|
HC CT ANGIO ABDOMEN W/WO CONTRAST
|
Facility
|
IP
|
$5,543.00
|
|
|
Service Code
|
CPT 74175
|
| Hospital Charge Code |
909201808
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,108.60 |
| Max. Negotiated Rate |
$4,988.70 |
| Rate for Payer: Adventist Health Commercial |
$1,108.60
|
| Rate for Payer: Cash Price |
$2,494.35
|
| Rate for Payer: Central Health Plan Commercial |
$4,434.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,217.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,217.20
|
| Rate for Payer: Galaxy Health WC |
$4,711.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,325.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,988.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,697.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,111.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,431.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,108.60
|
| Rate for Payer: Multiplan Commercial |
$4,157.25
|
| Rate for Payer: Networks By Design Commercial |
$3,602.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,711.55
|
|
|
HC CT ANGIO CHEST W/WO CONTRAST
|
Facility
|
OP
|
$3,658.00
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
909201802
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$3,292.20 |
| Rate for Payer: Adventist Health Commercial |
$731.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$226.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,858.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,148.34
|
| Rate for Payer: Blue Shield of California Commercial |
$2,220.41
|
| Rate for Payer: Blue Shield of California EPN |
$1,452.23
|
| Rate for Payer: Cash Price |
$1,646.10
|
| Rate for Payer: Cash Price |
$1,646.10
|
| Rate for Payer: Cash Price |
$1,646.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,926.40
|
| Rate for Payer: Cigna of CA HMO |
$2,341.12
|
| Rate for Payer: Cigna of CA PPO |
$2,706.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.36
|
| Rate for Payer: EPIC Health Plan Senior |
$226.19
|
| Rate for Payer: Galaxy Health WC |
$3,109.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,194.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,292.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$465.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: InnovAge PACE Commercial |
$339.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,439.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$514.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$731.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$303.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.09
|
| Rate for Payer: Multiplan Commercial |
$2,743.50
|
| Rate for Payer: Networks By Design Commercial |
$2,377.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$226.19
|
| Rate for Payer: Prime Health Services Commercial |
$3,109.30
|
| Rate for Payer: Prime Health Services Medicare |
$239.76
|
| Rate for Payer: Riverside University Health System MISP |
$248.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,194.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,194.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.48
|
| Rate for Payer: United Healthcare All Other HMO |
$866.48
|
| Rate for Payer: United Healthcare HMO Rider |
$866.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.48
|
| Rate for Payer: Upland Medical Group Pediatric |
$226.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC CT ANGIO CHEST W/WO CONTRAST
|
Facility
|
IP
|
$5,688.00
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
909201802
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,137.60 |
| Max. Negotiated Rate |
$5,119.20 |
| Rate for Payer: Adventist Health Commercial |
$1,137.60
|
| Rate for Payer: Cash Price |
$2,559.60
|
| Rate for Payer: Central Health Plan Commercial |
$4,550.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,275.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,275.20
|
| Rate for Payer: Galaxy Health WC |
$4,834.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,412.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,119.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,793.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,167.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,520.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,137.60
|
| Rate for Payer: Multiplan Commercial |
$4,266.00
|
| Rate for Payer: Networks By Design Commercial |
$3,697.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,834.80
|
|
|
HC CT ANGIO HEAD W/WO CONTRAST
|
Facility
|
OP
|
$4,285.00
|
|
|
Service Code
|
CPT 70496
|
| Hospital Charge Code |
909201800
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$3,856.50 |
| Rate for Payer: Adventist Health Commercial |
$857.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$226.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,519.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,516.58
|
| Rate for Payer: Blue Shield of California Commercial |
$2,600.99
|
| Rate for Payer: Blue Shield of California EPN |
$1,701.14
|
| Rate for Payer: Cash Price |
$1,928.25
|
| Rate for Payer: Cash Price |
$1,928.25
|
| Rate for Payer: Cash Price |
$1,928.25
|
| Rate for Payer: Central Health Plan Commercial |
$3,428.00
|
| Rate for Payer: Cigna of CA HMO |
$2,742.40
|
| Rate for Payer: Cigna of CA PPO |
$3,170.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.36
|
| Rate for Payer: EPIC Health Plan Senior |
$226.19
|
| Rate for Payer: Galaxy Health WC |
$3,642.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,571.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,856.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$457.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: InnovAge PACE Commercial |
