|
HC CT CARDIAC SCORING
|
Facility
|
IP
|
$961.00
|
|
|
Service Code
|
CPT 75571
|
| Hospital Charge Code |
909201981
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$192.20 |
| Max. Negotiated Rate |
$864.90 |
| Rate for Payer: Adventist Health Commercial |
$192.20
|
| Rate for Payer: Cash Price |
$432.45
|
| Rate for Payer: Central Health Plan Commercial |
$768.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$384.40
|
| Rate for Payer: EPIC Health Plan Senior |
$384.40
|
| Rate for Payer: Galaxy Health WC |
$816.85
|
| Rate for Payer: Global Benefits Group Commercial |
$576.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$864.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$640.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$366.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$594.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$192.20
|
| Rate for Payer: Multiplan Commercial |
$720.75
|
| Rate for Payer: Networks By Design Commercial |
$624.65
|
| Rate for Payer: Prime Health Services Commercial |
$816.85
|
|
|
HC CT CARDIAC SCORING
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
CPT 75571
|
| Hospital Charge Code |
909201981
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$2,364.00 |
| Rate for Payer: Adventist Health Commercial |
$108.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$251.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$317.14
|
| Rate for Payer: Blue Shield of California Commercial |
$327.78
|
| Rate for Payer: Blue Shield of California EPN |
$214.38
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Center for Health Promotion Commercial |
$25.00
|
| Rate for Payer: Central Health Plan Commercial |
$432.00
|
| Rate for Payer: Cigna of CA HMO |
$345.60
|
| Rate for Payer: Cigna of CA PPO |
$399.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$459.00
|
| Rate for Payer: Global Benefits Group Commercial |
$324.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$486.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$139.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: InnovAge PACE Commercial |
$167.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$360.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$405.00
|
| Rate for Payer: Networks By Design Commercial |
$351.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.88
|
| Rate for Payer: Prime Health Services Commercial |
$459.00
|
| Rate for Payer: Prime Health Services Medicare |
$118.59
|
| Rate for Payer: Riverside University Health System MISP |
$123.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$324.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$324.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.83
|
| Rate for Payer: United Healthcare All Other HMO |
$116.83
|
| Rate for Payer: United Healthcare HMO Rider |
$116.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$116.83
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC CT CHEST W CONTRAST
|
Facility
|
OP
|
$2,761.00
|
|
|
Service Code
|
CPT 71260
|
| Hospital Charge Code |
909201913
|
|
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 |
$1,459.42
|
| 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 |
$276.82
|
| 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 |
$305.79
|
| 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 CHEST W CONTRAST
|
Facility
|
IP
|
$4,918.00
|
|
|
Service Code
|
CPT 71260
|
| Hospital Charge Code |
909201913
|
|
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 CHEST W/O CONTRAST
|
Facility
|
OP
|
$2,248.00
|
|
|
Service Code
|
CPT 71250
|
| Hospital Charge Code |
909201912
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$2,364.00 |
| Rate for Payer: Adventist Health Commercial |
$449.60
|
| 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 |
$1,320.25
|
| Rate for Payer: Blue Shield of California Commercial |
$1,364.54
|
| Rate for Payer: Blue Shield of California EPN |
$892.46
|
| Rate for Payer: Cash Price |
$1,011.60
|
| Rate for Payer: Cash Price |
$1,011.60
|
| Rate for Payer: Cash Price |
$1,011.60
|
| Rate for Payer: Center for Health Promotion Commercial |
$145.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,798.40
|
| Rate for Payer: Cigna of CA HMO |
$1,438.72
|
| Rate for Payer: Cigna of CA PPO |
$1,663.52
|
| 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 |
$1,910.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,348.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,023.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$218.99
|
| 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 |
$1,499.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$241.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$449.60
|
| 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 |
$1,686.00
|
| Rate for Payer: Networks By Design Commercial |
$1,461.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,910.80
|
| 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 |
$1,348.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,348.80
|
| 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 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: 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 Permanente of CA Commercial/Self Funded |
$2,671.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,525.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,479.09
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$3,890.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,222.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,610.63
|
| 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 |
$226.19 |
| Max. Negotiated Rate |
$2,946.60 |
| Rate for Payer: Adventist Health Commercial |
$654.80
|
| 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 |
$1,819.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,922.82
|
| Rate for Payer: Blue Shield of California Commercial |
$1,987.32
|
| Rate for Payer: Blue Shield of California EPN |
$1,299.78
|
| 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: Central Health Plan Commercial |
$2,619.20
|
| Rate for Payer: Cigna of CA HMO |
$2,095.36
|
| Rate for Payer: Cigna of CA PPO |
$2,422.76
|
| 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 |
$2,782.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,964.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,946.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$329.57
|
| 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 |
