|
HC CT CHEST W/O CONTRAST
|
Facility
|
IP
|
$4,195.00
|
|
|
Service Code
|
CPT 71250
|
| Hospital Charge Code |
909201912
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$839.00 |
| Max. Negotiated Rate |
$3,565.75 |
| Rate for Payer: Adventist Health Commercial |
$839.00
|
| Rate for Payer: Cash Price |
$1,887.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,936.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,678.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,678.00
|
| Rate for Payer: Galaxy Health WC |
$3,565.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,517.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,663.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,475.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,006.80
|
| Rate for Payer: Multiplan Commercial |
$3,356.00
|
| Rate for Payer: Networks By Design Commercial |
$2,726.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,565.75
|
|
|
HC CT CHEST W/O CONTRAST
|
Facility
|
OP
|
$2,248.00
|
|
|
Service Code
|
CPT 71250
|
| Hospital Charge Code |
909201912
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$449.60
|
| Rate for Payer: Adventist Health Commercial |
$839.00
|
| 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 |
$1,442.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,691.93
|
| Rate for Payer: Blue Shield of California Commercial |
$1,766.10
|
| Rate for Payer: Blue Shield of California Commercial |
$1,434.22
|
| Rate for Payer: Blue Shield of California Commercial |
$946.41
|
| Rate for Payer: Blue Shield of California Commercial |
$2,676.41
|
| Rate for Payer: Cash Price |
$1,011.60
|
| Rate for Payer: Cash Price |
$1,011.60
|
| Rate for Payer: Cash Price |
$1,887.75
|
| Rate for Payer: Cash Price |
$1,011.60
|
| Rate for Payer: Cash Price |
$1,887.75
|
| Rate for Payer: Cash Price |
$1,887.75
|
| Rate for Payer: Cigna of CA HMO |
$1,438.72
|
| Rate for Payer: Cigna of CA HMO |
$2,684.80
|
| Rate for Payer: Cigna of CA PPO |
$1,663.52
|
| Rate for Payer: Cigna of CA PPO |
$3,104.30
|
| 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 |
$2,936.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,573.60
|
| 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 |
$3,565.75
|
| Rate for Payer: Galaxy Health WC |
$1,910.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,348.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,517.00
|
| 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 |
$213.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$213.90
|
| 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 |
$2,663.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,427.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$241.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$241.91
|
| 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 |
$539.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,006.80
|
| 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 |
$1,798.40
|
| Rate for Payer: Multiplan Commercial |
$3,356.00
|
| Rate for Payer: Networks By Design Commercial |
$2,726.75
|
| Rate for Payer: Networks By Design Commercial |
$1,461.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,910.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,565.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,517.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,348.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,348.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,517.00
|
| 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 CHEST W WO CONTRA
|
Facility
|
OP
|
$3,274.00
|
|
|
Service Code
|
CPT 71270
|
| Hospital Charge Code |
909201914
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.59 |
| Max. Negotiated Rate |
$2,782.90 |
| Rate for Payer: Adventist Health Commercial |
$654.80
|
| Rate for Payer: Adventist Health Commercial |
$1,221.80
|
| 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 |
$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 |
$2,100.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,920.15
|
| Rate for Payer: Blue Shield of California Commercial |
$2,571.89
|
| Rate for Payer: Blue Shield of California Commercial |
$1,378.35
|
| Rate for Payer: Blue Shield of California Commercial |
$2,088.81
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.54
|
| Rate for Payer: Cash Price |
$1,473.30
|
| Rate for Payer: Cash Price |
$1,473.30
|
| Rate for Payer: Cash Price |
$2,749.05
|
| Rate for Payer: Cash Price |
$1,473.30
|
| Rate for Payer: Cash Price |
$2,749.05
|
| Rate for Payer: Cash Price |
$2,749.05
|
| Rate for Payer: Cigna of CA HMO |
$2,095.36
|
| Rate for Payer: Cigna of CA HMO |
$3,909.76
|
| Rate for Payer: Cigna of CA PPO |
$2,422.76
|
| Rate for Payer: Cigna of CA PPO |
$4,520.66
|
| 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 |
$4,276.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,291.80
|
| 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 |
$5,192.65
|
| Rate for Payer: Galaxy Health WC |
$2,782.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,964.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,665.40
|
| 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 |
$321.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$321.90
|
| 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 |
$3,879.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,078.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$364.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$364.06
|
| 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 |
$785.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,466.16
|
| 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 |
$2,619.20
|
