|
HC CT ANGIO HEAD W/WO CONTRAST
|
Facility
|
IP
|
$7,722.00
|
|
|
Service Code
|
CPT 70496
|
| Hospital Charge Code |
909201800
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,544.40 |
| Max. Negotiated Rate |
$6,563.70 |
| Rate for Payer: Adventist Health Commercial |
$1,544.40
|
| Rate for Payer: Cash Price |
$3,474.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,405.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,088.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,088.80
|
| Rate for Payer: Galaxy Health WC |
$6,563.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,633.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,903.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,555.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,853.28
|
| Rate for Payer: Multiplan Commercial |
$6,177.60
|
| Rate for Payer: Networks By Design Commercial |
$5,019.30
|
| Rate for Payer: Prime Health Services Commercial |
$6,563.70
|
|
|
HC CT ANGIO LOW EXT W/WO CONT
|
Facility
|
IP
|
$4,873.00
|
|
|
Service Code
|
CPT 73706
|
| Hospital Charge Code |
909201807
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$974.60 |
| Max. Negotiated Rate |
$4,142.05 |
| Rate for Payer: Adventist Health Commercial |
$974.60
|
| Rate for Payer: Cash Price |
$2,192.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,411.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,949.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,949.20
|
| Rate for Payer: Galaxy Health WC |
$4,142.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,923.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,094.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,875.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,169.52
|
| Rate for Payer: Multiplan Commercial |
$3,898.40
|
| Rate for Payer: Networks By Design Commercial |
$3,167.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,142.05
|
|
|
HC CT ANGIO LOW EXT W/WO CONT
|
Facility
|
OP
|
$2,736.00
|
|
|
Service Code
|
CPT 73706
|
| Hospital Charge Code |
909201807
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.59 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$547.20
|
| Rate for Payer: Adventist Health Commercial |
$974.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,755.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,127.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,051.53
|
| Rate for Payer: Blue Shield of California Commercial |
$1,151.86
|
| Rate for Payer: Blue Shield of California Commercial |
$1,745.57
|
| Rate for Payer: Blue Shield of California Commercial |
$3,108.97
|
| Rate for Payer: Cash Price |
$1,231.20
|
| Rate for Payer: Cash Price |
$1,231.20
|
| Rate for Payer: Cash Price |
$2,192.85
|
| Rate for Payer: Cash Price |
$1,231.20
|
| Rate for Payer: Cash Price |
$2,192.85
|
| Rate for Payer: Cash Price |
$2,192.85
|
| Rate for Payer: Cigna of CA HMO |
$1,751.04
|
| Rate for Payer: Cigna of CA HMO |
$3,118.72
|
| Rate for Payer: Cigna of CA PPO |
$2,024.64
|
| Rate for Payer: Cigna of CA PPO |
$3,606.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,411.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,915.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: Galaxy Health WC |
$4,142.05
|
| Rate for Payer: Galaxy Health WC |
$2,325.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,641.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,923.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$530.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$530.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,094.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,737.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$600.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$600.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$656.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,169.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$284.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$284.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$302.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$2,188.80
|
| Rate for Payer: Multiplan Commercial |
$3,898.40
|
| Rate for Payer: Networks By Design Commercial |
$3,167.45
|
| Rate for Payer: Networks By Design Commercial |
$1,778.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,325.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,142.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,923.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,641.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,641.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,923.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.48
|
| Rate for Payer: United Healthcare All Other HMO |
$866.48
|
| Rate for Payer: United Healthcare All Other HMO |
$866.48
|
| Rate for Payer: United Healthcare HMO Rider |
$866.48
|
| Rate for Payer: United Healthcare HMO Rider |
$866.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.48
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
|
HC CT ANGIO NECK W/WO CONTRAST
|
Facility
|
IP
|
$7,722.00
|
|
|
Service Code
|
CPT 70498
|
| Hospital Charge Code |
909201801
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,544.40 |
| Max. Negotiated Rate |
$6,563.70 |
| Rate for Payer: Adventist Health Commercial |
$1,544.40
|
| Rate for Payer: Cash Price |
$3,474.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,405.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,088.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,088.80
|
| Rate for Payer: Galaxy Health WC |
$6,563.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,633.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,903.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,555.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,853.28
|
| Rate for Payer: Multiplan Commercial |
$6,177.60
|
| Rate for Payer: Networks By Design Commercial |
$5,019.30
|
| Rate for Payer: Prime Health Services Commercial |
$6,563.70
|
|
|
HC CT ANGIO NECK W/WO CONTRAST
|
Facility
|
OP
|
$7,722.00
|
|
|
Service Code
|
CPT 70498
|
| Hospital Charge Code |
