|
HC CT CHEST W/O CONTRAST
|
Facility
|
OP
|
$4,005.00
|
|
|
Service Code
|
CPT 71250
|
| Hospital Charge Code |
909201912
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$3,604.50 |
| Rate for Payer: Adventist Health Commercial |
$801.00
|
| Rate for Payer: Adventist Health Commercial |
$449.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| 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 Exchange |
$1,220.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,220.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,329.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,307.66
|
| Rate for Payer: Blue Shield of California Commercial |
$1,416.24
|
| Rate for Payer: Blue Shield of California Commercial |
$2,523.15
|
| Rate for Payer: Blue Shield of California EPN |
$1,589.98
|
| Rate for Payer: Blue Shield of California EPN |
$892.46
|
| Rate for Payer: Cash Price |
$1,011.60
|
| Rate for Payer: Cash Price |
$1,802.25
|
| Rate for Payer: Cash Price |
$1,802.25
|
| Rate for Payer: Cash Price |
$1,011.60
|
| Rate for Payer: Cash Price |
$1,011.60
|
| Rate for Payer: Cash Price |
$1,802.25
|
| Rate for Payer: Center for Health Promotion Commercial |
$145.00
|
| Rate for Payer: Center for Health Promotion Commercial |
$145.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,798.40
|
| Rate for Payer: Central Health Plan Commercial |
$3,204.00
|
| Rate for Payer: Cigna of CA HMO |
$2,563.20
|
| Rate for Payer: Cigna of CA HMO |
$1,438.72
|
| Rate for Payer: Cigna of CA PPO |
$2,963.70
|
| Rate for Payer: Cigna of CA PPO |
$1,663.52
|
| 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 |
$2,803.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,573.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$1,910.80
|
| Rate for Payer: Galaxy Health WC |
$3,404.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,348.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,403.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,023.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,604.50
|
| 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 |
$218.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$218.99
|
| 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 |
$1,427.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,543.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$241.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$241.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$449.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$801.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$3,003.75
|
| Rate for Payer: Multiplan Commercial |
$1,686.00
|
| Rate for Payer: Networks By Design Commercial |
$1,461.20
|
| Rate for Payer: Networks By Design Commercial |
$2,603.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: Prime Health Services Commercial |
$1,910.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,404.25
|
| Rate for Payer: Prime Health Services Medicare |
$142.53
|
| Rate for Payer: Prime Health Services Medicare |
$142.53
|
| Rate for Payer: Riverside University Health System MISP |
$147.91
|
| Rate for Payer: Riverside University Health System MISP |
$147.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,348.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,403.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,348.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,403.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$491.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$491.23
|
| Rate for Payer: United Healthcare All Other HMO |
$491.23
|
| Rate for Payer: United Healthcare All Other HMO |
$491.23
|
| Rate for Payer: United Healthcare HMO Rider |
$491.23
|
| Rate for Payer: United Healthcare HMO Rider |
$491.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$491.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$491.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC CT CHEST W/O CONTRAST
|
Facility
|
IP
|
$4,005.00
|
|
|
Service Code
|
CPT 71250
|
| Hospital Charge Code |
909201912
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$801.00 |
| Max. Negotiated Rate |
$3,604.50 |
| Rate for Payer: Adventist Health Commercial |
$801.00
|
| Rate for Payer: Cash Price |
$1,802.25
|
| Rate for Payer: Central Health Plan Commercial |
$3,204.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,803.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,602.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,602.00
|
| Rate for Payer: Galaxy Health WC |
$3,404.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,403.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,604.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,543.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,362.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$801.00
|
| Rate for Payer: Multiplan Commercial |
$3,003.75
|
| Rate for Payer: Networks By Design Commercial |
$2,603.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,404.25
|
|
|
HC CT CHEST W WO CONTRA
|
Facility
|
IP
|
$5,833.00
|
|
|
Service Code
|
CPT 71270
|
| Hospital Charge Code |
909201914
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,166.60 |
| Max. Negotiated Rate |
$5,249.70 |
| Rate for Payer: Adventist Health Commercial |
$1,166.60
|
| Rate for Payer: Cash Price |
$2,624.85
|
| Rate for Payer: Central Health Plan Commercial |
$4,666.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,083.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,333.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,333.20
|
| Rate for Payer: Galaxy Health WC |
$4,958.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,499.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,249.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,703.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,441.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,166.60
|
| Rate for Payer: Multiplan Commercial |
$4,374.75
|
| Rate for Payer: Networks By Design Commercial |
$3,791.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,958.05
|
|
|
HC CT CHEST W WO CONTRA
|
Facility
|
OP
|
$3,274.00
|
|
|
Service Code
|
CPT 71270
|
| Hospital Charge Code |
909201914
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.59 |
| Max. Negotiated Rate |
$2,946.60 |
| Rate for Payer: Adventist Health Commercial |
$654.80
|
| Rate for Payer: Adventist Health Commercial |
$1,166.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$225.59
|
| Rate for Payer: Adventist Health Medi-Cal |
$225.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| 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 Exchange |
$1,819.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,819.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,904.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,393.06
|
