|
HC CT HEAD W CONTRAST
|
Facility
|
OP
|
$2,743.00
|
|
|
Service Code
|
CPT 70460
|
| Hospital Charge Code |
909201900
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$2,057.25 |
| Rate for Payer: Adventist Health Commercial |
$548.60
|
| Rate for Payer: Adventist Health Commercial |
$592.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,831.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,695.17
|
| 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 |
$1,482.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,372.05
|
| Rate for Payer: Blue Shield of California Commercial |
$1,188.67
|
| Rate for Payer: Blue Shield of California Commercial |
$1,188.67
|
| Rate for Payer: Blue Shield of California EPN |
$955.89
|
| Rate for Payer: Blue Shield of California EPN |
$955.89
|
| Rate for Payer: Cash Price |
$1,333.80
|
| Rate for Payer: Cash Price |
$1,234.35
|
| Rate for Payer: Cash Price |
$1,234.35
|
| Rate for Payer: Cash Price |
$1,234.35
|
| Rate for Payer: Cash Price |
$1,234.35
|
| Rate for Payer: Cash Price |
$1,333.80
|
| Rate for Payer: Cash Price |
$1,333.80
|
| Rate for Payer: Cash Price |
$1,333.80
|
| 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 |
$1,413.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,308.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$536.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$496.48
|
| 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 |
$685.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$741.00
|
| 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 |
$2,057.25
|
| Rate for Payer: Multiplan Commercial |
$2,223.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Senior |
$225.00
|
| Rate for Payer: TriValley Medical Group Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$480.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$480.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$480.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$480.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
|
HC CT HEAD W/WO CONTRAS
|
Facility
|
OP
|
$3,065.00
|
|
|
Service Code
|
CPT 70470
|
| Hospital Charge Code |
909201902
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$2,298.75 |
| Rate for Payer: Adventist Health Commercial |
$613.00
|
| Rate for Payer: Adventist Health Commercial |
$663.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,051.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,894.17
|
| 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 |
$1,660.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,533.11
|
| 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 |
$1,493.55
|
| Rate for Payer: Cash Price |
$1,379.25
|
| Rate for Payer: Cash Price |
$1,379.25
|
| Rate for Payer: Cash Price |
$1,379.25
|
| Rate for Payer: Cash Price |
$1,379.25
|
| Rate for Payer: Cash Price |
$1,493.55
|
| Rate for Payer: Cash Price |
$1,493.55
|
| Rate for Payer: Cash Price |
$1,493.55
|
| 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 |
$1,583.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,462.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$600.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$554.76
|
| 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 |
$766.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$829.75
|
| 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 |
$2,298.75
|
| Rate for Payer: Multiplan Commercial |
$2,489.25
|
| 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 |
$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 HEAD W/WO CONTRAS
|
Facility
|
IP
|
$3,065.00
|
|
|
Service Code
|
CPT 70470
|
| Hospital Charge Code |
909201902
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$554.76 |
| Max. Negotiated Rate |
$2,298.75 |
| Rate for Payer: Adventist Health Commercial |
$613.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,973.86
|
| Rate for Payer: Cash Price |
$1,379.25
|
| Rate for Payer: Cash Price |
$1,379.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,075.01
|
| Rate for Payer: Heritage Provider Network Senior |
$2,075.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$554.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$766.25
|
| Rate for Payer: Multiplan Commercial |
$2,298.75
|
|
|
HC CTLSO W/INTERFACE MINERVA
|
Facility
|
OP
|
$5,769.00
|
|
|
Service Code
|
CPT L0710
|
| Hospital Charge Code |
905350710
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,442.25 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$2,365.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,565.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,903.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,172.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,326.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,319.14
|
| Rate for Payer: Blue Shield of California EPN |
$2,319.14
|
| Rate for Payer: Cash Price |
$2,596.05
|
| Rate for Payer: Cash Price |
$2,596.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,653.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,903.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,903.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,903.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,692.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,671.05