$339.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,858.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$505.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$857.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$303.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.09
|
| Rate for Payer: Multiplan Commercial |
$3,213.75
|
| Rate for Payer: Networks By Design Commercial |
$2,785.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$226.19
|
| Rate for Payer: Prime Health Services Commercial |
$3,642.25
|
| Rate for Payer: Prime Health Services Medicare |
$239.76
|
| Rate for Payer: Riverside University Health System MISP |
$248.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,571.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,571.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,142.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,142.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,142.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,142.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$226.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC CT ANGIO HEAD W/WO CONTRAST
|
Facility
|
IP
|
$6,106.00
|
|
|
Service Code
|
CPT 70496
|
| Hospital Charge Code |
909201800
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,221.20 |
| Max. Negotiated Rate |
$5,495.40 |
| Rate for Payer: Adventist Health Commercial |
$1,221.20
|
| Rate for Payer: Cash Price |
$2,747.70
|
| Rate for Payer: Central Health Plan Commercial |
$4,884.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,442.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,442.40
|
| Rate for Payer: Galaxy Health WC |
$5,190.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,663.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,495.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,072.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,326.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,779.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,221.20
|
| Rate for Payer: Multiplan Commercial |
$4,579.50
|
| Rate for Payer: Networks By Design Commercial |
$3,968.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,190.10
|
|
|
HC CT ANGIO LOW EXT W/WO CONT
|
Facility
|
IP
|
$4,873.00
|
|
|
Service Code
|
CPT 73706
|
| Hospital Charge Code |
909201807
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$974.60 |
| Max. Negotiated Rate |
$4,385.70 |
| Rate for Payer: Adventist Health Commercial |
$974.60
|
| Rate for Payer: Cash Price |
$2,192.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,898.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,949.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,949.20
|
| Rate for Payer: Galaxy Health WC |
$4,142.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,923.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,385.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,250.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,856.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,016.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$974.60
|
| Rate for Payer: Multiplan Commercial |
$3,654.75
|
| Rate for Payer: Networks By Design Commercial |
$3,167.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,142.05
|
|
|
HC CT ANGIO LOW EXT W/WO CONT
|
Facility
|
OP
|
$2,736.00
|
|
|
Service Code
|
CPT 73706
|
| Hospital Charge Code |
909201807
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$2,462.40 |
| Rate for Payer: Adventist Health Commercial |
$547.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$226.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,568.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,606.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1,660.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,086.19
|
| Rate for Payer: Cash Price |
$1,231.20
|
| Rate for Payer: Cash Price |
$1,231.20
|
| Rate for Payer: Cash Price |
$1,231.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,188.80
|
| Rate for Payer: Cigna of CA HMO |
$1,751.04
|
| Rate for Payer: Cigna of CA PPO |
$2,024.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.36
|
| Rate for Payer: EPIC Health Plan Senior |
$226.19
|
| Rate for Payer: Galaxy Health WC |
$2,325.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,641.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,462.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$543.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: InnovAge PACE Commercial |
$339.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,824.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$600.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$547.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$303.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.09
|
| Rate for Payer: Multiplan Commercial |
$2,052.00
|
| Rate for Payer: Networks By Design Commercial |
$1,778.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$226.19
|
| Rate for Payer: Prime Health Services Commercial |
$2,325.60
|
| Rate for Payer: Prime Health Services Medicare |
$239.76
|
| Rate for Payer: Riverside University Health System MISP |
$248.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,641.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,641.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.48
|
| Rate for Payer: United Healthcare All Other HMO |
$866.48
|
| Rate for Payer: United Healthcare HMO Rider |
$866.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.48
|
| Rate for Payer: Upland Medical Group Pediatric |
$226.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC CT ANGIO NECK W/WO CONTRAST
|
Facility
|
IP
|
$6,106.00
|
|
|
Service Code
|
CPT 70498
|
| Hospital Charge Code |
909201801
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,221.20 |
| Max. Negotiated Rate |
$5,495.40 |
| Rate for Payer: Adventist Health Commercial |
$1,221.20
|
