|
HC CT CSPINE WITH CONTRAST
|
Facility
|
IP
|
$6,509.00
|
|
|
Service Code
|
CPT 72126
|
| Hospital Charge Code |
909201916
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,301.80 |
| Max. Negotiated Rate |
$5,532.65 |
| Rate for Payer: Adventist Health Commercial |
$1,301.80
|
| Rate for Payer: Cash Price |
$2,929.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,603.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,603.60
|
| Rate for Payer: Galaxy Health WC |
$5,532.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,905.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,341.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,479.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,029.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,562.16
|
| Rate for Payer: Multiplan Commercial |
$5,207.20
|
| Rate for Payer: Networks By Design Commercial |
$4,230.85
|
| Rate for Payer: Prime Health Services Commercial |
$5,532.65
|
|
|
HC CT CSPINE WO CONTRAST
|
Facility
|
OP
|
$2,684.00
|
|
|
Service Code
|
CPT 72125
|
| Hospital Charge Code |
909201915
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$536.80
|
| 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 |
$1,648.24
|
| Rate for Payer: Blue Shield of California Commercial |
$1,642.61
|
| Rate for Payer: Blue Shield of California EPN |
$1,084.34
|
| Rate for Payer: Cash Price |
$1,207.80
|
| Rate for Payer: Cash Price |
$1,207.80
|
| Rate for Payer: Cash Price |
$1,207.80
|
| Rate for Payer: Cigna of CA HMO |
$1,717.76
|
| Rate for Payer: Cigna of CA PPO |
$1,986.16
|
| 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 |
$2,281.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,610.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$209.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,790.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$237.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$644.16
|
| 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 |
$2,147.20
|
| Rate for Payer: Networks By Design Commercial |
$1,744.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,281.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,610.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,610.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$491.23
|
| Rate for Payer: United Healthcare All Other HMO |
$491.23
|
| Rate for Payer: United Healthcare HMO Rider |
$491.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$491.23
|
| Rate for Payer: 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 WO CONTRAST
|
Facility
|
IP
|
$6,046.00
|
|
|
Service Code
|
CPT 72125
|
| Hospital Charge Code |
909201915
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,209.20 |
| Max. Negotiated Rate |
$5,139.10 |
| Rate for Payer: Adventist Health Commercial |
$1,209.20
|
| Rate for Payer: Cash Price |
$2,720.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,418.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,418.40
|
| Rate for Payer: Galaxy Health WC |
$5,139.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,627.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,032.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,303.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,742.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,451.04
|
| Rate for Payer: Multiplan Commercial |
$4,836.80
|
| Rate for Payer: Networks By Design Commercial |
$3,929.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,139.10
|
|
|
HC CT C SPINE W/WO CONTRAST
|
Facility
|
OP
|
$3,018.00
|
|
|
Service Code
|
CPT 72127
|
| Hospital Charge Code |
909201967
|
|
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 |
$323.20
|
| 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 |
$365.52
|
| 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 C SPINE W/WO CONTRAST
|
Facility
|
IP
|
$6,834.00
|
|
|
Service Code
|
CPT 72127
|
| Hospital Charge Code |
909201967
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,366.80 |
| Max. Negotiated Rate |
$5,808.90 |
| Rate for Payer: Adventist Health Commercial |
$1,366.80
|
| Rate for Payer: Cash Price |
$3,075.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,733.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,733.60
|
| Rate for Payer: Galaxy Health WC |
$5,808.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,100.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,558.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,603.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,230.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,640.16
|
| Rate for Payer: Multiplan Commercial |
$5,467.20
|
| Rate for Payer: Networks By Design Commercial |
$4,442.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,808.90
|
|
|
HC CT GUID ABCESS DRAIN
|
Facility
|
OP
|
$2,408.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
909201944
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$175.59 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$481.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,046.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,324.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,478.75
|
| Rate for Payer: Blue Shield of California Commercial |
$1,473.70
|
| Rate for Payer: Blue Shield of California EPN |
$972.83
|
| Rate for Payer: Cash Price |
$1,083.60
|
| Rate for Payer: Cash Price |
$1,083.60
|
| Rate for Payer: Cash Price |
$1,083.60
|
| Rate for Payer: Cigna of CA HMO |
$1,541.12
|
| Rate for Payer: Cigna of CA PPO |
$1,781.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,046.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,046.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,046.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$963.20
|
| Rate for Payer: EPIC Health Plan Senior |
$963.20
|
| Rate for Payer: Galaxy Health WC |
$2,046.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,444.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$175.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,606.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,490.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$577.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,685.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,685.60