909201801
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$225.59 |
| Max. Negotiated Rate |
$6,563.70 |
| Rate for Payer: Adventist Health Commercial |
$1,544.40
|
| Rate for Payer: Adventist Health Commercial |
$857.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,955.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,749.68
|
| Rate for Payer: Blue Shield of California Commercial |
$1,803.98
|
| Rate for Payer: Blue Shield of California Commercial |
$2,733.83
|
| Rate for Payer: Blue Shield of California Commercial |
$3,250.96
|
| Rate for Payer: Blue Shield of California Commercial |
$4,926.64
|
| Rate for Payer: Cash Price |
$3,474.90
|
| Rate for Payer: Cash Price |
$1,928.25
|
| Rate for Payer: Cash Price |
$1,928.25
|
| Rate for Payer: Cash Price |
$3,474.90
|
| Rate for Payer: Cash Price |
$1,928.25
|
| Rate for Payer: Cash Price |
$3,474.90
|
| Rate for Payer: Cigna of CA HMO |
$2,742.40
|
| Rate for Payer: Cigna of CA HMO |
$4,942.08
|
| Rate for Payer: Cigna of CA PPO |
$3,170.90
|
| Rate for Payer: Cigna of CA PPO |
$5,714.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,999.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,405.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: Galaxy Health WC |
$6,563.70
|
| Rate for Payer: Galaxy Health WC |
$3,642.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,633.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,571.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$445.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$445.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,903.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,720.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$503.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$503.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,853.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,028.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$284.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$284.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$302.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$3,428.00
|
| Rate for Payer: Multiplan Commercial |
$6,177.60
|
| Rate for Payer: Networks By Design Commercial |
$5,019.30
|
| Rate for Payer: Networks By Design Commercial |
$2,785.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,642.25
|
| Rate for Payer: Prime Health Services Commercial |
$6,563.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,633.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,571.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,571.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,633.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,142.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,861.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,861.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,142.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,861.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,142.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,142.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,861.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
|
HC CT ANGIO PELVIS W/WO CONTRAST
|
Facility
|
OP
|
$3,097.00
|
|
|
Service Code
|
CPT 72191
|
| Hospital Charge Code |
909201803
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.59 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$619.40
|
| Rate for Payer: Adventist Health Commercial |
$1,155.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,987.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,707.74
|
| Rate for Payer: Blue Shield of California Commercial |
$2,432.54
|
| Rate for Payer: Blue Shield of California Commercial |
$1,303.84
|
| Rate for Payer: Blue Shield of California Commercial |
$1,975.89
|
| Rate for Payer: Blue Shield of California Commercial |
$3,686.36
|
| Rate for Payer: Cash Price |
$1,393.65
|
| Rate for Payer: Cash Price |
$1,393.65
|
| Rate for Payer: Cash Price |
$2,600.10
|
| Rate for Payer: Cash Price |
$1,393.65
|
| Rate for Payer: Cash Price |
$2,600.10
|
| Rate for Payer: Cash Price |
$2,600.10
|
| Rate for Payer: Cigna of CA HMO |
$1,982.08
|
| Rate for Payer: Cigna of CA HMO |
$3,697.92
|
| Rate for Payer: Cigna of CA PPO |
$2,291.78
|
| Rate for Payer: Cigna of CA PPO |
$4,275.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,044.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,167.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: Galaxy Health WC |
$4,911.30
|
| Rate for Payer: Galaxy Health WC |
$2,632.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,858.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,466.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$461.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$461.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,669.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,966.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$522.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$522.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$743.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,386.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$284.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$284.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$302.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$2,477.60
|
| Rate for Payer: Multiplan Commercial |
$4,622.40
|
| Rate for Payer: Networks By Design Commercial |
$3,755.70
|
| Rate for Payer: Networks By Design Commercial |
$2,013.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,632.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,911.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,466.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,858.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,858.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,466.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.48
|
| Rate for Payer: United Healthcare All Other HMO |
$866.48
|
| Rate for Payer: United Healthcare All Other HMO |
$866.48
|
| Rate for Payer: United Healthcare HMO Rider |
