|
HC CT BONE L-SPINE W/O CONTRAST
|
Facility
|
IP
|
$4,758.00
|
|
|
Service Code
|
CPT 72131
|
| Hospital Charge Code |
909201007
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$951.60 |
| Max. Negotiated Rate |
$4,044.30 |
| Rate for Payer: Adventist Health Commercial |
$951.60
|
| Rate for Payer: Cash Price |
$2,141.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,903.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,903.20
|
| Rate for Payer: Galaxy Health WC |
$4,044.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,854.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,173.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,812.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,945.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,141.92
|
| Rate for Payer: Multiplan Commercial |
$3,806.40
|
| Rate for Payer: Networks By Design Commercial |
$3,092.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,044.30
|
|
|
HC CT BONE L-SPINE W/O CONTRAST
|
Facility
|
OP
|
$2,550.00
|
|
|
Service Code
|
CPT 72131
|
| Hospital Charge Code |
909201007
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$510.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,565.95
|
| Rate for Payer: Blue Shield of California Commercial |
$1,560.60
|
| Rate for Payer: Blue Shield of California EPN |
$1,030.20
|
| Rate for Payer: Cash Price |
$1,147.50
|
| Rate for Payer: Cash Price |
$1,147.50
|
| Rate for Payer: Cash Price |
$1,147.50
|
| Rate for Payer: Cigna of CA HMO |
$1,632.00
|
| Rate for Payer: Cigna of CA PPO |
$1,887.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$2,167.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,530.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$208.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,700.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$236.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$612.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$2,040.00
|
| Rate for Payer: Networks By Design Commercial |
$1,657.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,167.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,530.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,530.00
|
| 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: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC CT BONE L-SPINE W/WO CONTRAST
|
Facility
|
OP
|
$3,004.00
|
|
|
Service Code
|
CPT 72133
|
| Hospital Charge Code |
909201009
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$600.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,844.76
|
| Rate for Payer: Blue Shield of California Commercial |
$1,838.45
|
| Rate for Payer: Blue Shield of California EPN |
$1,213.62
|
| Rate for Payer: Cash Price |
$1,351.80
|
| Rate for Payer: Cash Price |
$1,351.80
|
| Rate for Payer: Cash Price |
$1,351.80
|
| Rate for Payer: Cigna of CA HMO |
$1,922.56
|
| Rate for Payer: Cigna of CA PPO |
$2,222.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.36
|
| Rate for Payer: EPIC Health Plan Senior |
$226.19
|
| Rate for Payer: Galaxy Health WC |
$2,553.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,802.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$322.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,003.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$364.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$720.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.09
|
| Rate for Payer: Multiplan Commercial |
$2,403.20
|
| Rate for Payer: Networks By Design Commercial |
$1,952.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,553.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,802.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,802.40
|
| 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: Upland Medical Group Pediatric |
$226.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC CT BONE L-SPINE W/WO CONTRAST
|
Facility
|
IP
|
$5,358.00
|
|
|
Service Code
|
CPT 72133
|
| Hospital Charge Code |
909201009
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,071.60 |
| Max. Negotiated Rate |
$4,554.30 |
| Rate for Payer: Adventist Health Commercial |
$1,071.60
|
| Rate for Payer: Cash Price |
$2,411.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,143.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,143.20
|
| Rate for Payer: Galaxy Health WC |
$4,554.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,214.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,573.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,041.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,316.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,285.92
|
| Rate for Payer: Multiplan Commercial |
$4,286.40
|
| Rate for Payer: Networks By Design Commercial |
$3,482.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,554.30
|
|
|
HC CT BONE PELVIS W CONTRAST
|
Facility
|
OP
|
$2,761.00
|
|
|
Service Code
|
CPT 72193
|
| Hospital Charge Code |
909201931
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$552.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,695.53
|
| Rate for Payer: Blue Shield of California Commercial |
$1,689.73
|
| Rate for Payer: Blue Shield of California EPN |
$1,115.44
|
| Rate for Payer: Cash Price |
$1,242.45
|
| Rate for Payer: Cash Price |
$1,242.45
|
| Rate for Payer: Cash Price |
$1,242.45
|
| Rate for Payer: Cigna of CA HMO |
$1,767.04
|
| Rate for Payer: Cigna of CA PPO |
$2,043.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.36
|
| Rate for Payer: EPIC Health Plan Senior |
$226.19
|
| Rate for Payer: Galaxy Health WC |
$2,346.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,656.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$343.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,841.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$388.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$662.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.09
|
| Rate for Payer: Multiplan Commercial |
$2,208.80
|
| Rate for Payer: Networks By Design Commercial |
