|
HC CT PERFUSION W/CONTRAST, CBF
|
Facility
|
OP
|
$5,710.00
|
|
|
Service Code
|
CPT 0042T
|
| Hospital Charge Code |
909201812
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,142.00 |
| Max. Negotiated Rate |
$4,853.50 |
| Rate for Payer: Adventist Health Commercial |
$1,142.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,853.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,140.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,282.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,664.11
|
| Rate for Payer: Blue Shield of California Commercial |
$2,403.91
|
| Rate for Payer: Blue Shield of California Commercial |
$3,642.98
|
| Rate for Payer: Cash Price |
$2,569.50
|
| Rate for Payer: Cash Price |
$2,569.50
|
| Rate for Payer: Cigna of CA HMO |
$3,654.40
|
| Rate for Payer: Cigna of CA PPO |
$4,225.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,853.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,853.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,853.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,997.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,284.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,284.00
|
| Rate for Payer: Galaxy Health WC |
$4,853.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,426.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,625.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,072.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,368.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,370.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,997.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,997.00
|
| Rate for Payer: Multiplan Commercial |
$4,568.00
|
| Rate for Payer: Networks By Design Commercial |
$3,711.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,853.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,426.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,426.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,855.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,855.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,855.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,855.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,853.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,853.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,853.50
|
|
|
HC CT RECONSTRUCTION FOR TRANSPLT
|
Facility
|
OP
|
$2,450.00
|
|
| Hospital Charge Code |
909201983
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$490.00 |
| Max. Negotiated Rate |
$2,082.50 |
| Rate for Payer: Adventist Health Commercial |
$490.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,606.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,082.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,347.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,837.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,572.16
|
| Rate for Payer: Blue Shield of California Commercial |
$1,031.45
|
| Rate for Payer: Blue Shield of California Commercial |
$1,563.10
|
| Rate for Payer: Cash Price |
$1,102.50
|
| Rate for Payer: Cigna of CA HMO |
$1,568.00
|
| Rate for Payer: Cigna of CA PPO |
$1,813.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,082.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,082.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,082.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,715.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$980.00
|
| Rate for Payer: EPIC Health Plan Senior |
$980.00
|
| Rate for Payer: Galaxy Health WC |
$2,082.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,470.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,555.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$889.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,445.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$588.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,715.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,715.00
|
| Rate for Payer: Multiplan Commercial |
$1,960.00
|
| Rate for Payer: Networks By Design Commercial |
$1,592.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,082.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,470.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,470.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,225.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,225.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,225.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,225.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,082.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,082.50
|
| Rate for Payer: Vantage Medical Group Senior |
$2,082.50
|
|
|
HC CT RECONSTRUCTION FOR TRANSPLT
|
Facility
|
IP
|
$2,450.00
|
|
| Hospital Charge Code |
909201983
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$490.00 |
| Max. Negotiated Rate |
$2,082.50 |
| Rate for Payer: Adventist Health Commercial |
$490.00
|
| Rate for Payer: Cash Price |
$1,102.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,715.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$980.00
|
| Rate for Payer: EPIC Health Plan Senior |
$980.00
|
| Rate for Payer: Galaxy Health WC |
$2,082.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,470.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,555.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,445.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$588.00
|
| Rate for Payer: Multiplan Commercial |
$1,960.00
|
| Rate for Payer: Networks By Design Commercial |
$1,592.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,082.50
|
|
|
HC CT SOFT TIS NCK W CONTR
|
Facility
|
IP
|
$6,175.00
|
|
|
Service Code
|
CPT 70491
|
| Hospital Charge Code |
909201910
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,235.00 |
| Max. Negotiated Rate |
$5,248.75 |
| Rate for Payer: Adventist Health Commercial |
$1,235.00
|
| Rate for Payer: Cash Price |
$2,778.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,322.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,470.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,470.00
|
| Rate for Payer: Galaxy Health WC |
$5,248.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,705.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,921.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,643.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,482.00