$866.48
|
| Rate for Payer: United Healthcare HMO Rider |
$866.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.48
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
|
HC CT ANGIO PELVIS W/WO CONTRAST
|
Facility
|
IP
|
$5,778.00
|
|
|
Service Code
|
CPT 72191
|
| Hospital Charge Code |
909201803
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,155.60 |
| Max. Negotiated Rate |
$4,911.30 |
| Rate for Payer: Adventist Health Commercial |
$1,155.60
|
| Rate for Payer: Cash Price |
$2,600.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,044.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,311.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,311.20
|
| Rate for Payer: Galaxy Health WC |
$4,911.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,466.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,669.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,409.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,386.72
|
| Rate for Payer: Multiplan Commercial |
$4,622.40
|
| Rate for Payer: Networks By Design Commercial |
$3,755.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,911.30
|
|
|
HC CT ANGIO UPP EXT W/WO CON
|
Facility
|
IP
|
$5,350.00
|
|
|
Service Code
|
CPT 73206
|
| Hospital Charge Code |
909201804
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,070.00 |
| Max. Negotiated Rate |
$4,547.50 |
| Rate for Payer: Adventist Health Commercial |
$1,070.00
|
| Rate for Payer: Cash Price |
$2,407.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,745.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,140.00
|
| Rate for Payer: Galaxy Health WC |
$4,547.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,210.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,397.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,156.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,284.00
|
| Rate for Payer: Multiplan Commercial |
$4,280.00
|
| Rate for Payer: Networks By Design Commercial |
$3,477.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,547.50
|
|
|
HC CT ANGIO UPP EXT W/WO CON
|
Facility
|
OP
|
$3,004.00
|
|
|
Service Code
|
CPT 73206
|
| Hospital Charge Code |
909201804
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.59 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$600.80
|
| Rate for Payer: Adventist Health Commercial |
$1,070.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,927.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,433.09
|
| Rate for Payer: Blue Shield of California Commercial |
$2,252.35
|
| Rate for Payer: Blue Shield of California Commercial |
$1,264.68
|
| Rate for Payer: Blue Shield of California Commercial |
$1,916.55
|
| Rate for Payer: Blue Shield of California Commercial |
$3,413.30
|
| Rate for Payer: Cash Price |
$1,351.80
|
| Rate for Payer: Cash Price |
$1,351.80
|
| Rate for Payer: Cash Price |
$2,407.50
|
| Rate for Payer: Cash Price |
$1,351.80
|
| Rate for Payer: Cash Price |
$2,407.50
|
| Rate for Payer: Cash Price |
$2,407.50
|
| Rate for Payer: Cigna of CA HMO |
$1,922.56
|
| Rate for Payer: Cigna of CA HMO |
$3,424.00
|
| Rate for Payer: Cigna of CA PPO |
$2,222.96
|
| Rate for Payer: Cigna of CA PPO |
$3,959.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,745.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,102.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: Galaxy Health WC |
$4,547.50
|
| Rate for Payer: Galaxy Health WC |
$2,553.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,802.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,210.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$488.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$488.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,397.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,907.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$553.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$553.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$720.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,284.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$284.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$284.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$302.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$2,403.20
|
| Rate for Payer: Multiplan Commercial |
$4,280.00
|
| Rate for Payer: Networks By Design Commercial |
$3,477.50
|
| Rate for Payer: Networks By Design Commercial |
$1,952.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,553.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,547.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,210.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,802.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,802.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.48
|
| Rate for Payer: United Healthcare All Other HMO |
$866.48
|
| Rate for Payer: United Healthcare All Other HMO |
$866.48
|
| Rate for Payer: United Healthcare HMO Rider |
$866.48
|
| Rate for Payer: United Healthcare HMO Rider |
$866.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.48
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
|
HC CT BONE L-SPINE W CONTRAST
|
Facility
|
OP
|
$2,736.00
|
|
|
Service Code
|
CPT 72132
|
| Hospital Charge Code |
909201008
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$273.97 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$547.20
|
| Rate for Payer: Adventist Health Commercial |
$1,020.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,755.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,275.24
|
| Rate for Payer: Blue Shield of California Commercial |
$2,148.78
|
| Rate for Payer: Blue Shield of California Commercial |
$1,151.86
|
| Rate for Payer: Blue Shield of California Commercial |
$1,745.57
|
| Rate for Payer: Blue Shield of California Commercial |
$3,256.35
|
| Rate for Payer: Cash Price |
$1,231.20
|
| Rate for Payer: Cash Price |
$1,231.20
|
| Rate for Payer: Cash Price |
$2,296.80
|
| Rate for Payer: Cash Price |
$1,231.20
|
| Rate for Payer: Cash Price |
$2,296.80
|
| Rate for Payer: Cash Price |
$2,296.80
|
| Rate for Payer: Cigna of CA HMO |