|
| Rate for Payer: Multiplan Commercial |
$1,926.40
|
| Rate for Payer: Networks By Design Commercial |
$1,565.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,046.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,444.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,444.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,204.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,204.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,204.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,204.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,046.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,046.80
|
| Rate for Payer: Vantage Medical Group Senior |
$2,046.80
|
|
|
HC CT GUID ABCESS DRAIN
|
Facility
|
IP
|
$2,408.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
909201944
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$481.60 |
| Max. Negotiated Rate |
$2,046.80 |
| Rate for Payer: Adventist Health Commercial |
$481.60
|
| Rate for Payer: Cash Price |
$1,083.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$963.20
|
| Rate for Payer: EPIC Health Plan Senior |
$963.20
|
| Rate for Payer: Galaxy Health WC |
$2,046.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,444.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,606.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$917.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,490.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$577.92
|
| Rate for Payer: Multiplan Commercial |
$1,926.40
|
| Rate for Payer: Networks By Design Commercial |
$1,565.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,046.80
|
|
|
HC CT GUIDANCE/NEEDLE PLACEMENT
|
Facility
|
OP
|
$3,971.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
909201935
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$186.56 |
| Max. Negotiated Rate |
$3,375.35 |
| Rate for Payer: Adventist Health Commercial |
$794.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,375.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,184.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,978.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,438.59
|
| Rate for Payer: Blue Shield of California Commercial |
$2,430.25
|
| Rate for Payer: Blue Shield of California EPN |
$1,604.28
|
| Rate for Payer: Cash Price |
$1,786.95
|
| Rate for Payer: Cash Price |
$1,786.95
|
| Rate for Payer: Cash Price |
$1,786.95
|
| Rate for Payer: Cigna of CA HMO |
$2,541.44
|
| Rate for Payer: Cigna of CA PPO |
$2,938.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,375.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,375.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,375.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,588.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,588.40
|
| Rate for Payer: Galaxy Health WC |
$3,375.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,382.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$186.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,648.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$211.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,458.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$953.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,779.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,779.70
|
| Rate for Payer: Multiplan Commercial |
$3,176.80
|
| Rate for Payer: Networks By Design Commercial |
$2,581.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,375.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,382.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,382.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,985.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,985.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,985.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,985.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,375.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,375.35
|
| Rate for Payer: Vantage Medical Group Senior |
$3,375.35
|
|
|
HC CT GUIDANCE/NEEDLE PLACEMENT
|
Facility
|
IP
|
$3,971.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
909201935
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$794.20 |
| Max. Negotiated Rate |
$3,375.35 |
| Rate for Payer: Adventist Health Commercial |
$794.20
|
| Rate for Payer: Cash Price |
$1,786.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,588.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,588.40
|
| Rate for Payer: Galaxy Health WC |
$3,375.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,382.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,648.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,512.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,458.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$953.04
|
| Rate for Payer: Multiplan Commercial |
$3,176.80
|
| Rate for Payer: Networks By Design Commercial |
$2,581.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,375.35
|
|
|
HC CT GUIDNC VISCERAL TISS ABLATN
|
Facility
|
IP
|
$9,602.00
|
|
|
Service Code
|
CPT 77013
|
| Hospital Charge Code |
909201810
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,920.40 |
| Max. Negotiated Rate |
$8,161.70 |
| Rate for Payer: Adventist Health Commercial |
$1,920.40
|
| Rate for Payer: Cash Price |
$4,320.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,840.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,840.80
|
| Rate for Payer: Galaxy Health WC |
$8,161.70
|
| Rate for Payer: Global Benefits Group Commercial |
$5,761.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,404.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,658.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,943.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,304.48
|
| Rate for Payer: Multiplan Commercial |
$7,681.60
|
| Rate for Payer: Networks By Design Commercial |
$6,241.30
|
| Rate for Payer: Prime Health Services Commercial |
$8,161.70
|
|
|
HC CT GUIDNC VISCERAL TISS ABLATN
|
Facility
|
OP
|
$6,737.00
|
|
|
Service Code
|
CPT 77013
|
| Hospital Charge Code |
909201810
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$270.18 |
| Max. Negotiated Rate |
$5,726.45 |