| Rate for Payer: Multiplan Commercial |
$4,887.20
|
| Rate for Payer: Networks By Design Commercial |
$3,970.85
|
| Rate for Payer: Networks By Design Commercial |
$2,128.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,782.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,192.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,665.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,964.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,964.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,665.40
|
| 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 CHEST W WO CONTRA
|
Facility
|
IP
|
$6,109.00
|
|
|
Service Code
|
CPT 71270
|
| Hospital Charge Code |
909201914
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,221.80 |
| Max. Negotiated Rate |
$5,192.65 |
| Rate for Payer: Adventist Health Commercial |
$1,221.80
|
| Rate for Payer: Cash Price |
$2,749.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,276.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,443.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,443.60
|
| Rate for Payer: Galaxy Health WC |
$5,192.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,665.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,879.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,604.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,466.16
|
| Rate for Payer: Multiplan Commercial |
$4,887.20
|
| Rate for Payer: Networks By Design Commercial |
$3,970.85
|
| Rate for Payer: Prime Health Services Commercial |
$5,192.65
|
|
|
HC CT COLONOGRAPHY SCREEN
|
Facility
|
OP
|
$1,172.00
|
|
|
Service Code
|
CPT 74263
|
| Hospital Charge Code |
909201813
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$234.40 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$234.40
|
| Rate for Payer: Adventist Health Commercial |
$437.40
|
| 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 |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$752.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,403.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,395.31
|
| Rate for Payer: Blue Shield of California Commercial |
$747.74
|
| Rate for Payer: Blue Shield of California Commercial |
$493.41
|
| Rate for Payer: Blue Shield of California Commercial |
$920.73
|
| Rate for Payer: Cash Price |
$527.40
|
| Rate for Payer: Cash Price |
$984.15
|
| Rate for Payer: Cash Price |
$984.15
|
| Rate for Payer: Cash Price |
$527.40
|
| Rate for Payer: Cash Price |
$984.15
|
| Rate for Payer: Cash Price |
$527.40
|
| Rate for Payer: Cigna of CA HMO |
$750.08
|
| Rate for Payer: Cigna of CA HMO |
$1,399.68
|
| Rate for Payer: Cigna of CA PPO |
$867.28
|
| Rate for Payer: Cigna of CA PPO |
$1,618.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,530.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$820.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: Galaxy Health WC |
$1,858.95
|
| Rate for Payer: Galaxy Health WC |
$996.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,312.20
|
| Rate for Payer: Global Benefits Group Commercial |
$703.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.28
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,388.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$744.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$524.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$281.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$1,749.60
|
| Rate for Payer: Multiplan Commercial |
$937.60
|
| Rate for Payer: Networks By Design Commercial |
$761.80
|
| Rate for Payer: Networks By Design Commercial |
$1,421.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,858.95
|
| Rate for Payer: Prime Health Services Commercial |
$996.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,312.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$703.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$703.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,312.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,781.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,781.07
|
| Rate for Payer: United Healthcare All Other HMO |
$1,781.07
|
| Rate for Payer: United Healthcare All Other HMO |
$1,781.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1,781.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1,781.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,781.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,781.07
|
| Rate for Payer: Upland Medical Group Pediatric |
$306.88
|
| Rate for Payer: Upland Medical Group Pediatric |
$306.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC CT COLONOGRAPHY SCREEN
|
Facility
|
IP
|
$2,187.00
|
|
|
Service Code
|
CPT 74263
|
| Hospital Charge Code |
909201813
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$437.40 |
| Max. Negotiated Rate |
$1,858.95 |
| Rate for Payer: Adventist Health Commercial |
$437.40
|
| Rate for Payer: Cash Price |
$984.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,530.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.80
|
| Rate for Payer: EPIC Health Plan Senior |
$874.80
|
| Rate for Payer: Galaxy Health WC |
$1,858.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,312.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,388.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,290.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$524.88
|
| Rate for Payer: Multiplan Commercial |
$1,749.60
|
| Rate for Payer: Networks By Design Commercial |
$1,421.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,858.95
|
|
|
HC CT COLONOGRAPHY W/CONTRAST
|
Facility
|
OP
|
$3,484.00
|
|
|
Service Code
|
CPT 74262
|
| Hospital Charge Code |
909202000
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.59 |
