|
HC CT BONE L-SPINE W/WO CONTRAST
|
Facility
IP
|
$6,019.00
|
|
|
Service Code
|
CPT 72133
|
| Hospital Charge Code |
909201009
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,444.56 |
| Max. Negotiated Rate |
$5,116.15 |
| Rate for Payer: Cash Price |
$2,708.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,407.60
|
| Rate for Payer: Galaxy Health WC |
$5,116.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,611.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,014.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,293.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,444.56
|
| Rate for Payer: Multiplan Commercial |
$4,815.20
|
| Rate for Payer: Networks By Design Commercial |
$3,912.35
|
| Rate for Payer: Prime Health Services Commercial |
$5,116.15
|
|
|
HC CT BONE L-SPINE W/WO CONTRAST
|
Facility
OP
|
$3,534.00
|
|
|
Service Code
|
CPT 72133
|
| Hospital Charge Code |
909201009
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$229.56 |
| Max. Negotiated Rate |
$3,003.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,105.56
|
| Rate for Payer: BCBS Transplant Transplant |
$2,120.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,088.59
|
| Rate for Payer: Blue Shield of California EPN |
$1,657.45
|
| Rate for Payer: Cash Price |
$1,590.30
|
| Rate for Payer: Cash Price |
$1,590.30
|
| Rate for Payer: Cigna of CA HMO |
$2,261.76
|
| Rate for Payer: Cigna of CA PPO |
$2,615.16
|
| 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 |
$3,003.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,120.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,650.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$376.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$376.48
|
| Rate for Payer: IEHP Medi-Cal |
$371.89
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$371.89
|
| Rate for Payer: IEHP Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,357.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$364.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$848.16
|
| 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 |
$2,827.20
|
| Rate for Payer: Networks By Design Commercial |
$2,297.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,003.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$250.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,120.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,120.40
|
| 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 BONE PELVIS W CONTRAST
|
Facility
OP
|
$3,248.00
|
|
|
Service Code
|
CPT 72193
|
| Hospital Charge Code |
909201931
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$229.56 |
| Max. Negotiated Rate |
$2,760.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,935.16
|
| Rate for Payer: BCBS Transplant Transplant |
$1,948.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,919.57
|
| Rate for Payer: Blue Shield of California EPN |
$1,523.31
|
| Rate for Payer: Cash Price |
$1,461.60
|
| Rate for Payer: Cash Price |
$1,461.60
|
| Rate for Payer: Cigna of CA HMO |
$2,078.72
|
| Rate for Payer: Cigna of CA PPO |
$2,403.52
|
| 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 |
$2,760.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,948.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,436.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$376.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$376.48
|
| Rate for Payer: IEHP Medi-Cal |
$371.89
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$371.89
|
| Rate for Payer: IEHP Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,166.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$388.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$779.52
|
| 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 |
$2,598.40
|
| Rate for Payer: Networks By Design Commercial |
$2,111.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,760.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$250.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,948.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,948.80
|
| 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 BONE PELVIS W CONTRAST
|
Facility
IP
|
$5,786.00
|
|
|
Service Code
|
CPT 72193
|
| Hospital Charge Code |
909201931
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,388.64 |
| Max. Negotiated Rate |
$4,918.10 |
| Rate for Payer: Cash Price |
$2,603.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,314.40
|
| Rate for Payer: Galaxy Health WC |
$4,918.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,471.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,859.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,204.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,388.64
|
| Rate for Payer: Multiplan Commercial |
$4,628.80
|
| Rate for Payer: Networks By Design Commercial |
$3,760.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,918.10
|
|
|
HC CT BONE PELVIS W/O CONTRAST
|
Facility
OP
|
$2,989.00
|
|
|
Service Code
|
CPT 72192
|
| Hospital Charge Code |
909201930
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,780.85
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: IEHP Medi-Cal |
$222.52
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$222.52
|
| Rate for Payer: 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 |
$242.42
|
| 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: Redlands Yucaipa Medical Group Commercial/Senior |
$250.00
|
| 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 BONE PELVIS W/O CONTRAST
|
Facility
IP
|
$5,324.00
|
|
|
Service Code
|
CPT 72192
|
| Hospital Charge Code |
909201930
|
|
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 BONE PELVIS W/WO CONTRAST
|
Facility
IP
|
$6,324.00
|
|
|
Service Code
|
CPT 72194
|