| Rate for Payer: Adventist Health Commercial |
$1,347.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,726.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,705.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,052.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,137.19
|
| Rate for Payer: Blue Shield of California Commercial |
$4,123.04
|
| Rate for Payer: Blue Shield of California EPN |
$2,721.75
|
| Rate for Payer: Cash Price |
$3,031.65
|
| Rate for Payer: Cash Price |
$3,031.65
|
| Rate for Payer: Cash Price |
$3,031.65
|
| Rate for Payer: Cigna of CA HMO |
$4,311.68
|
| Rate for Payer: Cigna of CA PPO |
$4,985.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,726.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,726.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,726.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,694.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,694.80
|
| Rate for Payer: Galaxy Health WC |
$5,726.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,042.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$270.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,493.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$305.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,170.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,616.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,715.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,715.90
|
| Rate for Payer: Multiplan Commercial |
$5,389.60
|
| Rate for Payer: Networks By Design Commercial |
$4,379.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,726.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,042.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,042.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,368.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,368.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,368.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,368.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,726.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,726.45
|
| Rate for Payer: Vantage Medical Group Senior |
$5,726.45
|
|
|
HC CT GUID RAD THERAPY
|
Facility
|
IP
|
$2,596.00
|
|
|
Service Code
|
CPT 77014
|
| Hospital Charge Code |
909100165
|
|
Hospital Revenue Code
|
359
|
| Min. Negotiated Rate |
$519.20 |
| Max. Negotiated Rate |
$2,206.60 |
| Rate for Payer: Adventist Health Commercial |
$519.20
|
| Rate for Payer: Cash Price |
$1,168.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,038.40
|
| Rate for Payer: Galaxy Health WC |
$2,206.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,557.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,731.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$989.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,606.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$623.04
|
| Rate for Payer: Multiplan Commercial |
$2,076.80
|
| Rate for Payer: Networks By Design Commercial |
$1,687.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,206.60
|
|
|
HC CT GUID RAD THERAPY
|
Facility
|
OP
|
$1,391.00
|
|
|
Service Code
|
CPT 77014
|
| Hospital Charge Code |
909100165
|
|
Hospital Revenue Code
|
359
|
| Min. Negotiated Rate |
$176.67 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$278.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,182.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$765.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,043.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$766.31
|
| Rate for Payer: Cash Price |
$625.95
|
| Rate for Payer: Cash Price |
$625.95
|
| Rate for Payer: Cash Price |
$625.95
|
| Rate for Payer: Cigna of CA HMO |
$890.24
|
| Rate for Payer: Cigna of CA PPO |
$1,029.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,182.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,182.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,182.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$556.40
|
| Rate for Payer: EPIC Health Plan Senior |
$556.40
|
| Rate for Payer: Galaxy Health WC |
$1,182.35
|
| Rate for Payer: Global Benefits Group Commercial |
$834.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$176.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$927.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$199.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$861.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$333.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$973.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$973.70
|
| Rate for Payer: Multiplan Commercial |
$1,112.80
|
| Rate for Payer: Networks By Design Commercial |
$904.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,182.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$834.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$834.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$695.50
|
| Rate for Payer: United Healthcare All Other HMO |
$695.50
|
| Rate for Payer: United Healthcare HMO Rider |
$695.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$695.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,182.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,182.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,182.35
|
|
|
HC CT HEAD NO CONTRAST
|
Facility
|
IP
|
$5,719.00
|
|
|
Service Code
|
CPT 70450
|
| Hospital Charge Code |
909201901
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,143.80 |
| Max. Negotiated Rate |
$4,861.15 |
| Rate for Payer: Adventist Health Commercial |
$1,143.80
|
| Rate for Payer: Cash Price |
$2,573.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,287.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,287.60
|
| Rate for Payer: Galaxy Health WC |
$4,861.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,431.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,814.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,178.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,540.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,372.56
|
| Rate for Payer: Multiplan Commercial |
$4,575.20
|
| Rate for Payer: Networks By Design Commercial |
$3,717.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,861.15
|
|
|
HC CT HEAD NO CONTRAST