|
| Rate for Payer: Heritage Provider Network Senior |
$2,671.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,884.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,884.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,884.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,442.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,038.30
|
| Rate for Payer: Multiplan Commercial |
$4,326.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,084.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,910.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,903.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,903.65
|
| Rate for Payer: Vantage Medical Group Senior |
$4,903.65
|
|
|
HC CTLSO W/INTERFACE MINERVA
|
Facility
|
IP
|
$5,769.00
|
|
|
Service Code
|
CPT L0710
|
| Hospital Charge Code |
905350710
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,153.80 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$1,153.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,715.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,319.14
|
| Rate for Payer: Blue Shield of California EPN |
$2,319.14
|
| Rate for Payer: Cash Price |
$2,596.05
|
| Rate for Payer: Cash Price |
$2,596.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,653.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,115.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,671.05
|
| Rate for Payer: Heritage Provider Network Senior |
$2,671.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,884.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,884.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,884.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,442.25
|
| Rate for Payer: Multiplan Commercial |
$4,326.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,084.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,910.12
|
|
|
HC CT MAXILLOFACIAL W/WO CONTRAST
|
Facility
|
OP
|
$2,625.00
|
|
|
Service Code
|
CPT 70488
|
| Hospital Charge Code |
909201950
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$1,968.75 |
| Rate for Payer: Adventist Health Commercial |
$525.00
|
| Rate for Payer: Adventist Health Commercial |
$672.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,078.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,622.25
|
| 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 |
$1,682.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,313.03
|
| 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 |
$1,513.35
|
| Rate for Payer: Cash Price |
$1,181.25
|
| Rate for Payer: Cash Price |
$1,181.25
|
| Rate for Payer: Cash Price |
$1,181.25
|
| Rate for Payer: Cash Price |
$1,181.25
|
| Rate for Payer: Cash Price |
$1,513.35
|
| Rate for Payer: Cash Price |
$1,513.35
|
| Rate for Payer: Cash Price |
$1,513.35
|
| 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 |
$1,604.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,252.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$608.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$475.12
|
| 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 |
$656.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$840.75
|
| 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 |
$1,968.75
|
| Rate for Payer: Multiplan Commercial |
$2,522.25
|
| 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 |
$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 MAXILLOFACIAL W/WO CONTRAST
|
Facility
|
IP
|
$2,625.00
|
|
|
Service Code
|
CPT 70488
|
| Hospital Charge Code |
909201950
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$475.12 |
| Max. Negotiated Rate |
$1,968.75 |
| Rate for Payer: Adventist Health Commercial |
$525.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,690.50
|
| Rate for Payer: Cash Price |
$1,181.25
|
| Rate for Payer: Cash Price |
$1,181.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,777.12
|
| Rate for Payer: Heritage Provider Network Senior |
$1,777.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$475.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$656.25
|
| Rate for Payer: Multiplan Commercial |
$1,968.75
|
|
|
HC CT MAXILLOFAC W CONT
|
Facility
|
IP
|
$2,526.00
|
|
|
Service Code
|
CPT 70487
|
| Hospital Charge Code |
909201907
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$457.21 |
| Max. Negotiated Rate |
$1,894.50 |
| Rate for Payer: Adventist Health Commercial |
$505.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,626.74
|
| Rate for Payer: Cash Price |
$1,136.70
|
| Rate for Payer: Cash Price |
$1,136.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,710.10
|
| Rate for Payer: Heritage Provider Network Senior |
$1,710.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$457.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$631.50
|
| Rate for Payer: Multiplan Commercial |
$1,894.50
|
|
|
HC CT MAXILLOFAC W CONT
|
Facility
|
OP
|
$2,433.00
|
|
|
Service Code
|
CPT 70487
|
| Hospital Charge Code |
909201907
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$1,824.75 |
| Rate for Payer: Adventist Health Commercial |
$486.60
|