$1,794.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,346.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,656.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,656.60
|
| 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: Upland Medical Group Pediatric |
$226.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC CT BONE PELVIS W CONTRAST
|
Facility
|
IP
|
$5,151.00
|
|
|
Service Code
|
CPT 72193
|
| Hospital Charge Code |
909201931
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,030.20 |
| Max. Negotiated Rate |
$4,378.35 |
| Rate for Payer: Adventist Health Commercial |
$1,030.20
|
| Rate for Payer: Cash Price |
$2,317.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,060.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,060.40
|
| Rate for Payer: Galaxy Health WC |
$4,378.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,090.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,435.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,962.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,188.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,236.24
|
| Rate for Payer: Multiplan Commercial |
$4,120.80
|
| Rate for Payer: Networks By Design Commercial |
$3,348.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,378.35
|
|
|
HC CT BONE PELVIS W/O CONTRAST
|
Facility
|
IP
|
$4,740.00
|
|
|
Service Code
|
CPT 72192
|
| Hospital Charge Code |
909201930
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$948.00 |
| Max. Negotiated Rate |
$4,029.00 |
| Rate for Payer: Adventist Health Commercial |
$948.00
|
| Rate for Payer: Cash Price |
$2,133.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,896.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,896.00
|
| Rate for Payer: Galaxy Health WC |
$4,029.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,844.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,161.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,805.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,934.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,137.60
|
| Rate for Payer: Multiplan Commercial |
$3,792.00
|
| Rate for Payer: Networks By Design Commercial |
$3,081.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,029.00
|
|
|
HC CT BONE PELVIS W/O CONTRAST
|
Facility
|
OP
|
$2,541.00
|
|
|
Service Code
|
CPT 72192
|
| Hospital Charge Code |
909201930
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$508.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,560.43
|
| Rate for Payer: Blue Shield of California Commercial |
$1,555.09
|
| Rate for Payer: Blue Shield of California EPN |
$1,026.56
|
| Rate for Payer: Cash Price |
$1,143.45
|
| Rate for Payer: Cash Price |
$1,143.45
|
| Rate for Payer: Cash Price |
$1,143.45
|
| Rate for Payer: Cigna of CA HMO |
$1,626.24
|
| Rate for Payer: Cigna of CA PPO |
$1,880.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$2,159.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,524.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$214.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,694.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$242.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$609.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$2,032.80
|
| Rate for Payer: Networks By Design Commercial |
$1,651.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,159.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,524.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,524.60
|
| 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: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC CT BONE PELVIS W/WO CONTRAST
|
Facility
|
IP
|
$5,630.00
|
|
|
Service Code
|
CPT 72194
|
| Hospital Charge Code |
909201932
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,126.00 |
| Max. Negotiated Rate |
$4,785.50 |
| Rate for Payer: Adventist Health Commercial |
$1,126.00
|
| Rate for Payer: Cash Price |
$2,533.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,252.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,252.00
|
| Rate for Payer: Galaxy Health WC |
$4,785.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,378.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,755.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,145.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,484.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,351.20
|
| Rate for Payer: Multiplan Commercial |
$4,504.00
|
| Rate for Payer: Networks By Design Commercial |
$3,659.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,785.50
|
|
|
HC CT BONE PELVIS W/WO CONTRAST
|
Facility
|
OP
|
$3,018.00
|
|
|
Service Code
|
CPT 72194
|
| Hospital Charge Code |
909201932
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$603.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,853.35
|
| Rate for Payer: Blue Shield of California Commercial |
$1,847.02
|
| Rate for Payer: Blue Shield of California EPN |
$1,219.27
|
| Rate for Payer: Cash Price |
$1,358.10
|
| Rate for Payer: Cash Price |
$1,358.10
|
| Rate for Payer: Cash Price |
$1,358.10
|
| Rate for Payer: Cigna of CA HMO |
$1,931.52
|
| Rate for Payer: Cigna of CA PPO |
$2,233.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.36
|
| Rate for Payer: EPIC Health Plan Senior |
$226.19
|
| Rate for Payer: Galaxy Health WC |
$2,565.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,810.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$397.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,013.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$449.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$724.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.09
|
| Rate for Payer: Multiplan Commercial |
$2,414.40
|
| Rate for Payer: Networks By Design Commercial |
$1,961.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,565.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,810.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,810.80
|
| 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: Upland Medical Group Pediatric |
$226.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC CT CARDIAC SCORING
