|
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: 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 |
$1,705.18
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: 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 |
$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: Redlands Yucaipa Medical Group Commercial/Senior |
$250.00
|
| 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: 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 |
$1,488.90
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: 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 |
$1,666.83
|
| 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: Redlands Yucaipa Medical Group Commercial/Senior |
$250.00
|
| 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: 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 |
$2,077.55
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: 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 |
$2,325.83
|
| 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: Redlands Yucaipa Medical Group Commercial/Senior |
$250.00
|
| 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
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: Cash Price |
$1,406.25
|
| 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 |
$1,861.88
|
| Rate for Payer: BCBS Transplant 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: 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 Transplant 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: 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 |
$2,084.38
|
| 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: Redlands Yucaipa Medical Group Commercial/Senior |
$250.00
|
| 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 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 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: 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 |
$2,289.06
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: 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 |
$2,562.61
|
| 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: Redlands Yucaipa Medical Group Commercial/Senior |
$250.00
|
| 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
|
|
|
HC CT ORB/SEL/PFOSSA/EAR W/WO CNT
|
Facility
IP
|
$6,517.00
|
|
|
Service Code
|
CPT 70482
|
| Hospital Charge Code |
909201905
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,564.08 |
| Max. Negotiated Rate |
$5,539.45 |
| Rate for Payer: Cash Price |
$2,932.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,606.80
|
| Rate for Payer: Galaxy Health WC |
$5,539.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,910.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,346.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,482.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,564.08
|
| Rate for Payer: Multiplan Commercial |
$5,213.60
|
| Rate for Payer: Networks By Design Commercial |
$4,236.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,539.45
|
|
|
HC CT PERFUSION W/CONTRAST, CBF
|
Facility
OP
|
$4,201.00
|
|
|
Service Code
|
CPT 0042T
|
| Hospital Charge Code |
909201812
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$3,570.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,570.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,310.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,310.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,502.96
|
| Rate for Payer: BCBS Transplant Transplant |
$2,520.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,482.79
|
| Rate for Payer: Blue Shield of California EPN |
$1,970.27
|
| Rate for Payer: Cash Price |
$1,890.45
|
| Rate for Payer: Cash Price |
$1,890.45
|
| Rate for Payer: Cigna of CA HMO |
$2,688.64
|
| Rate for Payer: Cigna of CA PPO |
$3,108.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,570.85
|
| Rate for Payer: Dignity Health Media |
$3,570.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,570.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,680.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,680.40
|
| Rate for Payer: Galaxy Health WC |
$3,570.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,520.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,150.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,802.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,008.24
|
| Rate for Payer: Multiplan Commercial |
$3,360.80
|
| Rate for Payer: Networks By Design Commercial |
$2,730.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,570.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$250.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,520.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,520.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,100.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,100.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,100.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,100.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,570.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,570.85
|
| Rate for Payer: Vantage Medical Group Senior |
$3,570.85
|
|
|
HC CT PERFUSION W/CONTRAST, CBF
|
Facility
IP
|
$6,414.00
|
|
|
Service Code
|
CPT 0042T
|
| Hospital Charge Code |
909201812
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,539.36 |
| Max. Negotiated Rate |
$5,451.90 |
| Rate for Payer: Cash Price |
$2,886.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,565.60
|
| Rate for Payer: Galaxy Health WC |
$5,451.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,848.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,278.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,443.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,539.36
|
| Rate for Payer: Multiplan Commercial |
$5,131.20
|
| Rate for Payer: Networks By Design Commercial |
$4,169.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,451.90
|
|
|
HC CT RECONSTRUCTION FOR TRANSPLT
|
Facility
IP
|
$2,379.00
|
|
| Hospital Charge Code |
909201983
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$570.96 |
| Max. Negotiated Rate |
$2,022.15 |
| Rate for Payer: Cash Price |
$1,070.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$951.60
|
| Rate for Payer: Galaxy Health WC |
$2,022.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,427.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,586.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$906.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$570.96
|
| Rate for Payer: Multiplan Commercial |
$1,903.20
|
