|
HC CT MAXILLOFAC W CONT
|
Facility
|
OP
|
$2,433.00
|
|
|
Service Code
|
CPT 70487
|
| Hospital Charge Code |
909201907
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$486.60
|
| 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 |
$1,494.11
|
| Rate for Payer: Blue Shield of California Commercial |
$1,489.00
|
| Rate for Payer: Blue Shield of California EPN |
$982.93
|
| Rate for Payer: Cash Price |
$1,094.85
|
| Rate for Payer: Cash Price |
$1,094.85
|
| Rate for Payer: Cash Price |
$1,094.85
|
| Rate for Payer: Cigna of CA HMO |
$1,557.12
|
| Rate for Payer: Cigna of CA PPO |
$1,800.42
|
| 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 |
$2,068.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,459.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$246.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,622.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$278.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$583.92
|
| 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 |
$1,946.40
|
| Rate for Payer: Networks By Design Commercial |
$1,581.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,068.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,459.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,459.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,216.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,216.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,216.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,216.50
|
| 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 MAXILLOFAC W/O CO
|
Facility
|
IP
|
$4,785.00
|
|
|
Service Code
|
CPT 70486
|
| Hospital Charge Code |
909201906
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$957.00 |
| Max. Negotiated Rate |
$4,067.25 |
| Rate for Payer: Adventist Health Commercial |
$957.00
|
| Rate for Payer: Cash Price |
$2,153.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,914.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,914.00
|
| Rate for Payer: Galaxy Health WC |
$4,067.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,871.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,191.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,823.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,961.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,148.40
|
| Rate for Payer: Multiplan Commercial |
$3,828.00
|
| Rate for Payer: Networks By Design Commercial |
$3,110.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,067.25
|
|
|
HC CT MAXILLOFAC W/O CO
|
Facility
|
OP
|
$2,124.00
|
|
|
Service Code
|
CPT 70486
|
| Hospital Charge Code |
909201906
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$424.80
|
| 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 |
$1,304.35
|
| Rate for Payer: Blue Shield of California Commercial |
$1,299.89
|
| Rate for Payer: Blue Shield of California EPN |
$858.10
|
| Rate for Payer: Cash Price |
$955.80
|
| Rate for Payer: Cash Price |
$955.80
|
| Rate for Payer: Cash Price |
$955.80
|
| Rate for Payer: Cigna of CA HMO |
$1,359.36
|
| Rate for Payer: Cigna of CA PPO |
$1,571.76
|
| 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 |
$1,805.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,274.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$207.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,416.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$234.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$509.76
|
| 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 |
$1,699.20
|
| Rate for Payer: Networks By Design Commercial |
$1,380.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,805.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,274.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,274.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,062.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,062.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,062.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,062.00
|
| 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 ORB/SEL/PFOSSA/EAR W CONTR
|
Facility
|
OP
|
$2,964.00
|
|
|
Service Code
|
CPT 70481
|
| Hospital Charge Code |
909201904
|
|
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 |
$294.69
|
| 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 |
$333.28
|
| 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 ORB/SEL/PFOSSA/EAR W CONTR
|
Facility
|
IP
|
$6,674.00
|
|
|
Service Code
|
CPT 70481
|
| Hospital Charge Code |
909201904
|
|
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 ORB/SEL/PFOSSA/EAR WO CONTR
|
Facility
|
IP
|
$5,982.00
|
|
|
Service Code
|
CPT 70480
|
| Hospital Charge Code |
909201903
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,196.40 |
| Max. Negotiated Rate |
$5,084.70 |
| Rate for Payer: Adventist Health Commercial |
$1,196.40
|
| Rate for Payer: Cash Price |
$2,691.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,392.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,392.80
|
| Rate for Payer: Galaxy Health WC |
$5,084.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,589.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,989.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,279.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,702.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,435.68
|
| Rate for Payer: Multiplan Commercial |
$4,785.60
|
| Rate for Payer: Networks By Design Commercial |
$3,888.30
|
| Rate for Payer: Prime Health Services Commercial |
$5,084.70
|
|
|
HC CT ORB/SEL/PFOSSA/EAR WO CONTR
|
Facility
|
OP
|
$2,656.00
|
|
|
Service Code
|
CPT 70480
|
| Hospital Charge Code |
909201903
|
|
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 |