|
Facility
|
IP
|
$1,006.00
|
|
|
Service Code
|
CPT 75571
|
| Hospital Charge Code |
909201981
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$201.20 |
| Max. Negotiated Rate |
$855.10 |
| Rate for Payer: Adventist Health Commercial |
$201.20
|
| Rate for Payer: Cash Price |
$452.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$402.40
|
| Rate for Payer: EPIC Health Plan Senior |
$402.40
|
| Rate for Payer: Galaxy Health WC |
$855.10
|
| Rate for Payer: Global Benefits Group Commercial |
$603.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$671.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$383.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$622.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$241.44
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: Networks By Design Commercial |
$653.90
|
| Rate for Payer: Prime Health Services Commercial |
$855.10
|
|
|
HC CT CARDIAC SCORING
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
CPT 75571
|
| Hospital Charge Code |
909201981
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$108.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$331.61
|
| Rate for Payer: Blue Shield of California Commercial |
$330.48
|
| Rate for Payer: Blue Shield of California EPN |
$218.16
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cigna of CA HMO |
$345.60
|
| Rate for Payer: Cigna of CA PPO |
$399.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$459.00
|
| Rate for Payer: Global Benefits Group Commercial |
$324.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$136.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$360.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$432.00
|
| Rate for Payer: Networks By Design Commercial |
$351.00
|
| Rate for Payer: Prime Health Services Commercial |
$459.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$324.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$324.00
|
| 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: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC CT CHEST W CONTRAST
|
Facility
|
OP
|
$2,761.00
|
|
|
Service Code
|
CPT 71260
|
| Hospital Charge Code |
909201913
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$552.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,695.53
|
| Rate for Payer: Blue Shield of California Commercial |
$1,689.73
|
| Rate for Payer: Blue Shield of California EPN |
$1,115.44
|
| Rate for Payer: Cash Price |
$1,242.45
|
| Rate for Payer: Cash Price |
$1,242.45
|
| Rate for Payer: Cash Price |
$1,242.45
|
| Rate for Payer: Cigna of CA HMO |
$1,767.04
|
| Rate for Payer: Cigna of CA PPO |
$2,043.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.36
|
| Rate for Payer: EPIC Health Plan Senior |
$226.19
|
| Rate for Payer: Galaxy Health WC |
$2,346.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,656.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$270.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,841.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$305.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$662.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.09
|
| Rate for Payer: Multiplan Commercial |
$2,208.80
|
| Rate for Payer: Networks By Design Commercial |
$1,794.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,346.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,656.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,656.60
|
| 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: Upland Medical Group Pediatric |
$226.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC CT CHEST W CONTRAST
|
Facility
|
IP
|
$4,918.00
|
|
|
Service Code
|
CPT 71260
|
| Hospital Charge Code |
909201913
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$983.60 |
| Max. Negotiated Rate |
$4,180.30 |
| Rate for Payer: Adventist Health Commercial |
$983.60
|
| Rate for Payer: Cash Price |
$2,213.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,967.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,967.20
|
| Rate for Payer: Galaxy Health WC |
$4,180.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,950.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,280.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,873.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,044.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,180.32
|
| Rate for Payer: Multiplan Commercial |
$3,934.40
|
| Rate for Payer: Networks By Design Commercial |
$3,196.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,180.30
|
|
|
HC CT CHEST W/O CONTRAST
|
Facility
|
OP
|
$2,248.00
|
|
|
Service Code
|
CPT 71250
|
| Hospital Charge Code |
909201912
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$449.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,380.50
|
| Rate for Payer: Blue Shield of California Commercial |
$1,375.78
|
| Rate for Payer: Blue Shield of California EPN |
$908.19
|
| Rate for Payer: Cash Price |
$1,011.60
|
| Rate for Payer: Cash Price |
$1,011.60
|
| Rate for Payer: Cash Price |
$1,011.60
|
| Rate for Payer: Cigna of CA HMO |
$1,438.72
|
| Rate for Payer: Cigna of CA PPO |
$1,663.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$1,910.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,348.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$213.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,499.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$241.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$539.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$1,798.40
|
| Rate for Payer: Networks By Design Commercial |
$1,461.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,910.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,348.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,348.80
|
| 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: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC CT CHEST W/O CONTRAST
|
Facility
|
IP
|
$4,195.00
|
|
|
Service Code
|
CPT 71250
|
| Hospital Charge Code |
909201912
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$839.00 |