|
| Rate for Payer: Multiplan Commercial |
$4,940.00
|
| Rate for Payer: Networks By Design Commercial |
$4,013.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,248.75
|
|
|
HC CT SOFT TIS NCK W CONTR
|
Facility
|
OP
|
$6,175.00
|
|
|
Service Code
|
CPT 70491
|
| Hospital Charge Code |
909201910
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$225.59 |
| Max. Negotiated Rate |
$5,248.75 |
| Rate for Payer: Adventist Health Commercial |
$1,235.00
|
| Rate for Payer: Adventist Health Commercial |
$548.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,962.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,758.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1,153.54
|
| Rate for Payer: Blue Shield of California Commercial |
$1,748.12
|
| Rate for Payer: Blue Shield of California Commercial |
$2,599.68
|
| Rate for Payer: Blue Shield of California Commercial |
$3,939.65
|
| Rate for Payer: Cash Price |
$2,778.75
|
| Rate for Payer: Cash Price |
$1,233.00
|
| Rate for Payer: Cash Price |
$1,233.00
|
| Rate for Payer: Cash Price |
$2,778.75
|
| Rate for Payer: Cash Price |
$1,233.00
|
| Rate for Payer: Cash Price |
$2,778.75
|
| Rate for Payer: Cigna of CA HMO |
$1,753.60
|
| Rate for Payer: Cigna of CA HMO |
$3,952.00
|
| Rate for Payer: Cigna of CA PPO |
$2,027.60
|
| Rate for Payer: Cigna of CA PPO |
$4,569.50
|
| 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 |
$1,918.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,322.50
|
| 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 |
$5,248.75
|
| Rate for Payer: Galaxy Health WC |
$2,329.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,705.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,644.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$299.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$299.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,921.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,739.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$339.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$339.25
|
| 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 |
$1,482.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$657.60
|
| 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 |
$2,192.00
|
| Rate for Payer: Multiplan Commercial |
$4,940.00
|
| Rate for Payer: Networks By Design Commercial |
$4,013.75
|
| Rate for Payer: Networks By Design Commercial |
$1,781.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,329.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,248.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,705.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,644.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,644.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,705.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,370.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,087.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,087.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,370.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,087.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,370.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,370.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,087.50
|
| 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 SOFT TIS NCK WO CONTR
|
Facility
|
IP
|
$5,480.00
|
|
|
Service Code
|
CPT 70490
|
| Hospital Charge Code |
909201909
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,096.00 |
| Max. Negotiated Rate |
$4,658.00 |
| Rate for Payer: Adventist Health Commercial |
$1,096.00
|
| Rate for Payer: Cash Price |
$2,466.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,836.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,192.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,192.00
|
| Rate for Payer: Galaxy Health WC |
$4,658.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,288.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,479.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,233.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,315.20
|
| Rate for Payer: Multiplan Commercial |
$4,384.00
|
| Rate for Payer: Networks By Design Commercial |
$3,562.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,658.00
|
|
|
HC CT SOFT TIS NCK WO CONTR
|
Facility
|
OP
|
$5,480.00
|
|
|
Service Code
|
CPT 70490
|
| Hospital Charge Code |
909201909
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$4,658.00 |
| Rate for Payer: Adventist Health Commercial |
$1,096.00
|
| Rate for Payer: Adventist Health Commercial |
$486.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,516.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,561.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1,024.29
|
| Rate for Payer: Blue Shield of California Commercial |
$1,552.25
|
| Rate for Payer: Blue Shield of California Commercial |
$2,307.08
|
| Rate for Payer: Blue Shield of California Commercial |
$3,496.24
|
| Rate for Payer: Cash Price |
$2,466.00
|
| Rate for Payer: Cash Price |
$1,094.85
|
| Rate for Payer: Cash Price |
$1,094.85
|
| Rate for Payer: Cash Price |
$2,466.00
|
| Rate for Payer: Cash Price |
$1,094.85
|
| Rate for Payer: Cash Price |
$2,466.00
|
| Rate for Payer: Cigna of CA HMO |
$1,557.12
|
| Rate for Payer: Cigna of CA HMO |
$3,507.20
|
| Rate for Payer: Cigna of CA PPO |
$1,800.42
|
| Rate for Payer: Cigna of CA PPO |
$4,055.20
|
| 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 |
$1,703.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,836.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$4,658.00
|
| Rate for Payer: Galaxy Health WC |
$2,068.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,288.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,459.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$241.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$241.94
|
| 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 |
$3,479.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,544.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$273.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$273.62
|
| 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 |