$255.93
|
| 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 |
$289.45
|
| 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 ORB/SEL/PFOSSA/EAR W/WO CNT
|
Facility
|
OP
|
$3,266.00
|
|
|
Service Code
|
CPT 70482
|
| Hospital Charge Code |
909201905
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$2,776.10 |
| Rate for Payer: Adventist Health Commercial |
$653.20
|
| 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 |
$2,005.65
|
| Rate for Payer: Blue Shield of California Commercial |
$1,998.79
|
| Rate for Payer: Blue Shield of California EPN |
$1,319.46
|
| Rate for Payer: Cash Price |
$1,469.70
|
| Rate for Payer: Cash Price |
$1,469.70
|
| Rate for Payer: Cash Price |
$1,469.70
|
| Rate for Payer: Cigna of CA HMO |
$2,090.24
|
| Rate for Payer: Cigna of CA PPO |
$2,416.84
|
| 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 |
$2,776.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,959.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$346.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,178.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$391.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$783.84
|
| 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 |
$2,612.80
|
| Rate for Payer: Networks By Design Commercial |
$2,122.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,776.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,959.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,959.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,633.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,633.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,633.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,633.00
|
| 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 ORB/SEL/PFOSSA/EAR W/WO CNT
|
Facility
|
IP
|
$7,006.00
|
|
|
Service Code
|
CPT 70482
|
| Hospital Charge Code |
909201905
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,401.20 |
| Max. Negotiated Rate |
$5,955.10 |
| Rate for Payer: Adventist Health Commercial |
$1,401.20
|
| Rate for Payer: Cash Price |
$3,152.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,802.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,802.40
|
| Rate for Payer: Galaxy Health WC |
$5,955.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,203.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,673.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,669.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,336.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,681.44
|
| Rate for Payer: Multiplan Commercial |
$5,604.80
|
| Rate for Payer: Networks By Design Commercial |
$4,553.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,955.10
|
|
|
HC CT PERFUSION W/CONTRAST, CBF
|
Facility
|
IP
|
$5,710.00
|
|
|
Service Code
|
CPT 0042T
|
| Hospital Charge Code |
909201812
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,142.00 |
| Max. Negotiated Rate |
$4,853.50 |
| Rate for Payer: Adventist Health Commercial |
$1,142.00
|
| Rate for Payer: Cash Price |
$2,569.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,284.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,284.00
|
| Rate for Payer: Galaxy Health WC |
$4,853.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,426.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,808.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,175.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,534.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,370.40
|
| Rate for Payer: Multiplan Commercial |
$4,568.00
|
| Rate for Payer: Networks By Design Commercial |
$3,711.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,853.50
|
|
|
HC CT PERFUSION W/CONTRAST, CBF
|
Facility
|
OP
|
$3,571.00
|
|
|
Service Code
|
CPT 0042T
|
| Hospital Charge Code |
909201812
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$714.20 |
| Max. Negotiated Rate |
$3,035.35 |
| Rate for Payer: Adventist Health Commercial |
$714.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,035.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,964.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,678.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,192.95
|
| Rate for Payer: Blue Shield of California Commercial |
$2,185.45
|
| Rate for Payer: Blue Shield of California EPN |
$1,442.68
|
| Rate for Payer: Cash Price |
$1,606.95
|
| Rate for Payer: Cash Price |
$1,606.95
|
| Rate for Payer: Cigna of CA HMO |
$2,285.44
|
| Rate for Payer: Cigna of CA PPO |
$2,642.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,035.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,035.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,035.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,428.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,428.40
|
| Rate for Payer: Galaxy Health WC |
$3,035.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,142.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,381.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,210.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$857.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,499.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,499.70
|
| Rate for Payer: Multiplan Commercial |
$2,856.80
|
| Rate for Payer: Networks By Design Commercial |
$2,321.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,035.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,142.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,142.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,785.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,785.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,785.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,785.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,035.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,035.35
