|
HC CT COLONOGRAPHY SCREEN
|
Facility
|
IP
|
$1,204.00
|
|
|
Service Code
|
CPT 74263
|
| Hospital Charge Code |
909201813
|
|
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 COLONOGRAPHY W/CONTRAST
|
Facility
|
OP
|
$3,484.00
|
|
|
Service Code
|
CPT 74262
|
| Hospital Charge Code |
909202000
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$3,124.22 |
| Rate for Payer: Adventist Health Commercial |
$696.80
|
| Rate for Payer: Adventist Health Commercial |
$1,122.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,468.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,153.11
|
| 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 |
$2,807.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,742.70
|
| Rate for Payer: Blue Shield of California Commercial |
$3,124.22
|
| Rate for Payer: Blue Shield of California Commercial |
$3,124.22
|
| Rate for Payer: Blue Shield of California EPN |
$2,512.40
|
| Rate for Payer: Blue Shield of California EPN |
$2,512.40
|
| Rate for Payer: Cash Price |
$2,525.85
|
| Rate for Payer: Cash Price |
$1,567.80
|
| Rate for Payer: Cash Price |
$1,567.80
|
| Rate for Payer: Cash Price |
$1,567.80
|
| Rate for Payer: Cash Price |
$1,567.80
|
| Rate for Payer: Cash Price |
$2,525.85
|
| Rate for Payer: Cash Price |
$2,525.85
|
| Rate for Payer: Cash Price |
$2,525.85
|
| 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 |
$2,677.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,661.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,015.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$630.60
|
| 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 |
$871.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,403.25
|
| 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 |
$2,613.00
|
| Rate for Payer: Multiplan Commercial |
$4,209.75
|
| 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 COLONOGRAPHY W/CONTRAST
|
Facility
|
IP
|
$5,613.00
|
|
|
Service Code
|
CPT 74262
|
| Hospital Charge Code |
909202000
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$711.00 |
| Max. Negotiated Rate |
$4,209.75 |
| Rate for Payer: Adventist Health Commercial |
$1,122.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,614.77
|
| Rate for Payer: Cash Price |
$2,525.85
|
| Rate for Payer: Cash Price |
$2,525.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,800.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,800.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,015.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,403.25
|
| Rate for Payer: Multiplan Commercial |
$4,209.75
|
|
|
HC CT COLONOGRAPHY W/O CONTRAST
|
Facility
|
OP
|
$1,204.00
|
|
|
Service Code
|
CPT 74261
|
| Hospital Charge Code |
909201811
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$2,778.82 |
| Rate for Payer: Adventist Health Commercial |
$240.80
|
| Rate for Payer: Adventist Health Commercial |
$630.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$744.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,947.32
|
| 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 |
$602.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,576.13
|
| Rate for Payer: Blue Shield of California Commercial |
$2,778.82
|
| Rate for Payer: Blue Shield of California Commercial |
$2,778.82
|
| Rate for Payer: Blue Shield of California EPN |
$2,234.63
|
| Rate for Payer: Blue Shield of California EPN |
$2,234.63
|
| Rate for Payer: Cash Price |
$541.80
|
| Rate for Payer: Cash Price |
$1,417.95
|
| 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 |
$1,417.95
|
| Rate for Payer: Cash Price |
$1,417.95
|
| Rate for Payer: Cash Price |
$1,417.95
|
| 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 |
$574.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,503.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$570.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$217.92
|
| 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 |
$787.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$301.00
|
| 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 |
$903.00
|
| Rate for Payer: Multiplan Commercial |
$2,363.25
|
| 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 |
$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 COLONOGRAPHY W/O CONTRAST
|
Facility
|
IP
|
$1,204.00
|
|
|
Service Code
|
CPT 74261
|
| Hospital Charge Code |
909201811
|
|
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 CPA W CON W CT CTA OF SAME ANTMY
|
Facility
|
IP
|
$2,673.00
|
|
|
Service Code
|
CPT 70472
|
| Hospital Charge Code |
909201821
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$483.81 |
| Max. Negotiated Rate |
$2,004.75 |
| Rate for Payer: Adventist Health Commercial |
$534.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,721.41
|
| Rate for Payer: Cash Price |
$1,202.85
|
| Rate for Payer: Cash Price |
$1,202.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,809.62
|
| Rate for Payer: Heritage Provider Network Senior |
$1,809.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$483.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$668.25
|
| Rate for Payer: Multiplan Commercial |
$2,004.75
|
|
|
HC CT CPA W CON W CT CTA OF SAME ANTMY
|
Facility
|
OP
|
$2,673.00
|
|
|
Service Code
|
CPT 70472
|
| Hospital Charge Code |
909201821
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$2,272.05 |
| Rate for Payer: Adventist Health Commercial |
$534.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,651.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,272.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,470.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,004.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,337.03