$1,751.04
|
| Rate for Payer: Cigna of CA HMO |
$3,266.56
|
| Rate for Payer: Cigna of CA PPO |
$2,024.64
|
| Rate for Payer: Cigna of CA PPO |
$3,776.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,572.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,915.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.37
|
| Rate for Payer: EPIC Health Plan Senior |
$493.58
|
| Rate for Payer: EPIC Health Plan Senior |
$493.58
|
| Rate for Payer: Galaxy Health WC |
$4,338.40
|
| Rate for Payer: Galaxy Health WC |
$2,325.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,641.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,062.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$735.88
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$735.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$273.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$273.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,241.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,737.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$309.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$309.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$656.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,224.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$565.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$565.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$601.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$601.27
|
| Rate for Payer: Multiplan Commercial |
$2,188.80
|
| Rate for Payer: Multiplan Commercial |
$4,083.20
|
| Rate for Payer: Networks By Design Commercial |
$3,317.60
|
| Rate for Payer: Networks By Design Commercial |
$1,778.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,325.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,338.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,062.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,641.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,641.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,062.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$769.25
|
| 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 All Other HMO |
$769.25
|
| Rate for Payer: United Healthcare HMO Rider |
$769.25
|
| Rate for Payer: United Healthcare HMO Rider |
$769.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$769.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$769.25
|
| Rate for Payer: Upland Medical Group Pediatric |
$448.71
|
| Rate for Payer: Upland Medical Group Pediatric |
$448.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
|
|
HC CT BONE L-SPINE W CONTRAST
|
Facility
|
IP
|
$5,104.00
|
|
|
Service Code
|
CPT 72132
|
| Hospital Charge Code |
909201008
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,572.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3,241.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,011.36
|
| 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 BONE L-SPINE W/O CONTRAST
|
Facility
|
IP
|
$4,758.00
|
|
|
Service Code
|
CPT 72131
|
| Hospital Charge Code |
909201007
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$951.60 |
| Max. Negotiated Rate |
$4,044.30 |
| Rate for Payer: Adventist Health Commercial |
$951.60
|
| Rate for Payer: Cash Price |
$2,141.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,330.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3,021.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,807.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,141.92
|
| Rate for Payer: Multiplan Commercial |
$3,806.40
|
| Rate for Payer: Networks By Design Commercial |
$3,092.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,044.30
|
|
|
HC CT BONE L-SPINE W/O CONTRAST
|
Facility
|
OP
|
$2,550.00
|
|
|
Service Code
|
CPT 72131
|
| Hospital Charge Code |
909201007
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$510.00
|
| Rate for Payer: Adventist Health Commercial |
$951.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,636.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,053.21
|
| Rate for Payer: Blue Shield of California Commercial |
$2,003.12
|
| Rate for Payer: Blue Shield of California Commercial |
$1,073.55
|
| Rate for Payer: Blue Shield of California Commercial |
$1,626.90
|
| Rate for Payer: Blue Shield of California Commercial |
$3,035.60
|
| Rate for Payer: Cash Price |
$1,147.50
|
| Rate for Payer: Cash Price |
$1,147.50
|
| Rate for Payer: Cash Price |
$2,141.10
|
| Rate for Payer: Cash Price |
$1,147.50
|
| Rate for Payer: Cash Price |
$2,141.10
|
| Rate for Payer: Cash Price |
$2,141.10
|
| Rate for Payer: Cigna of CA HMO |
$1,632.00
|
| Rate for Payer: Cigna of CA HMO |
$3,045.12
|
| Rate for Payer: Cigna of CA PPO |
$1,887.00
|
| Rate for Payer: Cigna of CA PPO |
$3,520.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,330.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,785.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$4,044.30
|
| Rate for Payer: Galaxy Health WC |
$2,167.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,530.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,854.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$208.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$208.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,021.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,619.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$236.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$236.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$612.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,141.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$2,040.00
|
| Rate for Payer: Multiplan Commercial |
$3,806.40
|
| Rate for Payer: Networks By Design Commercial |
$3,092.70
|
| Rate for Payer: Networks By Design Commercial |
$1,657.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,167.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,044.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,854.80
|
| 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: TriValley Medical Group Commercial/Senior |
