|
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
|
|
|
HC CT GUID RAD THERAPY
|
Facility
|
OP
|
$2,596.00
|
|
|
Service Code
|
CPT 77387
|
| Hospital Charge Code |
909100165
|
|
Hospital Revenue Code
|
359
|
| Min. Negotiated Rate |
$261.40 |
| Max. Negotiated Rate |
$2,206.60 |
| Rate for Payer: Adventist Health Commercial |
$519.20
|
| Rate for Payer: Adventist Health Commercial |
$278.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$261.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$261.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,182.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,206.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,427.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$765.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,043.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,947.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$492.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$492.40
|
| Rate for Payer: Cash Price |
$1,168.20
|
| Rate for Payer: Cash Price |
$625.95
|
| Rate for Payer: Cash Price |
$625.95
|
| Rate for Payer: Cash Price |
$1,168.20
|
| Rate for Payer: Cigna of CA HMO |
$1,661.44
|
| Rate for Payer: Cigna of CA HMO |
$890.24
|
| Rate for Payer: Cigna of CA PPO |
$1,029.34
|
| Rate for Payer: Cigna of CA PPO |
$1,921.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,206.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,182.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,182.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,206.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,182.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,206.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,817.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$973.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$556.40
|
| Rate for Payer: EPIC Health Plan Senior |
$556.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,038.40
|
| Rate for Payer: Galaxy Health WC |
$2,206.60
|
| Rate for Payer: Galaxy Health WC |
$1,182.35
|
| Rate for Payer: Global Benefits Group Commercial |
$834.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,557.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$883.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,648.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$820.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,531.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$333.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$623.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,817.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$973.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,817.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$973.70
|
| Rate for Payer: Multiplan Commercial |
$1,112.80
|
| Rate for Payer: Multiplan Commercial |
$2,076.80
|
| Rate for Payer: Networks By Design Commercial |
$904.15
|
| Rate for Payer: Networks By Design Commercial |
$1,687.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,206.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,182.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,557.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$834.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,557.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$834.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,298.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$695.50
|
| Rate for Payer: United Healthcare All Other HMO |
$695.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,298.00
|
| Rate for Payer: United Healthcare HMO Rider |
$695.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,298.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$695.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,182.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,206.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,182.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,206.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,182.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,206.60
|
|
|
HC CT GUID RAD THERAPY
|
Facility
|
IP
|
$2,596.00
|
|
|
Service Code
|
CPT 77387
|
| Hospital Charge Code |
909100165
|
|
Hospital Revenue Code
|
359
|
| Min. Negotiated Rate |
$519.20 |
| Max. Negotiated Rate |
$2,206.60 |
| Rate for Payer: Adventist Health Commercial |
$519.20
|
| Rate for Payer: Cash Price |
$1,168.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,817.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,038.40
|
| Rate for Payer: Galaxy Health WC |
$2,206.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,557.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,648.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,531.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$623.04
|
| Rate for Payer: Multiplan Commercial |
$2,076.80
|
| Rate for Payer: Networks By Design Commercial |
$1,687.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,206.60
|
|
|
HC CT HEAD NO CONTRAST
|
Facility
|
OP
|
$5,719.00
|
|
|
Service Code
|
CPT 70450
|
| Hospital Charge Code |
909201901
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$4,861.15 |
| Rate for Payer: Adventist Health Commercial |
$1,143.80
|
| Rate for Payer: Adventist Health Commercial |
$531.20
|
| 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 |
$3,669.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,704.36
|
| Rate for Payer: Blue Shield of California Commercial |
$1,118.18
|
| Rate for Payer: Blue Shield of California Commercial |
$1,694.53
|
| Rate for Payer: Blue Shield of California Commercial |
$2,407.70
|
| Rate for Payer: Blue Shield of California Commercial |
$3,648.72
|
| Rate for Payer: Cash Price |
$2,573.55
|
| Rate for Payer: Cash Price |
$1,195.20
|
| Rate for Payer: Cash Price |
$1,195.20
|
| Rate for Payer: Cash Price |
$2,573.55
|
| Rate for Payer: Cash Price |
$1,195.20
|
| Rate for Payer: Cash Price |
$2,573.55
|
| Rate for Payer: Cigna of CA HMO |
$1,699.84
|
| Rate for Payer: Cigna of CA HMO |
$3,660.16
|
| Rate for Payer: Cigna of CA PPO |
$1,965.44
|
| Rate for Payer: Cigna of CA PPO |
$4,232.06
|