| Rate for Payer: Adventist Health Commercial |
$505.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,561.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,503.59
|
| 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 |
$1,263.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,216.99
|
| Rate for Payer: Blue Shield of California Commercial |
$1,188.67
|
| Rate for Payer: Blue Shield of California Commercial |
$1,188.67
|
| Rate for Payer: Blue Shield of California EPN |
$955.89
|
| Rate for Payer: Blue Shield of California EPN |
$955.89
|
| Rate for Payer: Cash Price |
$1,136.70
|
| Rate for Payer: Cash Price |
$1,094.85
|
| Rate for Payer: Cash Price |
$1,094.85
|
| Rate for Payer: Cash Price |
$1,094.85
|
| Rate for Payer: Cash Price |
$1,094.85
|
| Rate for Payer: Cash Price |
$1,136.70
|
| Rate for Payer: Cash Price |
$1,136.70
|
| Rate for Payer: Cash Price |
$1,136.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$1,204.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,160.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$457.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$440.37
|
| 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 |
$608.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$631.50
|
| 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 |
$1,824.75
|
| Rate for Payer: Multiplan Commercial |
$1,894.50
|
| 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 |
$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 MAXILLOFAC W/O CO
|
Facility
|
IP
|
$2,140.00
|
|
|
Service Code
|
CPT 70486
|
| Hospital Charge Code |
909201906
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$387.34 |
| Max. Negotiated Rate |
$1,605.00 |
| Rate for Payer: Adventist Health Commercial |
$428.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,378.16
|
| Rate for Payer: Cash Price |
$963.00
|
| Rate for Payer: Cash Price |
$963.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,448.78
|
| Rate for Payer: Heritage Provider Network Senior |
$1,448.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$387.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$535.00
|
| Rate for Payer: Multiplan Commercial |
$1,605.00
|
|
|
HC CT MAXILLOFAC W/O CO
|
Facility
|
OP
|
$2,124.00
|
|
|
Service Code
|
CPT 70486
|
| Hospital Charge Code |
909201906
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$1,593.00 |
| Rate for Payer: Adventist Health Commercial |
$424.80
|
| Rate for Payer: Adventist Health Commercial |
$428.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,322.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,312.63
|
| 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 |
$1,070.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,062.42
|
| 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 |
$963.00
|
| Rate for Payer: Cash Price |
$955.80
|
| Rate for Payer: Cash Price |
$955.80
|
| Rate for Payer: Cash Price |
$955.80
|
| Rate for Payer: Cash Price |
$955.80
|
| Rate for Payer: Cash Price |
$963.00
|
| Rate for Payer: Cash Price |
$963.00
|
| Rate for Payer: Cash Price |
$963.00
|
| 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 |
$1,020.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,013.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$387.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$384.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$531.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$535.00
|
| 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 |
$1,593.00
|
| Rate for Payer: Multiplan Commercial |
$1,605.00
|
| 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 PERFUSION W/CONTRAST, CBF
|
Facility
|
OP
|
$2,701.00
|
|
|
Service Code
|
CPT 0042T
|
| Hospital Charge Code |
909201812
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$2,295.85 |
| Rate for Payer: Adventist Health Commercial |
$540.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,669.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,295.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,485.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,351.04
|
| Rate for Payer: Blue Shield of California Commercial |
$1,647.61
|
| Rate for Payer: Blue Shield of California EPN |
$1,318.09
|
| Rate for Payer: Cash Price |
$1,215.45
|
| Rate for Payer: Cash Price |
$1,215.45
|
| Rate for Payer: Cash Price |
$1,215.45
|
| Rate for Payer: Cash Price |
$1,215.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,295.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,295.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,295.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,288.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$488.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$675.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,890.70
|
| Rate for Payer: Multiplan Commercial |
$2,025.75
|
| 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 |
$1,350.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,350.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,295.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,295.85
|
| Rate for Payer: Vantage Medical Group Senior |
$2,295.85
|
|
|