| Hospital Charge Code |
909201932
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,517.76 |
| Max. Negotiated Rate |
$5,375.40 |
| Rate for Payer: Cash Price |
$2,845.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,529.60
|
| Rate for Payer: Galaxy Health WC |
$5,375.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,794.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,218.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,409.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,517.76
|
| Rate for Payer: Multiplan Commercial |
$5,059.20
|
| Rate for Payer: Networks By Design Commercial |
$4,110.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,375.40
|
|
|
HC CT BONE PELVIS W/WO CONTRAST
|
Facility
OP
|
$3,550.00
|
|
|
Service Code
|
CPT 72194
|
| Hospital Charge Code |
909201932
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$229.56 |
| Max. Negotiated Rate |
$3,017.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,115.09
|
| Rate for Payer: BCBS Transplant Transplant |
$2,130.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,098.05
|
| Rate for Payer: Blue Shield of California EPN |
$1,664.95
|
| Rate for Payer: Cash Price |
$1,597.50
|
| Rate for Payer: Cash Price |
$1,597.50
|
| Rate for Payer: Cigna of CA HMO |
$2,272.00
|
| Rate for Payer: Cigna of CA PPO |
$2,627.00
|
| 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 |
$3,017.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,130.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,662.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$376.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$376.48
|
| Rate for Payer: IEHP Medi-Cal |
$371.89
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$371.89
|
| Rate for Payer: IEHP Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,367.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$449.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$852.00
|
| 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 |
$2,840.00
|
| Rate for Payer: Networks By Design Commercial |
$2,307.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,017.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$250.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,130.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,130.00
|
| 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 CARDIAC SCORING
|
Facility
IP
|
$1,131.00
|
|
|
Service Code
|
CPT 75571
|
| Hospital Charge Code |
909201981
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$271.44 |
| Max. Negotiated Rate |
$961.35 |
| Rate for Payer: Cash Price |
$508.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$452.40
|
| Rate for Payer: Galaxy Health WC |
$961.35
|
| Rate for Payer: Global Benefits Group Commercial |
$678.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$754.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$430.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.44
|
| Rate for Payer: Multiplan Commercial |
$904.80
|
| Rate for Payer: Networks By Design Commercial |
$735.15
|
| Rate for Payer: Prime Health Services Commercial |
$961.35
|
|
|
HC CT CARDIAC SCORING
|
Facility
OP
|
$635.00
|
|
|
Service Code
|
CPT 75571
|
| Hospital Charge Code |
909201981
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$113.54 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$378.33
|
| Rate for Payer: BCBS Transplant Transplant |
$381.00
|
| Rate for Payer: Blue Shield of California Commercial |
$375.28
|
| Rate for Payer: Blue Shield of California EPN |
$297.82
|
| Rate for Payer: Cash Price |
$285.75
|
| Rate for Payer: Cash Price |
$285.75
|
| Rate for Payer: Cigna of CA HMO |
$406.40
|
| Rate for Payer: Cigna of CA PPO |
$469.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$539.75
|
| Rate for Payer: Global Benefits Group Commercial |
$381.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$476.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$186.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$186.21
|
| Rate for Payer: IEHP Medi-Cal |
$183.93
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$183.93
|
| Rate for Payer: IEHP Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$423.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$508.00
|
| Rate for Payer: Networks By Design Commercial |
$412.75
|
| Rate for Payer: Prime Health Services Commercial |
$539.75
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$250.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$381.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$381.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.83
|
| Rate for Payer: United Healthcare All Other HMO |
$116.83
|
| Rate for Payer: United Healthcare HMO Rider |
$116.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$116.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC CT CHEST W CONTRAST
|
Facility
OP
|
$3,248.00
|
|
|
Service Code
|
CPT 71260
|
| Hospital Charge Code |
909201913
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$229.56 |
| Max. Negotiated Rate |
$2,760.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,935.16
|
| Rate for Payer: BCBS Transplant Transplant |
$1,948.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,919.57
|
| Rate for Payer: Blue Shield of California EPN |
$1,523.31
|
| Rate for Payer: Cash Price |
$1,461.60
|
| Rate for Payer: Cash Price |
$1,461.60
|
| Rate for Payer: Cigna of CA HMO |
$2,078.72
|
| Rate for Payer: Cigna of CA PPO |
$2,403.52
|
| 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 |
$2,760.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,948.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,436.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$376.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$376.48