| Rate for Payer: Cash Price |
$2,747.70
|
| Rate for Payer: Central Health Plan Commercial |
$4,884.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,442.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,442.40
|
| Rate for Payer: Galaxy Health WC |
$5,190.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,663.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,495.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,072.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,326.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,779.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,221.20
|
| Rate for Payer: Multiplan Commercial |
$4,579.50
|
| Rate for Payer: Networks By Design Commercial |
$3,968.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,190.10
|
|
|
HC CT ANGIO NECK W/WO CONTRAST
|
Facility
|
OP
|
$4,285.00
|
|
|
Service Code
|
CPT 70498
|
| Hospital Charge Code |
909201801
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$3,856.50 |
| Rate for Payer: Adventist Health Commercial |
$857.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$226.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,519.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,516.58
|
| Rate for Payer: Blue Shield of California Commercial |
$2,600.99
|
| Rate for Payer: Blue Shield of California EPN |
$1,701.14
|
| Rate for Payer: Cash Price |
$1,928.25
|
| Rate for Payer: Cash Price |
$1,928.25
|
| Rate for Payer: Cash Price |
$1,928.25
|
| Rate for Payer: Central Health Plan Commercial |
$3,428.00
|
| Rate for Payer: Cigna of CA HMO |
$2,742.40
|
| Rate for Payer: Cigna of CA PPO |
$3,170.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.36
|
| Rate for Payer: EPIC Health Plan Senior |
$226.19
|
| Rate for Payer: Galaxy Health WC |
$3,642.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,571.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,856.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$456.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: InnovAge PACE Commercial |
$339.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,858.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$503.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$857.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$303.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.09
|
| Rate for Payer: Multiplan Commercial |
$3,213.75
|
| Rate for Payer: Networks By Design Commercial |
$2,785.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$226.19
|
| Rate for Payer: Prime Health Services Commercial |
$3,642.25
|
| Rate for Payer: Prime Health Services Medicare |
$239.76
|
| Rate for Payer: Riverside University Health System MISP |
$248.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,571.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,571.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,142.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,142.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,142.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,142.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$226.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC CT ANGIO PELVIS W/WO CONTRAST
|
Facility
|
IP
|
$5,516.00
|
|
|
Service Code
|
CPT 72191
|
| Hospital Charge Code |
909201803
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,103.20 |
| Max. Negotiated Rate |
$4,964.40 |
| Rate for Payer: Adventist Health Commercial |
$1,103.20
|
| Rate for Payer: Cash Price |
$2,482.20
|
| Rate for Payer: Central Health Plan Commercial |
$4,412.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,206.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,206.40
|
| Rate for Payer: Galaxy Health WC |
$4,688.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,309.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,964.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,679.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,101.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,414.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,103.20
|
| Rate for Payer: Multiplan Commercial |
$4,137.00
|
| Rate for Payer: Networks By Design Commercial |
$3,585.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,688.60
|
|
|
HC CT ANGIO PELVIS W/WO CONTRAST
|
Facility
|
OP
|
$3,097.00
|
|
|
Service Code
|
CPT 72191
|
| Hospital Charge Code |
909201803
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$2,787.30 |
| Rate for Payer: Adventist Health Commercial |
$619.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$226.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,786.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,818.87
|
| Rate for Payer: Blue Shield of California Commercial |
$1,879.88
|
| Rate for Payer: Blue Shield of California EPN |
$1,229.51
|
| Rate for Payer: Cash Price |
$1,393.65
|
| Rate for Payer: Cash Price |
$1,393.65
|
| Rate for Payer: Cash Price |
$1,393.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,477.60
|
| Rate for Payer: Cigna of CA HMO |
$1,982.08
|
| Rate for Payer: Cigna of CA PPO |
$2,291.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.36
|
| Rate for Payer: EPIC Health Plan Senior |
$226.19
|
| Rate for Payer: Galaxy Health WC |
$2,632.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,858.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,787.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$472.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: InnovAge PACE Commercial |
$339.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,065.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$522.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$619.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$303.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.09
|
| Rate for Payer: Multiplan Commercial |
$2,322.75
|