|
Facility
|
OP
|
$2,656.00
|
|
|
Service Code
|
CPT 70450
|
| Hospital Charge Code |
909201901
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$531.20
|
| 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 |
$1,631.05
|
| Rate for Payer: Blue Shield of California Commercial |
$1,625.47
|
| Rate for Payer: Blue Shield of California EPN |
$1,073.02
|
| Rate for Payer: Cash Price |
$1,195.20
|
| Rate for Payer: Cash Price |
$1,195.20
|
| Rate for Payer: Cash Price |
$1,195.20
|
| Rate for Payer: Cigna of CA HMO |
$1,699.84
|
| Rate for Payer: Cigna of CA PPO |
$1,965.44
|
| 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 |
$2,257.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,593.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$170.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,771.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$192.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$637.44
|
| 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 |
$2,124.80
|
| Rate for Payer: Networks By Design Commercial |
$1,726.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,257.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,593.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,593.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,328.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,328.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,328.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,328.00
|
| 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 HEAD W CONTRAST
|
Facility
|
IP
|
$6,674.00
|
|
|
Service Code
|
CPT 70460
|
| Hospital Charge Code |
909201900
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,334.80 |
| Max. Negotiated Rate |
$5,672.90 |
| Rate for Payer: Adventist Health Commercial |
$1,334.80
|
| Rate for Payer: Cash Price |
$3,003.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,669.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,669.60
|
| Rate for Payer: Galaxy Health WC |
$5,672.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,004.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,451.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,542.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,131.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,601.76
|
| Rate for Payer: Multiplan Commercial |
$5,339.20
|
| Rate for Payer: Networks By Design Commercial |
$4,338.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,672.90
|
|
|
HC CT HEAD W CONTRAST
|
Facility
|
OP
|
$2,964.00
|
|
|
Service Code
|
CPT 70460
|
| Hospital Charge Code |
909201900
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$592.80
|
| 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 |
$1,820.19
|
| Rate for Payer: Blue Shield of California Commercial |
$1,813.97
|
| Rate for Payer: Blue Shield of California EPN |
$1,197.46
|
| Rate for Payer: Cash Price |
$1,333.80
|
| Rate for Payer: Cash Price |
$1,333.80
|
| Rate for Payer: Cash Price |
$1,333.80
|
| Rate for Payer: Cigna of CA HMO |
$1,896.96
|
| Rate for Payer: Cigna of CA PPO |
$2,193.36
|
| 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 |
$2,519.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,778.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$239.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,976.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$271.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$711.36
|
| 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 |
$2,371.20
|
| Rate for Payer: Networks By Design Commercial |
$1,926.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,519.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,778.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,778.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,482.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,482.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,482.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,482.00
|
| 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 HEAD W/WO CONTRAS
|
Facility
|
OP
|
$3,319.00
|
|
|
Service Code
|
CPT 70470
|
| Hospital Charge Code |
909201902
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$2,821.15 |
| Rate for Payer: Adventist Health Commercial |
$663.80
|
| 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 |
$2,038.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,031.23
|
| Rate for Payer: Blue Shield of California EPN |
$1,340.88
|
| Rate for Payer: Cash Price |
$1,493.55
|
| Rate for Payer: Cash Price |
$1,493.55
|
| Rate for Payer: Cash Price |
$1,493.55
|
| Rate for Payer: Cigna of CA HMO |
$2,124.16
|
| Rate for Payer: Cigna of CA PPO |
$2,456.06
|
| 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 |
$2,821.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,991.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$282.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,213.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$319.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$796.56
|
| 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 |
$2,655.20
|
| Rate for Payer: Networks By Design Commercial |
$2,157.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,821.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,991.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,991.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,659.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,659.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,659.50
|
| 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 HEAD W/WO CONTRAS
|
Facility
|
IP
|
$6,934.00
|
|
|
Service Code
|
CPT 70470
|
| Hospital Charge Code |
909201902
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,386.80 |
| Max. Negotiated Rate |
$5,893.90 |
| Rate for Payer: Adventist Health Commercial |
$1,386.80
|
| Rate for Payer: Cash Price |
$3,120.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,773.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,773.60
|
| Rate for Payer: Galaxy Health WC |
