|
HC CT GUID RAD THERAPY
|
Facility
|
OP
|
$1,637.00
|
|
|
Service Code
|
CPT 77014
|
| Hospital Charge Code |
909100165
|
|
Hospital Revenue Code
|
359
|
| Min. Negotiated Rate |
$199.80 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,391.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$900.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$900.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$707.85
|
| Rate for Payer: Blue Distinction Transplant |
$982.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,206.47
|
| Rate for Payer: Blue Shield of California EPN |
$956.01
|
| Rate for Payer: Cash Price |
$736.65
|
| Rate for Payer: Cash Price |
$736.65
|
| Rate for Payer: Cigna of CA HMO |
$1,047.68
|
| Rate for Payer: Cigna of CA PPO |
$1,211.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,391.45
|
| Rate for Payer: Dignity Health Media |
$1,391.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,391.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$654.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$654.80
|
| Rate for Payer: Galaxy Health WC |
$1,391.45
|
| Rate for Payer: Global Benefits Group Commercial |
$982.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,227.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,091.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$199.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.88
|
| Rate for Payer: Multiplan Commercial |
$1,309.60
|
| Rate for Payer: Networks By Design Commercial |
$1,064.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,391.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$982.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$982.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$818.50
|
| Rate for Payer: United Healthcare All Other HMO |
$818.50
|
| Rate for Payer: United Healthcare HMO Rider |
$818.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$818.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,391.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,391.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,391.45
|
|
|
HC CT GUID RAD THERAPY
|
Facility
|
IP
|
$2,916.00
|
|
|
Service Code
|
CPT 77014
|
| Hospital Charge Code |
909100165
|
|
Hospital Revenue Code
|
359
|
| Min. Negotiated Rate |
$699.84 |
| Max. Negotiated Rate |
$2,478.60 |
| Rate for Payer: Cash Price |
$1,312.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.40
|
| Rate for Payer: Galaxy Health WC |
$2,478.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,749.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,944.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,111.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$699.84
|
| Rate for Payer: Multiplan Commercial |
$2,332.80
|
| Rate for Payer: Networks By Design Commercial |
$1,895.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,478.60
|
|
|
HC CT HEAD NO CONTRAST
|
Facility
|
IP
|
$5,320.00
|
|
|
Service Code
|
CPT 70450
|
| Hospital Charge Code |
909201901
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,276.80 |
| Max. Negotiated Rate |
$4,522.00 |
| Rate for Payer: Cash Price |
$2,394.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,128.00
|
| Rate for Payer: Galaxy Health WC |
$4,522.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,192.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,548.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,026.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,276.80
|
| Rate for Payer: Multiplan Commercial |
$4,256.00
|
| Rate for Payer: Networks By Design Commercial |
$3,458.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,522.00
|
|
|
HC CT HEAD NO CONTRAST
|
Facility
|
OP
|
$3,125.00
|
|
|
Service Code
|
CPT 70450
|
| Hospital Charge Code |
909201901
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,861.88
|
| Rate for Payer: Blue Distinction Transplant |
$1,875.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,846.88
|
| Rate for Payer: Blue Shield of California EPN |
$1,465.62
|
| Rate for Payer: Cash Price |
$1,406.25
|
| Rate for Payer: Cash Price |
$1,406.25
|
| Rate for Payer: Cigna of CA HMO |
$2,000.00
|
| Rate for Payer: Cigna of CA PPO |
$2,312.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$2,656.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,875.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,343.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,084.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$192.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$750.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$2,500.00
|
| Rate for Payer: Networks By Design Commercial |
$2,031.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,656.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,875.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,875.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,562.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,562.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,562.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,562.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC CT HEAD W CONTRAST
|
Facility
|
OP
|
$3,487.00
|
|
|
Service Code
|
CPT 70460
|
| Hospital Charge Code |
909201900
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$229.56 |
| Max. Negotiated Rate |
$2,963.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,077.55
|
| Rate for Payer: Blue Distinction Transplant |
$2,092.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,060.82
|
| Rate for Payer: Blue Shield of California EPN |
$1,635.40
|
| Rate for Payer: Cash Price |
$1,569.15
|
| Rate for Payer: Cash Price |
$1,569.15
|
| Rate for Payer: Cigna of CA HMO |
$2,231.68
|
| Rate for Payer: Cigna of CA PPO |
$2,580.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Media |
$229.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$229.56
|
| Rate for Payer: Galaxy Health WC |
$2,963.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,092.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,615.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$376.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$376.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$371.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$371.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,325.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$271.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$836.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$307.61
|
| Rate for Payer: Multiplan Commercial |
$2,789.60
|
| Rate for Payer: Networks By Design Commercial |