| Rate for Payer: Networks By Design Commercial |
$2,013.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$226.19
|
| Rate for Payer: Prime Health Services Commercial |
$2,632.45
|
| Rate for Payer: Prime Health Services Medicare |
$239.76
|
| Rate for Payer: Riverside University Health System MISP |
$248.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,858.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,858.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.48
|
| Rate for Payer: United Healthcare All Other HMO |
$866.48
|
| Rate for Payer: United Healthcare HMO Rider |
$866.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.48
|
| Rate for Payer: Upland Medical Group Pediatric |
$226.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC CT ANGIO UPP EXT W/WO CON
|
Facility
|
IP
|
$5,350.00
|
|
|
Service Code
|
CPT 73206
|
| Hospital Charge Code |
909201804
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,070.00 |
| Max. Negotiated Rate |
$4,815.00 |
| Rate for Payer: Adventist Health Commercial |
$1,070.00
|
| Rate for Payer: Cash Price |
$2,407.50
|
| Rate for Payer: Central Health Plan Commercial |
$4,280.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,140.00
|
| Rate for Payer: Galaxy Health WC |
$4,547.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,815.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,568.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,038.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,311.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,070.00
|
| Rate for Payer: Multiplan Commercial |
$4,012.50
|
| Rate for Payer: Networks By Design Commercial |
$3,477.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,547.50
|
|
|
HC CT ANGIO UPP EXT W/WO CON
|
Facility
|
OP
|
$3,004.00
|
|
|
Service Code
|
CPT 73206
|
| Hospital Charge Code |
909201804
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$2,703.60 |
| Rate for Payer: Adventist Health Commercial |
$600.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$226.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,568.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,764.25
|
| Rate for Payer: Blue Shield of California Commercial |
$1,823.43
|
| Rate for Payer: Blue Shield of California EPN |
$1,192.59
|
| Rate for Payer: Cash Price |
$1,351.80
|
| Rate for Payer: Cash Price |
$1,351.80
|
| Rate for Payer: Cash Price |
$1,351.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,403.20
|
| Rate for Payer: Cigna of CA HMO |
$1,922.56
|
| Rate for Payer: Cigna of CA PPO |
$2,222.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.36
|
| Rate for Payer: EPIC Health Plan Senior |
$226.19
|
| Rate for Payer: Galaxy Health WC |
$2,553.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,802.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,703.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$500.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: InnovAge PACE Commercial |
$339.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,003.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$553.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$600.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$303.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.09
|
| Rate for Payer: Multiplan Commercial |
$2,253.00
|
| Rate for Payer: Networks By Design Commercial |
$1,952.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$226.19
|
| Rate for Payer: Prime Health Services Commercial |
$2,553.40
|
| Rate for Payer: Prime Health Services Medicare |
$239.76
|
| Rate for Payer: Riverside University Health System MISP |
$248.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,802.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,802.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.48
|
| Rate for Payer: United Healthcare All Other HMO |
$866.48
|
| Rate for Payer: United Healthcare HMO Rider |
$866.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.48
|
| Rate for Payer: Upland Medical Group Pediatric |
$226.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC CT BONE L-SPINE W CONTRAST
|
Facility
|
IP
|
$4,873.00
|
|
|
Service Code
|
CPT 72132
|
| Hospital Charge Code |
909201008
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$974.60 |
| Max. Negotiated Rate |
$4,385.70 |
| Rate for Payer: Adventist Health Commercial |
$974.60
|
| Rate for Payer: Cash Price |
$2,192.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,898.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,949.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,949.20
|
| Rate for Payer: Galaxy Health WC |
$4,142.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,923.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,385.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,250.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,856.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,016.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$974.60
|
| Rate for Payer: Multiplan Commercial |
$3,654.75
|
| Rate for Payer: Networks By Design Commercial |
$3,167.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,142.05
|
|
|
HC CT BONE L-SPINE W CONTRAST
|
Facility
|
OP
|
$2,736.00
|
|
|
Service Code
|
CPT 72132
|
| Hospital Charge Code |
909201008
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$280.50 |
| Max. Negotiated Rate |
$2,462.40 |
| Rate for Payer: Adventist Health Commercial |
$547.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$453.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,458.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,606.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1,660.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,086.19
|
| Rate for Payer: Cash Price |
$1,231.20
|
| Rate for Payer: Cash Price |
$1,231.20
|
| Rate for Payer: Cash Price |