$1,315.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$583.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,946.40
|
| Rate for Payer: Multiplan Commercial |
$4,384.00
|
| Rate for Payer: Networks By Design Commercial |
$3,562.00
|
| Rate for Payer: Networks By Design Commercial |
$1,581.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,068.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,658.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,288.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,459.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,459.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,288.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,216.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,740.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,740.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,216.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,740.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,216.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,216.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,740.00
|
| 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 SOFT TISSUE NECK W/WO CNTRST
|
Facility
|
OP
|
$6,272.00
|
|
|
Service Code
|
CPT 70492
|
| Hospital Charge Code |
909201911
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$225.59 |
| Max. Negotiated Rate |
$5,331.20 |
| Rate for Payer: Adventist Health Commercial |
$1,254.40
|
| Rate for Payer: Adventist Health Commercial |
$653.20
|
| 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 |
$4,024.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,095.79
|
| Rate for Payer: Blue Shield of California Commercial |
$1,374.99
|
| Rate for Payer: Blue Shield of California Commercial |
$2,083.71
|
| Rate for Payer: Blue Shield of California Commercial |
$2,640.51
|
| Rate for Payer: Blue Shield of California Commercial |
$4,001.54
|
| Rate for Payer: Cash Price |
$2,822.40
|
| Rate for Payer: Cash Price |
$1,469.70
|
| Rate for Payer: Cash Price |
$1,469.70
|
| Rate for Payer: Cash Price |
$2,822.40
|
| Rate for Payer: Cash Price |
$1,469.70
|
| Rate for Payer: Cash Price |
$2,822.40
|
| Rate for Payer: Cigna of CA HMO |
$2,090.24
|
| Rate for Payer: Cigna of CA HMO |
$4,014.08
|
| Rate for Payer: Cigna of CA PPO |
$2,416.84
|
| Rate for Payer: Cigna of CA PPO |
$4,641.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,286.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,390.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: Galaxy Health WC |
$5,331.20
|
| Rate for Payer: Galaxy Health WC |
$2,776.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,763.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,959.60
|
| 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 |
$360.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$360.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,982.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,073.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$408.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$408.20
|
| 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 |
$1,505.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$783.84
|
| 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 |
$2,612.80
|
| Rate for Payer: Multiplan Commercial |
$5,017.60
|
| Rate for Payer: Networks By Design Commercial |
$4,076.80
|
| Rate for Payer: Networks By Design Commercial |
$2,122.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,776.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,331.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,763.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,959.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,959.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,763.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,633.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,633.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,136.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,633.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,633.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,136.00
|
| 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 SOFT TISSUE NECK W/WO CNTRST
|
Facility
|
IP
|
$6,272.00
|
|
|
Service Code
|
CPT 70492
|
| Hospital Charge Code |
909201911
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,254.40 |
| Max. Negotiated Rate |
$5,331.20 |
| Rate for Payer: Adventist Health Commercial |
$1,254.40
|
| Rate for Payer: Cash Price |
$2,822.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,390.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,508.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,508.80
|
| Rate for Payer: Galaxy Health WC |
$5,331.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,763.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,982.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,700.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,505.28
|
| Rate for Payer: Multiplan Commercial |
$5,017.60
|
| Rate for Payer: Networks By Design Commercial |
$4,076.80
|
| Rate for Payer: Prime Health Services Commercial |
$5,331.20
|
|
|
HC CT STEREOTACTIC LOCALIZATION
|
Facility
|
OP
|
$2,354.00
|
|
|
Service Code
|
CPT 77011
|
| Hospital Charge Code |
909001159
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$335.13 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$470.80
|
| Rate for Payer: Adventist Health Commercial |
$315.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,341.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,000.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,294.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$867.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,765.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,183.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,012.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,510.56
|
| Rate for Payer: Blue Shield of California Commercial |
$991.03
|
| Rate for Payer: Blue Shield of California Commercial |
$664.34
|
| Rate for Payer: Blue Shield of California Commercial |
$1,006.76
|
| Rate for Payer: Blue Shield of California Commercial |
$1,501.85
|
| Rate for Payer: Cash Price |
$710.10
|
| Rate for Payer: Cash Price |