$2,266.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,963.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,092.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,092.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,743.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,743.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,743.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,743.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC CT HEAD W CONTRAST
|
Facility
|
IP
|
$6,208.00
|
|
|
Service Code
|
CPT 70460
|
| Hospital Charge Code |
909201900
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,489.92 |
| Max. Negotiated Rate |
$5,276.80 |
| Rate for Payer: Cash Price |
$2,793.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,483.20
|
| Rate for Payer: Galaxy Health WC |
$5,276.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,724.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,140.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,365.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,489.92
|
| Rate for Payer: Multiplan Commercial |
$4,966.40
|
| Rate for Payer: Networks By Design Commercial |
$4,035.20
|
| Rate for Payer: Prime Health Services Commercial |
$5,276.80
|
|
|
HC CT HEAD W/WO CONTRAS
|
Facility
|
IP
|
$6,450.00
|
|
|
Service Code
|
CPT 70470
|
| Hospital Charge Code |
909201902
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,548.00 |
| Max. Negotiated Rate |
$5,482.50 |
| Rate for Payer: Cash Price |
$2,902.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,580.00
|
| Rate for Payer: Galaxy Health WC |
$5,482.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,870.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,302.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,457.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,548.00
|
| Rate for Payer: Multiplan Commercial |
$5,160.00
|
| Rate for Payer: Networks By Design Commercial |
$4,192.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,482.50
|
|
|
HC CT HEAD W/WO CONTRAS
|
Facility
|
OP
|
$3,905.00
|
|
|
Service Code
|
CPT 70470
|
| Hospital Charge Code |
909201902
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$229.56 |
| Max. Negotiated Rate |
$3,319.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,326.60
|
| Rate for Payer: Blue Distinction Transplant |
$2,343.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,307.86
|
| Rate for Payer: Blue Shield of California EPN |
$1,831.44
|
| Rate for Payer: Cash Price |
$1,757.25
|
| Rate for Payer: Cash Price |
$1,757.25
|
| Rate for Payer: Cigna of CA HMO |
$2,499.20
|
| Rate for Payer: Cigna of CA PPO |
$2,889.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Media |
$229.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$229.56
|
| Rate for Payer: Galaxy Health WC |
$3,319.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,343.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,928.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$376.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$376.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$371.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$371.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,604.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$319.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$937.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$307.61
|
| Rate for Payer: Multiplan Commercial |
$3,124.00
|
| Rate for Payer: Networks By Design Commercial |
$2,538.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,319.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,343.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,343.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,952.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,952.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,952.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,952.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC CT LOWER EXT W CONT
|
Facility
|
OP
|
$3,357.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
909201958
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$229.56 |
| Max. Negotiated Rate |
$2,853.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,000.10
|
| Rate for Payer: Blue Distinction Transplant |
$2,014.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,983.99
|
| Rate for Payer: Blue Shield of California EPN |
$1,574.43
|
| Rate for Payer: Cash Price |
$1,510.65
|
| Rate for Payer: Cash Price |
$1,510.65
|
| Rate for Payer: Cigna of CA HMO |
$2,148.48
|
| Rate for Payer: Cigna of CA PPO |
$2,484.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Media |
$229.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$229.56
|
| Rate for Payer: Galaxy Health WC |
$2,853.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,014.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,517.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$376.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$376.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$371.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$371.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,239.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$306.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$805.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$307.61
|
| Rate for Payer: Multiplan Commercial |
$2,685.60
|
| Rate for Payer: Networks By Design Commercial |
$2,182.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,853.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,014.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,014.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$769.25
|
| Rate for Payer: United Healthcare All Other HMO |
$769.25
|
| Rate for Payer: United Healthcare HMO Rider |
$769.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$769.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC CT LOWER EXT W CONT
|
Facility
|
IP
|
$5,978.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
909201958
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,434.72 |
| Max. Negotiated Rate |
$5,081.30 |
| Rate for Payer: Cash Price |
$2,690.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,391.20
|
| Rate for Payer: Galaxy Health WC |
$5,081.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,586.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,987.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,277.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,434.72
|
| Rate for Payer: Multiplan Commercial |
$4,782.40