| Rate for Payer: Blue Shield of California Commercial |
$3,674.79
|
| Rate for Payer: Blue Shield of California Commercial |
$2,062.62
|
| Rate for Payer: Blue Shield of California EPN |
$1,299.78
|
| Rate for Payer: Blue Shield of California EPN |
$2,315.70
|
| Rate for Payer: Cash Price |
$1,473.30
|
| Rate for Payer: Cash Price |
$1,473.30
|
| Rate for Payer: Cash Price |
$1,473.30
|
| Rate for Payer: Cash Price |
$2,624.85
|
| Rate for Payer: Cash Price |
$2,624.85
|
| Rate for Payer: Cash Price |
$2,624.85
|
| Rate for Payer: Central Health Plan Commercial |
$4,666.40
|
| Rate for Payer: Central Health Plan Commercial |
$2,619.20
|
| Rate for Payer: Cigna of CA HMO |
$3,733.12
|
| Rate for Payer: Cigna of CA HMO |
$2,095.36
|
| Rate for Payer: Cigna of CA PPO |
$4,316.42
|
| Rate for Payer: Cigna of CA PPO |
$2,422.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,083.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,291.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: Galaxy Health WC |
$2,782.90
|
| Rate for Payer: Galaxy Health WC |
$4,958.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,499.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,964.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,249.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,946.60
|
| 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 |
$329.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$329.57
|
| 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 |
$3,703.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,078.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$364.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$364.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$654.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,166.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$4,374.75
|
| Rate for Payer: Multiplan Commercial |
$2,455.50
|
| Rate for Payer: Networks By Design Commercial |
$2,128.10
|
| Rate for Payer: Networks By Design Commercial |
$3,791.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$225.59
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$225.59
|
| Rate for Payer: Prime Health Services Commercial |
$2,782.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,958.05
|
| Rate for Payer: Prime Health Services Medicare |
$239.13
|
| Rate for Payer: Prime Health Services Medicare |
$239.13
|
| Rate for Payer: Riverside University Health System MISP |
$248.15
|
| Rate for Payer: Riverside University Health System MISP |
$248.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,964.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,499.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,964.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,499.80
|
| 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 COLONOGRAPHY SCREEN
|
Facility
|
IP
|
$2,088.00
|
|
|
Service Code
|
CPT 74263
|
| Hospital Charge Code |
909201813
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$417.60 |
| Max. Negotiated Rate |
$1,879.20 |
| Rate for Payer: Adventist Health Commercial |
$417.60
|
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,670.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,461.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$835.20
|
| Rate for Payer: EPIC Health Plan Senior |
$835.20
|
| Rate for Payer: Galaxy Health WC |
$1,774.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,252.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,879.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,325.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,231.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$417.60
|
| Rate for Payer: Multiplan Commercial |
$1,566.00
|
| Rate for Payer: Networks By Design Commercial |
$1,357.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,774.80
|
|
|
HC CT COLONOGRAPHY SCREEN
|
Facility
|
OP
|
$1,172.00
|
|
|
Service Code
|
CPT 74263
|
| Hospital Charge Code |
909201813
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$234.40 |
| Max. Negotiated Rate |
$3,306.29 |
| Rate for Payer: Adventist Health Commercial |
$234.40
|
| Rate for Payer: Adventist Health Commercial |
$417.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$306.88
|
| Rate for Payer: Adventist Health Medi-Cal |
$306.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,306.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,306.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$681.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,214.59
|
| Rate for Payer: Blue Shield of California Commercial |
$738.36
|
| Rate for Payer: Blue Shield of California Commercial |
$1,315.44
|
| Rate for Payer: Blue Shield of California EPN |
$465.28
|
| Rate for Payer: Blue Shield of California EPN |
$828.94
|
| Rate for Payer: Cash Price |
$527.40
|
| Rate for Payer: Cash Price |
$527.40
|
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Cash Price |
$527.40
|
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Center for Health Promotion Commercial |
$286.00
|
| Rate for Payer: Center for Health Promotion Commercial |
$286.00
|
| Rate for Payer: Central Health Plan Commercial |
$937.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,670.40
|
| Rate for Payer: Cigna of CA HMO |
$750.08
|
| Rate for Payer: Cigna of CA HMO |
$1,336.32
|
| Rate for Payer: Cigna of CA PPO |
$1,545.12
|
| Rate for Payer: Cigna of CA PPO |
$867.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,461.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$820.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: Galaxy Health WC |
$996.20
|
| Rate for Payer: Galaxy Health WC |
$1,774.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,252.80
|
| Rate for Payer: Global Benefits Group Commercial |
$703.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,054.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,879.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.28
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$744.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,325.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$417.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$1,566.00
|
| Rate for Payer: Multiplan Commercial |
$879.00
|
| Rate for Payer: Networks By Design Commercial |
$761.80
|
| Rate for Payer: Networks By Design Commercial |
$1,357.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$306.88
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$306.88
|
| Rate for Payer: Prime Health Services Commercial |
$1,774.80
|
| Rate for Payer: Prime Health Services Commercial |
$996.20
|
| Rate for Payer: Prime Health Services Medicare |
$325.29
|
| Rate for Payer: Prime Health Services Medicare |
$325.29
|
| Rate for Payer: Riverside University Health System MISP |
$337.57
|
| Rate for Payer: Riverside University Health System MISP |