|
| Rate for Payer: Blue Shield of California Commercial |
$1,630.53
|
| Rate for Payer: Blue Shield of California EPN |
$1,304.42
|
| Rate for Payer: Cash Price |
$1,202.85
|
| Rate for Payer: Cash Price |
$1,202.85
|
| Rate for Payer: Cash Price |
$1,202.85
|
| Rate for Payer: Cash Price |
$1,202.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,272.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,272.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,272.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,275.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$483.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$668.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,871.10
|
| Rate for Payer: Multiplan Commercial |
$2,004.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,336.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,336.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,272.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,272.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,272.05
|
|
|
HC CT CPA W CON WO CT CTA OF SAME ANTMY
|
Facility
|
OP
|
$567.00
|
|
|
Service Code
|
CPT 70473
|
| Hospital Charge Code |
909201822
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$102.63 |
| Max. Negotiated Rate |
$910.00 |
| Rate for Payer: Adventist Health Commercial |
$113.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$350.41
|
| 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 Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$283.61
|
| Rate for Payer: Blue Shield of California Commercial |
$345.87
|
| Rate for Payer: Blue Shield of California EPN |
$276.70
|
| Rate for Payer: Cash Price |
$255.15
|
| Rate for Payer: Cash Price |
$255.15
|
| Rate for Payer: Cash Price |
$255.15
|
| Rate for Payer: Cash Price |
$255.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$225.59
|
| 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 |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$270.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$102.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$259.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$425.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$283.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$283.50
|
| 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 Senior |
$225.59
|
|
|
HC CT CPA W CON WO CT CTA OF SAME ANTMY
|
Facility
|
IP
|
$567.00
|
|
|
Service Code
|
CPT 70473
|
| Hospital Charge Code |
909201822
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$102.63 |
| Max. Negotiated Rate |
$711.00 |
| Rate for Payer: Adventist Health Commercial |
$113.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$365.15
|
| Rate for Payer: Cash Price |
$255.15
|
| Rate for Payer: Cash Price |
$255.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$383.86
|
| Rate for Payer: Heritage Provider Network Senior |
$383.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$102.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.75
|
| Rate for Payer: Multiplan Commercial |
$425.25
|
|
|
HC CT CSPINE WITH CONTRAST
|
Facility
|
OP
|
$2,889.00
|
|
|
Service Code
|
CPT 72126
|
| Hospital Charge Code |
909201916
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$2,166.75 |
| Rate for Payer: Adventist Health Commercial |
$577.80
|
| Rate for Payer: Adventist Health Commercial |
$703.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,172.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,785.40
|
| 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 |
$1,758.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,445.08
|
| 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 |
$1,582.20
|
| Rate for Payer: Cash Price |
$1,300.05
|
| Rate for Payer: Cash Price |
$1,300.05
|
| Rate for Payer: Cash Price |
$1,300.05
|
| Rate for Payer: Cash Price |
$1,300.05
|
| Rate for Payer: Cash Price |
$1,582.20
|
| Rate for Payer: Cash Price |
$1,582.20
|
| Rate for Payer: Cash Price |
$1,582.20
|
| 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 |
$1,677.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,378.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$636.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$522.91
|
| 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 |
$722.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$879.00
|
| 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 |
$2,166.75
|
| Rate for Payer: Multiplan Commercial |
$2,637.00
|
| 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 CSPINE WITH CONTRAST
|
Facility
|
IP
|
$3,516.00
|
|
|
Service Code
|
CPT 72126
|
| Hospital Charge Code |
909201916
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$636.40 |
| Max. Negotiated Rate |
$2,637.00 |
| Rate for Payer: Adventist Health Commercial |
$703.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,264.30
|
| Rate for Payer: Cash Price |
$1,582.20
|
| Rate for Payer: Cash Price |
$1,582.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,380.33
|
| Rate for Payer: Heritage Provider Network Senior |
$2,380.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$636.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$879.00
|
| Rate for Payer: Multiplan Commercial |
$2,637.00
|
|
|
HC CT CSPINE WO CONTRAST
|
Facility
|
IP
|
$3,296.00
|
|
|
Service Code
|
CPT 72125
|
| Hospital Charge Code |
909201915
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$596.58 |
| Max. Negotiated Rate |
$2,472.00 |
| Rate for Payer: Adventist Health Commercial |
$659.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,122.62
|
| Rate for Payer: Cash Price |