|
| Rate for Payer: Networks By Design Commercial |
$3,885.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,081.30
|
|
|
HC CT LOWER EXT WO CONT
|
Facility
|
IP
|
$5,324.00
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
909201957
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,277.76 |
| Max. Negotiated Rate |
$4,525.40 |
| Rate for Payer: Cash Price |
$2,395.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,129.60
|
| Rate for Payer: Galaxy Health WC |
$4,525.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,194.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,551.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,028.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,277.76
|
| Rate for Payer: Multiplan Commercial |
$4,259.20
|
| Rate for Payer: Networks By Design Commercial |
$3,460.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,525.40
|
|
|
HC CT LOWER EXT WO CONT
|
Facility
|
OP
|
$2,989.00
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
909201957
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,780.85
|
| Rate for Payer: Blue Distinction Transplant |
$1,793.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,766.50
|
| Rate for Payer: Blue Shield of California EPN |
$1,401.84
|
| Rate for Payer: Cash Price |
$1,345.05
|
| Rate for Payer: Cash Price |
$1,345.05
|
| Rate for Payer: Cigna of CA HMO |
$1,912.96
|
| Rate for Payer: Cigna of CA PPO |
$2,211.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$2,540.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,793.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,241.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,993.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$236.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$717.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$2,391.20
|
| Rate for Payer: Networks By Design Commercial |
$1,942.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,540.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,793.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,793.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$491.23
|
| Rate for Payer: United Healthcare All Other HMO |
$491.23
|
| Rate for Payer: United Healthcare HMO Rider |
$491.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$491.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC CT LOWR EXTR W/WO CONT
|
Facility
|
OP
|
$3,754.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
909201959
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$229.56 |
| Max. Negotiated Rate |
$3,190.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,236.63
|
| Rate for Payer: Blue Distinction Transplant |
$2,252.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,218.61
|
| Rate for Payer: Blue Shield of California EPN |
$1,760.63
|
| Rate for Payer: Cash Price |
$1,689.30
|
| Rate for Payer: Cash Price |
$1,689.30
|
| Rate for Payer: Cigna of CA HMO |
$2,402.56
|
| Rate for Payer: Cigna of CA PPO |
$2,777.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Media |
$229.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$229.56
|
| Rate for Payer: Galaxy Health WC |
$3,190.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,252.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,815.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$376.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$376.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$371.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$371.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,503.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$359.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$900.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$307.61
|
| Rate for Payer: Multiplan Commercial |
$3,003.20
|
| Rate for Payer: Networks By Design Commercial |
$2,440.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,190.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,252.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,252.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$855.26
|
| Rate for Payer: United Healthcare All Other HMO |
$855.26
|
| Rate for Payer: United Healthcare HMO Rider |
$855.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$855.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC CT LOWR EXTR W/WO CONT
|
Facility
|
IP
|
$6,278.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
909201959
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,506.72 |
| Max. Negotiated Rate |
$5,336.30 |
| Rate for Payer: Cash Price |
$2,825.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,511.20
|
| Rate for Payer: Galaxy Health WC |
$5,336.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,766.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,187.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,391.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,506.72
|
| Rate for Payer: Multiplan Commercial |
$5,022.40
|
| Rate for Payer: Networks By Design Commercial |
$4,080.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,336.30
|
|
|
HC CT MAXILLOFACIAL W/WO CONTRAST
|
Facility
|
OP
|
$3,956.00
|
|
|
Service Code
|
CPT 70488
|
| Hospital Charge Code |
909201950
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$229.56 |
| Max. Negotiated Rate |
$3,362.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.98
|
| Rate for Payer: Blue Distinction Transplant |
$2,373.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,338.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,855.36
|
| Rate for Payer: Cash Price |
$1,780.20
|
| Rate for Payer: Cash Price |
$1,780.20
|
| Rate for Payer: Cigna of CA HMO |
$2,531.84
|
| Rate for Payer: Cigna of CA PPO |
$2,927.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Media |
$229.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$229.56
|
| Rate for Payer: Galaxy Health WC |
$3,362.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,373.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,967.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$376.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$376.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$371.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$371.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,638.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$341.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$949.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$307.61
|
| Rate for Payer: Multiplan Commercial |
$3,164.80
|
| Rate for Payer: Networks By Design Commercial |