| 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 |
$1,859.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,003.30
|
| 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 |
$4,861.15
|
| Rate for Payer: Galaxy Health WC |
$2,257.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,431.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,593.60
|
| 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 |
$170.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$170.13
|
| 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 |
$3,631.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,686.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$192.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$192.41
|
| 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 |
$1,372.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$637.44
|
| 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 |
$2,124.80
|
| Rate for Payer: Multiplan Commercial |
$4,575.20
|
| Rate for Payer: Networks By Design Commercial |
$3,717.35
|
| Rate for Payer: Networks By Design Commercial |
$1,726.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,257.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,861.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,431.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,593.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,593.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,431.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,328.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,859.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,859.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,328.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,859.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,328.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,328.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,859.50
|
| 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 HEAD NO CONTRAST
|
Facility
|
IP
|
$5,719.00
|
|
|
Service Code
|
CPT 70450
|
| Hospital Charge Code |
909201901
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,143.80 |
| Max. Negotiated Rate |
$4,861.15 |
| Rate for Payer: Adventist Health Commercial |
$1,143.80
|
| Rate for Payer: Cash Price |
$2,573.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,003.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,287.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,287.60
|
| Rate for Payer: Galaxy Health WC |
$4,861.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,431.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,631.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,374.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,372.56
|
| Rate for Payer: Multiplan Commercial |
$4,575.20
|
| Rate for Payer: Networks By Design Commercial |
$3,717.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,861.15
|
|
|
HC CT HEAD W CONTRAST
|
Facility
|
OP
|
$6,674.00
|
|
|
Service Code
|
CPT 70460
|
| Hospital Charge Code |
909201900
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$225.59 |
| Max. Negotiated Rate |
$5,672.90 |
| Rate for Payer: Adventist Health Commercial |
$1,334.80
|
| Rate for Payer: Adventist Health Commercial |
$592.80
|
| 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 |
$4,282.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,902.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,247.84
|
| Rate for Payer: Blue Shield of California Commercial |
$1,891.03
|
| Rate for Payer: Blue Shield of California Commercial |
$2,809.75
|
| Rate for Payer: Blue Shield of California Commercial |
$4,258.01
|
| Rate for Payer: Cash Price |
$3,003.30
|
| Rate for Payer: Cash Price |
$1,333.80
|
| Rate for Payer: Cash Price |
$1,333.80
|
| Rate for Payer: Cash Price |
$3,003.30
|
| Rate for Payer: Cash Price |
$1,333.80
|
| Rate for Payer: Cash Price |
$3,003.30
|
| Rate for Payer: Cigna of CA HMO |
$1,896.96
|
| Rate for Payer: Cigna of CA HMO |
$4,271.36
|
| Rate for Payer: Cigna of CA PPO |
$2,193.36
|
| Rate for Payer: Cigna of CA PPO |
$4,938.76
|
| 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 |
$2,074.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,671.80
|
| 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 |
$5,672.90
|
| Rate for Payer: Galaxy Health WC |
$2,519.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,004.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,778.40
|
| 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 |
$239.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$239.95
|
| 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 |
$4,237.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,882.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$271.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$271.38
|
| 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 |
$1,601.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$711.36
|
| 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 |
$2,371.20
|
| Rate for Payer: Multiplan Commercial |
$5,339.20
|
| Rate for Payer: Networks By Design Commercial |
$4,338.10
|
| Rate for Payer: Networks By Design Commercial |
$1,926.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,519.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,672.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,004.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,778.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,778.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,004.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,482.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,337.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,337.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,482.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,337.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,482.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,482.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,337.00
|
| 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
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
|
HC CT HEAD W CONTRAST
|
Facility
|
IP
|
$6,674.00
|
|
|
Service Code