| Rate for Payer: Networks By Design Commercial |
$1,546.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,022.15
|
|
|
HC CT RECONSTRUCTION FOR TRANSPLT
|
Facility
OP
|
$2,379.00
|
|
| Hospital Charge Code |
909201983
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$2,022.15 |
| Rate for Payer: Dignity Health Media |
$2,022.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,022.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$951.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,560.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,022.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,308.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,308.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,417.41
|
| Rate for Payer: BCBS Transplant Transplant |
$1,427.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,405.99
|
| Rate for Payer: Blue Shield of California EPN |
$1,115.75
|
| Rate for Payer: Cash Price |
$1,070.55
|
| Rate for Payer: Cash Price |
$1,070.55
|
| Rate for Payer: Cigna of CA HMO |
$1,522.56
|
| Rate for Payer: Cigna of CA PPO |
$1,760.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,022.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$951.60
|
| Rate for Payer: Galaxy Health WC |
$2,022.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,427.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,784.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,586.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$906.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$570.96
|
| Rate for Payer: Multiplan Commercial |
$1,903.20
|
| Rate for Payer: Networks By Design Commercial |
$1,546.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,022.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$250.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,427.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,427.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,189.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,189.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,189.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,189.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,022.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,022.15
|
| Rate for Payer: Vantage Medical Group Senior |
$2,022.15
|
|
|
HC CT SOFT TIS NCK W CONTR
|
Facility
OP
|
$3,224.00
|
|
|
Service Code
|
CPT 70491
|
| Hospital Charge Code |
909201910
|
|
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: 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 |
$1,920.86
|
| Rate for Payer: BCBS Transplant Transplant |
$1,934.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,905.38
|
| Rate for Payer: Blue Shield of California EPN |
$1,512.06
|
| Rate for Payer: Cash Price |
$1,450.80
|
| Rate for Payer: Cash Price |
$1,450.80
|
| Rate for Payer: Cigna of CA HMO |
$2,063.36
|
| Rate for Payer: Cigna of CA PPO |
$2,385.76
|
| 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 |
$2,740.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,934.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,418.00
|
| 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 |
$2,150.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$339.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$773.76
|
| 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 |
$2,579.20
|
| Rate for Payer: Networks By Design Commercial |
$2,095.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,740.40
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$250.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,934.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,934.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,612.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,612.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,612.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,612.00
|
| 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 SOFT TIS NCK W CONTR
|
Facility
IP
|
$5,744.00
|
|
|
Service Code
|
CPT 70491
|
| Hospital Charge Code |
909201910
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,378.56 |
| Max. Negotiated Rate |
$4,882.40 |
| Rate for Payer: Cash Price |
$2,584.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,297.60
|
| Rate for Payer: Galaxy Health WC |
$4,882.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,446.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,831.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,188.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,378.56
|
| Rate for Payer: Multiplan Commercial |
$4,595.20
|
| Rate for Payer: Networks By Design Commercial |
$3,733.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,882.40
|
|
|
HC CT SOFT TIS NCK WO CONTR
|
Facility
IP
|
$5,098.00
|
|
|
Service Code
|
CPT 70490
|
| Hospital Charge Code |
909201909
|
|
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 SOFT TIS NCK WO CONTR
|
Facility
OP
|
$2,862.00
|
|
|
Service Code
|
CPT 70490
|
| Hospital Charge Code |
909201909
|
|
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: 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 |
$1,705.18
|
| Rate for Payer: BCBS Transplant 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 |
$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 |
$2,432.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,717.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,146.50
|
| 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 |
$1,908.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$273.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$686.88
|
| 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 |
$2,289.60
|
| Rate for Payer: Networks By Design Commercial |
$1,860.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,432.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$250.00
|
| 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 |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC CT SOFT TISSUE NECK W/WO CNTRST
|
Facility
IP
|
$5,834.00
|
|
|
Service Code
|
CPT 70492
|
| Hospital Charge Code |
909201911
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,400.16 |
| Max. Negotiated Rate |
$4,958.90 |
| Rate for Payer: Cash Price |
$2,625.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,333.60
|
| Rate for Payer: Galaxy Health WC |
$4,958.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,500.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,891.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,222.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,400.16