$337.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,252.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$703.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,252.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$703.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,781.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,781.07
|
| Rate for Payer: United Healthcare All Other HMO |
$1,781.07
|
| Rate for Payer: United Healthcare All Other HMO |
$1,781.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1,781.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1,781.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,781.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,781.07
|
| Rate for Payer: Upland Medical Group Pediatric |
$306.88
|
| Rate for Payer: Upland Medical Group Pediatric |
$306.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC CT COLONOGRAPHY W/CONTRAST
|
Facility
|
IP
|
$5,613.00
|
|
|
Service Code
|
CPT 74262
|
| Hospital Charge Code |
909202000
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,122.60 |
| Max. Negotiated Rate |
$5,051.70 |
| Rate for Payer: Adventist Health Commercial |
$1,122.60
|
| Rate for Payer: Cash Price |
$2,525.85
|
| Rate for Payer: Central Health Plan Commercial |
$4,490.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,929.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,245.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,245.20
|
| Rate for Payer: Galaxy Health WC |
$4,771.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,367.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,051.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,564.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,311.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,122.60
|
| Rate for Payer: Multiplan Commercial |
$4,209.75
|
| Rate for Payer: Networks By Design Commercial |
$3,648.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,771.05
|
|
|
HC CT COLONOGRAPHY W/CONTRAST
|
Facility
|
OP
|
$5,613.00
|
|
|
Service Code
|
CPT 74262
|
| Hospital Charge Code |
909202000
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.59 |
| Max. Negotiated Rate |
$5,051.70 |
| Rate for Payer: Adventist Health Commercial |
$1,122.60
|
| Rate for Payer: Adventist Health Commercial |
$696.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$225.59
|
| Rate for Payer: Adventist Health Medi-Cal |
$225.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| 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 Exchange |
$1,663.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,663.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,265.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,026.64
|
| Rate for Payer: Blue Shield of California Commercial |
$2,194.92
|
| Rate for Payer: Blue Shield of California Commercial |
$3,536.19
|
| Rate for Payer: Blue Shield of California EPN |
$2,228.36
|
| Rate for Payer: Blue Shield of California EPN |
$1,383.15
|
| Rate for Payer: Cash Price |
$1,567.80
|
| Rate for Payer: Cash Price |
$2,525.85
|
| Rate for Payer: Cash Price |
$2,525.85
|
| Rate for Payer: Cash Price |
$1,567.80
|
| Rate for Payer: Cash Price |
$1,567.80
|
| Rate for Payer: Cash Price |
$2,525.85
|
| Rate for Payer: Center for Health Promotion Commercial |
$286.00
|
| Rate for Payer: Center for Health Promotion Commercial |
$286.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,787.20
|
| Rate for Payer: Central Health Plan Commercial |
$4,490.40
|
| Rate for Payer: Cigna of CA HMO |
$3,592.32
|
| Rate for Payer: Cigna of CA HMO |
$2,229.76
|
| Rate for Payer: Cigna of CA PPO |
$4,153.62
|
| Rate for Payer: Cigna of CA PPO |
$2,578.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,929.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,438.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: Galaxy Health WC |
$2,961.40
|
| Rate for Payer: Galaxy Health WC |
$4,771.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,090.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,367.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,135.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,051.70
|
| 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 |
$806.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$806.18
|
| 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 |
$2,212.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,564.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$890.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$890.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$696.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,122.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$4,209.75
|
| Rate for Payer: Multiplan Commercial |
$2,613.00
|
| Rate for Payer: Networks By Design Commercial |
$2,264.60
|
| Rate for Payer: Networks By Design Commercial |
$3,648.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$225.59
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$225.59
|
| Rate for Payer: Prime Health Services Commercial |
$2,961.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,771.05
|
| Rate for Payer: Prime Health Services Medicare |
$239.13
|
| Rate for Payer: Prime Health Services Medicare |
$239.13
|
| Rate for Payer: Riverside University Health System MISP |
$248.15
|
| Rate for Payer: Riverside University Health System MISP |
$248.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,090.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,367.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,090.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,367.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$769.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$769.25
|
| Rate for Payer: United Healthcare All Other HMO |
$769.25
|
| Rate for Payer: United Healthcare All Other HMO |
$769.25
|
| Rate for Payer: United Healthcare HMO Rider |
$769.25
|
| Rate for Payer: United Healthcare HMO Rider |
$769.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$769.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$769.25
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
|
HC CT COLONOGRAPHY W/O CONTRAST
|
Facility
|
OP
|
$4,966.00
|
|
|
Service Code
|
CPT 74261
|
| Hospital Charge Code |
909201811
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$4,469.40 |
| Rate for Payer: Adventist Health Commercial |
$993.20
|
| Rate for Payer: Adventist Health Commercial |
$630.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| 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 Exchange |
$1,093.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,093.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,888.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,832.94
|
| Rate for Payer: Blue Shield of California Commercial |