|
| Rate for Payer: Vantage Medical Group Senior |
$3,035.35
|
|
|
HC CT RECONSTRUCTION FOR TRANSPLT
|
Facility
|
OP
|
$2,450.00
|
|
| Hospital Charge Code |
909201983
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$490.00 |
| Max. Negotiated Rate |
$2,082.50 |
| Rate for Payer: Adventist Health Commercial |
$490.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,606.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,082.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,347.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,837.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,504.55
|
| Rate for Payer: Blue Shield of California Commercial |
$1,499.40
|
| Rate for Payer: Blue Shield of California EPN |
$989.80
|
| Rate for Payer: Cash Price |
$1,102.50
|
| Rate for Payer: Cigna of CA HMO |
$1,568.00
|
| Rate for Payer: Cigna of CA PPO |
$1,813.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,082.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,082.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,082.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$980.00
|
| Rate for Payer: EPIC Health Plan Senior |
$980.00
|
| Rate for Payer: Galaxy Health WC |
$2,082.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,470.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,634.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$933.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,516.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$588.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,715.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,715.00
|
| Rate for Payer: Multiplan Commercial |
$1,960.00
|
| Rate for Payer: Networks By Design Commercial |
$1,592.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,082.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,470.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,470.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,225.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,225.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,225.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,225.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,082.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,082.50
|
| Rate for Payer: Vantage Medical Group Senior |
$2,082.50
|
|
|
HC CT RECONSTRUCTION FOR TRANSPLT
|
Facility
|
IP
|
$2,450.00
|
|
| Hospital Charge Code |
909201983
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$490.00 |
| Max. Negotiated Rate |
$2,082.50 |
| Rate for Payer: Adventist Health Commercial |
$490.00
|
| Rate for Payer: Cash Price |
$1,102.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$980.00
|
| Rate for Payer: EPIC Health Plan Senior |
$980.00
|
| Rate for Payer: Galaxy Health WC |
$2,082.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,470.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,634.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$933.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,516.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$588.00
|
| Rate for Payer: Multiplan Commercial |
$1,960.00
|
| Rate for Payer: Networks By Design Commercial |
$1,592.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,082.50
|
|
|
HC CT SOFT TIS NCK W CONTR
|
Facility
|
OP
|
$2,740.00
|
|
|
Service Code
|
CPT 70491
|
| Hospital Charge Code |
909201910
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$548.00
|
| 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 |
$1,682.63
|
| Rate for Payer: Blue Shield of California Commercial |
$1,676.88
|
| Rate for Payer: Blue Shield of California EPN |
$1,106.96
|
| Rate for Payer: Cash Price |
$1,233.00
|
| Rate for Payer: Cash Price |
$1,233.00
|
| Rate for Payer: Cash Price |
$1,233.00
|
| Rate for Payer: Cigna of CA HMO |
$1,753.60
|
| Rate for Payer: Cigna of CA PPO |
$2,027.60
|
| 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 |
$2,329.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,644.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$299.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,827.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$339.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$657.60
|
| 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 |
$2,192.00
|
| Rate for Payer: Networks By Design Commercial |
$1,781.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,329.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,644.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,644.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,370.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,370.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,370.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,370.00
|
| 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 SOFT TIS NCK W CONTR
|
Facility
|
IP
|
$6,175.00
|
|
|
Service Code
|
CPT 70491
|
| Hospital Charge Code |
909201910
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,235.00 |
| Max. Negotiated Rate |
$5,248.75 |
| Rate for Payer: Adventist Health Commercial |
$1,235.00
|
| Rate for Payer: Cash Price |
$2,778.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,470.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,470.00
|
| Rate for Payer: Galaxy Health WC |
$5,248.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,705.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,118.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,352.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,822.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,482.00