| Max. Negotiated Rate |
$3,565.75 |
| Rate for Payer: Adventist Health Commercial |
$839.00
|
| Rate for Payer: Cash Price |
$1,887.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,678.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,678.00
|
| Rate for Payer: Galaxy Health WC |
$3,565.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,517.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,798.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,598.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,596.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,006.80
|
| Rate for Payer: Multiplan Commercial |
$3,356.00
|
| Rate for Payer: Networks By Design Commercial |
$2,726.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,565.75
|
|
|
HC CT CHEST W WO CONTRA
|
Facility
|
IP
|
$6,109.00
|
|
|
Service Code
|
CPT 71270
|
| Hospital Charge Code |
909201914
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,221.80 |
| Max. Negotiated Rate |
$5,192.65 |
| Rate for Payer: Adventist Health Commercial |
$1,221.80
|
| Rate for Payer: Cash Price |
$2,749.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,443.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,443.60
|
| Rate for Payer: Galaxy Health WC |
$5,192.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,665.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,074.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,327.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,781.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,466.16
|
| Rate for Payer: Multiplan Commercial |
$4,887.20
|
| Rate for Payer: Networks By Design Commercial |
$3,970.85
|
| Rate for Payer: Prime Health Services Commercial |
$5,192.65
|
|
|
HC CT CHEST W WO CONTRA
|
Facility
|
OP
|
$3,274.00
|
|
|
Service Code
|
CPT 71270
|
| Hospital Charge Code |
909201914
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$2,782.90 |
| Rate for Payer: Adventist Health Commercial |
$654.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,010.56
|
| Rate for Payer: Blue Shield of California Commercial |
$2,003.69
|
| Rate for Payer: Blue Shield of California EPN |
$1,322.70
|
| Rate for Payer: Cash Price |
$1,473.30
|
| Rate for Payer: Cash Price |
$1,473.30
|
| Rate for Payer: Cash Price |
$1,473.30
|
| Rate for Payer: Cigna of CA HMO |
$2,095.36
|
| Rate for Payer: Cigna of CA PPO |
$2,422.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.36
|
| Rate for Payer: EPIC Health Plan Senior |
$226.19
|
| Rate for Payer: Galaxy Health WC |
$2,782.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,964.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$321.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,183.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$364.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$785.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.09
|
| Rate for Payer: Multiplan Commercial |
$2,619.20
|
| Rate for Payer: Networks By Design Commercial |
$2,128.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,782.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,964.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,964.40
|
| 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: Upland Medical Group Pediatric |
$226.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC CT COLONOGRAPHY SCREEN
|
Facility
|
IP
|
$2,187.00
|
|
|
Service Code
|
CPT 74263
|
| Hospital Charge Code |
909201813
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$437.40 |
| Max. Negotiated Rate |
$1,858.95 |
| Rate for Payer: Adventist Health Commercial |
$437.40
|
| Rate for Payer: Cash Price |
$984.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.80
|
| Rate for Payer: EPIC Health Plan Senior |
$874.80
|
| Rate for Payer: Galaxy Health WC |
$1,858.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,312.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,458.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$833.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,353.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$524.88
|
| Rate for Payer: Multiplan Commercial |
$1,749.60
|
| Rate for Payer: Networks By Design Commercial |
$1,421.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,858.95
|
|
|
HC CT COLONOGRAPHY SCREEN
|
Facility
|
OP
|
$1,172.00
|
|
|
Service Code
|
CPT 74263
|
| Hospital Charge Code |
909201813
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$234.40 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$234.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$719.73
|
| Rate for Payer: Blue Shield of California Commercial |
$717.26
|
| Rate for Payer: Blue Shield of California EPN |
$473.49
|
| Rate for Payer: Cash Price |
$527.40
|
| Rate for Payer: Cash Price |
$527.40
|
| Rate for Payer: Cash Price |
$527.40
|
| Rate for Payer: Cigna of CA HMO |
$750.08
|
| Rate for Payer: Cigna of CA PPO |
$867.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$996.20
|
| Rate for Payer: Global Benefits Group Commercial |
$703.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$781.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$281.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$937.60
|
| Rate for Payer: Networks By Design Commercial |
$761.80
|
| Rate for Payer: Prime Health Services Commercial |
$996.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$703.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$703.20
|
| 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: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC CT COLONOGRAPHY W/CONTRAST
|
Facility
|
IP
|
$5,879.00
|
|
|
Service Code
|
CPT 74262
|
| Hospital Charge Code |
909202000
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,175.80 |
| Max. Negotiated Rate |
$4,997.15 |
| Rate for Payer: Adventist Health Commercial |
$1,175.80
|
| Rate for Payer: Cash Price |
$2,645.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,351.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,351.60
|
| Rate for Payer: Galaxy Health WC |