$1,059.30
|
| Rate for Payer: Cash Price |
$710.10
|
| Rate for Payer: Cash Price |
$710.10
|
| Rate for Payer: Cash Price |
$1,059.30
|
| Rate for Payer: Cash Price |
$1,059.30
|
| Rate for Payer: Cigna of CA HMO |
$1,506.56
|
| Rate for Payer: Cigna of CA HMO |
$1,009.92
|
| Rate for Payer: Cigna of CA PPO |
$1,167.72
|
| Rate for Payer: Cigna of CA PPO |
$1,741.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,000.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,341.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,341.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,000.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,000.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,341.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,104.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,647.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$631.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$941.60
|
| Rate for Payer: EPIC Health Plan Senior |
$941.60
|
| Rate for Payer: EPIC Health Plan Senior |
$631.20
|
| Rate for Payer: Galaxy Health WC |
$2,000.90
|
| Rate for Payer: Galaxy Health WC |
$1,341.30
|
| Rate for Payer: Global Benefits Group Commercial |
$946.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,412.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$335.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$335.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,494.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,002.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$379.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$379.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$931.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,388.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$564.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$378.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,104.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,647.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,104.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,647.80
|
| Rate for Payer: Multiplan Commercial |
$1,262.40
|
| Rate for Payer: Multiplan Commercial |
$1,883.20
|
| Rate for Payer: Networks By Design Commercial |
$1,025.70
|
| Rate for Payer: Networks By Design Commercial |
$1,530.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,341.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,000.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,412.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$946.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,412.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$946.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,177.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$789.00
|
| Rate for Payer: United Healthcare All Other HMO |
$789.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,177.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,177.00
|
| Rate for Payer: United Healthcare HMO Rider |
$789.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$789.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,177.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,000.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,341.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,341.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,000.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,000.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,341.30
|
|
|
HC CT STEREOTACTIC LOCALIZATION
|
Facility
|
IP
|
$2,354.00
|
|
|
Service Code
|
CPT 77011
|
| Hospital Charge Code |
909001159
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$470.80 |
| Max. Negotiated Rate |
$2,000.90 |
| Rate for Payer: Adventist Health Commercial |
$470.80
|
| Rate for Payer: Cash Price |
$1,059.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,647.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$941.60
|
| Rate for Payer: EPIC Health Plan Senior |
$941.60
|
| Rate for Payer: Galaxy Health WC |
$2,000.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,412.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,494.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,388.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$564.96
|
| Rate for Payer: Multiplan Commercial |
$1,883.20
|
| Rate for Payer: Networks By Design Commercial |
$1,530.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,000.90
|
|
|
HC CT TSPINE W CONTRAST
|
Facility
|
OP
|
$2,523.00
|
|
|
Service Code
|
CPT 72129
|
| Hospital Charge Code |
909201918
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.59 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$504.60
|
| Rate for Payer: Adventist Health Commercial |
$1,020.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$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 |
$1,619.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,275.24
|
| Rate for Payer: Blue Shield of California Commercial |
$2,148.78
|
| Rate for Payer: Blue Shield of California Commercial |
$1,062.18
|
| Rate for Payer: Blue Shield of California Commercial |
$1,609.67
|
| Rate for Payer: Blue Shield of California Commercial |
$3,256.35
|
| Rate for Payer: Cash Price |
$1,135.35
|
| Rate for Payer: Cash Price |
$1,135.35
|
| Rate for Payer: Cash Price |
$2,296.80
|
| Rate for Payer: Cash Price |
$1,135.35
|
| Rate for Payer: Cash Price |
$2,296.80
|
| Rate for Payer: Cash Price |
$2,296.80
|
| Rate for Payer: Cigna of CA HMO |
$1,614.72
|
| Rate for Payer: Cigna of CA HMO |
$3,266.56
|
| Rate for Payer: Cigna of CA PPO |
$1,867.02
|
| Rate for Payer: Cigna of CA PPO |
$3,776.96
|
| 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 |
$3,572.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,766.10
|
| 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 |
$4,338.40
|
| Rate for Payer: Galaxy Health WC |
$2,144.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,513.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,062.40
|
| 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 |
$276.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$276.09
|
| 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 |