$1,985.13
|
| Rate for Payer: Blue Shield of California Commercial |
$3,128.58
|
| Rate for Payer: Blue Shield of California EPN |
$1,971.50
|
| Rate for Payer: Blue Shield of California EPN |
$1,250.95
|
| Rate for Payer: Cash Price |
$1,417.95
|
| Rate for Payer: Cash Price |
$2,234.70
|
| Rate for Payer: Cash Price |
$2,234.70
|
| Rate for Payer: Cash Price |
$1,417.95
|
| Rate for Payer: Cash Price |
$1,417.95
|
| Rate for Payer: Cash Price |
$2,234.70
|
| Rate for Payer: Center for Health Promotion Commercial |
$145.00
|
| Rate for Payer: Center for Health Promotion Commercial |
$145.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,520.80
|
| Rate for Payer: Central Health Plan Commercial |
$3,972.80
|
| Rate for Payer: Cigna of CA HMO |
$3,178.24
|
| Rate for Payer: Cigna of CA HMO |
$2,016.64
|
| Rate for Payer: Cigna of CA PPO |
$3,674.84
|
| Rate for Payer: Cigna of CA PPO |
$2,331.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,476.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,205.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$2,678.35
|
| Rate for Payer: Galaxy Health WC |
$4,221.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,890.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,979.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,835.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,469.40
|
| 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 |
$711.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$711.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,000.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,153.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$786.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$786.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$630.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$993.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$3,724.50
|
| Rate for Payer: Multiplan Commercial |
$2,363.25
|
| Rate for Payer: Networks By Design Commercial |
$2,048.15
|
| Rate for Payer: Networks By Design Commercial |
$3,227.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: Prime Health Services Commercial |
$2,678.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,221.10
|
| Rate for Payer: Prime Health Services Medicare |
$142.53
|
| Rate for Payer: Prime Health Services Medicare |
$142.53
|
| Rate for Payer: Riverside University Health System MISP |
$147.91
|
| Rate for Payer: Riverside University Health System MISP |
$147.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,890.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,979.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,890.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,979.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$491.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$491.23
|
| Rate for Payer: United Healthcare All Other HMO |
$491.23
|
| Rate for Payer: United Healthcare All Other HMO |
$491.23
|
| Rate for Payer: United Healthcare HMO Rider |
$491.23
|
| Rate for Payer: United Healthcare HMO Rider |
$491.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$491.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$491.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC CT COLONOGRAPHY W/O CONTRAST
|
Facility
|
IP
|
$4,966.00
|
|
|
Service Code
|
CPT 74261
|
| Hospital Charge Code |
909201811
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$993.20 |
| Max. Negotiated Rate |
$4,469.40 |
| Rate for Payer: Adventist Health Commercial |
$993.20
|
| Rate for Payer: Cash Price |
$2,234.70
|
| Rate for Payer: Central Health Plan Commercial |
$3,972.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,476.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,986.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,986.40
|
| Rate for Payer: Galaxy Health WC |
$4,221.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,979.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,469.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,153.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,929.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$993.20
|
| Rate for Payer: Multiplan Commercial |
$3,724.50
|
| Rate for Payer: Networks By Design Commercial |
$3,227.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,221.10
|
|
|
HC CT CPA W CON W CT CTA OF SAME ANTMY
|
Facility
|
OP
|
$2,673.00
|
|
|
Service Code
|
CPT 70472
|
| Hospital Charge Code |
909201821
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$471.55 |
| Max. Negotiated Rate |
$2,405.70 |
| Rate for Payer: Adventist Health Commercial |
$534.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,272.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,470.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,004.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$471.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,554.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1,683.99
|
| Rate for Payer: Blue Shield of California EPN |
$1,061.18
|
| Rate for Payer: Cash Price |
$1,202.85
|
| Rate for Payer: Cash Price |
$1,202.85
|
| Rate for Payer: Cash Price |
$1,202.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,138.40
|
| Rate for Payer: Cigna of CA HMO |
$1,710.72
|
| Rate for Payer: Cigna of CA PPO |
$1,978.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,272.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,272.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,272.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,871.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,069.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,069.20
|
| Rate for Payer: Galaxy Health WC |
$2,272.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,603.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,405.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,697.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,577.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$534.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,871.10
|
| Rate for Payer: Multiplan Commercial |
$2,004.75
|
| Rate for Payer: Networks By Design Commercial |
$1,737.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,272.05
|
| Rate for Payer: Riverside University Health System MISP |
$1,069.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,603.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,603.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,336.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,336.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,336.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,336.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,272.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,272.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,272.05
|