|
| Rate for Payer: Multiplan Commercial |
$4,940.00
|
| Rate for Payer: Networks By Design Commercial |
$4,013.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,248.75
|
|
|
HC CT SOFT TIS NCK WO CONTR
|
Facility
|
OP
|
$2,433.00
|
|
|
Service Code
|
CPT 70490
|
| Hospital Charge Code |
909201909
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$486.60
|
| 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 |
$1,494.11
|
| Rate for Payer: Blue Shield of California Commercial |
$1,489.00
|
| Rate for Payer: Blue Shield of California EPN |
$982.93
|
| Rate for Payer: Cash Price |
$1,094.85
|
| Rate for Payer: Cash Price |
$1,094.85
|
| Rate for Payer: Cash Price |
$1,094.85
|
| Rate for Payer: Cigna of CA HMO |
$1,557.12
|
| Rate for Payer: Cigna of CA PPO |
$1,800.42
|
| 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 |
$2,068.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,459.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$241.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,622.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$273.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$583.92
|
| 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 |
$1,946.40
|
| Rate for Payer: Networks By Design Commercial |
$1,581.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,068.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,459.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,459.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,216.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,216.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,216.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,216.50
|
| 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 SOFT TIS NCK WO CONTR
|
Facility
|
IP
|
$5,480.00
|
|
|
Service Code
|
CPT 70490
|
| Hospital Charge Code |
909201909
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,096.00 |
| Max. Negotiated Rate |
$4,658.00 |
| Rate for Payer: Adventist Health Commercial |
$1,096.00
|
| Rate for Payer: Cash Price |
$2,466.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,192.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,192.00
|
| Rate for Payer: Galaxy Health WC |
$4,658.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,288.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,655.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,087.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,392.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,315.20
|
| Rate for Payer: Multiplan Commercial |
$4,384.00
|
| Rate for Payer: Networks By Design Commercial |
$3,562.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,658.00
|
|
|
HC CT SOFT TISSUE NECK W/WO CNTRST
|
Facility
|
OP
|
$3,266.00
|
|
|
Service Code
|
CPT 70492
|
| Hospital Charge Code |
909201911
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$2,776.10 |
| Rate for Payer: Adventist Health Commercial |
$653.20
|
| 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 |
$2,005.65
|
| Rate for Payer: Blue Shield of California Commercial |
$1,998.79
|
| Rate for Payer: Blue Shield of California EPN |
$1,319.46
|
| Rate for Payer: Cash Price |
$1,469.70
|
| Rate for Payer: Cash Price |
$1,469.70
|
| Rate for Payer: Cash Price |
$1,469.70
|
| Rate for Payer: Cigna of CA HMO |
$2,090.24
|
| Rate for Payer: Cigna of CA PPO |
$2,416.84
|
| 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 |
$2,776.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,959.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$360.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,178.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$408.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$783.84
|
| 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 |
$2,612.80
|
| Rate for Payer: Networks By Design Commercial |
$2,122.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,776.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,959.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,959.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,633.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,633.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,633.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,633.00
|
| 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 SOFT TISSUE NECK W/WO CNTRST
|
Facility
|
IP
|
$6,272.00
|
|
|
Service Code
|
CPT 70492
|
| Hospital Charge Code |
909201911
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,254.40 |
| Max. Negotiated Rate |
$5,331.20 |
| Rate for Payer: Adventist Health Commercial |
$1,254.40
|
| Rate for Payer: Cash Price |
$2,822.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,508.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,508.80
|
| Rate for Payer: Galaxy Health WC |
$5,331.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,763.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,183.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,389.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,882.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,505.28
|
| Rate for Payer: Multiplan Commercial |
$5,017.60
|
| Rate for Payer: Networks By Design Commercial |
$4,076.80
|
| Rate for Payer: Prime Health Services Commercial |
$5,331.20
|
|
|
HC CT STEREOTACTIC LOCALIZATION
|
Facility
|
OP
|
$1,578.00
|
|
|
Service Code
|
CPT 77011
|
| Hospital Charge Code |
909001159
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$315.60 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$315.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,341.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$867.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,183.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$969.05
