|
HC CT BONE PELVIS W CONTRAST
|
Facility
|
IP
|
$2,761.00
|
|
|
Service Code
|
CPT 72193
|
| Hospital Charge Code |
909201931
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$552.20 |
| Max. Negotiated Rate |
$2,484.90 |
| Rate for Payer: Adventist Health Commercial |
$552.20
|
| Rate for Payer: Cash Price |
$1,518.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,208.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,104.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,104.40
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$1,841.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,051.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,709.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$552.20
|
| Rate for Payer: Multiplan Commercial |
$2,070.75
|
| Rate for Payer: Networks By Design Commercial |
$1,794.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,346.85
|
|
|
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 |
$1,518.55
|
| Rate for Payer: Cash Price |
$1,518.55
|
| Rate for Payer: Cash Price |
$1,518.55
|
| 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
|
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 |
$1,397.55
|
| Rate for Payer: Cash Price |
$1,397.55
|
| Rate for Payer: Cash Price |
$1,397.55
|
| 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/O CONTRAST
|
Facility
|
IP
|
$2,541.00
|
|
|
Service Code
|
CPT 72192
|
| Hospital Charge Code |
909201930
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$508.20 |
| Max. Negotiated Rate |
$2,286.90 |
| Rate for Payer: Adventist Health Commercial |
$508.20
|
| Rate for Payer: Cash Price |
$1,397.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,032.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,016.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,016.40
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$1,694.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$968.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,572.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$508.20
|
| Rate for Payer: Multiplan Commercial |
$1,905.75
|
| Rate for Payer: Networks By Design Commercial |
$1,651.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,159.85
|
|
|
HC CT BONE PELVIS W/WO CONTRAST
|
Facility
|
IP
|
$3,018.00
|
|
|
Service Code
|
CPT 72194
|
| Hospital Charge Code |
909201932
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$603.60 |
| Max. Negotiated Rate |
$2,716.20 |
| Rate for Payer: Adventist Health Commercial |
$603.60
|
| Rate for Payer: Cash Price |
$1,659.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,414.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,207.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,207.20
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$2,013.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,149.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,868.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$603.60
|
| Rate for Payer: Multiplan Commercial |
$2,263.50
|
| Rate for Payer: Networks By Design Commercial |
$1,961.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,565.30
|
|
|
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 |
$1,659.90
|
| Rate for Payer: Cash Price |
$1,659.90
|
| Rate for Payer: Cash Price |
$1,659.90
|
| 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
|
|
|
HC CT CARDIAC SCORING
|
Facility
|
IP
|
$540.00
|
|
|
Service Code
|
CPT 75571
|
| Hospital Charge Code |
909201981
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$486.00 |
| Rate for Payer: Adventist Health Commercial |
$108.00
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Central Health Plan Commercial |
$432.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.00
|
| Rate for Payer: EPIC Health Plan Senior |
$216.00
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$360.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$334.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.00
|
| Rate for Payer: Multiplan Commercial |
$405.00
|
| Rate for Payer: Networks By Design Commercial |
$351.00
|
| Rate for Payer: Prime Health Services Commercial |
$459.00
|
|
|
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 |
$297.00
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cash Price |
$297.00
|
| 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 |
$1,518.55
|
| Rate for Payer: Cash Price |
$1,518.55
|
| Rate for Payer: Cash Price |
$1,518.55
|
| 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
|
$2,761.00
|
|
|
Service Code
|
CPT 71260
|
| Hospital Charge Code |
909201913
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$552.20 |
| Max. Negotiated Rate |
$2,484.90 |
| Rate for Payer: Adventist Health Commercial |
$552.20
|
| Rate for Payer: Cash Price |
$1,518.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,208.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,104.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,104.40
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$1,841.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,051.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,709.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$552.20
|
| Rate for Payer: Multiplan Commercial |
$2,070.75
|
| Rate for Payer: Networks By Design Commercial |
$1,794.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,346.85
|
|
|
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 |
$1,236.40
|
| Rate for Payer: Cash Price |
$1,236.40
|
| Rate for Payer: Cash Price |
$1,236.40
|
| 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
|
$2,248.00
|
|
|
Service Code
|
CPT 71250
|
| Hospital Charge Code |
909201912
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$449.60 |
| Max. Negotiated Rate |
$2,023.20 |
| Rate for Payer: Adventist Health Commercial |
$449.60
|
| Rate for Payer: Cash Price |
$1,236.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,798.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$899.20
|
| Rate for Payer: EPIC Health Plan Senior |
$899.20
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$1,499.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$856.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,391.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$449.60
|
| Rate for Payer: Multiplan Commercial |
$1,686.00
|
| Rate for Payer: Networks By Design Commercial |
$1,461.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,910.80
|
|
|
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 |
$1,800.70
|
| Rate for Payer: Cash Price |
$1,800.70
|
| Rate for Payer: Cash Price |
$1,800.70
|
| 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 CHEST W WO CONTRA
|
Facility
|
IP
|
$3,274.00
|
|
|
Service Code
|
CPT 71270
|
| Hospital Charge Code |
909201914
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$654.80 |
| Max. Negotiated Rate |
$2,946.60 |
| Rate for Payer: Adventist Health Commercial |
$654.80
|
| Rate for Payer: Cash Price |