HC CT PERFUSION W/CONTRAST, CBF
|
Facility
|
IP
|
$2,701.00
|
|
|
Service Code
|
CPT 0042T
|
| Hospital Charge Code |
909201812
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$488.88 |
| Max. Negotiated Rate |
$2,025.75 |
| Rate for Payer: Adventist Health Commercial |
$540.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,739.44
|
| Rate for Payer: Cash Price |
$1,215.45
|
| Rate for Payer: Cash Price |
$1,215.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,828.58
|
| Rate for Payer: Heritage Provider Network Senior |
$1,828.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$488.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$675.25
|
| Rate for Payer: Multiplan Commercial |
$2,025.75
|
|
|
HC CT RECONSTRUCTION FOR TRANSPLT
|
Facility
|
OP
|
$2,596.00
|
|
| Hospital Charge Code |
909201983
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$2,206.60 |
| Rate for Payer: Adventist Health Commercial |
$519.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,604.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,206.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,427.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,947.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,298.52
|
| Rate for Payer: Blue Shield of California Commercial |
$1,583.56
|
| Rate for Payer: Blue Shield of California EPN |
$1,266.85
|
| Rate for Payer: Cash Price |
$1,168.20
|
| Rate for Payer: Cash Price |
$1,168.20
|
| Rate for Payer: Cash Price |
$1,168.20
|
| Rate for Payer: Cash Price |
$1,168.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,206.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,206.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,206.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,238.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$469.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$649.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,817.20
|
| Rate for Payer: Multiplan Commercial |
$1,947.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,298.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,206.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,206.60
|
| Rate for Payer: Vantage Medical Group Senior |
$2,206.60
|
|
|
HC CT RECONSTRUCTION FOR TRANSPLT
|
Facility
|
IP
|
$2,596.00
|
|
| Hospital Charge Code |
909201983
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$469.88 |
| Max. Negotiated Rate |
$1,947.00 |
| Rate for Payer: Adventist Health Commercial |
$519.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,671.82
|
| Rate for Payer: Cash Price |
$1,168.20
|
| Rate for Payer: Cash Price |
$1,168.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,757.49
|
| Rate for Payer: Heritage Provider Network Senior |
$1,757.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$469.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$649.00
|
| Rate for Payer: Multiplan Commercial |
$1,947.00
|
|
|
HC CT SOFT TIS NCK W CONTR
|
Facility
|
IP
|
$2,705.00
|
|
|
Service Code
|
CPT 70491
|
| Hospital Charge Code |
909201910
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$489.61 |
| Max. Negotiated Rate |
$2,028.75 |
| Rate for Payer: Adventist Health Commercial |
$541.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,742.02
|
| Rate for Payer: Cash Price |
$1,217.25
|
| Rate for Payer: Cash Price |
$1,217.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,831.29
|
| Rate for Payer: Heritage Provider Network Senior |
$1,831.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$489.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$676.25
|
| Rate for Payer: Multiplan Commercial |
$2,028.75
|
|
|
HC CT SOFT TIS NCK W CONTR
|
Facility
|
OP
|
$2,705.00
|
|
|
Service Code
|
CPT 70491
|
| Hospital Charge Code |
909201910
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$2,028.75 |
| Rate for Payer: Adventist Health Commercial |
$541.00
|
| Rate for Payer: Adventist Health Commercial |
$548.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,693.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,671.69
|
| 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 |
$1,370.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,353.04
|
| Rate for Payer: Blue Shield of California Commercial |
$1,188.67
|
| Rate for Payer: Blue Shield of California Commercial |
$1,188.67
|
| Rate for Payer: Blue Shield of California EPN |
$955.89
|
| Rate for Payer: Blue Shield of California EPN |
$955.89
|
| Rate for Payer: Cash Price |
$1,233.00
|
| Rate for Payer: Cash Price |
$1,217.25
|
| Rate for Payer: Cash Price |
$1,217.25
|
| Rate for Payer: Cash Price |
$1,217.25
|
| Rate for Payer: Cash Price |
$1,217.25
|
| Rate for Payer: Cash Price |
$1,233.00
|
| Rate for Payer: Cash Price |
$1,233.00
|
| Rate for Payer: Cash Price |
$1,233.00
|
| 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 |
$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 |
$1,306.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,290.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$495.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$489.61
|
| 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 |