$1,483.20
|
| Rate for Payer: Cash Price |
$1,483.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,231.39
|
| Rate for Payer: Heritage Provider Network Senior |
$2,231.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$596.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$824.00
|
| Rate for Payer: Multiplan Commercial |
$2,472.00
|
|
|
HC CT CSPINE WO CONTRAST
|
Facility
|
OP
|
$2,684.00
|
|
|
Service Code
|
CPT 72125
|
| Hospital Charge Code |
909201915
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$2,013.00 |
| Rate for Payer: Adventist Health Commercial |
$536.80
|
| Rate for Payer: Adventist Health Commercial |
$659.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,036.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,658.71
|
| 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 |
$1,648.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,342.54
|
| 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 |
$1,483.20
|
| Rate for Payer: Cash Price |
$1,207.80
|
| Rate for Payer: Cash Price |
$1,207.80
|
| Rate for Payer: Cash Price |
$1,207.80
|
| Rate for Payer: Cash Price |
$1,207.80
|
| Rate for Payer: Cash Price |
$1,483.20
|
| Rate for Payer: Cash Price |
$1,483.20
|
| Rate for Payer: Cash Price |
$1,483.20
|
| 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 |
$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 |
$1,572.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,280.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$596.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$485.80
|
| 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 |
$671.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$824.00
|
| 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 |
$2,013.00
|
| Rate for Payer: Multiplan Commercial |
$2,472.00
|
| 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 C SPINE W/WO CONTRAST
|
Facility
|
IP
|
$3,624.00
|
|
|
Service Code
|
CPT 72127
|
| Hospital Charge Code |
909201967
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$655.94 |
| Max. Negotiated Rate |
$2,718.00 |
| Rate for Payer: Adventist Health Commercial |
$724.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,333.86
|
| Rate for Payer: Cash Price |
$1,630.80
|
| Rate for Payer: Cash Price |
$1,630.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,453.45
|
| Rate for Payer: Heritage Provider Network Senior |
$2,453.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$655.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$906.00
|
| Rate for Payer: Multiplan Commercial |
$2,718.00
|
|
|
HC CT C SPINE W/WO CONTRAST
|
Facility
|
OP
|
$3,018.00
|
|
|
Service Code
|
CPT 72127
|
| Hospital Charge Code |
909201967
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$2,263.50 |
| Rate for Payer: Adventist Health Commercial |
$603.60
|
| Rate for Payer: Adventist Health Commercial |
$724.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,239.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,865.12
|
| 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 |
$1,812.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,509.60
|
| 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 |
$1,630.80
|
| Rate for Payer: Cash Price |
$1,358.10
|
| Rate for Payer: Cash Price |
$1,358.10
|
| Rate for Payer: Cash Price |
$1,358.10
|
| Rate for Payer: Cash Price |
$1,358.10
|
| Rate for Payer: Cash Price |
$1,630.80
|
| Rate for Payer: Cash Price |
$1,630.80
|
| Rate for Payer: Cash Price |
$1,630.80
|
| 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 |
$1,728.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,439.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$655.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$546.26
|
| 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 |
$754.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$906.00
|
| 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 |
$2,263.50
|
| Rate for Payer: Multiplan Commercial |
$2,718.00
|
| 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 GUID ABCESS DRAIN
|
Facility
|
IP
|
$1,995.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
909201944
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$361.10 |
| Max. Negotiated Rate |
$1,496.25 |
| Rate for Payer: Adventist Health Commercial |
$399.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,284.78
|
| Rate for Payer: Cash Price |
$897.75
|
| Rate for Payer: Cash Price |
$897.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,350.62
|
| Rate for Payer: Heritage Provider Network Senior |
$1,350.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$361.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$498.75
|
| Rate for Payer: Multiplan Commercial |
$1,496.25
|
|
|
HC CT GUID ABCESS DRAIN
|
Facility
|
OP
|
$1,995.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
909201944
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$1,695.75 |
| Rate for Payer: Adventist Health Commercial |
$399.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,232.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,695.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,097.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,496.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$997.90
|
| Rate for Payer: Blue Shield of California Commercial |
$664.90
|
| Rate for Payer: Blue Shield of California EPN |
$534.69
|
| Rate for Payer: Cash Price |
$897.75
|
| Rate for Payer: Cash Price |
$897.75
|
| Rate for Payer: Cash Price |
$897.75
|
| Rate for Payer: Cash Price |