$1,800.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,619.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,309.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,309.60
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$2,183.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,247.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,026.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$654.80
|
| Rate for Payer: Multiplan Commercial |
$2,455.50
|
| Rate for Payer: Networks By Design Commercial |
$2,128.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,782.90
|
|
|
HC CT COLONOGRAPHY SCREEN
|
Facility
|
IP
|
$1,172.00
|
|
|
Service Code
|
CPT 74263
|
| Hospital Charge Code |
909201813
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$234.40 |
| Max. Negotiated Rate |
$1,054.80 |
| Rate for Payer: Adventist Health Commercial |
$234.40
|
| Rate for Payer: Cash Price |
$644.60
|
| Rate for Payer: Central Health Plan Commercial |
$937.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$468.80
|
| Rate for Payer: EPIC Health Plan Senior |
$468.80
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$781.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$446.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$725.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.40
|
| Rate for Payer: Multiplan Commercial |
$879.00
|
| Rate for Payer: Networks By Design Commercial |
$761.80
|
| Rate for Payer: Prime Health Services Commercial |
$996.20
|
|
|
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 |
$644.60
|
| Rate for Payer: Cash Price |
$644.60
|
| Rate for Payer: Cash Price |
$644.60
|
| 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 W/CONTRAST
|
Facility
|
IP
|
$3,484.00
|
|
|
Service Code
|
CPT 74262
|
| Hospital Charge Code |
909202000
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$696.80 |
| Max. Negotiated Rate |
$3,135.60 |
| Rate for Payer: Adventist Health Commercial |
$696.80
|
| Rate for Payer: Cash Price |
$1,916.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,787.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,393.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,393.60
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$2,323.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,327.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,156.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$696.80
|
| Rate for Payer: Multiplan Commercial |
$2,613.00
|
| Rate for Payer: Networks By Design Commercial |
$2,264.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,961.40
|
|
|
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 |
$1,916.20
|
| Rate for Payer: Cash Price |
$1,916.20
|
| Rate for Payer: Cash Price |
$1,916.20
|
| 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/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 |
$1,733.05
|
| Rate for Payer: Cash Price |
$1,733.05
|
| Rate for Payer: Cash Price |
$1,733.05
|
| 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
|
$3,151.00
|
|
|
Service Code
|
CPT 74261
|
| Hospital Charge Code |
909201811
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$630.20 |
| Max. Negotiated Rate |
$2,835.90 |
| Rate for Payer: Adventist Health Commercial |
$630.20
|
| Rate for Payer: Cash Price |
$1,733.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,520.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,260.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,260.40
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$2,101.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,200.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,950.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$630.20
|
| Rate for Payer: Multiplan Commercial |
$2,363.25
|
| Rate for Payer: Networks By Design Commercial |
$2,048.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,678.35
|
|
|
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 |
$1,588.95
|
| Rate for Payer: Cash Price |
$1,588.95
|
| Rate for Payer: Cash Price |
$1,588.95
|
| 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
|
$2,889.00
|
|
|
Service Code
|
CPT 72126
|
| Hospital Charge Code |
909201916
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$577.80 |
| Max. Negotiated Rate |
$2,600.10 |
| Rate for Payer: Adventist Health Commercial |
$577.80
|
| Rate for Payer: Cash Price |
$1,588.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,311.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,155.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,155.60
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$1,926.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,100.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,788.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$577.80
|
| Rate for Payer: Multiplan Commercial |
$2,166.75
|
| Rate for Payer: Networks By Design Commercial |
$1,877.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,455.65
|
|
|
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 |
$1,476.20
|
| Rate for Payer: Cash Price |
$1,476.20
|
| Rate for Payer: Cash Price |
$1,476.20
|
| 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
|
$2,684.00
|
|
|
Service Code
|
CPT 72125
|
| Hospital Charge Code |
909201915
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$536.80 |
| Max. Negotiated Rate |
$2,415.60 |
| Rate for Payer: Adventist Health Commercial |
$536.80
|
| Rate for Payer: Cash Price |
$1,476.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,147.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,073.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,073.60
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$1,790.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,022.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,661.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$536.80
|
| Rate for Payer: Multiplan Commercial |
$2,013.00
|
| Rate for Payer: Networks By Design Commercial |
$1,744.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,281.40
|
|
|
HC CT C SPINE W/WO CONTRAST
|
Facility
|
IP
|
$3,018.00
|
|
|
Service Code
|
CPT 72127
|
| Hospital Charge Code |
909201967
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$603.60 |
| Max. Negotiated Rate |
$2,716.20 |
| Rate for Payer: Adventist Health Commercial |
$603.60
|
| Rate for Payer: Cash Price |
$1,659.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,414.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,207.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,207.20
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$2,013.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,149.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,868.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$603.60
|
| Rate for Payer: Multiplan Commercial |
$2,263.50
|
| Rate for Payer: Networks By Design Commercial |
$1,961.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,565.30
|
|