|
|
HC CT CPA W CON W CT CTA OF SAME ANTMY
|
Facility
|
IP
|
$2,673.00
|
|
|
Service Code
|
CPT 70472
|
| Hospital Charge Code |
909201821
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$534.60 |
| Max. Negotiated Rate |
$2,405.70 |
| Rate for Payer: Adventist Health Commercial |
$534.60
|
| Rate for Payer: Cash Price |
$1,202.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,138.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,871.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,069.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,069.20
|
| Rate for Payer: Galaxy Health WC |
$2,272.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,603.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,405.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,697.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,577.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$534.60
|
| Rate for Payer: Multiplan Commercial |
$2,004.75
|
| Rate for Payer: Networks By Design Commercial |
$1,737.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,272.05
|
|
|
HC CT CPA W CON WO CT CTA OF SAME ANTMY
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
CPT 70473
|
| Hospital Charge Code |
909201822
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$110.00 |
| Max. Negotiated Rate |
$2,364.00 |
| Rate for Payer: Adventist Health Commercial |
$110.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$225.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$721.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$319.94
|
| Rate for Payer: Blue Shield of California Commercial |
$346.50
|
| Rate for Payer: Blue Shield of California EPN |
$218.35
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Central Health Plan Commercial |
$440.00
|
| Rate for Payer: Cigna of CA HMO |
$352.00
|
| Rate for Payer: Cigna of CA PPO |
$407.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$385.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: Galaxy Health WC |
$467.50
|
| Rate for Payer: Global Benefits Group Commercial |
$330.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$495.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$349.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$412.50
|
| Rate for Payer: Networks By Design Commercial |
$357.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$225.59
|
| Rate for Payer: Prime Health Services Commercial |
$467.50
|
| Rate for Payer: Prime Health Services Medicare |
$239.13
|
| Rate for Payer: Riverside University Health System MISP |
$248.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$330.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$330.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$275.00
|
| Rate for Payer: United Healthcare All Other HMO |
$275.00
|
| Rate for Payer: United Healthcare HMO Rider |
$275.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$275.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
|
HC CT CPA W CON WO CT CTA OF SAME ANTMY
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
CPT 70473
|
| Hospital Charge Code |
909201822
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$110.00 |
| Max. Negotiated Rate |
$495.00 |
| Rate for Payer: Adventist Health Commercial |
$110.00
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Central Health Plan Commercial |
$440.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$385.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.00
|
| Rate for Payer: EPIC Health Plan Senior |
$220.00
|
| Rate for Payer: Galaxy Health WC |
$467.50
|
| Rate for Payer: Global Benefits Group Commercial |
$330.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$495.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$349.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$324.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.00
|
| Rate for Payer: Multiplan Commercial |
$412.50
|
| Rate for Payer: Networks By Design Commercial |
$357.50
|
| Rate for Payer: Prime Health Services Commercial |
$467.50
|
|
|
HC CT CSPINE WITH CONTRAST
|
Facility
|
OP
|
$2,889.00
|
|
|
Service Code
|
CPT 72126
|
| Hospital Charge Code |
909201916
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$280.50 |
| Max. Negotiated Rate |
$2,600.10 |
| Rate for Payer: Adventist Health Commercial |
$577.80
|
| Rate for Payer: Adventist Health Commercial |
$1,029.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$448.71
|
| Rate for Payer: Adventist Health Medi-Cal |
$448.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| 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 Exchange |
$1,458.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,458.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,680.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,994.01
|
| Rate for Payer: Blue Shield of California Commercial |
$3,242.61
|
| Rate for Payer: Blue Shield of California Commercial |
$1,820.07
|
| Rate for Payer: Blue Shield of California EPN |
$1,146.93
|
| Rate for Payer: Blue Shield of California EPN |
$2,043.36
|
| Rate for Payer: Cash Price |
$1,300.05
|
| Rate for Payer: Cash Price |
$1,300.05
|
| Rate for Payer: Cash Price |
$1,300.05
|
| Rate for Payer: Cash Price |
$2,316.15
|
| Rate for Payer: Cash Price |
$2,316.15
|
| Rate for Payer: Cash Price |
$2,316.15
|
| Rate for Payer: Central Health Plan Commercial |
$4,117.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,311.20
|
| Rate for Payer: Cigna of CA HMO |
$3,294.08
|
| Rate for Payer: Cigna of CA HMO |
$1,848.96
|
| Rate for Payer: Cigna of CA PPO |
$3,808.78
|
| Rate for Payer: Cigna of CA PPO |
$2,137.86
|
| 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 |
$3,602.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,022.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.37
|
| Rate for Payer: EPIC Health Plan Senior |
$493.58
|
| Rate for Payer: EPIC Health Plan Senior |
$493.58
|
| Rate for Payer: Galaxy Health WC |
$2,455.65
|
| Rate for Payer: Galaxy Health WC |
$4,374.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,088.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,733.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,632.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,600.10
|
| 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 |
$280.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$280.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,268.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,834.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$309.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$309.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$577.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,029.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$601.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$601.27
|