$5,893.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,160.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,624.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,641.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,292.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,664.16
|
| Rate for Payer: Multiplan Commercial |
$5,547.20
|
| Rate for Payer: Networks By Design Commercial |
$4,507.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,893.90
|
|
|
HC CT LOWER EXT W CONT
|
Facility
|
OP
|
$2,853.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
909201958
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$570.60
|
| 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 |
$1,752.03
|
| Rate for Payer: Blue Shield of California Commercial |
$1,746.04
|
| Rate for Payer: Blue Shield of California EPN |
$1,152.61
|
| Rate for Payer: Cash Price |
$1,283.85
|
| Rate for Payer: Cash Price |
$1,283.85
|
| Rate for Payer: Cash Price |
$1,283.85
|
| Rate for Payer: Cigna of CA HMO |
$1,825.92
|
| Rate for Payer: Cigna of CA PPO |
$2,111.22
|
| 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 |
$2,425.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,711.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$270.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,902.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$306.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$684.72
|
| 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 |
$2,282.40
|
| Rate for Payer: Networks By Design Commercial |
$1,854.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,425.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,711.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,711.80
|
| 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: 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 LOWER EXT W CONT
|
Facility
|
IP
|
$5,081.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
909201958
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,016.20 |
| Max. Negotiated Rate |
$4,318.85 |
| Rate for Payer: Adventist Health Commercial |
$1,016.20
|
| Rate for Payer: Cash Price |
$2,286.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,032.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,032.40
|
| Rate for Payer: Galaxy Health WC |
$4,318.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,048.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,389.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,935.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,145.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,219.44
|
| Rate for Payer: Multiplan Commercial |
$4,064.80
|
| Rate for Payer: Networks By Design Commercial |
$3,302.65
|
| Rate for Payer: Prime Health Services Commercial |
$4,318.85
|
|
|
HC CT LOWER EXT WO CONT
|
Facility
|
OP
|
$2,541.00
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
909201957
|
|
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 |
$208.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,694.85
|
| 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 |
$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 LOWER EXT WO CONT
|
Facility
|
IP
|
$4,525.00
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
909201957
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$905.00 |
| Max. Negotiated Rate |
$3,846.25 |
| Rate for Payer: Adventist Health Commercial |
$905.00
|
| Rate for Payer: Cash Price |
$2,036.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,810.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,810.00
|
| Rate for Payer: Galaxy Health WC |
$3,846.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,715.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,018.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,724.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,800.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,086.00
|
| Rate for Payer: Multiplan Commercial |
$3,620.00
|
| Rate for Payer: Networks By Design Commercial |
$2,941.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,846.25
|
|
|
HC CT LOWR EXTR W/WO CONT
|
Facility
|
OP
|
$3,191.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
909201959
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$638.20
|
| 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 |
$1,959.59
|
| Rate for Payer: Blue Shield of California Commercial |
$1,952.89
|
| Rate for Payer: Blue Shield of California EPN |
$1,289.16
|
| Rate for Payer: Cash Price |
$1,435.95
|
| Rate for Payer: Cash Price |
$1,435.95
|
| Rate for Payer: Cash Price |
$1,435.95
|
| Rate for Payer: Cigna of CA HMO |
$2,042.24
|
| Rate for Payer: Cigna of CA PPO |
$2,361.34
|
| 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 |
$2,712.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,914.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$318.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,128.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$359.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$765.84
|
| 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 |
$2,552.80
|
| Rate for Payer: Networks By Design Commercial |
$2,074.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,712.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,914.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,914.60
|
| 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 LOWR EXTR W/WO CONT
|
Facility
|
IP
|
$5,336.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
909201959
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,067.20 |
| Max. Negotiated Rate |
$4,535.60 |
| Rate for Payer: Adventist Health Commercial |
$1,067.20
|
| Rate for Payer: Cash Price |
$2,401.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,134.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,134.40
|
| Rate for Payer: Galaxy Health WC |
$4,535.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,201.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,559.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,033.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,302.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,280.64
|
| Rate for Payer: Multiplan Commercial |
$4,268.80
|
| Rate for Payer: Networks By Design Commercial |
$3,468.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,535.60
|
|