$3,241.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,602.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$312.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$312.25
|
| 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 |
$605.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,224.96
|
| 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 |
$2,018.40
|
| Rate for Payer: Multiplan Commercial |
$4,083.20
|
| Rate for Payer: Networks By Design Commercial |
$3,317.60
|
| Rate for Payer: Networks By Design Commercial |
$1,639.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,144.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,338.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,062.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,513.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,513.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,062.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$769.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$769.25
|
| Rate for Payer: United Healthcare All Other HMO |
$769.25
|
| Rate for Payer: United Healthcare All Other HMO |
$769.25
|
| Rate for Payer: United Healthcare HMO Rider |
$769.25
|
| Rate for Payer: United Healthcare HMO Rider |
$769.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$769.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$769.25
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 TSPINE W CONTRAST
|
Facility
|
IP
|
$5,104.00
|
|
|
Service Code
|
CPT 72129
|
| Hospital Charge Code |
909201918
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,020.80 |
| Max. Negotiated Rate |
$4,338.40 |
| Rate for Payer: Adventist Health Commercial |
$1,020.80
|
| Rate for Payer: Cash Price |
$2,296.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,572.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,041.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,041.60
|
| Rate for Payer: Galaxy Health WC |
$4,338.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,062.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,241.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,011.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,224.96
|
| Rate for Payer: Multiplan Commercial |
$4,083.20
|
| Rate for Payer: Networks By Design Commercial |
$3,317.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,338.40
|
|
|
HC CT TSPINE WO CONTRAST
|
Facility
|
IP
|
$4,758.00
|
|
|
Service Code
|
CPT 72128
|
| Hospital Charge Code |
909201917
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$951.60 |
| Max. Negotiated Rate |
$4,044.30 |
| Rate for Payer: Adventist Health Commercial |
$951.60
|
| Rate for Payer: Cash Price |
$2,141.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,330.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,903.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,903.20
|
| Rate for Payer: Galaxy Health WC |
$4,044.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,854.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,021.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,807.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,141.92
|
| Rate for Payer: Multiplan Commercial |
$3,806.40
|
| Rate for Payer: Networks By Design Commercial |
$3,092.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,044.30
|
|
|
HC CT TSPINE WO CONTRAST
|
Facility
|
OP
|
$2,550.00
|
|
|
Service Code
|
CPT 72128
|
| Hospital Charge Code |
909201917
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$510.00
|
| Rate for Payer: Adventist Health Commercial |
$951.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,636.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,053.21
|
| Rate for Payer: Blue Shield of California Commercial |
$2,003.12
|
| Rate for Payer: Blue Shield of California Commercial |
$1,073.55
|
| Rate for Payer: Blue Shield of California Commercial |
$1,626.90
|
| Rate for Payer: Blue Shield of California Commercial |
$3,035.60
|
| Rate for Payer: Cash Price |
$1,147.50
|
| Rate for Payer: Cash Price |
$1,147.50
|
| Rate for Payer: Cash Price |
$2,141.10
|
| Rate for Payer: Cash Price |
$1,147.50
|
| Rate for Payer: Cash Price |
$2,141.10
|
| Rate for Payer: Cash Price |
$2,141.10
|
| Rate for Payer: Cigna of CA HMO |
$1,632.00
|
| Rate for Payer: Cigna of CA HMO |
$3,045.12
|
| Rate for Payer: Cigna of CA PPO |
$1,887.00
|
| Rate for Payer: Cigna of CA PPO |
$3,520.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,330.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,785.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$4,044.30
|
| Rate for Payer: Galaxy Health WC |
$2,167.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,530.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,854.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$209.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$209.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,021.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,619.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$236.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$236.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$612.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,141.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$2,040.00
|
| Rate for Payer: Multiplan Commercial |
$3,806.40
|
| Rate for Payer: Networks By Design Commercial |
$3,092.70
|
| Rate for Payer: Networks By Design Commercial |
$1,657.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,167.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,044.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,854.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,530.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,530.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,854.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$491.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$491.23
|
| Rate for Payer: United Healthcare All Other HMO |
$491.23
|
| Rate for Payer: United Healthcare All Other HMO |
$491.23
|
| Rate for Payer: United Healthcare HMO Rider |
$491.23
|
| Rate for Payer: United Healthcare HMO Rider |
$491.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$491.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$491.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC CT TSPINE W W/O CONTRAST
|
Facility
|
IP
|