$2,854.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$491.23
|
| 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 All Other HMO |
$491.23
|
| Rate for Payer: United Healthcare HMO Rider |
$491.23
|
| Rate for Payer: United Healthcare HMO Rider |
$491.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$491.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$491.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC CT BONE L-SPINE W/WO CONTRAST
|
Facility
|
IP
|
$5,358.00
|
|
|
Service Code
|
CPT 72133
|
| Hospital Charge Code |
909201009
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,071.60 |
| Max. Negotiated Rate |
$4,554.30 |
| Rate for Payer: Cash Price |
$2,411.10
|
| Rate for Payer: Adventist Health Commercial |
$1,071.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,750.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,143.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,143.20
|
| Rate for Payer: Galaxy Health WC |
$4,554.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,214.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,402.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,161.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,285.92
|
| Rate for Payer: Multiplan Commercial |
$4,286.40
|
| Rate for Payer: Networks By Design Commercial |
$3,482.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,554.30
|
|
|
HC CT BONE L-SPINE W/WO CONTRAST
|
Facility
|
OP
|
$3,004.00
|
|
|
Service Code
|
CPT 72133
|
| Hospital Charge Code |
909201009
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.59 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$600.80
|
| Rate for Payer: Adventist Health Commercial |
$1,071.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,927.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,438.23
|
| Rate for Payer: Blue Shield of California Commercial |
$2,255.72
|
| Rate for Payer: Blue Shield of California Commercial |
$1,264.68
|
| Rate for Payer: Blue Shield of California Commercial |
$1,916.55
|
| Rate for Payer: Blue Shield of California Commercial |
$3,418.40
|
| Rate for Payer: Cash Price |
$1,351.80
|
| Rate for Payer: Cash Price |
$1,351.80
|
| Rate for Payer: Cash Price |
$2,411.10
|
| Rate for Payer: Cash Price |
$1,351.80
|
| Rate for Payer: Cash Price |
$2,411.10
|
| Rate for Payer: Cash Price |
$2,411.10
|
| Rate for Payer: Cigna of CA HMO |
$1,922.56
|
| Rate for Payer: Cigna of CA HMO |
$3,429.12
|
| Rate for Payer: Cigna of CA PPO |
$2,222.96
|
| Rate for Payer: Cigna of CA PPO |
$3,964.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,750.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,102.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: Galaxy Health WC |
$4,554.30
|
| Rate for Payer: Galaxy Health WC |
$2,553.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,802.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,214.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$322.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$322.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,402.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,907.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$364.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$364.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$720.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,285.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$284.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$284.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$302.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$2,403.20
|
| Rate for Payer: Multiplan Commercial |
$4,286.40
|
| Rate for Payer: Networks By Design Commercial |
$3,482.70
|
| Rate for Payer: Networks By Design Commercial |
$1,952.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,553.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,554.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,214.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,802.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,802.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,214.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$855.26
|
| 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 All Other HMO |
$855.26
|
| Rate for Payer: United Healthcare HMO Rider |
$855.26
|
| Rate for Payer: United Healthcare HMO Rider |
$855.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$855.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$855.26
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
|
HC CT BONE PELVIS W CONTRAST
|
Facility
|
IP
|
$5,151.00
|
|
|
Service Code
|
CPT 72193
|
| Hospital Charge Code |
909201931
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,030.20 |
| Max. Negotiated Rate |
$4,378.35 |
| Rate for Payer: Adventist Health Commercial |
$1,030.20
|
| Rate for Payer: Cash Price |
$2,317.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,605.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,060.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,060.40
|
| Rate for Payer: Galaxy Health WC |
$4,378.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,090.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,270.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,039.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,236.24
|
| Rate for Payer: Multiplan Commercial |
$4,120.80
|
| Rate for Payer: Networks By Design Commercial |
$3,348.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,378.35
|
|
|
HC CT BONE PELVIS W CONTRAST
|
Facility
|
OP
|
$2,761.00
|
|
|
Service Code
|
CPT 72193
|
| Hospital Charge Code |
909201931
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.59 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$552.20
|
| Rate for Payer: Adventist Health Commercial |
$1,030.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,771.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,305.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,168.57
|
| Rate for Payer: Blue Shield of California Commercial |
$1,162.38
|
| Rate for Payer: Blue Shield of California Commercial |
$1,761.52
|
| Rate for Payer: Blue Shield of California Commercial |