|
CPT 70460
|
| Hospital Charge Code |
909201900
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,334.80 |
| Max. Negotiated Rate |
$5,672.90 |
| Rate for Payer: Adventist Health Commercial |
$1,334.80
|
| Rate for Payer: Cash Price |
$3,003.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,671.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,669.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,669.60
|
| Rate for Payer: Galaxy Health WC |
$5,672.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,004.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,237.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,937.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,601.76
|
| Rate for Payer: Multiplan Commercial |
$5,339.20
|
| Rate for Payer: Networks By Design Commercial |
$4,338.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,672.90
|
|
|
HC CT HEAD W/WO CONTRAS
|
Facility
|
IP
|
$6,934.00
|
|
|
Service Code
|
CPT 70470
|
| Hospital Charge Code |
909201902
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,386.80 |
| Max. Negotiated Rate |
$5,893.90 |
| Rate for Payer: Adventist Health Commercial |
$1,386.80
|
| Rate for Payer: Cash Price |
$3,120.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,853.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,773.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,773.60
|
| Rate for Payer: Galaxy Health WC |
$5,893.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,160.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,403.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,091.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,664.16
|
| Rate for Payer: Multiplan Commercial |
$5,547.20
|
| Rate for Payer: Networks By Design Commercial |
$4,507.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,893.90
|
|
|
HC CT HEAD W/WO CONTRAS
|
Facility
|
OP
|
$6,934.00
|
|
|
Service Code
|
CPT 70470
|
| Hospital Charge Code |
909201902
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$225.59 |
| Max. Negotiated Rate |
$5,893.90 |
| Rate for Payer: Adventist Health Commercial |
$1,386.80
|
| Rate for Payer: Adventist Health Commercial |
$663.80
|
| 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 |
$4,449.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,129.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,397.30
|
| Rate for Payer: Blue Shield of California Commercial |
$2,117.52
|
| Rate for Payer: Blue Shield of California Commercial |
$2,919.21
|
| Rate for Payer: Blue Shield of California Commercial |
$4,423.89
|
| Rate for Payer: Cash Price |
$3,120.30
|
| Rate for Payer: Cash Price |
$1,493.55
|
| Rate for Payer: Cash Price |
$1,493.55
|
| Rate for Payer: Cash Price |
$3,120.30
|
| Rate for Payer: Cash Price |
$1,493.55
|
| Rate for Payer: Cash Price |
$3,120.30
|
| Rate for Payer: Cigna of CA HMO |
$2,124.16
|
| Rate for Payer: Cigna of CA HMO |
$4,437.76
|
| Rate for Payer: Cigna of CA PPO |
$2,456.06
|
| Rate for Payer: Cigna of CA PPO |
$5,131.16
|
| 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 |
$2,323.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,853.80
|
| 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 |
$5,893.90
|
| Rate for Payer: Galaxy Health WC |
$2,821.15
|
| Rate for Payer: Global Benefits Group Commercial |
$4,160.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,991.40
|
| 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 |
$282.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$282.31
|
| 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 |
$4,403.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,107.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$319.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$319.28
|
| 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 |
$1,664.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$796.56
|
| 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 |
$2,655.20
|
| Rate for Payer: Multiplan Commercial |
$5,547.20
|
| Rate for Payer: Networks By Design Commercial |
$4,507.10
|
| Rate for Payer: Networks By Design Commercial |
$2,157.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,821.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,893.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,160.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,991.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,991.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,160.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,467.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,467.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,659.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,467.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,659.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,659.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,467.00
|
| 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
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
|
HC CT LOWER EXT W CONT
|
Facility
|
OP
|
$2,853.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
909201958
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.59 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$570.60
|
| Rate for Payer: Adventist Health Commercial |
$1,016.20
|
| 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 |
$1,830.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,260.48
|
| Rate for Payer: Blue Shield of California Commercial |
$2,139.10
|
| Rate for Payer: Blue Shield of California Commercial |
$1,201.11
|
| Rate for Payer: Blue Shield of California Commercial |
$1,820.21
|
| Rate for Payer: Blue Shield of California Commercial |
$3,241.68
|
| Rate for Payer: Cash Price |
$1,283.85
|
| Rate for Payer: Cash Price |
$1,283.85
|
| Rate for Payer: Cash Price |
$2,286.45
|
| Rate for Payer: Cash Price |
$1,283.85
|
| Rate for Payer: Cash Price |
$2,286.45
|
| Rate for Payer: Cash Price |
$2,286.45
|
| Rate for Payer: Cigna of CA HMO |
$1,825.92
|
| Rate for Payer: Cigna of CA HMO |
$3,251.84
|
| Rate for Payer: Cigna of CA PPO |
$2,111.22
|
| Rate for Payer: Cigna of CA PPO |
$3,759.94
|
| 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 |