| Max. Negotiated Rate |
$2,961.40 |
| Rate for Payer: Adventist Health Commercial |
$696.80
|
| Rate for Payer: Adventist Health Commercial |
$1,175.80
|
| 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 |
$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 |
$2,235.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,772.55
|
| Rate for Payer: Blue Shield of California Commercial |
$2,475.06
|
| Rate for Payer: Blue Shield of California Commercial |
$1,466.76
|
| Rate for Payer: Blue Shield of California Commercial |
$2,222.79
|
| Rate for Payer: Blue Shield of California Commercial |
$3,750.80
|
| Rate for Payer: Cash Price |
$1,567.80
|
| Rate for Payer: Cash Price |
$1,567.80
|
| Rate for Payer: Cash Price |
$2,645.55
|
| Rate for Payer: Cash Price |
$1,567.80
|
| Rate for Payer: Cash Price |
$2,645.55
|
| Rate for Payer: Cash Price |
$2,645.55
|
| Rate for Payer: Cigna of CA HMO |
$2,229.76
|
| Rate for Payer: Cigna of CA HMO |
$3,762.56
|
| Rate for Payer: Cigna of CA PPO |
$2,578.16
|
| Rate for Payer: Cigna of CA PPO |
$4,350.46
|
| 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 |
$4,115.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,438.80
|
| 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 |
$4,997.15
|
| Rate for Payer: Galaxy Health WC |
$2,961.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,090.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,527.40
|
| 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 |
$787.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$787.43
|
| 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 |
$3,733.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,212.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$890.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$890.55
|
| 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 |
$836.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,410.96
|
| 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 |
$2,787.20
|
| Rate for Payer: Multiplan Commercial |
$4,703.20
|
| Rate for Payer: Networks By Design Commercial |
$3,821.35
|
| Rate for Payer: Networks By Design Commercial |
$2,264.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,961.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,997.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,527.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,090.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,090.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,527.40
|
| 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 |
$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 COLONOGRAPHY W/CONTRAST
|
Facility
|
IP
|
$5,879.00
|
|
|
Service Code
|
CPT 74262
|
| Hospital Charge Code |
909202000
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,175.80 |
| Max. Negotiated Rate |
$4,997.15 |
| Rate for Payer: Adventist Health Commercial |
$1,175.80
|
| Rate for Payer: Cash Price |
$2,645.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,115.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,351.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,351.60
|
| Rate for Payer: Galaxy Health WC |
$4,997.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,527.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,733.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,468.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,410.96
|
| Rate for Payer: Multiplan Commercial |
$4,703.20
|
| Rate for Payer: Networks By Design Commercial |
$3,821.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,997.15
|
|
|
HC CT COLONOGRAPHY W/O CONTRAST
|
Facility
|
IP
|
$5,201.00
|
|
|
Service Code
|
CPT 74261
|
| Hospital Charge Code |
909201811
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,040.20 |
| Max. Negotiated Rate |
$4,420.85 |
| Rate for Payer: EPIC Health Plan Senior |
$2,080.40
|
| Rate for Payer: Adventist Health Commercial |
$1,040.20
|
| Rate for Payer: Cash Price |
$2,340.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,640.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,080.40
|
| Rate for Payer: Galaxy Health WC |
$4,420.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,120.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,302.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,068.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,248.24
|
| Rate for Payer: Multiplan Commercial |
$4,160.80
|
| Rate for Payer: Networks By Design Commercial |
$3,380.65
|
| Rate for Payer: Prime Health Services Commercial |
$4,420.85
|
|
|
HC CT COLONOGRAPHY W/O CONTRAST
|
Facility
|
OP
|
$3,151.00
|
|
|
Service Code
|
CPT 74261
|
| Hospital Charge Code |
909201811
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$630.20
|
| Rate for Payer: Adventist Health Commercial |
$1,040.20
|
| 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 |
$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 |
$2,022.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,337.48
|
| Rate for Payer: Blue Shield of California Commercial |
$2,189.62
|
| Rate for Payer: Blue Shield of California Commercial |
$1,326.57
|
| Rate for Payer: Blue Shield of California Commercial |
$2,010.34
|
| Rate for Payer: Blue Shield of California Commercial |
$3,318.24
|
| Rate for Payer: Cash Price |
$1,417.95
|
| Rate for Payer: Cash Price |
$1,417.95
|
| Rate for Payer: Cash Price |
$2,340.45
|
| Rate for Payer: Cash Price |
$1,417.95
|
| Rate for Payer: Cash Price |
$2,340.45
|
| Rate for Payer: Cash Price |
$2,340.45
|
| Rate for Payer: Cigna of CA HMO |
$2,016.64
|
| Rate for Payer: Cigna of CA HMO |
$3,328.64
|
| Rate for Payer: Cigna of CA PPO |
$2,331.74
|
| Rate for Payer: Cigna of CA PPO |
$3,848.74
|