$3,286.34
|
| Rate for Payer: Cash Price |
$1,242.45
|
| Rate for Payer: Cash Price |
$1,242.45
|
| Rate for Payer: Cash Price |
$2,317.95
|
| Rate for Payer: Cash Price |
$1,242.45
|
| Rate for Payer: Cash Price |
$2,317.95
|
| Rate for Payer: Cash Price |
$2,317.95
|
| Rate for Payer: Cigna of CA HMO |
$1,767.04
|
| Rate for Payer: Cigna of CA HMO |
$3,296.64
|
| Rate for Payer: Cigna of CA PPO |
$2,043.14
|
| Rate for Payer: Cigna of CA PPO |
$3,811.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,605.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,932.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: Galaxy Health WC |
$4,378.35
|
| Rate for Payer: Galaxy Health WC |
$2,346.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,656.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,090.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$343.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$343.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,270.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,753.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$388.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$388.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$662.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,236.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$284.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$284.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$302.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$2,208.80
|
| Rate for Payer: Multiplan Commercial |
$4,120.80
|
| Rate for Payer: Networks By Design Commercial |
$3,348.15
|
| Rate for Payer: Networks By Design Commercial |
$1,794.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,346.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,378.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,090.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,656.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,656.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,090.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$769.25
|
| 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 All Other HMO |
$769.25
|
| Rate for Payer: United Healthcare HMO Rider |
$769.25
|
| Rate for Payer: United Healthcare HMO Rider |
$769.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$769.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$769.25
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
|
HC CT BONE PELVIS W/O CONTRAST
|
Facility
|
IP
|
$4,740.00
|
|
|
Service Code
|
CPT 72192
|
| Hospital Charge Code |
909201930
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$948.00 |
| Max. Negotiated Rate |
$4,029.00 |
| Rate for Payer: Adventist Health Commercial |
$948.00
|
| Rate for Payer: Cash Price |
$2,133.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,318.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,896.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,896.00
|
| Rate for Payer: Galaxy Health WC |
$4,029.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,844.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,009.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,796.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,137.60
|
| Rate for Payer: Multiplan Commercial |
$3,792.00
|
| Rate for Payer: Networks By Design Commercial |
$3,081.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,029.00
|
|
|
HC CT BONE PELVIS W/O CONTRAST
|
Facility
|
OP
|
$2,541.00
|
|
|
Service Code
|
CPT 72192
|
| Hospital Charge Code |
909201930
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$508.20
|
| Rate for Payer: Adventist Health Commercial |
$948.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,630.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,041.66
|
| Rate for Payer: Blue Shield of California Commercial |
$1,995.54
|
| Rate for Payer: Blue Shield of California Commercial |
$1,069.76
|
| Rate for Payer: Blue Shield of California Commercial |
$1,621.16
|
| Rate for Payer: Blue Shield of California Commercial |
$3,024.12
|
| Rate for Payer: Cash Price |
$1,143.45
|
| Rate for Payer: Cash Price |
$1,143.45
|
| Rate for Payer: Cash Price |
$2,133.00
|
| Rate for Payer: Cash Price |
$1,143.45
|
| Rate for Payer: Cash Price |
$2,133.00
|
| Rate for Payer: Cash Price |
$2,133.00
|
| Rate for Payer: Cigna of CA HMO |
$1,626.24
|
| Rate for Payer: Cigna of CA HMO |
$3,033.60
|
| Rate for Payer: Cigna of CA PPO |
$1,880.34
|
| Rate for Payer: Cigna of CA PPO |
$3,507.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,318.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,778.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$4,029.00
|
| Rate for Payer: Galaxy Health WC |
$2,159.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,524.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,844.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$214.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$214.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,009.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,613.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$242.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$242.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$609.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,137.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$2,032.80
|
| Rate for Payer: Multiplan Commercial |
$3,792.00
|
| Rate for Payer: Networks By Design Commercial |
$3,081.00
|
| Rate for Payer: Networks By Design Commercial |
$1,651.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,159.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,029.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,844.00
|
| 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: TriValley Medical Group Commercial/Senior |
$2,844.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$491.23
|
| 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 All Other HMO |
$491.23
|
| Rate for Payer: United Healthcare HMO Rider |
$491.23
|
| Rate for Payer: United Healthcare HMO Rider |