$3,556.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,997.10
|
| 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 |
$4,318.85
|
| Rate for Payer: Galaxy Health WC |
$2,425.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,711.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,048.60
|
| 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 |
$270.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$270.95
|
| 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 |
$3,226.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,811.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$306.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$306.43
|
| 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 |
$684.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,219.44
|
| 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 |
$2,282.40
|
| Rate for Payer: Multiplan Commercial |
$4,064.80
|
| Rate for Payer: Networks By Design Commercial |
$3,302.65
|
| Rate for Payer: Networks By Design Commercial |
$1,854.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,425.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,318.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,048.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,711.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,711.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,048.60
|
| 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 LOWER EXT W CONT
|
Facility
|
IP
|
$5,081.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
909201958
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,016.20 |
| Max. Negotiated Rate |
$4,318.85 |
| Rate for Payer: Adventist Health Commercial |
$1,016.20
|
| Rate for Payer: Cash Price |
$2,286.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,556.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,032.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,032.40
|
| Rate for Payer: Galaxy Health WC |
$4,318.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,048.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,226.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,997.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,219.44
|
| Rate for Payer: Multiplan Commercial |
$4,064.80
|
| Rate for Payer: Networks By Design Commercial |
$3,302.65
|
| Rate for Payer: Prime Health Services Commercial |
$4,318.85
|
|
|
HC CT LOWER EXT WO CONT
|
Facility
|
IP
|
$4,525.00
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
909201957
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$905.00 |
| Max. Negotiated Rate |
$3,846.25 |
| Rate for Payer: Adventist Health Commercial |
$905.00
|
| Rate for Payer: Cash Price |
$2,036.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,167.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,810.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,810.00
|
| Rate for Payer: Galaxy Health WC |
$3,846.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,715.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,873.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,669.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,086.00
|
| Rate for Payer: Multiplan Commercial |
$3,620.00
|
| Rate for Payer: Networks By Design Commercial |
$2,941.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,846.25
|
|
|
HC CT LOWER EXT WO CONT
|
Facility
|
OP
|
$2,541.00
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
909201957
|
|
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 |
$905.00
|
| 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 |
$2,903.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,905.03
|
| 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 |
$2,886.95
|
| Rate for Payer: Cash Price |
$1,143.45
|
| Rate for Payer: Cash Price |
$1,143.45
|
| Rate for Payer: Cash Price |
$2,036.25
|
| Rate for Payer: Cash Price |
$1,143.45
|
| Rate for Payer: Cash Price |
$2,036.25
|
| Rate for Payer: Cash Price |
$2,036.25
|
| Rate for Payer: Cigna of CA HMO |
$1,626.24
|
| Rate for Payer: Cigna of CA HMO |
$2,896.00
|
| Rate for Payer: Cigna of CA PPO |
$1,880.34
|
| Rate for Payer: Cigna of CA PPO |
$3,348.50
|
| 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 |
$3,167.50
|
| 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 |
$3,846.25
|
| 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 |
$2,715.00
|
| 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 |
$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 |
$2,873.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,613.54
|
| 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 |
$609.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,086.00
|
| 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 |
$3,620.00
|
| Rate for Payer: Networks By Design Commercial |
$2,941.25
|
| 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 |
$3,846.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,715.00
|
| 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 |
$2,715.00
|
| 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 LOWR EXTR W/WO CONT
|
Facility
|
IP
|
$5,336.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
909201959
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,067.20 |
| Max. Negotiated Rate |
$4,535.60 |
| Rate for Payer: Adventist Health Commercial |
$1,067.20
|
| Rate for Payer: Cash Price |
$2,401.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,735.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,134.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,134.40
|
| Rate for Payer: Galaxy Health WC |
$4,535.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,201.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,388.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,148.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,280.64
|
| Rate for Payer: Multiplan Commercial |
$4,268.80
|
| Rate for Payer: Networks By Design Commercial |
$3,468.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,535.60
|
|
|
HC CT LOWR EXTR W/WO CONT
|
Facility
|
OP
|
$3,191.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
909201959