| 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 |
$3,640.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,205.70
|
| 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 |
$4,420.85
|
| Rate for Payer: Galaxy Health WC |
$2,678.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,890.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,120.60
|
| 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 |
$695.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$695.42
|
| 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 |
$3,302.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,000.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$786.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$786.49
|
| 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 |
$756.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,248.24
|
| 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 |
$2,520.80
|
| Rate for Payer: Multiplan Commercial |
$4,160.80
|
| Rate for Payer: Networks By Design Commercial |
$3,380.65
|
| Rate for Payer: Networks By Design Commercial |
$2,048.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,678.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,420.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,120.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,890.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,890.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,120.60
|
| 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 CPA W CON W CT CTA OF SAME ANTMY
|
Facility
|
IP
|
$2,673.00
|
|
|
Service Code
|
CPT 70472
|
| Hospital Charge Code |
909201821
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$534.60 |
| Max. Negotiated Rate |
$2,272.05 |
| Rate for Payer: Adventist Health Commercial |
$534.60
|
| Rate for Payer: Cash Price |
$1,202.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,871.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,069.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,069.20
|
| Rate for Payer: Galaxy Health WC |
$2,272.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,603.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,697.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,577.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$641.52
|
| Rate for Payer: Multiplan Commercial |
$2,138.40
|
| Rate for Payer: Networks By Design Commercial |
$1,737.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,272.05
|
|
|
HC CT CPA W CON W CT CTA OF SAME ANTMY
|
Facility
|
OP
|
$2,673.00
|
|
|
Service Code
|
CPT 70472
|
| Hospital Charge Code |
909201821
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$534.60 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$534.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,272.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,470.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,004.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,715.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1,125.33
|
| Rate for Payer: Blue Shield of California Commercial |
$1,705.37
|
| Rate for Payer: Cash Price |
$1,202.85
|
| Rate for Payer: Cash Price |
$1,202.85
|
| Rate for Payer: Cigna of CA HMO |
$1,710.72
|
| Rate for Payer: Cigna of CA PPO |
$1,978.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,272.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,272.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,272.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,871.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,069.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,069.20
|
| Rate for Payer: Galaxy Health WC |
$2,272.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,603.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,697.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,577.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$641.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,871.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,871.10
|
| Rate for Payer: Multiplan Commercial |
$2,138.40
|
| Rate for Payer: Networks By Design Commercial |
$1,737.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,272.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,603.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,603.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,336.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,336.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,336.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,336.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,272.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,272.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,272.05
|
|
|
HC CT CPA W CON WO CT CTA OF SAME ANTMY
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
CPT 70473
|
| Hospital Charge Code |
909201822
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$110.00 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$110.00
|
| 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 Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$352.94
|
| Rate for Payer: Blue Shield of California Commercial |
$350.90
|
| Rate for Payer: Blue Shield of California Commercial |
$231.55
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Cigna of CA HMO |
$352.00
|
| Rate for Payer: Cigna of CA PPO |
$407.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$385.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: Galaxy Health WC |
$467.50
|
| Rate for Payer: Global Benefits Group Commercial |
$330.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$349.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$284.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$440.00