$5,358.00
|
|
|
Service Code
|
CPT 72130
|
| Hospital Charge Code |
909201966
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,071.60 |
| Max. Negotiated Rate |
$4,554.30 |
| Rate for Payer: Adventist Health Commercial |
$1,071.60
|
| Rate for Payer: Cash Price |
$2,411.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,750.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,143.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,143.20
|
| Rate for Payer: Galaxy Health WC |
$4,554.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,214.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,402.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,161.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,285.92
|
| Rate for Payer: Multiplan Commercial |
$4,286.40
|
| Rate for Payer: Networks By Design Commercial |
$3,482.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,554.30
|
|
|
HC CT TSPINE W W/O CONTRAST
|
Facility
|
OP
|
$3,004.00
|
|
|
Service Code
|
CPT 72130
|
| Hospital Charge Code |
909201966
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.59 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$600.80
|
| Rate for Payer: Adventist Health Commercial |
$1,071.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,927.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,438.23
|
| Rate for Payer: Blue Shield of California Commercial |
$2,255.72
|
| Rate for Payer: Blue Shield of California Commercial |
$1,264.68
|
| Rate for Payer: Blue Shield of California Commercial |
$1,916.55
|
| Rate for Payer: Blue Shield of California Commercial |
$3,418.40
|
| Rate for Payer: Cash Price |
$1,351.80
|
| Rate for Payer: Cash Price |
$1,351.80
|
| Rate for Payer: Cash Price |
$2,411.10
|
| Rate for Payer: Cash Price |
$1,351.80
|
| Rate for Payer: Cash Price |
$2,411.10
|
| Rate for Payer: Cash Price |
$2,411.10
|
| Rate for Payer: Cigna of CA HMO |
$1,922.56
|
| Rate for Payer: Cigna of CA HMO |
$3,429.12
|
| Rate for Payer: Cigna of CA PPO |
$2,222.96
|
| Rate for Payer: Cigna of CA PPO |
$3,964.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,750.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,102.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: Galaxy Health WC |
$4,554.30
|
| Rate for Payer: Galaxy Health WC |
$2,553.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,802.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,214.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$324.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$324.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,402.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,907.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$366.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$366.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$720.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,285.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$284.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$284.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$302.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$2,403.20
|
| Rate for Payer: Multiplan Commercial |
$4,286.40
|
| Rate for Payer: Networks By Design Commercial |
$3,482.70
|
| Rate for Payer: Networks By Design Commercial |
$1,952.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,553.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,554.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,214.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,802.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,802.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,214.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$855.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$855.26
|
| Rate for Payer: United Healthcare All Other HMO |
$855.26
|
| Rate for Payer: United Healthcare All Other HMO |
$855.26
|
| Rate for Payer: United Healthcare HMO Rider |
$855.26
|
| Rate for Payer: United Healthcare HMO Rider |
$855.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$855.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$855.26
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
|
HC CT UPPER EXT W CONT
|
Facility
|
OP
|
$2,355.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
909201955
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$330.57 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$471.00
|
| Rate for Payer: Adventist Health Commercial |
$910.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$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 |
$1,511.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,921.66
|
| Rate for Payer: Blue Shield of California Commercial |
$1,916.81
|
| Rate for Payer: Blue Shield of California Commercial |
$1,502.49
|
| Rate for Payer: Blue Shield of California Commercial |
$991.46
|
| Rate for Payer: Blue Shield of California Commercial |
$2,904.81
|
| Rate for Payer: Cash Price |
$1,059.75
|
| Rate for Payer: Cash Price |
$1,059.75
|
| Rate for Payer: Cash Price |
$2,048.85
|
| Rate for Payer: Cash Price |
$1,059.75
|
| Rate for Payer: Cash Price |
$2,048.85
|
| Rate for Payer: Cash Price |
$2,048.85
|
| Rate for Payer: Cigna of CA HMO |
$1,507.20
|
| Rate for Payer: Cigna of CA HMO |
$2,913.92
|
| Rate for Payer: Cigna of CA PPO |
$1,742.70
|
| Rate for Payer: Cigna of CA PPO |
$3,369.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,187.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,648.50
|
| 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 |
$3,870.05
|
| Rate for Payer: Galaxy Health WC |
$2,001.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,413.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,731.80
|
| 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 |
$330.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$330.57
|
| 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 |
$2,891.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,495.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$373.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$373.86
|
| 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 |
$565.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,092.72
|
| 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 |
$1,884.00
|