$897.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,695.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,695.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,695.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$951.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$361.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$498.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,396.50
|
| Rate for Payer: Multiplan Commercial |
$1,496.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$997.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$997.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,695.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,695.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,695.75
|
|
|
HC CT GUIDANCE/NEEDLE PLACEMENT
|
Facility
|
IP
|
$1,930.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
909201935
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$349.33 |
| Max. Negotiated Rate |
$1,447.50 |
| Rate for Payer: Adventist Health Commercial |
$386.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,242.92
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,306.61
|
| Rate for Payer: Heritage Provider Network Senior |
$1,306.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$349.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$482.50
|
| Rate for Payer: Multiplan Commercial |
$1,447.50
|
|
|
HC CT GUIDANCE/NEEDLE PLACEMENT
|
Facility
|
OP
|
$1,930.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
909201935
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$1,640.50 |
| Rate for Payer: Adventist Health Commercial |
$386.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,192.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,640.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,061.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,447.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$965.39
|
| Rate for Payer: Blue Shield of California Commercial |
$426.34
|
| Rate for Payer: Blue Shield of California EPN |
$342.85
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,640.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,640.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,640.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$920.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$349.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$482.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,351.00
|
| Rate for Payer: Multiplan Commercial |
$1,447.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$965.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$965.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,640.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,640.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,640.50
|
|
|
HC CT GUIDNC VISCERAL TISS ABLATN
|
Facility
|
OP
|
$6,737.00
|
|
|
Service Code
|
CPT 77013
|
| Hospital Charge Code |
909201810
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$5,726.45 |
| Rate for Payer: Adventist Health Commercial |
$1,347.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,163.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,726.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,705.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,052.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,369.85
|
| Rate for Payer: Blue Shield of California Commercial |
$4,109.57
|
| Rate for Payer: Blue Shield of California EPN |
$3,287.66
|
| Rate for Payer: Cash Price |
$3,031.65
|
| Rate for Payer: Cash Price |
$3,031.65
|
| Rate for Payer: Cash Price |
$3,031.65
|
| Rate for Payer: Cash Price |
$3,031.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,726.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,726.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,726.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,213.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,219.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,684.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,715.90
|
| Rate for Payer: Multiplan Commercial |
$5,052.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,368.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,368.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,726.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,726.45
|
| Rate for Payer: Vantage Medical Group Senior |
$5,726.45
|
|
|
HC CT GUID RAD THERAPY
|
Facility
|
IP
|
$1,710.00
|
|
|
Service Code
|
CPT 77387
|
| Hospital Charge Code |
909100165
|
|
Hospital Revenue Code
|
359
|
| Min. Negotiated Rate |
$309.51 |
| Max. Negotiated Rate |
$1,282.50 |
| Rate for Payer: Adventist Health Commercial |
$342.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,101.24
|
| Rate for Payer: Cash Price |
$769.50
|
| Rate for Payer: Cash Price |
$769.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,157.67
|
| Rate for Payer: Heritage Provider Network Senior |
$1,157.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$309.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$427.50
|
| Rate for Payer: Multiplan Commercial |
$1,282.50
|
|
|
HC CT GUID RAD THERAPY
|
Facility
|
OP
|
$1,391.00
|
|
|
Service Code
|
CPT 77387
|
| Hospital Charge Code |
909100165
|
|
Hospital Revenue Code
|
359
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$1,182.35 |
| Rate for Payer: Adventist Health Commercial |
$278.20
|
| Rate for Payer: Adventist Health Commercial |