|
| Rate for Payer: Networks By Design Commercial |
$357.50
|
| Rate for Payer: Prime Health Services Commercial |
$467.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$330.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$330.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$275.00
|
| Rate for Payer: United Healthcare All Other HMO |
$275.00
|
| Rate for Payer: United Healthcare HMO Rider |
$275.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$275.00
|
| 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 Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
|
HC CT CPA W CON WO CT CTA OF SAME ANTMY
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
CPT 70473
|
| Hospital Charge Code |
909201822
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$110.00 |
| Max. Negotiated Rate |
$467.50 |
| Rate for Payer: Adventist Health Commercial |
$110.00
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$385.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.00
|
| Rate for Payer: EPIC Health Plan Senior |
$220.00
|
| Rate for Payer: Galaxy Health WC |
$467.50
|
| Rate for Payer: Global Benefits Group Commercial |
$330.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$349.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$324.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.00
|
| Rate for Payer: Multiplan Commercial |
$440.00
|
| Rate for Payer: Networks By Design Commercial |
$357.50
|
| Rate for Payer: Prime Health Services Commercial |
$467.50
|
|
|
HC CT CSPINE WITH CONTRAST
|
Facility
|
OP
|
$2,889.00
|
|
|
Service Code
|
CPT 72126
|
| Hospital Charge Code |
909201916
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$273.97 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$577.80
|
| Rate for Payer: Adventist Health Commercial |
$1,301.80
|
| 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 |
$1,853.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,176.83
|
| Rate for Payer: Blue Shield of California Commercial |
$2,740.29
|
| Rate for Payer: Blue Shield of California Commercial |
$1,216.27
|
| Rate for Payer: Blue Shield of California Commercial |
$1,843.18
|
| Rate for Payer: Blue Shield of California Commercial |
$4,152.74
|
| Rate for Payer: Cash Price |
$1,300.05
|
| Rate for Payer: Cash Price |
$1,300.05
|
| Rate for Payer: Cash Price |
$2,929.05
|
| Rate for Payer: Cash Price |
$1,300.05
|
| Rate for Payer: Cash Price |
$2,929.05
|
| Rate for Payer: Cash Price |
$2,929.05
|
| Rate for Payer: Cigna of CA HMO |
$1,848.96
|
| Rate for Payer: Cigna of CA HMO |
$4,165.76
|
| Rate for Payer: Cigna of CA PPO |
$2,137.86
|
| Rate for Payer: Cigna of CA PPO |
$4,816.66
|
| 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 |
$4,556.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,022.30
|
| 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 |
$5,532.65
|
| Rate for Payer: Galaxy Health WC |
$2,455.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,733.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,905.40
|
| 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 |
$4,133.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,834.52
|
| 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 |
$693.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,562.16
|
| 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 |
$2,311.20
|
| Rate for Payer: Multiplan Commercial |
$5,207.20
|
| Rate for Payer: Networks By Design Commercial |
$4,230.85
|
| Rate for Payer: Networks By Design Commercial |
$1,877.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,455.65
|
| Rate for Payer: Prime Health Services Commercial |
$5,532.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,905.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,733.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,733.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,905.40
|
| 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 CSPINE WITH CONTRAST
|
Facility
|
IP
|
$6,509.00
|
|
|
Service Code
|
CPT 72126
|
| Hospital Charge Code |
909201916
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,301.80 |
| Max. Negotiated Rate |
$5,532.65 |
| Rate for Payer: Adventist Health Commercial |
$1,301.80
|
| Rate for Payer: Cash Price |
$2,929.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,556.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,603.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,603.60
|
| Rate for Payer: Galaxy Health WC |
$5,532.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,905.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,133.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,840.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,562.16
|
| Rate for Payer: Multiplan Commercial |
$5,207.20
|
| Rate for Payer: Networks By Design Commercial |
$4,230.85
|
| Rate for Payer: Prime Health Services Commercial |
$5,532.65
|
|
|
HC CT CSPINE WO CONTRAST
|
Facility
|
OP
|
$2,684.00
|
|
|
Service Code
|
CPT 72125
|
| Hospital Charge Code |
909201915
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$536.80
|
| Rate for Payer: Adventist Health Commercial |
$1,209.20
|
| 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 |
$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 |
$1,722.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,879.72
|
| Rate for Payer: Blue Shield of California Commercial |
$2,545.37
|
| Rate for Payer: Blue Shield of California Commercial |
$1,129.96
|
| Rate for Payer: Blue Shield of California Commercial |
$1,712.39
|
| Rate for Payer: Blue Shield of California Commercial |
$3,857.35
|
| Rate for Payer: Cash Price |
$1,207.80
|
| Rate for Payer: Cash Price |
$1,207.80
|