|
| Rate for Payer: IEHP Medi-Cal |
$371.89
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$371.89
|
| Rate for Payer: IEHP Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,166.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$305.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$779.52
|
| 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 |
$2,598.40
|
| Rate for Payer: Networks By Design Commercial |
$2,111.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,760.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$250.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,948.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,948.80
|
| 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 CHEST W CONTRAST
|
Facility
IP
|
$5,786.00
|
|
|
Service Code
|
CPT 71260
|
| Hospital Charge Code |
909201913
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,388.64 |
| Max. Negotiated Rate |
$4,918.10 |
| Rate for Payer: Cash Price |
$2,603.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,314.40
|
| Rate for Payer: Galaxy Health WC |
$4,918.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,471.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,859.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,204.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,388.64
|
| Rate for Payer: Multiplan Commercial |
$4,628.80
|
| Rate for Payer: Networks By Design Commercial |
$3,760.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,918.10
|
|
|
HC CT CHEST W/O CONTRAST
|
Facility
IP
|
$4,712.00
|
|
|
Service Code
|
CPT 71250
|
| Hospital Charge Code |
909201912
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,130.88 |
| Max. Negotiated Rate |
$4,005.20 |
| Rate for Payer: Cash Price |
$2,120.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,884.80
|
| Rate for Payer: Galaxy Health WC |
$4,005.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,827.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,142.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,795.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,130.88
|
| Rate for Payer: Multiplan Commercial |
$3,769.60
|
| Rate for Payer: Networks By Design Commercial |
$3,062.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,005.20
|
|
|
HC CT CHEST W/O CONTRAST
|
Facility
OP
|
$2,645.00
|
|
|
Service Code
|
CPT 71250
|
| Hospital Charge Code |
909201912
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,575.89
|
| Rate for Payer: BCBS Transplant Transplant |
$1,587.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,563.20
|
| Rate for Payer: Blue Shield of California EPN |
$1,240.50
|
| Rate for Payer: Cash Price |
$1,190.25
|
| Rate for Payer: Cash Price |
$1,190.25
|
| Rate for Payer: Cigna of CA HMO |
$1,692.80
|
| Rate for Payer: Cigna of CA PPO |
$1,957.30
|
| 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 |
$2,248.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,587.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,983.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: IEHP Medi-Cal |
$222.52
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$222.52
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,764.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$241.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$634.80
|
| 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 |
$2,116.00
|
| Rate for Payer: Networks By Design Commercial |
$1,719.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,248.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$250.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,587.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,587.00
|
| 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 CHEST W WO CONTRA
|
Facility
IP
|
$6,862.00
|
|
|
Service Code
|
CPT 71270
|
| Hospital Charge Code |
909201914
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,646.88 |
| Max. Negotiated Rate |
$5,832.70 |
| Rate for Payer: Cash Price |
$3,087.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,744.80
|
| Rate for Payer: Galaxy Health WC |
$5,832.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,117.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,576.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,614.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,646.88
|
| Rate for Payer: Multiplan Commercial |
$5,489.60
|
| Rate for Payer: Networks By Design Commercial |
$4,460.30
|
| Rate for Payer: Prime Health Services Commercial |
$5,832.70
|
|
|
HC CT CHEST W WO CONTRA
|
Facility
OP
|
$3,852.00
|
|
|
Service Code
|
CPT 71270
|
| Hospital Charge Code |
909201914
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$229.56 |
| Max. Negotiated Rate |
$3,274.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,295.02
|
| Rate for Payer: BCBS Transplant Transplant |
$2,311.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,276.53
|
| Rate for Payer: Blue Shield of California EPN |
$1,806.59
|
| Rate for Payer: Cash Price |
$1,733.40
|
| Rate for Payer: Cash Price |
$1,733.40
|
| Rate for Payer: Cigna of CA HMO |
$2,465.28
|
| Rate for Payer: Cigna of CA PPO |
$2,850.48
|
| 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 |
$3,274.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,311.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,889.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$376.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$376.48
|
| Rate for Payer: IEHP Medi-Cal |
$371.89
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$371.89
|
| Rate for Payer: IEHP Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,569.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$364.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$924.48