$676.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$685.00
|
| 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 |
$2,028.75
|
| Rate for Payer: Multiplan Commercial |
$2,055.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Senior |
$225.00
|
| Rate for Payer: TriValley Medical Group Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$480.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$480.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$480.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$480.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
|
HC CT SOFT TIS NCK WO CONTR
|
Facility
|
OP
|
$2,433.00
|
|
|
Service Code
|
CPT 70490
|
| Hospital Charge Code |
909201909
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$1,824.75 |
| Rate for Payer: Adventist Health Commercial |
$486.60
|
| Rate for Payer: Adventist Health Commercial |
$502.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,552.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,503.59
|
| 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 |
$1,256.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,216.99
|
| 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 |
$1,130.40
|
| Rate for Payer: Cash Price |
$1,094.85
|
| Rate for Payer: Cash Price |
$1,094.85
|
| Rate for Payer: Cash Price |
$1,094.85
|
| Rate for Payer: Cash Price |
$1,094.85
|
| Rate for Payer: Cash Price |
$1,130.40
|
| Rate for Payer: Cash Price |
$1,130.40
|
| Rate for Payer: Cash Price |
$1,130.40
|
| 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 |
$1,198.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,160.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$454.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$440.37
|
| 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 |
$608.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$628.00
|
| 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 |
$1,824.75
|
| Rate for Payer: Multiplan Commercial |
$1,884.00
|
| 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 SOFT TIS NCK WO CONTR
|
Facility
|
IP
|
$2,512.00
|
|
|
Service Code
|
CPT 70490
|
| Hospital Charge Code |
909201909
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$454.67 |
| Max. Negotiated Rate |
$1,884.00 |
| Rate for Payer: Adventist Health Commercial |
$502.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,617.73
|
| Rate for Payer: Cash Price |
$1,130.40
|
| Rate for Payer: Cash Price |
$1,130.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,700.62
|
| Rate for Payer: Heritage Provider Network Senior |
$1,700.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$454.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$628.00
|
| Rate for Payer: Multiplan Commercial |
$1,884.00
|
|
|
HC CT SOFT TISSUE NECK W/WO CNTRST
|
Facility
|
IP
|
$2,995.00
|
|
|
Service Code
|
CPT 70492
|
| Hospital Charge Code |
909201911
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$542.10 |
| Max. Negotiated Rate |
$2,246.25 |
| Rate for Payer: Adventist Health Commercial |
$599.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,928.78
|
| Rate for Payer: Cash Price |
$1,347.75
|
| Rate for Payer: Cash Price |
$1,347.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,027.62
|
| Rate for Payer: Heritage Provider Network Senior |
$2,027.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$542.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$748.75
|
| Rate for Payer: Multiplan Commercial |
$2,246.25
|
|
|
HC CT SOFT TISSUE NECK W/WO CNTRST
|
Facility
|
OP
|
$2,995.00
|
|
|
Service Code
|
CPT 70492
|
| Hospital Charge Code |
909201911
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$2,246.25 |
| Rate for Payer: Adventist Health Commercial |
$599.00
|
| Rate for Payer: Adventist Health Commercial |
$653.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,018.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,850.91
|
| 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 |
$1,633.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,498.10
|
| 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 |
$1,469.70
|
| Rate for Payer: Cash Price |
$1,347.75
|
| Rate for Payer: Cash Price |
$1,347.75
|
| Rate for Payer: Cash Price |
$1,347.75
|
| Rate for Payer: Cash Price |
$1,347.75
|
| Rate for Payer: Cash Price |
$1,469.70
|
| Rate for Payer: Cash Price |
$1,469.70
|
| Rate for Payer: Cash Price |
$1,469.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$1,557.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,428.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$591.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$542.10
|
| 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 |
$748.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$816.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$2,246.25
|
| Rate for Payer: Multiplan Commercial |
$2,449.50
|
| 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 STEREOTACTIC LOCALIZATION
|
Facility
|
OP
|
$1,883.00
|
|
|
Service Code
|
CPT 77011
|
| Hospital Charge Code |
909001159
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$3,930.86 |
| Rate for Payer: Adventist Health Commercial |
$376.60
|
| Rate for Payer: Adventist Health Commercial |