$1,231.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,188.80
|
| Rate for Payer: Cigna of CA HMO |
$1,751.04
|
| Rate for Payer: Cigna of CA PPO |
$2,024.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.59
|
| Rate for Payer: EPIC Health Plan Senior |
$453.77
|
| Rate for Payer: Galaxy Health WC |
$2,325.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,641.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,462.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$280.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: InnovAge PACE Commercial |
$680.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,824.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$309.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$547.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$608.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$608.05
|
| Rate for Payer: Multiplan Commercial |
$2,052.00
|
| Rate for Payer: Networks By Design Commercial |
$1,778.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$453.77
|
| Rate for Payer: Prime Health Services Commercial |
$2,325.60
|
| Rate for Payer: Prime Health Services Medicare |
$481.00
|
| Rate for Payer: Riverside University Health System MISP |
$499.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,641.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,641.60
|
| 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 HMO Rider |
$769.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$769.25
|
| Rate for Payer: Upland Medical Group Pediatric |
$453.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
HC CT BONE L-SPINE W/O CONTRAST
|
Facility
|
OP
|
$2,550.00
|
|
|
Service Code
|
CPT 72131
|
| Hospital Charge Code |
909201007
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$2,364.00 |
| Rate for Payer: Adventist Health Commercial |
$510.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,220.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,497.62
|
| Rate for Payer: Blue Shield of California Commercial |
$1,547.85
|
| Rate for Payer: Blue Shield of California EPN |
$1,012.35
|
| Rate for Payer: Cash Price |
$1,147.50
|
| Rate for Payer: Cash Price |
$1,147.50
|
| Rate for Payer: Cash Price |
$1,147.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,040.00
|
| Rate for Payer: Cigna of CA HMO |
$1,632.00
|
| Rate for Payer: Cigna of CA PPO |
$1,887.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$2,167.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,530.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,295.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$213.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: InnovAge PACE Commercial |
$202.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,700.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$236.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$510.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$1,912.50
|
| Rate for Payer: Networks By Design Commercial |
$1,657.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$2,167.50
|
| Rate for Payer: Prime Health Services Medicare |
$143.23
|
| Rate for Payer: Riverside University Health System MISP |
$148.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,530.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,530.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$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 Select/Navigate/Core |
$491.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC CT BONE L-SPINE W/O CONTRAST
|
Facility
|
IP
|
$4,543.00
|
|
|
Service Code
|
CPT 72131
|
| Hospital Charge Code |
909201007
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$908.60 |
| Max. Negotiated Rate |
$4,088.70 |
| Rate for Payer: Adventist Health Commercial |
$908.60
|
| Rate for Payer: Cash Price |
$2,044.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,634.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,817.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,817.20
|
| Rate for Payer: Galaxy Health WC |
$3,861.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,725.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,088.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,030.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,730.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,812.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$908.60
|
| Rate for Payer: Multiplan Commercial |
$3,407.25
|
| Rate for Payer: Networks By Design Commercial |
$2,952.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,861.55
|
|
|
HC CT BONE L-SPINE W/WO CONTRAST
|
Facility
|
IP
|
$5,116.00
|
|
|
Service Code
|
CPT 72133
|
| Hospital Charge Code |
909201009
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,023.20 |
| Max. Negotiated Rate |
$4,604.40 |
| Rate for Payer: Adventist Health Commercial |
$1,023.20
|
| Rate for Payer: Cash Price |
$2,302.20
|
| Rate for Payer: Central Health Plan Commercial |
$4,092.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,046.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,046.40
|
| Rate for Payer: Galaxy Health WC |
$4,348.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,069.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,604.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,412.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,949.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,166.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,023.20
|
| Rate for Payer: Multiplan Commercial |
$3,837.00
|
| Rate for Payer: Networks By Design Commercial |
$3,325.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,348.60
|
|
|
HC CT BONE L-SPINE W/WO CONTRAST
|
Facility
|
OP
|
$3,004.00
|
|
|
Service Code
|
CPT 72133
|
| Hospital Charge Code |
909201009
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$2,703.60 |