|
| Rate for Payer: Blue Shield of California Commercial |
$965.74
|
| Rate for Payer: Blue Shield of California EPN |
$637.51
|
| Rate for Payer: Cash Price |
$710.10
|
| Rate for Payer: Cash Price |
$710.10
|
| Rate for Payer: Cash Price |
$710.10
|
| Rate for Payer: Cigna of CA HMO |
$1,009.92
|
| Rate for Payer: Cigna of CA PPO |
$1,167.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,341.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,341.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,341.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$631.20
|
| Rate for Payer: EPIC Health Plan Senior |
$631.20
|
| Rate for Payer: Galaxy Health WC |
$1,341.30
|
| Rate for Payer: Global Benefits Group Commercial |
$946.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$335.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,052.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$379.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$976.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$378.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,104.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,104.60
|
| Rate for Payer: Multiplan Commercial |
$1,262.40
|
| Rate for Payer: Networks By Design Commercial |
$1,025.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,341.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$946.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$946.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$789.00
|
| Rate for Payer: United Healthcare All Other HMO |
$789.00
|
| Rate for Payer: United Healthcare HMO Rider |
$789.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$789.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,341.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,341.30
|
| Rate for Payer: Vantage Medical Group Senior |
$1,341.30
|
|
|
HC CT STEREOTACTIC LOCALIZATION
|
Facility
|
IP
|
$2,354.00
|
|
|
Service Code
|
CPT 77011
|
| Hospital Charge Code |
909001159
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$470.80 |
| Max. Negotiated Rate |
$2,000.90 |
| Rate for Payer: Adventist Health Commercial |
$470.80
|
| Rate for Payer: Cash Price |
$1,059.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$941.60
|
| Rate for Payer: EPIC Health Plan Senior |
$941.60
|
| Rate for Payer: Galaxy Health WC |
$2,000.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,412.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,570.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$896.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,457.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$564.96
|
| Rate for Payer: Multiplan Commercial |
$1,883.20
|
| Rate for Payer: Networks By Design Commercial |
$1,530.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,000.90
|
|
|
HC CT TSPINE W CONTRAST
|
Facility
|
OP
|
$2,523.00
|
|
|
Service Code
|
CPT 72129
|
| Hospital Charge Code |
909201918
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$504.60
|
| 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 |
$1,549.37
|
| Rate for Payer: Blue Shield of California Commercial |
$1,544.08
|
| Rate for Payer: Blue Shield of California EPN |
$1,019.29
|
| Rate for Payer: Cash Price |
$1,135.35
|
| Rate for Payer: Cash Price |
$1,135.35
|
| Rate for Payer: Cash Price |
$1,135.35
|
| Rate for Payer: Cigna of CA HMO |
$1,614.72
|
| Rate for Payer: Cigna of CA PPO |
$1,867.02
|
| 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 |
$2,144.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,513.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$276.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,682.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$312.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$605.52
|
| 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 |
$2,018.40
|
| Rate for Payer: Networks By Design Commercial |
$1,639.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,144.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,513.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,513.80
|
| 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 TSPINE W CONTRAST
|
Facility
|
IP
|
$5,104.00
|
|
|
Service Code
|
CPT 72129
|
| Hospital Charge Code |
909201918
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,020.80 |
| Max. Negotiated Rate |
$4,338.40 |
| Rate for Payer: Adventist Health Commercial |
$1,020.80
|
| Rate for Payer: Cash Price |
$2,296.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,041.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,041.60
|
| Rate for Payer: Galaxy Health WC |
$4,338.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,062.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,404.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,944.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,159.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,224.96
|
| Rate for Payer: Multiplan Commercial |
$4,083.20
|
| Rate for Payer: Networks By Design Commercial |
$3,317.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,338.40
|
|
|
HC CT TSPINE WO CONTRAST
|
Facility
|
OP
|
$2,550.00
|
|
|
Service Code
|
CPT 72128
|
| Hospital Charge Code |
909201917
|
|
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 |
$209.46
|
| 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 |
$236.89
|
| 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 TSPINE WO CONTRAST
|
Facility
|
IP
|
$4,758.00
|
|
|
Service Code
|
CPT 72128
|
| Hospital Charge Code |
909201917
|
|
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
|
|
