00
|
|
|
HC CT CARDIAC SCORING
|
Facility
|
IP
|
$1,204.00
|
|
|
Service Code
|
CPT 75571
|
| Hospital Charge Code |
909201981
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$217.92 |
| Max. Negotiated Rate |
$903.00 |
| Rate for Payer: Adventist Health Commercial |
$240.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$775.38
|
| Rate for Payer: Cash Price |
$541.80
|
| Rate for Payer: Cash Price |
$541.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$815.11
|
| Rate for Payer: Heritage Provider Network Senior |
$815.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$217.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$301.00
|
| Rate for Payer: Multiplan Commercial |
$903.00
|
|
|
HC CT CARDIAC SCORING
|
Facility
|
OP
|
$1,204.00
|
|
|
Service Code
|
CPT 75571
|
| Hospital Charge Code |
909201981
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$73.02 |
| Max. Negotiated Rate |
$910.00 |
| Rate for Payer: Adventist Health Commercial |
$240.80
|
| Rate for Payer: Adventist Health Commercial |
$108.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$333.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$744.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$270.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$602.24
|
| Rate for Payer: Blue Shield of California Commercial |
$516.53
|
| Rate for Payer: Blue Shield of California Commercial |
$516.53
|
| Rate for Payer: Blue Shield of California EPN |
$415.37
|
| Rate for Payer: Blue Shield of California EPN |
$415.37
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cash Price |
$541.80
|
| Rate for Payer: Cash Price |
$541.80
|
| Rate for Payer: Cash Price |
$541.80
|
| Rate for Payer: Cash Price |
$541.80
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cash Price |
$243.00
|
| 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 |
$167.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| 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 |
$111.93
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.93
|
| 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 |
$111.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$257.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$574.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$97.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$217.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$301.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$903.00
|
| Rate for Payer: Multiplan Commercial |
$405.00
|
| 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 |
$73.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$73.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$73.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$73.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC CT CHEST W/O CONTRAST
|
Facility
|
OP
|
$2,248.00
|
|
|
Service Code
|
CPT 71250
|
| Hospital Charge Code |
909201912
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$1,686.00 |
| Rate for Payer: Adventist Health Commercial |
$449.60
|
| Rate for Payer: Adventist Health Commercial |
$464.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,433.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,389.26
|
| 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 |
$1,160.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,124.45
|
| Rate for Payer: Blue Shield of California Commercial |
$1,242.62
|
| Rate for Payer: Blue Shield of California Commercial |
$1,242.62
|
| Rate for Payer: Blue Shield of California EPN |
$999.28
|
| Rate for Payer: Blue Shield of California EPN |
$999.28
|
| Rate for Payer: Cash Price |
$1,044.00
|
| Rate for Payer: Cash Price |
$1,011.60
|
| Rate for Payer: Cash Price |
$1,011.60
|
| Rate for Payer: Cash Price |
$1,011.60
|
| Rate for Payer: Cash Price |
$1,011.60
|
| Rate for Payer: Cash Price |
$1,044.00
|
| Rate for Payer: Cash Price |
$1,044.00
|
| Rate for Payer: Cash Price |
$1,044.00
|
| 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 |
$1,106.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,072.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$419.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$406.89
|
| 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 |
$562.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$580.00
|
| 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 |
$1,686.00
|
| Rate for Payer: Multiplan Commercial |
$1,740.00
|
| 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 |
$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 CHEST W/O CONTRAST
|
Facility
|
IP
|
$2,320.00
|
|
|
Service Code
|
CPT 71250
|
| Hospital Charge Code |
909201912
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$419.92 |
| Max. Negotiated Rate |
$1,740.00 |
| Rate for Payer: Adventist Health Commercial |
$464.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,494.08
|
| Rate for Payer: Cash Price |
$1,044.00
|
| Rate for Payer: Cash Price |
$1,044.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,570.64
|
| Rate for Payer: Heritage Provider Network Senior |
$1,570.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$419.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$580.00
|
| Rate for Payer: Multiplan Commercial |
$1,740.00
|
|
|
HC CT CHEST W WO CONTRA
|
Facility
|
IP
|
$2,652.00
|
|
|
Service Code
|
CPT 71270
|
| Hospital Charge Code |
909201914
|
|
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 CHEST W WO CONTRA
|
Facility
|
OP
|
$2,652.00
|
|
|
Service Code
|
CPT 71270
|
| Hospital Charge Code |
909201914
|
|
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 |
$654.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,023.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,638.94
|
| 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 |
$1,637.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,326.53
|
| Rate for Payer: Blue Shield of California Commercial |
$1,860.19
|
| Rate for Payer: Blue Shield of California Commercial |
$1,860.19
|
| Rate for Payer: Blue Shield of California EPN |
$1,495.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,495.90
|
| Rate for Payer: Cash Price |
$1,473.30
|
| 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 |
$1,473.30
|
| Rate for Payer: Cash Price |
$1,473.30
|
| Rate for Payer: Cash Price |
$1,473.30
|
| 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 |
$1,561.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,265.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$592.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$480.01
|
| 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 |
$663.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$818.50
|
| 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 |
$1,989.00
|
| Rate for Payer: Multiplan Commercial |
$2,455.50
|
| 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 |
$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 COLONOGRAPHY SCREEN
|
Facility
|
OP
|
$1,172.00
|
|
|
Service Code
|
CPT 74263
|
| Hospital Charge Code |
909201813
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$212.13 |
| Max. Negotiated Rate |
$3,301.97 |
| Rate for Payer: Adventist Health Commercial |
$234.40
|
| Rate for Payer: Adventist Health Commercial |
$240.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$744.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$724.30
|
| 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 |
$602.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$586.23
|
| Rate for Payer: Blue Shield of California Commercial |
$3,301.97
|
| Rate for Payer: Blue Shield of California Commercial |
$3,301.97
|
| Rate for Payer: Blue Shield of California EPN |
$2,655.33
|
| Rate for Payer: Blue Shield of California EPN |
$2,655.33
|
| Rate for Payer: Cash Price |
$541.80
|
| Rate for Payer: Cash Price |
$527.40
|
| Rate for Payer: Cash Price |
$527.40
|
| Rate for Payer: Cash Price |
$527.40
|
| Rate for Payer: Cash Price |
$527.40
|
| Rate for Payer: Cash Price |
$541.80
|
| Rate for Payer: Cash Price |
$541.80
|
| Rate for Payer: Cash Price |
$541.80
|
| 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 |
$574.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$559.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$217.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$212.13
|
| 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 |
$293.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$301.00
|
| 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 |
$879.00
|
| Rate for Payer: Multiplan Commercial |
$903.00
|
| 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 |
$1,113.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,113.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,113.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,113.17
|
| 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
|
|