$2,183.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$364.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$654.80
|
| 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 |
$2,455.50
|
| Rate for Payer: Networks By Design Commercial |
$2,128.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$226.19
|
| Rate for Payer: Prime Health Services Commercial |
$2,782.90
|
| 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 |
$1,964.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,964.40
|
| 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 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 Medi-Cal |
$307.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,306.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$688.32
|
| Rate for Payer: Blue Shield of California Commercial |
$711.40
|
| Rate for Payer: Blue Shield of California EPN |
$465.28
|
| Rate for Payer: Cash Price |
$527.40
|
| Rate for Payer: Cash Price |
$527.40
|
| Rate for Payer: Cash Price |
$527.40
|
| Rate for Payer: Center for Health Promotion Commercial |
$286.00
|
| Rate for Payer: Central Health Plan Commercial |
$937.60
|
| Rate for Payer: Cigna of CA HMO |
$750.08
|
| Rate for Payer: Cigna of CA PPO |
$867.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$996.20
|
| Rate for Payer: Global Benefits Group Commercial |
$703.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,054.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: InnovAge PACE Commercial |
$460.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$781.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$411.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$879.00
|
| Rate for Payer: Networks By Design Commercial |
$761.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$307.13
|
| Rate for Payer: Prime Health Services Commercial |
$996.20
|
| Rate for Payer: Prime Health Services Medicare |
$325.56
|
| Rate for Payer: Riverside University Health System MISP |
$337.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$703.20
|
| 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 HMO |
$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: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$1,392.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$795.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,292.47
|
| 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 W/CONTRAST
|
Facility
|
OP
|
$3,484.00
|
|
|
Service Code
|
CPT 74262
|
| Hospital Charge Code |
909202000
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$3,135.60 |
| Rate for Payer: Adventist Health Commercial |
$696.80
|
| 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 |
$1,663.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,046.15
|
| Rate for Payer: Blue Shield of California Commercial |
$2,114.79
|
| Rate for Payer: Blue Shield of California EPN |
$1,383.15
|
| Rate for Payer: Cash Price |
$1,567.80
|
| Rate for Payer: Cash Price |
$1,567.80
|
| Rate for Payer: Cash Price |
$1,567.80
|
| Rate for Payer: Center for Health Promotion Commercial |
$286.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,787.20
|
| Rate for Payer: Cigna of CA HMO |
$2,229.76
|
| Rate for Payer: Cigna of CA PPO |
$2,578.16
|
| 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 |
$2,961.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,090.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,135.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$806.18
|
| 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 |
$2,323.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$890.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$696.80
|
| 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 |
$2,613.00
|
| Rate for Payer: Networks By Design Commercial |
$2,264.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$226.19
|
| Rate for Payer: Prime Health Services Commercial |
$2,961.40
|
| 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 |
$2,090.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,090.40
|
| 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 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: 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 Permanente of CA Commercial/Self Funded |
$3,743.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,138.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,474.45
|
| 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/O CONTRAST
|
Facility
|
OP
|
$3,151.00
|
|
|
Service Code
|
CPT 74261
|
| Hospital Charge Code |
909201811
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$2,835.90 |
| Rate for Payer: Adventist Health Commercial |
$630.20
|
| 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 |
$1,093.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,850.58
|
| Rate for Payer: Blue Shield of California Commercial |
$1,912.66
|
| Rate for Payer: Blue Shield of California EPN |
$1,250.95
|
| Rate for Payer: Cash Price |
$1,417.95
|
| Rate for Payer: Cash Price |
$1,417.95
|
| Rate for Payer: Cash Price |
$1,417.95
|
| Rate for Payer: Center for Health Promotion Commercial |
$145.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,520.80
|
| Rate for Payer: Cigna of CA HMO |
$2,016.64
|
| Rate for Payer: Cigna of CA PPO |
$2,331.74
|
| 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 |
$2,678.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,890.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,835.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$711.98
|
| 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 |
$2,101.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$786.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$630.20
|
| 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 |
$2,363.25
|
| Rate for Payer: Networks By Design Commercial |
$2,048.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$2,678.35
|
| 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 |
$1,890.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,890.60
|
| 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 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: 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 Permanente of CA Commercial/Self Funded |
$3,312.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,892.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,073.95
|
| 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 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 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 |
$1,696.71
|