$4,997.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,527.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,921.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,239.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,639.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,410.96
|
| Rate for Payer: Multiplan Commercial |
$4,703.20
|
| Rate for Payer: Networks By Design Commercial |
$3,821.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,997.15
|
|
|
HC CT COLONOGRAPHY W/CONTRAST
|
Facility
|
OP
|
$3,484.00
|
|
|
Service Code
|
CPT 74262
|
| Hospital Charge Code |
909202000
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$2,961.40 |
| Rate for Payer: Adventist Health Commercial |
$696.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,139.52
|
| Rate for Payer: Blue Shield of California Commercial |
$2,132.21
|
| Rate for Payer: Blue Shield of California EPN |
$1,407.54
|
| Rate for Payer: Cash Price |
$1,567.80
|
| Rate for Payer: Cash Price |
$1,567.80
|
| Rate for Payer: Cash Price |
$1,567.80
|
| Rate for Payer: Cigna of CA HMO |
$2,229.76
|
| Rate for Payer: Cigna of CA PPO |
$2,578.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.36
|
| Rate for Payer: EPIC Health Plan Senior |
$226.19
|
| Rate for Payer: Galaxy Health WC |
$2,961.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,090.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$787.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,323.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$890.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$836.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.09
|
| Rate for Payer: Multiplan Commercial |
$2,787.20
|
| Rate for Payer: Networks By Design Commercial |
$2,264.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,961.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,090.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,090.40
|
| 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: Upland Medical Group Pediatric |
$226.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC CT COLONOGRAPHY W/O CONTRAST
|
Facility
|
IP
|
$5,201.00
|
|
|
Service Code
|
CPT 74261
|
| Hospital Charge Code |
909201811
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,040.20 |
| Max. Negotiated Rate |
$4,420.85 |
| Rate for Payer: Adventist Health Commercial |
$1,040.20
|
| Rate for Payer: Cash Price |
$2,340.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,080.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,080.40
|
| Rate for Payer: Galaxy Health WC |
$4,420.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,120.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,469.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,981.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,219.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,248.24
|
| Rate for Payer: Multiplan Commercial |
$4,160.80
|
| Rate for Payer: Networks By Design Commercial |
$3,380.65
|
| Rate for Payer: Prime Health Services Commercial |
$4,420.85
|
|
|
HC CT COLONOGRAPHY W/O CONTRAST
|
Facility
|
OP
|
$3,151.00
|
|
|
Service Code
|
CPT 74261
|
| Hospital Charge Code |
909201811
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$630.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,935.03
|
| Rate for Payer: Blue Shield of California Commercial |
$1,928.41
|
| Rate for Payer: Blue Shield of California EPN |
$1,273.00
|
| Rate for Payer: Cash Price |
$1,417.95
|
| Rate for Payer: Cash Price |
$1,417.95
|
| Rate for Payer: Cash Price |
$1,417.95
|
| Rate for Payer: Cigna of CA HMO |
$2,016.64
|
| Rate for Payer: Cigna of CA PPO |
$2,331.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$2,678.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,890.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$695.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,101.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$786.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$756.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$2,520.80
|
| Rate for Payer: Networks By Design Commercial |
$2,048.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,678.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,890.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,890.60
|
| 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: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC CT CSPINE WITH CONTRAST
|
Facility
|
OP
|
$2,889.00
|
|
|
Service Code
|
CPT 72126
|
| Hospital Charge Code |
909201916
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$273.97 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$577.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,774.13
|
| Rate for Payer: Blue Shield of California Commercial |
$1,768.07
|
| Rate for Payer: Blue Shield of California EPN |
$1,167.16
|
| Rate for Payer: Cash Price |
$1,300.05
|
| Rate for Payer: Cash Price |
$1,300.05
|
| Rate for Payer: Cash Price |
$1,300.05
|
| Rate for Payer: Cigna of CA HMO |
$1,848.96
|
| Rate for Payer: Cigna of CA PPO |
$2,137.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.59
|
| Rate for Payer: EPIC Health Plan Senior |
$453.77
|
| Rate for Payer: Galaxy Health WC |
$2,455.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,733.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$273.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,926.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$309.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$693.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$571.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$608.05
|
| Rate for Payer: Multiplan Commercial |
$2,311.20
|
| Rate for Payer: Networks By Design Commercial |
$1,877.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,455.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,733.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,733.40
|
| 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: Upland Medical Group Pediatric |
$453.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