| Rate for Payer: Multiplan Commercial |
$3,642.40
|
| Rate for Payer: Networks By Design Commercial |
$2,959.45
|
| Rate for Payer: Networks By Design Commercial |
$1,530.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,001.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,870.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,731.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,413.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,413.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,731.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$769.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$769.25
|
| Rate for Payer: United Healthcare All Other HMO |
$769.25
|
| Rate for Payer: United Healthcare All Other HMO |
$769.25
|
| Rate for Payer: United Healthcare HMO Rider |
$769.25
|
| Rate for Payer: United Healthcare HMO Rider |
$769.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$769.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$769.25
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 UPPER EXT W CONT
|
Facility
|
IP
|
$4,553.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
909201955
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$910.60 |
| Max. Negotiated Rate |
$3,870.05 |
| Rate for Payer: Adventist Health Commercial |
$910.60
|
| Rate for Payer: Cash Price |
$2,048.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,187.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,821.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,821.20
|
| Rate for Payer: Galaxy Health WC |
$3,870.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,731.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,891.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,686.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,092.72
|
| Rate for Payer: Multiplan Commercial |
$3,642.40
|
| Rate for Payer: Networks By Design Commercial |
$2,959.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,870.05
|
|
|
HC CT UPPER EXT W/WO CONT
|
Facility
|
OP
|
$2,751.00
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
909201956
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.59 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: Adventist Health Commercial |
$550.20
|
| Rate for Payer: Adventist Health Commercial |
$980.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,765.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,144.33
|
| Rate for Payer: Blue Shield of California Commercial |
$2,062.90
|
| Rate for Payer: Blue Shield of California Commercial |
$1,158.17
|
| Rate for Payer: Blue Shield of California Commercial |
$1,755.14
|
| Rate for Payer: Blue Shield of California Commercial |
$3,126.20
|
| Rate for Payer: Cash Price |
$1,237.95
|
| Rate for Payer: Cash Price |
$1,237.95
|
| Rate for Payer: Cash Price |
$2,205.00
|
| Rate for Payer: Cash Price |
$1,237.95
|
| Rate for Payer: Cash Price |
$2,205.00
|
| Rate for Payer: Cash Price |
$2,205.00
|
| Rate for Payer: Cigna of CA HMO |
$1,760.64
|
| Rate for Payer: Cigna of CA HMO |
$3,136.00
|
| Rate for Payer: Cigna of CA PPO |
$2,035.74
|
| Rate for Payer: Cigna of CA PPO |
$3,626.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,430.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,925.70
|
| 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: Galaxy Health WC |
$4,165.00
|
| Rate for Payer: Galaxy Health WC |
$2,338.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,650.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,940.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$415.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$415.55
|
| 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 |
$3,111.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,746.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$469.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$469.96
|
| 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 |
$660.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,176.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$284.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$284.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$302.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$2,200.80
|
| Rate for Payer: Multiplan Commercial |
$3,920.00
|
| Rate for Payer: Networks By Design Commercial |
$3,185.00
|
| Rate for Payer: Networks By Design Commercial |
$1,788.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,338.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,165.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,940.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,650.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,650.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,940.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$855.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$855.26
|
| Rate for Payer: United Healthcare All Other HMO |
$855.26
|
| Rate for Payer: United Healthcare All Other HMO |
$855.26
|
| Rate for Payer: United Healthcare HMO Rider |
$855.26
|
| Rate for Payer: United Healthcare HMO Rider |
$855.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$855.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$855.26
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
|
HC CT UPPER EXT W/WO CONT
|
Facility
|
IP
|
$4,900.00
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
909201956
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$980.00 |
| Max. Negotiated Rate |
$4,165.00 |
| Rate for Payer: Adventist Health Commercial |
$980.00
|
| Rate for Payer: Cash Price |
$2,205.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,430.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,960.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,960.00
|
| Rate for Payer: Galaxy Health WC |
$4,165.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,940.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,111.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,891.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,176.00
|
| Rate for Payer: Multiplan Commercial |
$3,920.00
|
| Rate for Payer: Networks By Design Commercial |
$3,185.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,165.00
|
|
|
HC CT UPPR EXTR WO CONT
|
Facility
|
IP
|
