|
HC XRAY HIP W/PELVIS UNI 1 VIEW
|
Facility
|
OP
|
$659.00
|
|
|
Service Code
|
CPT 73501
|
| Hospital Charge Code |
909073501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$50.37 |
| Max. Negotiated Rate |
$560.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$127.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$214.55
|
| Rate for Payer: Blue Distinction Transplant |
$395.40
|
| Rate for Payer: Blue Shield of California Commercial |
$389.47
|
| Rate for Payer: Blue Shield of California EPN |
$309.07
|
| Rate for Payer: Cash Price |
$296.55
|
| Rate for Payer: Cash Price |
$296.55
|
| Rate for Payer: Cigna of CA HMO |
$421.76
|
| Rate for Payer: Cigna of CA PPO |
$487.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$560.15
|
| Rate for Payer: Global Benefits Group Commercial |
$395.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$494.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$186.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$186.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$183.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$183.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$439.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$527.20
|
| Rate for Payer: Networks By Design Commercial |
$428.35
|
| Rate for Payer: Prime Health Services Commercial |
$560.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$395.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$395.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$155.65
|
| Rate for Payer: United Healthcare All Other HMO |
$155.65
|
| Rate for Payer: United Healthcare HMO Rider |
$155.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$155.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC XRAY HIP W/PELVIS UNI 2-3 VIEW
|
Facility
|
OP
|
$915.00
|
|
|
Service Code
|
CPT 73502
|
| Hospital Charge Code |
909073502
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$70.83 |
| Max. Negotiated Rate |
$777.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$191.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$317.50
|
| Rate for Payer: Blue Distinction Transplant |
$549.00
|
| Rate for Payer: Blue Shield of California Commercial |
$540.76
|
| Rate for Payer: Blue Shield of California EPN |
$429.14
|
| Rate for Payer: Cash Price |
$411.75
|
| Rate for Payer: Cash Price |
$411.75
|
| Rate for Payer: Cigna of CA HMO |
$585.60
|
| Rate for Payer: Cigna of CA PPO |
$677.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$777.75
|
| Rate for Payer: Global Benefits Group Commercial |
$549.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$686.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$186.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$186.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$183.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$183.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$610.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$732.00
|
| Rate for Payer: Networks By Design Commercial |
$594.75
|
| Rate for Payer: Prime Health Services Commercial |
$777.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$549.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$549.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$155.65
|
| Rate for Payer: United Healthcare All Other HMO |
$155.65
|
| Rate for Payer: United Healthcare HMO Rider |
$155.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$155.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC XRAY HIP W/PELVIS UNI 2-3 VIEW
|
Facility
|
IP
|
$915.00
|
|
|
Service Code
|
CPT 73502
|
| Hospital Charge Code |
909073502
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$219.60 |
| Max. Negotiated Rate |
$777.75 |
| Rate for Payer: Cash Price |
$411.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$366.00
|
| Rate for Payer: Galaxy Health WC |
$777.75
|
| Rate for Payer: Global Benefits Group Commercial |
$549.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$610.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$348.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.60
|
| Rate for Payer: Multiplan Commercial |
$732.00
|
| Rate for Payer: Networks By Design Commercial |
$594.75
|
| Rate for Payer: Prime Health Services Commercial |
$777.75
|
|
|
HC XRAY HIP W/PELVIS UNI 4 GT VIEWS
|
Facility
|
OP
|
$1,130.00
|
|
|
Service Code
|
CPT 73503
|
| Hospital Charge Code |
909073503
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$88.48 |
| Max. Negotiated Rate |
$960.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$237.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$393.36
|
| Rate for Payer: Blue Distinction Transplant |
$678.00
|
| Rate for Payer: Blue Shield of California Commercial |
$667.83
|
| Rate for Payer: Blue Shield of California EPN |
$529.97
|
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: Cigna of CA HMO |
$723.20
|
| Rate for Payer: Cigna of CA PPO |
$836.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$960.50
|
| Rate for Payer: Global Benefits Group Commercial |
$678.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$847.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$753.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$904.00
|
| Rate for Payer: Networks By Design Commercial |
$734.50
|
| Rate for Payer: Prime Health Services Commercial |
$960.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$678.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$678.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$257.76
|
| Rate for Payer: United Healthcare All Other HMO |
$257.76
|
| Rate for Payer: United Healthcare HMO Rider |
$257.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$257.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC XRAY HIP W/PELVIS UNI 4 GT VIEWS
|
Facility
|
IP
|
$1,130.00
|
|
|
Service Code
|
CPT 73503
|
| Hospital Charge Code |
909073503