|
| 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 |
$3,081.60
|
| Rate for Payer: Networks By Design Commercial |
$2,503.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,274.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$250.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,311.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,311.20
|
| 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 COLONOGRAPHY SCREEN
|
Facility
IP
|
$2,457.00
|
|
|
Service Code
|
CPT 74263
|
| Hospital Charge Code |
909201813
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$589.68 |
| Max. Negotiated Rate |
$2,088.45 |
| Rate for Payer: Cash Price |
$1,105.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$982.80
|
| Rate for Payer: Galaxy Health WC |
$2,088.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,474.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,638.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$936.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$589.68
|
| Rate for Payer: Multiplan Commercial |
$1,965.60
|
| Rate for Payer: Networks By Design Commercial |
$1,597.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,088.45
|
|
|
HC CT COLONOGRAPHY SCREEN
|
Facility
OP
|
$1,379.00
|
|
|
Service Code
|
CPT 74263
|
| Hospital Charge Code |
909201813
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,172.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$758.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$758.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$821.61
|
| Rate for Payer: BCBS Transplant Transplant |
$827.40
|
| Rate for Payer: Blue Shield of California Commercial |
$814.99
|
| Rate for Payer: Blue Shield of California EPN |
$646.75
|
| Rate for Payer: Cash Price |
$620.55
|
| Rate for Payer: Cash Price |
$620.55
|
| Rate for Payer: Cigna of CA HMO |
$882.56
|
| Rate for Payer: Cigna of CA PPO |
$1,020.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,172.15
|
| Rate for Payer: Dignity Health Media |
$1,172.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,172.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$551.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$551.60
|
| Rate for Payer: Galaxy Health WC |
$1,172.15
|
| Rate for Payer: Global Benefits Group Commercial |
$827.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,034.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$919.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$330.96
|
| Rate for Payer: Multiplan Commercial |
$1,103.20
|
| Rate for Payer: Networks By Design Commercial |
$896.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,172.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$250.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$827.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$827.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,781.07
|
| Rate for Payer: United Healthcare All Other HMO |
$1,781.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1,781.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,781.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,172.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,172.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,172.15
|
|
|
HC CT COLONOGRAPHY W/CONTRAST
|
Facility
IP
|
$6,603.00
|
|
|
Service Code
|
CPT 74262
|
| Hospital Charge Code |
909202000
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,584.72 |
| Max. Negotiated Rate |
$5,612.55 |
| Rate for Payer: Cash Price |
$2,971.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,641.20
|
| Rate for Payer: Galaxy Health WC |
$5,612.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,961.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,404.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,515.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,584.72
|
| Rate for Payer: Multiplan Commercial |
$5,282.40
|
| Rate for Payer: Networks By Design Commercial |
$4,291.95
|
| Rate for Payer: Prime Health Services Commercial |
$5,612.55
|
|
|
HC CT COLONOGRAPHY W/CONTRAST
|
Facility
OP
|
$4,099.00
|
|
|
Service Code
|
CPT 74262
|
| Hospital Charge Code |
909202000
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$229.56 |
| Max. Negotiated Rate |
$3,484.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,442.18
|
| Rate for Payer: BCBS Transplant Transplant |
$2,459.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,422.51
|
| Rate for Payer: Blue Shield of California EPN |
$1,922.43
|
| Rate for Payer: Cash Price |
$1,844.55
|
| Rate for Payer: Cash Price |
$1,844.55
|
| Rate for Payer: Cigna of CA HMO |
$2,623.36
|
| Rate for Payer: Cigna of CA PPO |
$3,033.26
|
| 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 |
$3,484.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,459.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,074.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$376.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$376.48
|
| Rate for Payer: IEHP Medi-Cal |
$371.89
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$371.89
|
| Rate for Payer: IEHP Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,734.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$890.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$983.76
|
| 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 |
$3,279.20
|
| Rate for Payer: Networks By Design Commercial |
$2,664.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,484.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$250.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,459.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,459.40
|
| 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 COLONOGRAPHY W/O CONTRAST
|
Facility
IP