$315.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,163.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$975.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,600.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,341.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$867.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,035.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,412.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,183.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$789.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$941.88
|
| Rate for Payer: Blue Shield of California Commercial |
$3,930.86
|
| Rate for Payer: Blue Shield of California Commercial |
$3,930.86
|
| Rate for Payer: Blue Shield of California EPN |
$3,161.07
|
| Rate for Payer: Blue Shield of California EPN |
$3,161.07
|
| Rate for Payer: Cash Price |
$710.10
|
| Rate for Payer: Cash Price |
$847.35
|
| Rate for Payer: Cash Price |
$710.10
|
| Rate for Payer: Cash Price |
$710.10
|
| Rate for Payer: Cash Price |
$710.10
|
| Rate for Payer: Cash Price |
$847.35
|
| Rate for Payer: Cash Price |
$847.35
|
| Rate for Payer: Cash Price |
$847.35
|
| 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 |
$1,341.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,600.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,341.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,600.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,341.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,600.55
|
| 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 |
$898.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$752.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$285.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$340.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$470.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$394.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,318.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,104.60
|
| Rate for Payer: Multiplan Commercial |
$1,412.25
|
| Rate for Payer: Multiplan Commercial |
$1,183.50
|
| 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 |
$789.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$941.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$789.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$941.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,341.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,600.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,341.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,600.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,600.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,341.30
|
|
|
HC CT STEREOTACTIC LOCALIZATION
|
Facility
|
IP
|
$1,883.00
|
|
|
Service Code
|
CPT 77011
|
| Hospital Charge Code |
909001159
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$340.82 |
| Max. Negotiated Rate |
$1,412.25 |
| Rate for Payer: Adventist Health Commercial |
$376.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,212.65
|
| Rate for Payer: Cash Price |
$847.35
|
| Rate for Payer: Cash Price |
$847.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,274.79
|
| Rate for Payer: Heritage Provider Network Senior |
$1,274.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$340.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$470.75
|
| Rate for Payer: Multiplan Commercial |
$1,412.25
|
|
|
HC CT, THX, LD FOR LC SCRN WO CON
|
Facility
|
IP
|
$241.00
|
|
|
Service Code
|
CPT 71271
|
| Hospital Charge Code |
909201271
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$43.62 |
| Max. Negotiated Rate |
$711.00 |
| Rate for Payer: Adventist Health Commercial |
$48.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$155.20
|
| Rate for Payer: Cash Price |
$108.45
|
| Rate for Payer: Cash Price |
$108.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$163.16
|
| Rate for Payer: Heritage Provider Network Senior |
$163.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.25
|
| Rate for Payer: Multiplan Commercial |
$180.75
|
|
|
HC CT, THX, LD FOR LC SCRN WO CON
|
Facility
|
OP
|
$241.00
|
|
|
Service Code
|
CPT 71271
|
| Hospital Charge Code |
909201271
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$43.62 |
| Max. Negotiated Rate |
$910.00 |
| Rate for Payer: Adventist Health Commercial |
$48.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$148.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.55
|
| Rate for Payer: Blue Shield of California Commercial |
$565.01
|
| Rate for Payer: Blue Shield of California EPN |
$454.36
|
| Rate for Payer: Cash Price |
$108.45
|
| Rate for Payer: Cash Price |
$108.45
|
| Rate for Payer: Cash Price |
$108.45
|
| Rate for Payer: Cash Price |
$108.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| 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 |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$114.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$180.75
|
| 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 |
$129.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$129.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