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$271.20 |
| Max. Negotiated Rate |
$960.50 |
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$452.00
|
| Rate for Payer: Galaxy Health WC |
$960.50
|
| Rate for Payer: Global Benefits Group Commercial |
$678.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$753.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$430.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.20
|
| Rate for Payer: Multiplan Commercial |
$904.00
|
| Rate for Payer: Networks By Design Commercial |
$734.50
|
| Rate for Payer: Prime Health Services Commercial |
$960.50
|
|
|
HC XRAY SKULL RADIOGRAPH LTD
|
Facility
|
OP
|
$971.00
|
|
|
Service Code
|
CPT 70250
|
| Hospital Charge Code |
908801144
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$49.36 |
| Max. Negotiated Rate |
$825.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$159.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$162.28
|
| Rate for Payer: Blue Distinction Transplant |
$582.60
|
| Rate for Payer: Blue Shield of California Commercial |
$573.86
|
| Rate for Payer: Blue Shield of California EPN |
$455.40
|
| Rate for Payer: Cash Price |
$436.95
|
| Rate for Payer: Cash Price |
$436.95
|
| Rate for Payer: Cigna of CA HMO |
$621.44
|
| Rate for Payer: Cigna of CA PPO |
$718.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$825.35
|
| Rate for Payer: Global Benefits Group Commercial |
$582.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$728.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$647.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$776.80
|
| Rate for Payer: Networks By Design Commercial |
$631.15
|
| Rate for Payer: Prime Health Services Commercial |
$825.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$582.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$582.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC XRAY SKULL RADIOGRAPH LTD
|
Facility
|
IP
|
$971.00
|
|
|
Service Code
|
CPT 70250
|
| Hospital Charge Code |
908801144
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$233.04 |
| Max. Negotiated Rate |
$825.35 |
| Rate for Payer: Cash Price |
$436.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$388.40
|
| Rate for Payer: Galaxy Health WC |
$825.35
|
| Rate for Payer: Global Benefits Group Commercial |
$582.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$647.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$369.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.04
|
| Rate for Payer: Multiplan Commercial |
$776.80
|
| Rate for Payer: Networks By Design Commercial |
$631.15
|
| Rate for Payer: Prime Health Services Commercial |
$825.35
|
|
|
HC XR RIBS UNI & PA CHEST
|
Facility
|
IP
|
$1,026.00
|
|
|
Service Code
|
CPT 71101
|
| Hospital Charge Code |
950463101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$246.24 |
| Max. Negotiated Rate |
$872.10 |
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$410.40
|
| Rate for Payer: Galaxy Health WC |
$872.10
|
| Rate for Payer: Global Benefits Group Commercial |
$615.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$684.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$390.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.24
|
| Rate for Payer: Multiplan Commercial |
$820.80
|
| Rate for Payer: Networks By Design Commercial |
$666.90
|
| Rate for Payer: Prime Health Services Commercial |
$872.10
|
|
|
HC XR RIBS UNI & PA CHEST
|
Facility
|
OP
|
$1,026.00
|
|
|
Service Code
|
CPT 71101
|
| Hospital Charge Code |
950463101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$61.41 |
| Max. Negotiated Rate |
$872.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$167.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$175.73
|
| Rate for Payer: Blue Distinction Transplant |
$615.60
|
| Rate for Payer: Blue Shield of California Commercial |
$606.37
|
| Rate for Payer: Blue Shield of California EPN |
$481.19
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cigna of CA HMO |
$656.64
|
| Rate for Payer: Cigna of CA PPO |
$759.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$872.10
|
| Rate for Payer: Global Benefits Group Commercial |
$615.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$769.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$684.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$820.80
|
| Rate for Payer: Networks By Design Commercial |
$666.90
|
| Rate for Payer: Prime Health Services Commercial |
$872.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$615.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$615.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC XR RIBS W PA CXR
|
Facility
|
OP
|
$1,306.00
|
|
|
Service Code
|
CPT 71111
|
| Hospital Charge Code |
950463102
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$80.56 |
| Max. Negotiated Rate |
$1,110.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$237.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$233.72
|
| Rate for Payer: Blue Distinction Transplant |
$783.60
|
| Rate for Payer: Blue Shield of California Commercial |
$771.85
|
| Rate for Payer: Blue Shield of California EPN |
$612.51
|
| Rate for Payer: Cash Price |
$587.70
|
| Rate for Payer: Cash Price |
$587.70
|
| Rate for Payer: Cigna of CA HMO |
$835.84
|
| Rate for Payer: Cigna of CA PPO |
$966.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,110.10
|
| Rate for Payer: Global Benefits Group Commercial |
$783.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$979.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$871.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,044.80
|
| Rate for Payer: Networks By Design Commercial |
$848.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,110.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$783.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$783.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$193.23