| Rate for Payer: Blue Shield of California Commercial |
$1,753.62
|
| Rate for Payer: Blue Shield of California EPN |
$1,146.93
|
| 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: Central Health Plan Commercial |
$2,311.20
|
| Rate for Payer: Cigna of CA HMO |
$1,848.96
|
| Rate for Payer: Cigna of CA PPO |
$2,137.86
|
| 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 |
$2,455.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,733.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,600.10
|
| 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 |
$1,926.96
|
| 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 |
$577.80
|
| 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 |
$2,166.75
|
| Rate for Payer: Networks By Design Commercial |
$1,877.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$453.77
|
| Rate for Payer: Prime Health Services Commercial |
$2,455.65
|
| 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 |
$1,733.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,733.40
|
| 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 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: 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 Permanente of CA Commercial/Self Funded |
$3,433.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,961.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,185.99
|
| 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
|
OP
|
$2,684.00
|
|
|
Service Code
|
CPT 72125
|
| Hospital Charge Code |
909201915
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$2,415.60 |
| Rate for Payer: Adventist Health Commercial |
$536.80
|
| 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 |
$1,576.31
|
| Rate for Payer: Blue Shield of California Commercial |
$1,629.19
|
| Rate for Payer: Blue Shield of California EPN |
$1,065.55
|
| 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: Central Health Plan Commercial |
$2,147.20
|
| Rate for Payer: Cigna of CA HMO |
$1,717.76
|
| Rate for Payer: Cigna of CA PPO |
$1,986.16
|
| 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 |
$2,281.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,610.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,415.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$214.98
|
| 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 |
$1,790.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$237.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$536.80
|
| 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 |
$2,013.00
|
| Rate for Payer: Networks By Design Commercial |
$1,744.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$2,281.40
|
| 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 |
$1,610.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,610.40
|
| 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 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: 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 Permanente of CA Commercial/Self Funded |
$3,188.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,821.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,958.82
|
| 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 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: 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 Permanente of CA Commercial/Self Funded |
$3,603.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,058.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,344.46
|
| 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 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 |
$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 |
$1,817.88
|
| 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 |
$330.89
|
| 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 |
$365.52
|
| 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
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$1,458.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$833.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,353.75
|
| 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 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 |
$1,284.43
|
| Rate for Payer: Blue Shield of California Commercial |
$1,327.51
|
| 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: 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: InnovAge PACE Commercial |
$1,093.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,458.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,353.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$437.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,530.90
|
| Rate for Payer: Molina Healthcare of CA 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 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: 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 Permanente of CA Commercial/Self Funded |
$2,529.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,444.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,347.25
|
| 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 |
$2,227.04
|
| Rate for Payer: Blue Shield of California Commercial |
$2,301.74
|
| 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: 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: InnovAge PACE Commercial |
$1,896.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,529.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$211.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,347.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$758.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,654.40
|
| Rate for Payer: Molina Healthcare of CA 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
|
OP
|
$3,792.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
909201935
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$191.01 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$758.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 |
$2,227.04
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| 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: 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: InnovAge PACE Commercial |
$1,896.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,529.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$211.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,347.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$758.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,654.40
|
| Rate for Payer: Molina Healthcare of CA 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: 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
|
|