|
| Rate for Payer: Multiplan Commercial |
$4,667.20
|
| Rate for Payer: Networks By Design Commercial |
$3,792.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,958.90
|
|
|
HC CT SOFT TISSUE NECK W/WO CNTRST
|
Facility
OP
|
$3,842.00
|
|
|
Service Code
|
CPT 70492
|
| Hospital Charge Code |
909201911
|
|
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: 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 |
$2,289.06
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: 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 |
$2,562.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$408.20
|
| 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: Redlands Yucaipa Medical Group Commercial/Senior |
$250.00
|
| 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
|
|
|
HC CT STEREOTACTIC LOCALIZATION
|
Facility
OP
|
$1,856.00
|
|
|
Service Code
|
CPT 77011
|
| Hospital Charge Code |
909001159
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,577.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,577.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,577.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,020.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,020.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,105.80
|
| Rate for Payer: BCBS Transplant Transplant |
$1,113.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,096.90
|
| Rate for Payer: Blue Shield of California EPN |
$870.46
|
| Rate for Payer: Cash Price |
$835.20
|
| Rate for Payer: Cash Price |
$835.20
|
| Rate for Payer: Cigna of CA HMO |
$1,187.84
|
| Rate for Payer: Cigna of CA PPO |
$1,373.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,577.60
|
| Rate for Payer: Dignity Health Media |
$1,577.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,577.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$742.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$742.40
|
| Rate for Payer: Galaxy Health WC |
$1,577.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,113.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,392.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,237.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$379.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$445.44
|
| Rate for Payer: Multiplan Commercial |
$1,484.80
|
| Rate for Payer: Networks By Design Commercial |
$1,206.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,577.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$250.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,113.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,113.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$928.00
|
| Rate for Payer: United Healthcare All Other HMO |
$928.00
|
| Rate for Payer: United Healthcare HMO Rider |
$928.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$928.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,577.60
|
|
|
HC CT STEREOTACTIC LOCALIZATION
|
Facility
IP
|
$2,645.00
|
|
|
Service Code
|
CPT 77011
|
| Hospital Charge Code |
909001159
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$634.80 |
| Max. Negotiated Rate |
$2,248.25 |
| Rate for Payer: Cash Price |
$1,190.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,058.00
|
| Rate for Payer: Galaxy Health WC |
$2,248.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,587.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,764.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,007.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$634.80
|
| 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
|
|
|
HC CT TSPINE W CONTRAST
|
Facility
IP
|
$5,733.00
|
|
|
Service Code
|
CPT 72129
|
| Hospital Charge Code |
909201918
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,375.92 |
| Max. Negotiated Rate |
$4,873.05 |
| Rate for Payer: Cash Price |
$2,579.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,293.20
|
| Rate for Payer: Galaxy Health WC |
$4,873.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,439.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,823.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,184.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,375.92
|
| Rate for Payer: Multiplan Commercial |
$4,586.40
|
| Rate for Payer: Networks By Design Commercial |
$3,726.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,873.05
|
|
|
HC CT TSPINE W CONTRAST
|
Facility
OP
|
$2,968.00
|
|
|
Service Code
|
CPT 72129
|
| Hospital Charge Code |
909201918
|
|
Hospital Revenue Code
|
352
|
| 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: 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 |
$1,768.33
|
| Rate for Payer: BCBS Transplant Transplant |
$1,780.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,754.09
|
| Rate for Payer: Blue Shield of California EPN |
$1,391.99
|
| Rate for Payer: Cash Price |
$1,335.60
|
| Rate for Payer: Cash Price |
$1,335.60
|
| Rate for Payer: Cigna of CA HMO |
$1,899.52
|
| Rate for Payer: Cigna of CA PPO |
$2,196.32
|
| 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 |
$2,522.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,780.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,226.00
|
| 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 |
$1,979.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$312.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$712.32
|
| 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 |
$2,374.40
|
| Rate for Payer: Networks By Design Commercial |
$1,929.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,522.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$250.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,780.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,780.80
|
| 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 TSPINE WO CONTRAST
|
Facility
IP
|
$5,345.00
|
|
|
Service Code
|
CPT 72128
|
| Hospital Charge Code |
909201917
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,282.80 |
| Max. Negotiated Rate |
$4,543.25 |
| Rate for Payer: Cash Price |
$2,405.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,138.00
|
| Rate for Payer: Galaxy Health WC |
$4,543.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,207.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,565.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,036.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,282.80
|
| Rate for Payer: Multiplan Commercial |
$4,276.00
|
| Rate for Payer: Networks By Design Commercial |
$3,474.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,543.25
|
|