$2,571.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,362.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,373.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,373.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,978.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,978.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,978.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,978.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC CT MAXILLOFACIAL W/WO CONTRAST
|
Facility
|
IP
|
$5,882.00
|
|
|
Service Code
|
CPT 70488
|
| Hospital Charge Code |
909201950
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,411.68 |
| Max. Negotiated Rate |
$4,999.70 |
| Rate for Payer: Cash Price |
$2,646.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,352.80
|
| Rate for Payer: Galaxy Health WC |
$4,999.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,529.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,923.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,241.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,411.68
|
| Rate for Payer: Multiplan Commercial |
$4,705.60
|
| Rate for Payer: Networks By Design Commercial |
$3,823.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,999.70
|
|
|
HC CT MAXILLOFAC W CONT
|
Facility
|
IP
|
$5,098.00
|
|
|
Service Code
|
CPT 70487
|
| Hospital Charge Code |
909201907
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,223.52 |
| Max. Negotiated Rate |
$4,333.30 |
| Rate for Payer: Cash Price |
$2,294.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,039.20
|
| Rate for Payer: Galaxy Health WC |
$4,333.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,058.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,400.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,942.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,223.52
|
| Rate for Payer: Multiplan Commercial |
$4,078.40
|
| Rate for Payer: Networks By Design Commercial |
$3,313.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,333.30
|
|
|
HC CT MAXILLOFAC W CONT
|
Facility
|
OP
|
$2,862.00
|
|
|
Service Code
|
CPT 70487
|
| Hospital Charge Code |
909201907
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$229.56 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,705.18
|
| Rate for Payer: Blue Distinction Transplant |
$1,717.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,691.44
|
| Rate for Payer: Blue Shield of California EPN |
$1,342.28
|
| Rate for Payer: Cash Price |
$1,287.90
|
| Rate for Payer: Cash Price |
$1,287.90
|
| Rate for Payer: Cigna of CA HMO |
$1,831.68
|
| Rate for Payer: Cigna of CA PPO |
$2,117.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Media |
$229.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$229.56
|
| Rate for Payer: Galaxy Health WC |
$2,432.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,717.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,146.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$376.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$376.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$371.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$371.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,908.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$278.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$686.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$307.61
|
| Rate for Payer: Multiplan Commercial |
$2,289.60
|
| Rate for Payer: Networks By Design Commercial |
$1,860.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,432.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,717.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,717.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,431.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,431.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,431.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,431.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC CT MAXILLOFAC W/O CO
|
Facility
|
IP
|
$4,451.00
|
|
|
Service Code
|
CPT 70486
|
| Hospital Charge Code |
909201906
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,068.24 |
| Max. Negotiated Rate |
$3,783.35 |
| Rate for Payer: Cash Price |
$2,002.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,780.40
|
| Rate for Payer: Galaxy Health WC |
$3,783.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,670.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,968.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,695.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,068.24
|
| Rate for Payer: Multiplan Commercial |
$3,560.80
|
| Rate for Payer: Networks By Design Commercial |
$2,893.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,783.35
|
|
|
HC CT MAXILLOFAC W/O CO
|
Facility
|
OP
|
$2,499.00
|
|
|
Service Code
|
CPT 70486
|
| Hospital Charge Code |
909201906
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,488.90
|
| Rate for Payer: Blue Distinction Transplant |
$1,499.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,476.91
|
| Rate for Payer: Blue Shield of California EPN |
$1,172.03
|
| Rate for Payer: Cash Price |
$1,124.55
|
| Rate for Payer: Cash Price |
$1,124.55
|
| Rate for Payer: Cigna of CA HMO |
$1,599.36
|
| Rate for Payer: Cigna of CA PPO |
$1,849.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$2,124.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,499.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,874.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,666.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$234.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$599.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,999.20
|
| Rate for Payer: Networks By Design Commercial |
$1,624.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,124.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,499.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,499.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,249.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,249.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,249.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,249.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC CT ORB/SEL/PFOSSA/EAR W CONTR
|
Facility
|
OP
|
$3,487.00
|
|
|
Service Code
|
CPT 70481
|
| Hospital Charge Code |
909201904
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$229.56 |
| Max. Negotiated Rate |
$2,963.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,077.55
|
| Rate for Payer: Blue Distinction Transplant |
$2,092.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,060.82