|
$5,842.00
|
|
|
Service Code
|
CPT 74261
|
| Hospital Charge Code |
909201811
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,402.08 |
| Max. Negotiated Rate |
$4,965.70 |
| Rate for Payer: Cash Price |
$2,628.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,336.80
|
| Rate for Payer: Galaxy Health WC |
$4,965.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,505.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,896.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,225.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,402.08
|
| Rate for Payer: Multiplan Commercial |
$4,673.60
|
| Rate for Payer: Networks By Design Commercial |
$3,797.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,965.70
|
|
|
HC CT COLONOGRAPHY W/O CONTRAST
|
Facility
OP
|
$3,707.00
|
|
|
Service Code
|
CPT 74261
|
| Hospital Charge Code |
909201811
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$3,150.95 |
| Rate for Payer: BCBS Transplant Transplant |
$2,224.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,208.63
|
| Rate for Payer: Blue Shield of California Commercial |
$2,190.84
|
| Rate for Payer: Blue Shield of California EPN |
$1,738.58
|
| Rate for Payer: Cash Price |
$1,668.15
|
| Rate for Payer: Cash Price |
$1,668.15
|
| Rate for Payer: Cigna of CA HMO |
$2,372.48
|
| Rate for Payer: Cigna of CA PPO |
$2,743.18
|
| 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 |
$3,150.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,224.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,780.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: IEHP Medi-Cal |
$222.52
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$222.52
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,472.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$786.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$889.68
|
| 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 |
$2,965.60
|
| Rate for Payer: Networks By Design Commercial |
$2,409.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,150.95
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$250.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,224.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,224.20
|
| 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 CSPINE WITH CONTRAST
|
Facility
OP
|
$3,399.00
|
|
|
Service Code
|
CPT 72126
|
| Hospital Charge Code |
909201916
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$2,889.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,025.12
|
| Rate for Payer: BCBS Transplant Transplant |
$2,039.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,008.81
|
| Rate for Payer: Blue Shield of California EPN |
$1,594.13
|
| Rate for Payer: Cash Price |
$1,529.55
|
| Rate for Payer: Cash Price |
$1,529.55
|
| Rate for Payer: Cigna of CA HMO |
$2,175.36
|
| Rate for Payer: Cigna of CA PPO |
$2,515.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: Dignity Health Media |
$480.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$480.50
|
| Rate for Payer: Galaxy Health WC |
$2,889.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,039.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,549.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$788.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$788.02
|
| Rate for Payer: IEHP Medi-Cal |
$778.41
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$778.41
|
| Rate for Payer: IEHP Medicare Advantage |
$480.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,267.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$309.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$815.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$605.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.87
|
| Rate for Payer: Multiplan Commercial |
$2,719.20
|
| Rate for Payer: Networks By Design Commercial |
$2,209.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,889.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$250.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,039.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,039.40
|
| 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 |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC CT CSPINE WITH CONTRAST
|
Facility
IP
|
$6,055.00
|
|
|
Service Code
|
CPT 72126
|
| Hospital Charge Code |
909201916
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,453.20 |
| Max. Negotiated Rate |
$5,146.75 |
| Rate for Payer: Cash Price |
$2,724.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,422.00
|
| Rate for Payer: Galaxy Health WC |
$5,146.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,633.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,038.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,306.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,453.20
|
| Rate for Payer: Multiplan Commercial |
$4,844.00
|
| Rate for Payer: Networks By Design Commercial |
$3,935.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,146.75
|
|
|
HC CT CSPINE WO CONTRAST
|
Facility
IP
|
$5,624.00
|
|
|
Service Code
|
CPT 72125
|
| Hospital Charge Code |
909201915
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,349.76 |
| Max. Negotiated Rate |
$4,780.40 |
| Rate for Payer: Cash Price |
$2,530.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,249.60
|
| Rate for Payer: Galaxy Health WC |
$4,780.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,374.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,751.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,142.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,349.76
|
| Rate for Payer: Multiplan Commercial |
$4,499.20
|
| Rate for Payer: Networks By Design Commercial |
$3,655.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,780.40
|
|