| Rate for Payer: Adventist Health Commercial |
$600.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$226.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,817.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,764.25
|
| Rate for Payer: Blue Shield of California Commercial |
$1,823.43
|
| Rate for Payer: Blue Shield of California EPN |
$1,192.59
|
| Rate for Payer: Cash Price |
$1,351.80
|
| Rate for Payer: Cash Price |
$1,351.80
|
| Rate for Payer: Cash Price |
$1,351.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,403.20
|
| Rate for Payer: Cigna of CA HMO |
$1,922.56
|
| Rate for Payer: Cigna of CA PPO |
$2,222.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.36
|
| Rate for Payer: EPIC Health Plan Senior |
$226.19
|
| Rate for Payer: Galaxy Health WC |
$2,553.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,802.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,703.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$330.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: InnovAge PACE Commercial |
$339.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,003.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$364.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$600.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$303.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.09
|
| Rate for Payer: Multiplan Commercial |
$2,253.00
|
| Rate for Payer: Networks By Design Commercial |
$1,952.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$226.19
|
| Rate for Payer: Prime Health Services Commercial |
$2,553.40
|
| Rate for Payer: Prime Health Services Medicare |
$239.76
|
| Rate for Payer: Riverside University Health System MISP |
$248.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,802.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,802.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$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 Select/Navigate/Core |
$855.26
|
| Rate for Payer: Upland Medical Group Pediatric |
$226.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC CT BONE PELVIS W CONTRAST
|
Facility
|
IP
|
$4,918.00
|
|
|
Service Code
|
CPT 72193
|
| Hospital Charge Code |
909201931
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$983.60 |
| Max. Negotiated Rate |
$4,426.20 |
| Rate for Payer: Adventist Health Commercial |
$983.60
|
| Rate for Payer: Cash Price |
$2,213.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,934.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,967.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,967.20
|
| Rate for Payer: Galaxy Health WC |
$4,180.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,950.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,426.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,280.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,873.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,044.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$983.60
|
| Rate for Payer: Multiplan Commercial |
$3,688.50
|
| Rate for Payer: Networks By Design Commercial |
$3,196.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,180.30
|
|
|
HC CT BONE PELVIS W CONTRAST
|
Facility
|
OP
|
$2,761.00
|
|
|
Service Code
|
CPT 72193
|
| Hospital Charge Code |
909201931
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$2,484.90 |
| Rate for Payer: Adventist Health Commercial |
$552.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$226.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,409.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,621.54
|
| Rate for Payer: Blue Shield of California Commercial |
$1,675.93
|
| Rate for Payer: Blue Shield of California EPN |
$1,096.12
|
| Rate for Payer: Cash Price |
$1,242.45
|
| Rate for Payer: Cash Price |
$1,242.45
|
| Rate for Payer: Cash Price |
$1,242.45
|
| Rate for Payer: Central Health Plan Commercial |
$2,208.80
|
| Rate for Payer: Cigna of CA HMO |
$1,767.04
|
| Rate for Payer: Cigna of CA PPO |
$2,043.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.36
|
| Rate for Payer: EPIC Health Plan Senior |
$226.19
|
| Rate for Payer: Galaxy Health WC |
$2,346.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,656.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,484.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$351.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: InnovAge PACE Commercial |
$339.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,841.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$388.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$552.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$303.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.09
|
| Rate for Payer: Multiplan Commercial |
$2,070.75
|
| Rate for Payer: Networks By Design Commercial |
$1,794.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$226.19
|
| Rate for Payer: Prime Health Services Commercial |
$2,346.85
|
| Rate for Payer: Prime Health Services Medicare |
$239.76
|
| Rate for Payer: Riverside University Health System MISP |
$248.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,656.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,656.60
|
| 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 HMO Rider |
$769.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$769.25
|
| Rate for Payer: Upland Medical Group Pediatric |
$226.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC CT BONE PELVIS W/O CONTRAST
|
Facility
|
IP
|
$4,525.00
|
|
|
Service Code
|
CPT 72192
|
| Hospital Charge Code |
909201930
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$905.00 |
| Max. Negotiated Rate |
$4,072.50 |
| Rate for Payer: Adventist Health Commercial |
$905.00
|
| Rate for Payer: Cash Price |
$2,036.25
|
| Rate for Payer: Central Health Plan Commercial |