$491.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$491.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$491.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC CT BONE PELVIS W/WO CONTRAST
|
Facility
|
OP
|
$3,018.00
|
|
|
Service Code
|
CPT 72194
|
| Hospital Charge Code |
909201932
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.59 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$603.60
|
| Rate for Payer: Adventist Health Commercial |
$1,126.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,936.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,612.77
|
| Rate for Payer: Blue Shield of California Commercial |
$2,370.23
|
| Rate for Payer: Blue Shield of California Commercial |
$1,270.58
|
| Rate for Payer: Blue Shield of California Commercial |
$1,925.48
|
| Rate for Payer: Blue Shield of California Commercial |
$3,591.94
|
| Rate for Payer: Cash Price |
$1,358.10
|
| Rate for Payer: Cash Price |
$1,358.10
|
| Rate for Payer: Cash Price |
$2,533.50
|
| Rate for Payer: Cash Price |
$1,358.10
|
| Rate for Payer: Cash Price |
$2,533.50
|
| Rate for Payer: Cash Price |
$2,533.50
|
| Rate for Payer: Cigna of CA HMO |
$1,931.52
|
| Rate for Payer: Cigna of CA HMO |
$3,603.20
|
| Rate for Payer: Cigna of CA PPO |
$2,233.32
|
| Rate for Payer: Cigna of CA PPO |
$4,166.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,941.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,112.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: Galaxy Health WC |
$4,785.50
|
| Rate for Payer: Galaxy Health WC |
$2,565.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,810.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,378.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$397.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$397.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,575.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,916.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$449.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$449.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$724.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,351.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$284.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$284.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$302.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$2,414.40
|
| Rate for Payer: Multiplan Commercial |
$4,504.00
|
| Rate for Payer: Networks By Design Commercial |
$3,659.50
|
| Rate for Payer: Networks By Design Commercial |
$1,961.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,565.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,785.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,378.00
|
| 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: TriValley Medical Group Commercial/Senior |
$3,378.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$855.26
|
| 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 All Other HMO |
$855.26
|
| Rate for Payer: United Healthcare HMO Rider |
$855.26
|
| Rate for Payer: United Healthcare HMO Rider |
$855.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$855.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$855.26
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
|
HC CT BONE PELVIS W/WO CONTRAST
|
Facility
|
IP
|
$5,630.00
|
|
|
Service Code
|
CPT 72194
|
| Hospital Charge Code |
909201932
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,126.00 |
| Max. Negotiated Rate |
$4,785.50 |
| Rate for Payer: Adventist Health Commercial |
$1,126.00
|
| Rate for Payer: Cash Price |
$2,533.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,941.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,252.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,252.00
|
| Rate for Payer: Galaxy Health WC |
$4,785.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,378.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,575.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,321.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,351.20
|
| Rate for Payer: Multiplan Commercial |
$4,504.00
|
| Rate for Payer: Networks By Design Commercial |
$3,659.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,785.50
|
|
|
HC CT CARDIAC SCORING
|
Facility
|
OP
|
$1,006.00
|
|
|
Service Code
|
CPT 75571
|
| Hospital Charge Code |
909201981
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$111.93 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$201.20
|
| Rate for Payer: Adventist Health Commercial |
$108.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$645.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$346.52
|
| Rate for Payer: Blue Shield of California Commercial |
$227.34
|
| Rate for Payer: Blue Shield of California Commercial |
$423.53
|
| Rate for Payer: Blue Shield of California Commercial |
$641.83
|
| Rate for Payer: Blue Shield of California Commercial |
$344.52
|
| Rate for Payer: Cash Price |
$452.70
|
| Rate for Payer: Cash Price |
$452.70
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cash Price |
$452.70
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cigna of CA HMO |
$643.84
|
| Rate for Payer: Cigna of CA HMO |
$345.60
|
| Rate for Payer: Cigna of CA PPO |
$744.44
|
| Rate for Payer: Cigna of CA PPO |
$399.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$378.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$704.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$459.00
|
| Rate for Payer: Galaxy Health WC |
$855.10
|
| Rate for Payer: Global Benefits Group Commercial |
$603.60
|
| Rate for Payer: Global Benefits Group Commercial |
$324.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$136.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$136.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$342.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$638.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$154.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$154.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$241.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$141.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$141.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: Multiplan Commercial |