| Rate for Payer: Cash Price |
$2,720.70
|
| Rate for Payer: Cash Price |
$1,207.80
|
| Rate for Payer: Cash Price |
$2,720.70
|
| Rate for Payer: Cash Price |
$2,720.70
|
| Rate for Payer: Cigna of CA HMO |
$1,717.76
|
| Rate for Payer: Cigna of CA HMO |
$3,869.44
|
| Rate for Payer: Cigna of CA PPO |
$1,986.16
|
| Rate for Payer: Cigna of CA PPO |
$4,474.04
|
| 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 |
$4,232.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,878.80
|
| 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 |
$5,139.10
|
| Rate for Payer: Galaxy Health WC |
$2,281.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,610.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,627.60
|
| 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 |
$209.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$209.98
|
| 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 |
$3,839.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,704.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$237.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$237.48
|
| 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 |
$644.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,451.04
|
| 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 |
$2,147.20
|
| Rate for Payer: Multiplan Commercial |
$4,836.80
|
| Rate for Payer: Networks By Design Commercial |
$3,929.90
|
| Rate for Payer: Networks By Design Commercial |
$1,744.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,281.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,139.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,627.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,610.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,610.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,627.60
|
| 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 CSPINE WO CONTRAST
|
Facility
|
IP
|
$6,046.00
|
|
|
Service Code
|
CPT 72125
|
| Hospital Charge Code |
909201915
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,209.20 |
| Max. Negotiated Rate |
$5,139.10 |
| Rate for Payer: Adventist Health Commercial |
$1,209.20
|
| Rate for Payer: Cash Price |
$2,720.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,232.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,418.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,418.40
|
| Rate for Payer: Galaxy Health WC |
$5,139.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,627.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,839.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,567.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,451.04
|
| Rate for Payer: Multiplan Commercial |
$4,836.80
|
| Rate for Payer: Networks By Design Commercial |
$3,929.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,139.10
|
|
|
HC CT C SPINE W/WO CONTRAST
|
Facility
|
IP
|
$6,834.00
|
|
|
Service Code
|
CPT 72127
|
| Hospital Charge Code |
909201967
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,366.80 |
| Max. Negotiated Rate |
$5,808.90 |
| Rate for Payer: Adventist Health Commercial |
$1,366.80
|
| Rate for Payer: Cash Price |
$3,075.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,783.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,733.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,733.60
|
| Rate for Payer: Galaxy Health WC |
$5,808.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,100.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,339.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,032.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,640.16
|
| Rate for Payer: Multiplan Commercial |
$5,467.20
|
| Rate for Payer: Networks By Design Commercial |
$4,442.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,808.90
|
|
|
HC CT C SPINE W/WO CONTRAST
|
Facility
|
OP
|
$3,018.00
|
|
|
Service Code
|
CPT 72127
|
| Hospital Charge Code |
909201967
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.59 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$603.60
|
| Rate for Payer: Adventist Health Commercial |
$1,366.80
|
| 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 |
$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 |
$4,385.38
|
| Rate for Payer: Blue Shield of California Commercial |
$2,877.11
|
| 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 |
$4,360.09
|
| Rate for Payer: Cash Price |
$1,358.10
|
| Rate for Payer: Cash Price |
$1,358.10
|
| Rate for Payer: Cash Price |
$3,075.30
|
| Rate for Payer: Cash Price |
$1,358.10
|
| Rate for Payer: Cash Price |
$3,075.30
|
| Rate for Payer: Cash Price |
$3,075.30
|
| Rate for Payer: Cigna of CA HMO |
$1,931.52
|
| Rate for Payer: Cigna of CA HMO |
$4,373.76
|
| Rate for Payer: Cigna of CA PPO |
$2,233.32
|
| Rate for Payer: Cigna of CA PPO |
$5,057.16
|
| 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 |
$4,783.80
|
| 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 |
$5,808.90
|
| 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 |
$4,100.40
|
| 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 |
$323.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$323.20
|
| 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 |
$4,339.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,916.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$365.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$365.52
|
| 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 |
$1,640.16
|
| 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 |
$5,467.20
|
| Rate for Payer: Networks By Design Commercial |
$4,442.10
|
| 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 |
$5,808.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,100.40
|