| Rate for Payer: Multiplan Commercial |
$3,860.25
|
| Rate for Payer: Multiplan Commercial |
$2,166.75
|
| Rate for Payer: Networks By Design Commercial |
$1,877.85
|
| Rate for Payer: Networks By Design Commercial |
$3,345.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$448.71
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$448.71
|
| Rate for Payer: Prime Health Services Commercial |
$2,455.65
|
| Rate for Payer: Prime Health Services Commercial |
$4,374.95
|
| Rate for Payer: Prime Health Services Medicare |
$475.63
|
| Rate for Payer: Prime Health Services Medicare |
$475.63
|
| Rate for Payer: Riverside University Health System MISP |
$493.58
|
| Rate for Payer: Riverside University Health System MISP |
$493.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,733.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,088.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,733.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,088.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$769.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$769.25
|
| Rate for Payer: United Healthcare All Other HMO |
$769.25
|
| Rate for Payer: United Healthcare All Other HMO |
$769.25
|
| Rate for Payer: United Healthcare HMO Rider |
$769.25
|
| Rate for Payer: United Healthcare HMO Rider |
$769.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$769.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$769.25
|
| Rate for Payer: Upland Medical Group Pediatric |
$448.71
|
| Rate for Payer: Upland Medical Group Pediatric |
$448.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
|
|
HC CT CSPINE WITH CONTRAST
|
Facility
|
IP
|
$5,147.00
|
|
|
Service Code
|
CPT 72126
|
| Hospital Charge Code |
909201916
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,029.40 |
| Max. Negotiated Rate |
$4,632.30 |
| Rate for Payer: Adventist Health Commercial |
$1,029.40
|
| Rate for Payer: Cash Price |
$2,316.15
|
| Rate for Payer: Central Health Plan Commercial |
$4,117.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,602.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,058.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.80
|
| Rate for Payer: Galaxy Health WC |
$4,374.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,088.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,632.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,268.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,036.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,029.40
|
| Rate for Payer: Multiplan Commercial |
$3,860.25
|
| Rate for Payer: Networks By Design Commercial |
$3,345.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,374.95
|
|
|
HC CT CSPINE WO CONTRAST
|
Facility
|
IP
|
$4,780.00
|
|
|
Service Code
|
CPT 72125
|
| Hospital Charge Code |
909201915
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$956.00 |
| Max. Negotiated Rate |
$4,302.00 |
| Rate for Payer: Adventist Health Commercial |
$956.00
|
| Rate for Payer: Cash Price |
$2,151.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,824.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,346.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,912.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,912.00
|
| Rate for Payer: Galaxy Health WC |
$4,063.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,868.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,302.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,035.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,820.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$956.00
|
| Rate for Payer: Multiplan Commercial |
$3,585.00
|
| Rate for Payer: Networks By Design Commercial |
$3,107.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,063.00
|
|
|
HC CT CSPINE WO CONTRAST
|
Facility
|
OP
|
$2,684.00
|
|
|
Service Code
|
CPT 72125
|
| Hospital Charge Code |
909201915
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$2,415.60 |
| Rate for Payer: Adventist Health Commercial |
$536.80
|
| Rate for Payer: Adventist Health Commercial |
$956.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| 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 Exchange |
$1,220.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,220.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,561.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,780.53
|
| Rate for Payer: Blue Shield of California Commercial |
$3,011.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,690.92
|
| Rate for Payer: Blue Shield of California EPN |
$1,065.55
|
| Rate for Payer: Blue Shield of California EPN |
$1,897.66
|
| Rate for Payer: Cash Price |
$1,207.80
|
| Rate for Payer: Cash Price |
$1,207.80
|
| Rate for Payer: Cash Price |
$1,207.80
|
| Rate for Payer: Cash Price |
$2,151.00
|
| Rate for Payer: Cash Price |
$2,151.00
|
| Rate for Payer: Cash Price |
$2,151.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,824.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,147.20
|
| Rate for Payer: Cigna of CA HMO |
$3,059.20
|
| Rate for Payer: Cigna of CA HMO |
$1,717.76
|
| Rate for Payer: Cigna of CA PPO |
$3,537.20
|
| Rate for Payer: Cigna of CA PPO |
$1,986.16
|
| 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 |
$3,346.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,878.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$2,281.40
|
| Rate for Payer: Galaxy Health WC |
$4,063.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,868.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,610.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,302.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,415.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$214.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$214.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,035.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,704.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$237.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$237.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$536.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$956.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$3,585.00
|
| Rate for Payer: Multiplan Commercial |
$2,013.00
|
| Rate for Payer: Networks By Design Commercial |
$1,744.60
|
| Rate for Payer: Networks By Design Commercial |
$3,107.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: Prime Health Services Commercial |
$2,281.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,063.00
|
| Rate for Payer: Prime Health Services Medicare |
$142.53
|
| Rate for Payer: Prime Health Services Medicare |
$142.53
|
| Rate for Payer: Riverside University Health System MISP |
$147.91
|
| Rate for Payer: Riverside University Health System MISP |