|
| Rate for Payer: United Healthcare All Other HMO |
$193.23
|
| Rate for Payer: United Healthcare HMO Rider |
$193.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC XR RIBS W PA CXR
|
Facility
|
IP
|
$1,306.00
|
|
|
Service Code
|
CPT 71111
|
| Hospital Charge Code |
950463102
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.44 |
| Max. Negotiated Rate |
$1,110.10 |
| Rate for Payer: Cash Price |
$587.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$522.40
|
| Rate for Payer: Galaxy Health WC |
$1,110.10
|
| Rate for Payer: Global Benefits Group Commercial |
$783.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$871.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$497.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.44
|
| Rate for Payer: Multiplan Commercial |
$1,044.80
|
| Rate for Payer: Networks By Design Commercial |
$848.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,110.10
|
|
|
HC XR TEMP MANDIBULAR BILAT
|
Facility
|
OP
|
$941.00
|
|
|
Service Code
|
CPT 70330
|
| Hospital Charge Code |
909020170
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$72.37 |
| Max. Negotiated Rate |
$799.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$230.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$218.12
|
| Rate for Payer: Blue Distinction Transplant |
$564.60
|
| Rate for Payer: Blue Shield of California Commercial |
$556.13
|
| Rate for Payer: Blue Shield of California EPN |
$441.33
|
| Rate for Payer: Cash Price |
$423.45
|
| Rate for Payer: Cash Price |
$423.45
|
| Rate for Payer: Cigna of CA HMO |
$602.24
|
| Rate for Payer: Cigna of CA PPO |
$696.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$799.85
|
| Rate for Payer: Global Benefits Group Commercial |
$564.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$705.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$186.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$186.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$183.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$183.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$627.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$752.80
|
| Rate for Payer: Networks By Design Commercial |
$611.65
|
| Rate for Payer: Prime Health Services Commercial |
$799.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$564.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$564.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC XR TEMP MANDIBULAR BILAT
|
Facility
|
IP
|
$941.00
|
|
|
Service Code
|
CPT 70330
|
| Hospital Charge Code |
909020170
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$225.84 |
| Max. Negotiated Rate |
$799.85 |
| Rate for Payer: Cash Price |
$423.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$376.40
|
| Rate for Payer: Galaxy Health WC |
$799.85
|
| Rate for Payer: Global Benefits Group Commercial |
$564.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$627.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$358.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.84
|
| Rate for Payer: Multiplan Commercial |
$752.80
|
| Rate for Payer: Networks By Design Commercial |
$611.65
|
| Rate for Payer: Prime Health Services Commercial |
$799.85
|
|
|
HC XYLOSE TOLERANCE BLD
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 84620
|
| Hospital Charge Code |
900910321
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.46 |
| Max. Negotiated Rate |
$108.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$98.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.04
|
| Rate for Payer: Blue Distinction Transplant |
$27.00
|
| Rate for Payer: Blue Shield of California Commercial |
$29.07
|
| Rate for Payer: Blue Shield of California EPN |
$23.04
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cigna of CA HMO |
$28.80
|
| Rate for Payer: Cigna of CA PPO |
$33.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.36
|
| Rate for Payer: Dignity Health Media |
$12.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.91
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.91
|
| Rate for Payer: Galaxy Health WC |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$33.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.17
|
| Rate for Payer: Heritage Provider Network Transplant |
$21.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$20.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.30
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.46
|
| Rate for Payer: United Healthcare All Other HMO |
$10.46
|
| Rate for Payer: United Healthcare HMO Rider |
$10.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.20
|
| Rate for Payer: Vantage Medical Group Senior |
$12.91
|
|
|
HC Y-90 ZEVALIN UP TO 40 MCI
|
Facility
|
IP
|
$89,048.00
|
|
|
Service Code
|
CPT A9543
|
| Hospital Charge Code |
909301343
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$21,371.52 |
| Max. Negotiated Rate |
$75,690.80 |
| Rate for Payer: Blue Shield of California Commercial |
$63,402.18
|
| Rate for Payer: Blue Shield of California EPN |
$45,592.58
|
| Rate for Payer: Cash Price |
$40,071.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$35,619.20
|
| Rate for Payer: Galaxy Health WC |
$75,690.80
|
| Rate for Payer: Global Benefits Group Commercial |
$53,428.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59,395.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33,927.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21,371.52
|
| Rate for Payer: Multiplan Commercial |
$71,238.40
|
| Rate for Payer: Networks By Design Commercial |
$57,881.20
|
| Rate for Payer: Prime Health Services Commercial |
$75,690.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$33,624.52
|
| Rate for Payer: United Healthcare All Other HMO |
$32,840.90
|
| Rate for Payer: United Healthcare HMO Rider |
$32,128.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29,385.84