| 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 |
$4,100.40
|
| 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 GUID ABCESS DRAIN
|
Facility
|
OP
|
$2,408.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
909201944
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$175.59 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$481.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,046.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,324.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,545.21
|
| Rate for Payer: Blue Shield of California Commercial |
$1,536.30
|
| Rate for Payer: Blue Shield of California Commercial |
$1,013.77
|
| Rate for Payer: Cash Price |
$1,083.60
|
| Rate for Payer: Cash Price |
$1,083.60
|
| Rate for Payer: Cash Price |
$1,083.60
|
| Rate for Payer: Cigna of CA HMO |
$1,541.12
|
| Rate for Payer: Cigna of CA PPO |
$1,781.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,046.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,046.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,046.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,685.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$963.20
|
| Rate for Payer: EPIC Health Plan Senior |
$963.20
|
| Rate for Payer: Galaxy Health WC |
$2,046.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,444.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$175.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,529.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$198.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,420.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$577.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,685.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,685.60
|
| Rate for Payer: Multiplan Commercial |
$1,926.40
|
| Rate for Payer: Networks By Design Commercial |
$1,565.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,046.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,444.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,444.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,204.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,204.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,204.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,204.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,046.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,046.80
|
| Rate for Payer: Vantage Medical Group Senior |
$2,046.80
|
|
|
HC CT GUID ABCESS DRAIN
|
Facility
|
IP
|
$2,408.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
909201944
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$481.60 |
| Max. Negotiated Rate |
$2,046.80 |
| Rate for Payer: Adventist Health Commercial |
$481.60
|
| Rate for Payer: Cash Price |
$1,083.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,685.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$963.20
|
| Rate for Payer: EPIC Health Plan Senior |
$963.20
|
| Rate for Payer: Galaxy Health WC |
$2,046.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,444.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,529.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,420.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$577.92
|
| Rate for Payer: Multiplan Commercial |
$1,926.40
|
| Rate for Payer: Networks By Design Commercial |
$1,565.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,046.80
|
|
|
HC CT GUIDANCE/NEEDLE PLACEMENT
|
Facility
|
IP
|
$3,971.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
909201935
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$794.20 |
| Max. Negotiated Rate |
$3,375.35 |
| Rate for Payer: Adventist Health Commercial |
$794.20
|
| Rate for Payer: Cash Price |
$1,786.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,779.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,588.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,588.40
|
| Rate for Payer: Galaxy Health WC |
$3,375.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,382.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,521.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,342.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$953.04
|
| Rate for Payer: Multiplan Commercial |
$3,176.80
|
| Rate for Payer: Networks By Design Commercial |
$2,581.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,375.35
|
|
|
HC CT GUIDANCE/NEEDLE PLACEMENT
|
Facility
|
OP
|
$3,971.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
909201935
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$186.56 |
| Max. Negotiated Rate |
$3,375.35 |
| Rate for Payer: Adventist Health Commercial |
$794.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,375.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,184.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,978.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,548.19
|
| Rate for Payer: Blue Shield of California Commercial |
$2,533.50
|
| Rate for Payer: Blue Shield of California Commercial |
$1,671.79
|
| Rate for Payer: Cash Price |
$1,786.95
|
| Rate for Payer: Cash Price |
$1,786.95
|
| Rate for Payer: Cash Price |
$1,786.95
|
| Rate for Payer: Cigna of CA HMO |
$2,541.44
|
| Rate for Payer: Cigna of CA PPO |
$2,938.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,375.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,375.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,375.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,779.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,588.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,588.40
|
| Rate for Payer: Galaxy Health WC |