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.59 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$638.20
|
| Rate for Payer: Adventist Health Commercial |
$1,067.20
|
| 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 |
$2,047.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,424.11
|
| Rate for Payer: Blue Shield of California Commercial |
$2,246.46
|
| Rate for Payer: Blue Shield of California Commercial |
$1,343.41
|
| Rate for Payer: Blue Shield of California Commercial |
$2,035.86
|
| Rate for Payer: Blue Shield of California Commercial |
$3,404.37
|
| Rate for Payer: Cash Price |
$1,435.95
|
| Rate for Payer: Cash Price |
$1,435.95
|
| Rate for Payer: Cash Price |
$2,401.20
|
| Rate for Payer: Cash Price |
$1,435.95
|
| Rate for Payer: Cash Price |
$2,401.20
|
| Rate for Payer: Cash Price |
$2,401.20
|
| Rate for Payer: Cigna of CA HMO |
$2,042.24
|
| Rate for Payer: Cigna of CA HMO |
$3,415.04
|
| Rate for Payer: Cigna of CA PPO |
$2,361.34
|
| Rate for Payer: Cigna of CA PPO |
$3,948.64
|
| 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 |
$3,735.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,233.70
|
| 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 |
$4,535.60
|
| Rate for Payer: Galaxy Health WC |
$2,712.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,914.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,201.60
|
| 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 |
$318.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$318.31
|
| 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 |
$3,388.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,026.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$359.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$359.99
|
| 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 |
$765.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,280.64
|
| 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 |
$2,552.80
|
| Rate for Payer: Multiplan Commercial |
$4,268.80
|
| Rate for Payer: Networks By Design Commercial |
$3,468.40
|
| Rate for Payer: Networks By Design Commercial |
$2,074.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,712.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,535.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,201.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,914.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,914.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,201.60
|
| 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 CTLSO AXILLARY SLING
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
CPT L1010
|
| Hospital Charge Code |
915351010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.88 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Adventist Health Commercial |
$66.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$137.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$89.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$121.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$98.06
|
| Rate for Payer: Blue Shield of California Commercial |
$82.13
|
| Rate for Payer: Blue Shield of California Commercial |
$124.58
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cigna of CA HMO |
$113.40
|
| Rate for Payer: Cigna of CA PPO |
$113.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$137.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$137.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$137.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$113.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.80
|
| Rate for Payer: EPIC Health Plan Senior |
$64.80
|
| Rate for Payer: Galaxy Health WC |
$137.70
|
| Rate for Payer: Global Benefits Group Commercial |
$97.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$52.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$102.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$113.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$113.40
|
| Rate for Payer: Multiplan Commercial |
$129.60
|
| Rate for Payer: Networks By Design Commercial |
$81.00
|
| Rate for Payer: Prime Health Services Commercial |
$137.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$97.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$97.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.80
|
| Rate for Payer: United Healthcare All Other HMO |
$59.18
|
| Rate for Payer: United Healthcare HMO Rider |
$57.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$137.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$137.70
|
| Rate for Payer: Vantage Medical Group Senior |
$137.70
|
|
|
HC CTLSO AXILLARY SLING
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
CPT L1010
|
| Hospital Charge Code |
905351010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$32.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cigna of CA HMO |
$113.40
|
| Rate for Payer: Cigna of CA PPO |
$113.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$113.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.80
|
| Rate for Payer: EPIC Health Plan Senior |
$64.80
|
| Rate for Payer: Galaxy Health WC |
$137.70
|
| Rate for Payer: Global Benefits Group Commercial |
$97.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$102.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.88
|
| Rate for Payer: Multiplan Commercial |
$129.60
|
| Rate for Payer: Networks By Design Commercial |
$105.30
|
| Rate for Payer: Prime Health Services Commercial |
$137.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.80
|
| Rate for Payer: United Healthcare All Other HMO |
$59.18
|
| Rate for Payer: United Healthcare HMO Rider |
$57.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.05
|
|
|
HC CTLSO AXILLARY SLING
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
CPT L1010
|
| Hospital Charge Code |
915351010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$32.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cigna of CA HMO |
$113.40
|
| Rate for Payer: Cigna of CA PPO |
$113.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$113.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.80
|
| Rate for Payer: EPIC Health Plan Senior |
$64.80