|
|
|
HC Y-90 ZEVALIN UP TO 40 MCI
|
Facility
|
OP
|
$89,048.00
|
|
|
Service Code
|
CPT A9543
|
| Hospital Charge Code |
909301343
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$21,371.52 |
| Max. Negotiated Rate |
$427,722.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$427,722.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$98,214.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$72,024.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$65,476.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118,458.81
|
| Rate for Payer: Blue Distinction Transplant |
$53,428.80
|
| Rate for Payer: Blue Shield of California Commercial |
$52,627.37
|
| Rate for Payer: Blue Shield of California EPN |
$41,763.51
|
| Rate for Payer: Cash Price |
$40,071.60
|
| Rate for Payer: Cash Price |
$40,071.60
|
| Rate for Payer: Cigna of CA HMO |
$56,990.72
|
| Rate for Payer: Cigna of CA PPO |
$65,895.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$98,214.87
|
| Rate for Payer: Dignity Health Media |
$65,476.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$72,024.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$88,393.39
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$65,476.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$65,476.58
|
| Rate for Payer: Galaxy Health WC |
$75,690.80
|
| Rate for Payer: Global Benefits Group Commercial |
$53,428.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$66,786.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$107,381.59
|
| Rate for Payer: Heritage Provider Network Transplant |
$107,381.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$106,072.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$106,072.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$65,476.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59,395.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117,372.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65,476.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21,371.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$82,500.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$87,738.62
|
| Rate for Payer: Multiplan Commercial |
$71,238.40
|
| Rate for Payer: Networks By Design Commercial |
$57,881.20
|
| Rate for Payer: Prime Health Services Commercial |
$75,690.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$53,428.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$53,428.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$44,524.00
|
| Rate for Payer: United Healthcare All Other HMO |
$44,524.00
|
| Rate for Payer: United Healthcare HMO Rider |
$44,524.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44,524.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$98,214.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$72,024.24
|
| Rate for Payer: Vantage Medical Group Senior |
$65,476.58
|
|
|
HEAD TRAUMA WITH COMA > 1 HOUR OR HEMORRHAGE
|
Facility
|
IP
|
$36,676.94
|
|
|
Service Code
|
APR-DRG 0554
|
| Min. Negotiated Rate |
$28,135.07 |
| Max. Negotiated Rate |
$36,676.94 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$28,135.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36,676.94
|
|
|
HEAD TRAUMA WITH COMA > 1 HOUR OR HEMORRHAGE
|
Facility
|
IP
|
$13,852.50
|
|
|
Service Code
|
APR-DRG 0552
|
| Min. Negotiated Rate |
$10,626.33 |
| Max. Negotiated Rate |
$13,852.50 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10,626.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,852.50
|
|
|
HEAD TRAUMA WITH COMA > 1 HOUR OR HEMORRHAGE
|
Facility
|
IP
|
$20,758.36
|
|
|
Service Code
|
APR-DRG 0553
|
| Min. Negotiated Rate |
$15,923.84 |
| Max. Negotiated Rate |
$20,758.36 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15,923.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20,758.36
|
|
|
HEAD TRAUMA WITH COMA > 1 HOUR OR HEMORRHAGE
|
Facility
|
IP
|
$9,833.83
|
|
|
Service Code
|
APR-DRG 0551
|
| Min. Negotiated Rate |
$7,543.58 |
| Max. Negotiated Rate |
$9,833.83 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,543.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,833.83
|
|
|
HEART AND/OR LUNG TRANSPLANT
|
Facility
|
IP
|
$223,695.38
|
|
|
Service Code
|
APR-DRG 0023
|
| Min. Negotiated Rate |
$117,734.41 |
| Max. Negotiated Rate |
$223,695.38 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$171,597.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$117,734.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$223,695.38
|
|
|
HEART AND/OR LUNG TRANSPLANT
|
Facility
|
IP
|
$142,311.29
|
|
|
Service Code
|
APR-DRG 0021
|
| Min. Negotiated Rate |
$74,900.68 |
| Max. Negotiated Rate |
$142,311.29 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$109,167.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$74,900.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142,311.29
|
|
|
HEART AND/OR LUNG TRANSPLANT
|
Facility
|
IP
|
$166,006.50
|
|
|
Service Code
|
APR-DRG 0022
|
| Min. Negotiated Rate |
$87,371.84 |
| Max. Negotiated Rate |
$166,006.50 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$127,344.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$87,371.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$166,006.50
|
|
|
HEART AND/OR LUNG TRANSPLANT
|
Facility
|
IP
|
$361,741.51
|
|
|
Service Code
|
APR-DRG 0024
|
| Min. Negotiated Rate |
$190,390.27 |
| Max. Negotiated Rate |
$361,741.51 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$277,493.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$190,390.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$361,741.51
|
|
|
HEART FAILURE
|
Facility
|
IP
|
$14,787.11
|
|
|
Service Code
|
APR-DRG 1943
|
| Min. Negotiated Rate |
$11,343.27 |
| Max. Negotiated Rate |
$14,787.11 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11,343.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,787.11
|
|