$3,375.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,382.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$186.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,521.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$211.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,342.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$953.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,779.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,779.70
|
| Rate for Payer: Multiplan Commercial |
$3,176.80
|
| Rate for Payer: Networks By Design Commercial |
$2,581.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,375.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,382.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,382.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,985.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,985.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,985.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,985.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,375.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,375.35
|
| Rate for Payer: Vantage Medical Group Senior |
$3,375.35
|
|
|
HC CT GUIDNC VISCERAL TISS ABLATN
|
Facility
|
OP
|
$9,602.00
|
|
|
Service Code
|
CPT 77013
|
| Hospital Charge Code |
909201810
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$270.18 |
| Max. Negotiated Rate |
$8,161.70 |
| Rate for Payer: Adventist Health Commercial |
$1,920.40
|
| Rate for Payer: Adventist Health Commercial |
$1,347.40
|
| 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 |
$5,726.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,161.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,281.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,705.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,201.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,052.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,323.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,161.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6,126.08
|
| Rate for Payer: Blue Shield of California Commercial |
$4,298.21
|
| Rate for Payer: Blue Shield of California Commercial |
$2,836.28
|
| Rate for Payer: Blue Shield of California Commercial |
$4,042.44
|
| Rate for Payer: Cash Price |
$3,031.65
|
| Rate for Payer: Cash Price |
$4,320.90
|
| Rate for Payer: Cash Price |
$3,031.65
|
| Rate for Payer: Cash Price |
$3,031.65
|
| Rate for Payer: Cash Price |
$4,320.90
|
| Rate for Payer: Cash Price |
$4,320.90
|
| Rate for Payer: Cigna of CA HMO |
$6,145.28
|
| Rate for Payer: Cigna of CA HMO |
$4,311.68
|
| Rate for Payer: Cigna of CA PPO |
$4,985.38
|
| Rate for Payer: Cigna of CA PPO |
$7,105.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,161.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,726.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,726.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,161.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,161.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,726.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,715.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,721.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,694.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,840.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,840.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,694.80
|
| Rate for Payer: Galaxy Health WC |
$8,161.70
|
| Rate for Payer: Galaxy Health WC |
$5,726.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,042.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,761.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$270.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$270.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,097.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,277.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$305.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$305.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,974.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,665.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,304.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,616.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,715.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,721.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,715.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,721.40
|
| Rate for Payer: Multiplan Commercial |
$5,389.60
|
| Rate for Payer: Multiplan Commercial |
$7,681.60
|
| Rate for Payer: Networks By Design Commercial |
$4,379.05
|
| Rate for Payer: Networks By Design Commercial |
$6,241.30
|
| Rate for Payer: Prime Health Services Commercial |
$5,726.45
|
| Rate for Payer: Prime Health Services Commercial |
$8,161.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,761.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,042.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,761.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,042.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,801.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,368.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,368.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,801.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,801.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,368.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,368.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,801.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,161.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,726.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,726.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,161.70
|
| Rate for Payer: Vantage Medical Group Senior |
$8,161.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5,726.45
|
|