$3,620.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,810.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,810.00
|
| Rate for Payer: Galaxy Health WC |
$3,846.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,715.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,072.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,018.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,724.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,800.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$905.00
|
| Rate for Payer: Multiplan Commercial |
$3,393.75
|
| Rate for Payer: Networks By Design Commercial |
$2,941.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,846.25
|
|
|
HC CT BONE PELVIS W/O CONTRAST
|
Facility
|
OP
|
$2,541.00
|
|
|
Service Code
|
CPT 72192
|
| Hospital Charge Code |
909201930
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$2,364.00 |
| Rate for Payer: Adventist Health Commercial |
$508.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,219.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,492.33
|
| Rate for Payer: Blue Shield of California Commercial |
$1,542.39
|
| Rate for Payer: Blue Shield of California EPN |
$1,008.78
|
| Rate for Payer: Cash Price |
$1,143.45
|
| Rate for Payer: Cash Price |
$1,143.45
|
| Rate for Payer: Cash Price |
$1,143.45
|
| Rate for Payer: Central Health Plan Commercial |
$2,032.80
|
| Rate for Payer: Cigna of CA HMO |
$1,626.24
|
| Rate for Payer: Cigna of CA PPO |
$1,880.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$2,159.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,524.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,286.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$219.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: InnovAge PACE Commercial |
$202.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,694.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$242.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$508.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$1,905.75
|
| Rate for Payer: Networks By Design Commercial |
$1,651.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$2,159.85
|
| Rate for Payer: Prime Health Services Medicare |
$143.23
|
| Rate for Payer: Riverside University Health System MISP |
$148.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,524.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,524.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$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 Select/Navigate/Core |
$491.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC CT BONE PELVIS W/WO CONTRAST
|
Facility
|
IP
|
$5,375.00
|
|
|
Service Code
|
CPT 72194
|
| Hospital Charge Code |
909201932
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,075.00 |
| Max. Negotiated Rate |
$4,837.50 |
| Rate for Payer: Adventist Health Commercial |
$1,075.00
|
| Rate for Payer: Cash Price |
$2,418.75
|
| Rate for Payer: Central Health Plan Commercial |
$4,300.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,150.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,150.00
|
| Rate for Payer: Galaxy Health WC |
$4,568.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,225.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,837.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,585.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,047.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,327.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,075.00
|
| Rate for Payer: Multiplan Commercial |
$4,031.25
|
| Rate for Payer: Networks By Design Commercial |
$3,493.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,568.75
|
|
|
HC CT BONE PELVIS W/WO CONTRAST
|
Facility
|
OP
|
$3,018.00
|
|
|
Service Code
|
CPT 72194
|
| Hospital Charge Code |
909201932
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$2,716.20 |
| Rate for Payer: Adventist Health Commercial |
$603.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$226.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,744.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,772.47
|
| Rate for Payer: Blue Shield of California Commercial |
$1,831.93
|
| Rate for Payer: Blue Shield of California EPN |
$1,198.15
|
| 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: Central Health Plan Commercial |
$2,414.40
|
| Rate for Payer: Cigna of CA HMO |
$1,931.52
|
| Rate for Payer: Cigna of CA PPO |
$2,233.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.36
|
| Rate for Payer: EPIC Health Plan Senior |
$226.19
|
| Rate for Payer: Galaxy Health WC |
$2,565.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,810.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,716.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$406.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: InnovAge PACE Commercial |
$339.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,013.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$449.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$603.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$303.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.09
|
| Rate for Payer: Multiplan Commercial |
$2,263.50
|
| Rate for Payer: Networks By Design Commercial |
$1,961.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$226.19
|
| Rate for Payer: Prime Health Services Commercial |
$2,565.30
|
| Rate for Payer: Prime Health Services Medicare |
$239.76
|
| Rate for Payer: Riverside University Health System MISP |
$248.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,810.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,810.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$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 Select/Navigate/Core |
$855.26
|
| Rate for Payer: Upland Medical Group Pediatric |
$226.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