$342.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$859.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,056.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,453.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,182.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$765.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$940.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,282.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,043.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$452.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$452.95
|
| Rate for Payer: Blue Shield of California Commercial |
$1,043.10
|
| Rate for Payer: Blue Shield of California Commercial |
$848.51
|
| Rate for Payer: Blue Shield of California EPN |
$834.48
|
| Rate for Payer: Blue Shield of California EPN |
$678.81
|
| Rate for Payer: Cash Price |
$625.95
|
| Rate for Payer: Cash Price |
$769.50
|
| Rate for Payer: Cash Price |
$769.50
|
| Rate for Payer: Cash Price |
$769.50
|
| Rate for Payer: Cash Price |
$625.95
|
| Rate for Payer: Cash Price |
$769.50
|
| Rate for Payer: Cash Price |
$625.95
|
| Rate for Payer: Cash Price |
$625.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,453.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,182.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,453.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,182.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,453.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,182.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| 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: Kaiser Foundation Hospitals Commercial |
$815.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$663.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$251.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$309.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$347.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$427.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$973.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,197.00
|
| Rate for Payer: Multiplan Commercial |
$1,282.50
|
| Rate for Payer: Multiplan Commercial |
$1,043.25
|
| 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 |
$695.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$855.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$695.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$855.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,182.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,453.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,182.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,453.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,453.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,182.35
|
|
|
HC CT HEAD NO CONTRAST
|
Facility
|
IP
|
$2,644.00
|
|
|
Service Code
|
CPT 70450
|
| Hospital Charge Code |
909201901
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$478.56 |
| Max. Negotiated Rate |
$1,983.00 |
| Rate for Payer: Adventist Health Commercial |
$528.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,702.74
|
| Rate for Payer: Cash Price |
$1,189.80
|
| Rate for Payer: Cash Price |
$1,189.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,789.99
|
| Rate for Payer: Heritage Provider Network Senior |
$1,789.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$478.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$661.00
|
| Rate for Payer: Multiplan Commercial |
$1,983.00
|
|
|
HC CT HEAD NO CONTRAST
|
Facility
|
OP
|
$2,644.00
|
|
|
Service Code
|
CPT 70450
|
| Hospital Charge Code |
909201901
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$1,983.00 |
| Rate for Payer: Adventist Health Commercial |
$528.80
|
| Rate for Payer: Adventist Health Commercial |
$531.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,641.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,633.99
|
| 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 |
$1,328.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,322.53
|
| Rate for Payer: Blue Shield of California Commercial |
$993.60
|
| Rate for Payer: Blue Shield of California Commercial |
$993.60
|
| Rate for Payer: Blue Shield of California EPN |
$799.02
|
| Rate for Payer: Blue Shield of California EPN |
$799.02
|
| Rate for Payer: Cash Price |
$1,195.20
|
| Rate for Payer: Cash Price |
$1,189.80
|
| Rate for Payer: Cash Price |
$1,189.80
|
| Rate for Payer: Cash Price |
$1,189.80
|
| Rate for Payer: Cash Price |
$1,189.80
|
| Rate for Payer: Cash Price |
$1,195.20
|
| Rate for Payer: Cash Price |
$1,195.20
|
| Rate for Payer: Cash Price |
$1,195.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: 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 |
$1,266.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,261.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$480.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$478.56
|
| 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 |
$661.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$664.00
|
| 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 |
$1,983.00
|
| Rate for Payer: Multiplan Commercial |
$1,992.00
|
| 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 HEAD W CONTRAST
|
Facility
|
IP
|
$2,743.00
|
|
|
Service Code
|
CPT 70460
|
| Hospital Charge Code |
909201900
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$496.48 |
| Max. Negotiated Rate |
$2,057.25 |
| Rate for Payer: Adventist Health Commercial |
$548.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,766.49
|
| Rate for Payer: Cash Price |
$1,234.35
|
| Rate for Payer: Cash Price |
$1,234.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,857.01
|
| Rate for Payer: Heritage Provider Network Senior |
$1,857.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$496.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$685.75
|
| Rate for Payer: Multiplan Commercial |
$2,057.25
|
|