$432.00
|
| Rate for Payer: Networks By Design Commercial |
$351.00
|
| Rate for Payer: Networks By Design Commercial |
$653.90
|
| Rate for Payer: Prime Health Services Commercial |
$855.10
|
| Rate for Payer: Prime Health Services Commercial |
$459.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$324.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$603.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$603.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$324.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.83
|
| Rate for Payer: United Healthcare All Other HMO |
$116.83
|
| Rate for Payer: United Healthcare All Other HMO |
$116.83
|
| Rate for Payer: United Healthcare HMO Rider |
$116.83
|
| Rate for Payer: United Healthcare HMO Rider |
$116.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$116.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$116.83
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.93
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC CT CARDIAC SCORING
|
Facility
|
IP
|
$1,006.00
|
|
|
Service Code
|
CPT 75571
|
| Hospital Charge Code |
909201981
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$201.20 |
| Max. Negotiated Rate |
$855.10 |
| Rate for Payer: Adventist Health Commercial |
$201.20
|
| Rate for Payer: Cash Price |
$452.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$704.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$402.40
|
| Rate for Payer: EPIC Health Plan Senior |
$402.40
|
| Rate for Payer: Galaxy Health WC |
$855.10
|
| Rate for Payer: Global Benefits Group Commercial |
$603.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$638.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$593.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$241.44
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: Networks By Design Commercial |
$653.90
|
| Rate for Payer: Prime Health Services Commercial |
$855.10
|
|
|
HC CT CHEST W CONTRAST
|
Facility
|
IP
|
$4,918.00
|
|
|
Service Code
|
CPT 71260
|
| Hospital Charge Code |
909201913
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$983.60 |
| Max. Negotiated Rate |
$4,180.30 |
| Rate for Payer: Adventist Health Commercial |
$983.60
|
| Rate for Payer: Cash Price |
$2,213.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,442.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,967.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,967.20
|
| Rate for Payer: Galaxy Health WC |
$4,180.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,950.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,122.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,901.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,180.32
|
| Rate for Payer: Multiplan Commercial |
$3,934.40
|
| Rate for Payer: Networks By Design Commercial |
$3,196.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,180.30
|
|
|
HC CT CHEST W CONTRAST
|
Facility
|
OP
|
$2,761.00
|
|
|
Service Code
|
CPT 71260
|
| Hospital Charge Code |
909201913
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.59 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$552.20
|
| Rate for Payer: Adventist Health Commercial |
$983.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,771.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,155.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2,070.48
|
| Rate for Payer: Blue Shield of California Commercial |
$1,162.38
|
| Rate for Payer: Blue Shield of California Commercial |
$1,761.52
|
| Rate for Payer: Blue Shield of California Commercial |
$3,137.68
|
| Rate for Payer: Cash Price |
$1,242.45
|
| Rate for Payer: Cash Price |
$1,242.45
|
| Rate for Payer: Cash Price |
$2,213.10
|
| Rate for Payer: Cash Price |
$1,242.45
|
| Rate for Payer: Cash Price |
$2,213.10
|
| Rate for Payer: Cash Price |
$2,213.10
|
| Rate for Payer: Cigna of CA HMO |
$1,767.04
|
| Rate for Payer: Cigna of CA HMO |
$3,147.52
|
| Rate for Payer: Cigna of CA PPO |
$2,043.14
|
| Rate for Payer: Cigna of CA PPO |
$3,639.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,442.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,932.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: Galaxy Health WC |
$4,180.30
|
| Rate for Payer: Galaxy Health WC |
$2,346.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,656.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,950.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$270.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$270.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,122.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,753.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$305.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$305.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$662.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,180.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$284.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$284.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$302.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$2,208.80
|
| Rate for Payer: Multiplan Commercial |
$3,934.40
|
| Rate for Payer: Networks By Design Commercial |
$3,196.70
|
| Rate for Payer: Networks By Design Commercial |
$1,794.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,346.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,180.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,950.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,656.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,656.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,950.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$769.25
|
| 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 All Other HMO |
$769.25
|
| Rate for Payer: United Healthcare HMO Rider |
$769.25
|
| Rate for Payer: United Healthcare HMO Rider |
$769.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$769.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$769.25
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