|
| Rate for Payer: Blue Shield of California EPN |
$1,635.40
|
| Rate for Payer: Cash Price |
$1,569.15
|
| Rate for Payer: Cash Price |
$1,569.15
|
| Rate for Payer: Cigna of CA HMO |
$2,231.68
|
| Rate for Payer: Cigna of CA PPO |
$2,580.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Media |
$229.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$229.56
|
| Rate for Payer: Galaxy Health WC |
$2,963.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,092.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,615.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$376.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$376.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$371.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$371.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,325.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$333.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$836.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$307.61
|
| Rate for Payer: Multiplan Commercial |
$2,789.60
|
| Rate for Payer: Networks By Design Commercial |
$2,266.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,963.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,092.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,092.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,743.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,743.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,743.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,743.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC CT ORB/SEL/PFOSSA/EAR W CONTR
|
Facility
|
IP
|
$6,208.00
|
|
|
Service Code
|
CPT 70481
|
| Hospital Charge Code |
909201904
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,489.92 |
| Max. Negotiated Rate |
$5,276.80 |
| Rate for Payer: Cash Price |
$2,793.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,483.20
|
| Rate for Payer: Galaxy Health WC |
$5,276.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,724.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,140.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,365.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,489.92
|
| Rate for Payer: Multiplan Commercial |
$4,966.40
|
| Rate for Payer: Networks By Design Commercial |
$4,035.20
|
| Rate for Payer: Prime Health Services Commercial |
$5,276.80
|
|
|
HC CT ORB/SEL/PFOSSA/EAR WO CONTR
|
Facility
|
IP
|
$5,565.00
|
|
|
Service Code
|
CPT 70480
|
| Hospital Charge Code |
909201903
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,335.60 |
| Max. Negotiated Rate |
$4,730.25 |
| Rate for Payer: Cash Price |
$2,504.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,226.00
|
| Rate for Payer: Galaxy Health WC |
$4,730.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,339.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,711.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,120.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,335.60
|
| Rate for Payer: Multiplan Commercial |
$4,452.00
|
| Rate for Payer: Networks By Design Commercial |
$3,617.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,730.25
|
|
|
HC CT ORB/SEL/PFOSSA/EAR WO CONTR
|
Facility
|
OP
|
$3,125.00
|
|
|
Service Code
|
CPT 70480
|
| Hospital Charge Code |
909201903
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,861.88
|
| Rate for Payer: Blue Distinction Transplant |
$1,875.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,846.88
|
| Rate for Payer: Blue Shield of California EPN |
$1,465.62
|
| Rate for Payer: Cash Price |
$1,406.25
|
| Rate for Payer: Cash Price |
$1,406.25
|
| Rate for Payer: Cigna of CA HMO |
$2,000.00
|
| Rate for Payer: Cigna of CA PPO |
$2,312.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$2,656.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,875.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,343.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,084.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$289.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$750.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$2,500.00
|
| Rate for Payer: Networks By Design Commercial |
$2,031.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,656.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,875.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,875.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,562.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,562.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,562.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,562.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC CT ORB/SEL/PFOSSA/EAR W/WO CNT
|
Facility
|
OP
|
$3,842.00
|
|
|
Service Code
|
CPT 70482
|
| Hospital Charge Code |
909201905
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$229.56 |
| Max. Negotiated Rate |
$3,265.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,289.06
|
| Rate for Payer: Blue Distinction Transplant |
$2,305.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,270.62
|
| Rate for Payer: Blue Shield of California EPN |
$1,801.90
|
| Rate for Payer: Cash Price |
$1,728.90
|
| Rate for Payer: Cash Price |
$1,728.90
|
| Rate for Payer: Cigna of CA HMO |
$2,458.88
|
| Rate for Payer: Cigna of CA PPO |
$2,843.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Media |
$229.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$229.56
|
| Rate for Payer: Galaxy Health WC |
$3,265.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,305.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,881.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$376.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$376.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$371.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$371.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,562.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$391.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$922.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$307.61
|
| Rate for Payer: Multiplan Commercial |
$3,073.60
|
| Rate for Payer: Networks By Design Commercial |
$2,497.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,265.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,305.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,305.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,921.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,921.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,921.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,921.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