$4,205.00
|
|
|
Service Code
|
CPT 73200
|
| Hospital Charge Code |
909201954
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$841.00 |
| Max. Negotiated Rate |
$3,574.25 |
| Rate for Payer: Adventist Health Commercial |
$841.00
|
| Rate for Payer: Cash Price |
$1,892.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,943.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,682.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,682.00
|
| Rate for Payer: Galaxy Health WC |
$3,574.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,523.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,670.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,480.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,009.20
|
| Rate for Payer: Multiplan Commercial |
$3,364.00
|
| Rate for Payer: Networks By Design Commercial |
$2,733.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,574.25
|
|
|
HC CT UPPR EXTR WO CONT
|
Facility
|
OP
|
$2,360.00
|
|
|
Service Code
|
CPT 73200
|
| Hospital Charge Code |
909201954
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$472.00
|
| Rate for Payer: Adventist Health Commercial |
$841.00
|
| 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 |
$1,514.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,698.35
|
| Rate for Payer: Blue Shield of California Commercial |
$1,770.31
|
| Rate for Payer: Blue Shield of California Commercial |
$1,505.68
|
| Rate for Payer: Blue Shield of California Commercial |
$993.56
|
| Rate for Payer: Blue Shield of California Commercial |
$2,682.79
|
| Rate for Payer: Cash Price |
$1,062.00
|
| Rate for Payer: Cash Price |
$1,062.00
|
| Rate for Payer: Cash Price |
$1,892.25
|
| Rate for Payer: Cash Price |
$1,062.00
|
| Rate for Payer: Cash Price |
$1,892.25
|
| Rate for Payer: Cash Price |
$1,892.25
|
| Rate for Payer: Cigna of CA HMO |
$1,510.40
|
| Rate for Payer: Cigna of CA HMO |
$2,691.20
|
| Rate for Payer: Cigna of CA PPO |
$1,746.40
|
| Rate for Payer: Cigna of CA PPO |
$3,111.70
|
| 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 |
$2,943.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,652.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$3,574.25
|
| Rate for Payer: Galaxy Health WC |
$2,006.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,416.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,523.00
|
| 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 |
$266.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$266.40
|
| 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 |
$2,670.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,498.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$301.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$301.28
|
| 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 |
$566.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,009.20
|
| 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 |
$1,888.00
|
| Rate for Payer: Multiplan Commercial |
$3,364.00
|
| Rate for Payer: Networks By Design Commercial |
$2,733.25
|
| Rate for Payer: Networks By Design Commercial |
$1,534.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,006.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,574.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,523.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,416.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,416.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,523.00
|
| 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 CUIRASS SHELL
|
Facility
|
OP
|
$2,300.00
|
|
| Hospital Charge Code |
900800900
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$1,955.00 |
| Rate for Payer: Adventist Health Commercial |
$460.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,508.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,265.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,725.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,475.91
|
| Rate for Payer: Cash Price |
$1,035.00
|
| Rate for Payer: Cigna of CA HMO |
$1,472.00
|
| Rate for Payer: Cigna of CA PPO |
$1,702.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,955.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,955.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,610.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: EPIC Health Plan Senior |
$920.00
|
| Rate for Payer: Galaxy Health WC |
$1,955.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,380.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,460.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$834.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,357.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$552.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,610.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,610.00
|
| Rate for Payer: Multiplan Commercial |
$1,840.00
|
| Rate for Payer: Networks By Design Commercial |
$1,495.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,955.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,380.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,380.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,150.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,150.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,150.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,150.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,955.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,955.00
|
|
|
HC CUIRASS SHELL
|
Facility
|
IP
|
$2,300.00
|
|
| Hospital Charge Code |
900800900
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$1,955.00 |
| Rate for Payer: Adventist Health Commercial |
$460.00
|
| Rate for Payer: Cash Price |
$1,035.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,610.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: EPIC Health Plan Senior |
$920.00
|
| Rate for Payer: Galaxy Health WC |
$1,955.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,380.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,460.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,357.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$552.00
|
| Rate for Payer: Multiplan Commercial |
$1,840.00
|
| Rate for Payer: Networks By Design Commercial |
$1,495.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,955.00
|
|