$147.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,610.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,868.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,610.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,868.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$491.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$491.23
|
| Rate for Payer: United Healthcare All Other HMO |
$491.23
|
| Rate for Payer: United Healthcare All Other HMO |
$491.23
|
| Rate for Payer: United Healthcare HMO Rider |
$491.23
|
| Rate for Payer: United Healthcare HMO Rider |
$491.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$491.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$491.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC CT C SPINE W/WO CONTRAST
|
Facility
|
OP
|
$3,018.00
|
|
|
Service Code
|
CPT 72127
|
| Hospital Charge Code |
909201967
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.59 |
| Max. Negotiated Rate |
$2,716.20 |
| Rate for Payer: Adventist Health Commercial |
$603.60
|
| Rate for Payer: Adventist Health Commercial |
$1,080.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$225.59
|
| Rate for Payer: Adventist Health Medi-Cal |
$225.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| 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 Exchange |
$1,817.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,817.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,755.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,142.93
|
| Rate for Payer: Blue Shield of California Commercial |
$3,403.89
|
| Rate for Payer: Blue Shield of California Commercial |
$1,901.34
|
| Rate for Payer: Blue Shield of California EPN |
$1,198.15
|
| Rate for Payer: Blue Shield of California EPN |
$2,144.99
|
| Rate for Payer: Cash Price |
$1,358.10
|
| Rate for Payer: Cash Price |
$1,358.10
|
| Rate for Payer: Cash Price |
$1,358.10
|
| Rate for Payer: Cash Price |
$2,431.35
|
| Rate for Payer: Cash Price |
$2,431.35
|
| Rate for Payer: Cash Price |
$2,431.35
|
| Rate for Payer: Central Health Plan Commercial |
$4,322.40
|
| Rate for Payer: Central Health Plan Commercial |
$2,414.40
|
| Rate for Payer: Cigna of CA HMO |
$3,457.92
|
| Rate for Payer: Cigna of CA HMO |
$1,931.52
|
| Rate for Payer: Cigna of CA PPO |
$3,998.22
|
| Rate for Payer: Cigna of CA PPO |
$2,233.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,782.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,112.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: Galaxy Health WC |
$2,565.30
|
| Rate for Payer: Galaxy Health WC |
$4,592.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,241.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,810.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,862.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,716.20
|
| 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 |
$330.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$330.89
|
| 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 |
$3,430.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,916.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$365.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$365.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$603.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,080.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$4,052.25
|
| Rate for Payer: Multiplan Commercial |
$2,263.50
|
| Rate for Payer: Networks By Design Commercial |
$1,961.70
|
| Rate for Payer: Networks By Design Commercial |
$3,511.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$225.59
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$225.59
|
| Rate for Payer: Prime Health Services Commercial |
$2,565.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,592.55
|
| Rate for Payer: Prime Health Services Medicare |
$239.13
|
| Rate for Payer: Prime Health Services Medicare |
$239.13
|
| Rate for Payer: Riverside University Health System MISP |
$248.15
|
| Rate for Payer: Riverside University Health System MISP |
$248.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,810.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,241.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,810.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,241.80
|
| 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 C SPINE W/WO CONTRAST
|
Facility
|
IP
|
$5,403.00
|
|
|
Service Code
|
CPT 72127
|
| Hospital Charge Code |
909201967
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,080.60 |
| Max. Negotiated Rate |
$4,862.70 |
| Rate for Payer: Adventist Health Commercial |
$1,080.60
|
| Rate for Payer: Cash Price |
$2,431.35
|
| Rate for Payer: Central Health Plan Commercial |
$4,322.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,782.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,161.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,161.20
|
| Rate for Payer: Galaxy Health WC |
$4,592.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,241.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,862.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,430.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,187.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,080.60
|
| Rate for Payer: Multiplan Commercial |
$4,052.25
|
| Rate for Payer: Networks By Design Commercial |
$3,511.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,592.55
|
|
|
HC CT GUID ABCESS DRAIN
|
Facility
|
OP
|
$2,187.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
909201944
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$179.77 |
| Max. Negotiated Rate |
$2,364.00 |
| Rate for Payer: Adventist Health Commercial |
$437.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,858.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,202.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,640.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$651.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,272.18
|
| Rate for Payer: Blue Shield of California Commercial |
$1,377.81
|
| Rate for Payer: Blue Shield of California EPN |
$868.24
|
| Rate for Payer: Cash Price |
$984.15
|
| Rate for Payer: Cash Price |
$984.15
|
| Rate for Payer: Cash Price |
$984.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,749.60
|
| Rate for Payer: Cigna of CA HMO |
$1,399.68
|
| Rate for Payer: Cigna of CA PPO |
$1,618.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,858.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,858.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,858.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,530.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.80
|
| Rate for Payer: EPIC Health Plan Senior |
$874.80
|
| Rate for Payer: Galaxy Health WC |