|
| Rate for Payer: Galaxy Health WC |
$137.70
|
| Rate for Payer: Global Benefits Group Commercial |
$97.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$102.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.88
|
| Rate for Payer: Multiplan Commercial |
$129.60
|
| Rate for Payer: Networks By Design Commercial |
$105.30
|
| Rate for Payer: Prime Health Services Commercial |
$137.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.80
|
| Rate for Payer: United Healthcare All Other HMO |
$59.18
|
| Rate for Payer: United Healthcare HMO Rider |
$57.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.05
|
|
|
HC CTLSO AXILLARY SLING
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
CPT L1010
|
| Hospital Charge Code |
905351010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.88 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Adventist Health Commercial |
$66.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$137.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$89.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$121.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$98.06
|
| Rate for Payer: Blue Shield of California Commercial |
$82.13
|
| Rate for Payer: Blue Shield of California Commercial |
$124.58
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cigna of CA HMO |
$113.40
|
| Rate for Payer: Cigna of CA PPO |
$113.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$137.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$137.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$137.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$113.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.80
|
| Rate for Payer: EPIC Health Plan Senior |
$64.80
|
| Rate for Payer: Galaxy Health WC |
$137.70
|
| Rate for Payer: Global Benefits Group Commercial |
$97.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$52.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$102.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$113.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$113.40
|
| Rate for Payer: Multiplan Commercial |
$129.60
|
| Rate for Payer: Networks By Design Commercial |
$81.00
|
| Rate for Payer: Prime Health Services Commercial |
$137.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$97.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$97.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.80
|
| Rate for Payer: United Healthcare All Other HMO |
$59.18
|
| Rate for Payer: United Healthcare HMO Rider |
$57.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$137.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$137.70
|
| Rate for Payer: Vantage Medical Group Senior |
$137.70
|
|
|
HC CTLSO BILAT OUTRIGGER
|
Facility
|
OP
|
$367.00
|
|
|
Service Code
|
CPT L1085
|
| Hospital Charge Code |
915351085
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$88.08 |
| Max. Negotiated Rate |
$311.95 |
| Rate for Payer: Adventist Health Commercial |
$150.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$311.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$201.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$275.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$222.15
|
| Rate for Payer: Blue Shield of California Commercial |
$282.22
|
| Rate for Payer: Blue Shield of California Commercial |
$186.07
|
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: Cigna of CA HMO |
$256.90
|
| Rate for Payer: Cigna of CA PPO |
$256.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$311.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$311.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$311.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$256.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.80
|
| Rate for Payer: EPIC Health Plan Senior |
$146.80
|
| Rate for Payer: Galaxy Health WC |
$311.95
|
| Rate for Payer: Global Benefits Group Commercial |
$220.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$172.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$233.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$195.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$216.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$256.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$256.90
|
| Rate for Payer: Multiplan Commercial |
$293.60
|
| Rate for Payer: Networks By Design Commercial |
$183.50
|
| Rate for Payer: Prime Health Services Commercial |
$311.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$220.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$220.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$137.74
|
| Rate for Payer: United Healthcare All Other HMO |
$134.07
|
| Rate for Payer: United Healthcare HMO Rider |
$131.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$120.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$311.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$311.95
|
| Rate for Payer: Vantage Medical Group Senior |
$311.95
|
|
|
HC CTLSO BILAT OUTRIGGER
|
Facility
|
IP
|
$367.00
|
|
|
Service Code
|
CPT L1085
|
| Hospital Charge Code |
915351085
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$73.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$73.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: Cigna of CA HMO |
$256.90
|
| Rate for Payer: Cigna of CA PPO |
$256.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$256.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.80
|
| Rate for Payer: EPIC Health Plan Senior |
$146.80
|
| Rate for Payer: Galaxy Health WC |
$311.95
|
| Rate for Payer: Global Benefits Group Commercial |
$220.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$233.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$216.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.08
|
| Rate for Payer: Multiplan Commercial |
$293.60
|
| Rate for Payer: Networks By Design Commercial |
$238.55
|
| Rate for Payer: Prime Health Services Commercial |
$311.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$137.74
|
| Rate for Payer: United Healthcare All Other HMO |
$134.07
|
| Rate for Payer: United Healthcare HMO Rider |
$131.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$120.19
|
|
|
HC CTLSO BILAT OUTRIGGER
|
Facility
|
IP
|
$367.00
|
|
|
Service Code
|
CPT L1085
|
| Hospital Charge Code |
905351085
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$73.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$73.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: Cigna of CA HMO |
$256.90
|
| Rate for Payer: Cigna of CA PPO |
$256.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$256.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.80
|
| Rate for Payer: EPIC Health Plan Senior |
$146.80
|
| Rate for Payer: Galaxy Health WC |
$311.95
|
| Rate for Payer: Global Benefits Group Commercial |
$220.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$233.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$216.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.08
|
| Rate for Payer: Multiplan Commercial |
$293.60
|
| Rate for Payer: Networks By Design Commercial |
$238.55
|
| Rate for Payer: Prime Health Services Commercial |
$311.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$137.74
|
| Rate for Payer: United Healthcare All Other HMO |
$134.07
|
| Rate for Payer: United Healthcare HMO Rider |
$131.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$120.19
|
|
|
HC CTLSO BILAT OUTRIGGER
|
Facility
|
OP
|
$367.00
|
|
|
Service Code
|
CPT L1085
|
| Hospital Charge Code |
905351085
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$88.08 |
| Max. Negotiated Rate |
$311.95 |
| Rate for Payer: Adventist Health Commercial |
$150.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$311.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$201.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$275.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$222.15
|
| Rate for Payer: Blue Shield of California Commercial |
$282.22
|
| Rate for Payer: Blue Shield of California Commercial |
$186.07
|
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: Cigna of CA HMO |
$256.90
|
| Rate for Payer: Cigna of CA PPO |
$256.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$311.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$311.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$311.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$256.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.80
|
| Rate for Payer: EPIC Health Plan Senior |
$146.80
|
| Rate for Payer: Galaxy Health WC |
$311.95
|
| Rate for Payer: Global Benefits Group Commercial |
$220.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$172.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$233.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$195.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$216.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$256.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$256.90
|
| Rate for Payer: Multiplan Commercial |
$293.60
|
| Rate for Payer: Networks By Design Commercial |
$183.50
|
| Rate for Payer: Prime Health Services Commercial |
$311.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$220.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$220.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$137.74
|
| Rate for Payer: United Healthcare All Other HMO |
$134.07
|
| Rate for Payer: United Healthcare HMO Rider |
$131.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$120.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$311.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$311.95
|
| Rate for Payer: Vantage Medical Group Senior |
$311.95
|
|
|
HC CTLSO INFANT IMMOBILIZER PREFAB
|
Facility
|
IP
|
$5,600.00
|
|
|
Service Code
|
CPT L1001
|
| Hospital Charge Code |
905351001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,120.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Cash Price |
$2,520.00
|
| Rate for Payer: Adventist Health Commercial |
$1,120.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$2,520.00
|
| Rate for Payer: Cigna of CA HMO |
$3,920.00
|
| Rate for Payer: Cigna of CA PPO |
$3,920.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,920.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,240.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,240.00
|
| Rate for Payer: Galaxy Health WC |
$4,760.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,360.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,556.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,304.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,344.00
|
| Rate for Payer: Multiplan Commercial |
$4,480.00
|
| Rate for Payer: Networks By Design Commercial |
$3,640.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,760.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,101.68
|
| Rate for Payer: United Healthcare All Other HMO |
$2,045.68
|
| Rate for Payer: United Healthcare HMO Rider |
$2,001.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,834.00
|
|
|
HC CTLSO INFANT IMMOBILIZER PREFAB
|
Facility
|
IP
|
$5,600.00
|
|
|
Service Code
|
CPT L1001
|
| Hospital Charge Code |
915351001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,120.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,120.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$2,520.00
|
| Rate for Payer: Cash Price |
$2,520.00
|
| Rate for Payer: Cigna of CA HMO |
$3,920.00
|
| Rate for Payer: Cigna of CA PPO |
$3,920.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,920.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,240.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,240.00
|
| Rate for Payer: Galaxy Health WC |
$4,760.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,360.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,556.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,304.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,344.00
|
| Rate for Payer: Multiplan Commercial |
$4,480.00
|
| Rate for Payer: Networks By Design Commercial |
$3,640.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,760.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,101.68
|
| Rate for Payer: United Healthcare All Other HMO |
$2,045.68
|
| Rate for Payer: United Healthcare HMO Rider |
$2,001.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,834.00
|
|