$1,858.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,312.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,968.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$179.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,388.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$198.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,290.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$437.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,530.90
|
| Rate for Payer: Multiplan Commercial |
$1,640.25
|
| Rate for Payer: Networks By Design Commercial |
$1,421.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,858.95
|
| Rate for Payer: Riverside University Health System MISP |
$874.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,312.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,312.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,093.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,093.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,093.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,858.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,858.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,858.95
|
|
|
HC CT GUID ABCESS DRAIN
|
Facility
|
IP
|
$2,187.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
909201944
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$437.40 |
| Max. Negotiated Rate |
$1,968.30 |
| Rate for Payer: Adventist Health Commercial |
$437.40
|
| Rate for Payer: Cash Price |
$984.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,749.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,530.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.80
|
| Rate for Payer: EPIC Health Plan Senior |
$874.80
|
| Rate for Payer: Galaxy Health WC |
$1,858.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,312.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,968.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,388.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,290.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$437.40
|
| Rate for Payer: Multiplan Commercial |
$1,640.25
|
| Rate for Payer: Networks By Design Commercial |
$1,421.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,858.95
|
|
|
HC CT GUIDANCE/NEEDLE PLACEMENT
|
Facility
|
IP
|
$3,792.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
909201935
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$758.40 |
| Max. Negotiated Rate |
$3,412.80 |
| Rate for Payer: Adventist Health Commercial |
$758.40
|
| Rate for Payer: Cash Price |
$1,706.40
|
| Rate for Payer: Central Health Plan Commercial |
$3,033.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,654.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,516.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,516.80
|
| Rate for Payer: Galaxy Health WC |
$3,223.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,275.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,412.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,407.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,237.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$758.40
|
| Rate for Payer: Multiplan Commercial |
$2,844.00
|
| Rate for Payer: Networks By Design Commercial |
$2,464.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,223.20
|
|
|
HC CT GUIDANCE/NEEDLE PLACEMENT
|
Facility
|
OP
|
$3,792.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
909201935
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$191.01 |
| Max. Negotiated Rate |
$3,412.80 |
| Rate for Payer: Adventist Health Commercial |
$758.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,223.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,085.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,844.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,708.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,205.81
|
| Rate for Payer: Blue Shield of California Commercial |
$2,388.96
|
| Rate for Payer: Blue Shield of California EPN |
$1,505.42
|
| Rate for Payer: Cash Price |
$1,706.40
|
| Rate for Payer: Cash Price |
$1,706.40
|
| Rate for Payer: Cash Price |
$1,706.40
|
| Rate for Payer: Central Health Plan Commercial |
$3,033.60
|
| Rate for Payer: Cigna of CA HMO |
$2,426.88
|
| Rate for Payer: Cigna of CA PPO |
$2,806.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,223.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,223.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,223.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,654.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,516.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,516.80
|
| Rate for Payer: Galaxy Health WC |
$3,223.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,275.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,412.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$191.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,407.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$211.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,237.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$758.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,654.40
|
| Rate for Payer: Multiplan Commercial |
$2,844.00
|
| Rate for Payer: Networks By Design Commercial |
$2,464.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,223.20
|
| Rate for Payer: Riverside University Health System MISP |
$1,516.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,275.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,275.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,896.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,896.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,896.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,896.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,223.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,223.20
|
| Rate for Payer: Vantage Medical Group Senior |
$3,223.20
|
|
|
HC CT GUIDANCE/NEEDLE PLACEMENT
|
Facility
|
IP
|
$3,792.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
909201935
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$758.40 |
| Max. Negotiated Rate |
$3,412.80 |
| Rate for Payer: Adventist Health Commercial |
$758.40
|
| Rate for Payer: Cash Price |
$1,706.40
|
| Rate for Payer: Central Health Plan Commercial |
$3,033.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,654.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,516.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,516.80
|
| Rate for Payer: Galaxy Health WC |
$3,223.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,275.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,412.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,407.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,237.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$758.40
|
| Rate for Payer: Multiplan Commercial |
$2,844.00
|
| Rate for Payer: Networks By Design Commercial |
$2,464.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,223.20
|
|
