|
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 |
$1,659.90
|
| 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 |
$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 |
$1,202.85
|
| 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 |
$1,202.85
|
| Rate for Payer: Cash Price |
$1,202.85
|
| Rate for Payer: Cash Price |
$1,202.85
|
| Rate for Payer: Central Health Plan Commercial |
$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 |
$2,085.60
|
| 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
|
IP
|
$3,792.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
909201935
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$758.40 |
| Max. Negotiated Rate |
$3,412.80 |
| Rate for Payer: Adventist Health Commercial |
$758.40
|
| Rate for Payer: Cash Price |
$2,085.60
|
| 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
|
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 |
$2,085.60
|
| Rate for Payer: Cash Price |
$2,085.60
|
| Rate for Payer: Cash Price |
$2,085.60
|
| 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
|
|
|
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 |
$2,085.60
|
| Rate for Payer: Cash Price |
$2,085.60
|
| Rate for Payer: Cash Price |
$2,085.60
|
| 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 GUIDNC VISCERAL TISS ABLATN
|
Facility
|
OP
|
$6,737.00
|
|
|
Service Code
|
CPT 77013
|
| Hospital Charge Code |
909201810
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$276.61 |
| Max. Negotiated Rate |
$6,063.30 |
| Rate for Payer: Adventist Health Commercial |
$1,347.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,726.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,705.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,052.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,794.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,956.64
|
| Rate for Payer: Blue Shield of California Commercial |
$4,089.36
|
| Rate for Payer: Blue Shield of California EPN |
$2,674.59
|
| Rate for Payer: Cash Price |
$3,705.35
|
| Rate for Payer: Cash Price |
$3,705.35
|
| Rate for Payer: Cash Price |
$3,705.35
|
| Rate for Payer: Central Health Plan Commercial |
$5,389.60
|
| Rate for Payer: Cigna of CA HMO |
$4,311.68
|
| Rate for Payer: Cigna of CA PPO |
$4,985.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,726.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,726.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,726.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,694.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,694.80
|
| Rate for Payer: Galaxy Health WC |
$5,726.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,042.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,063.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$276.61
|
| Rate for Payer: InnovAge PACE Commercial |
$3,368.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,493.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$305.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,170.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,347.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,715.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,715.90
|
| Rate for Payer: Multiplan Commercial |
$5,052.75
|
| Rate for Payer: Networks By Design Commercial |
$4,379.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,726.45
|
| Rate for Payer: Riverside University Health System MISP |
$2,694.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,042.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,042.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,368.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,368.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,368.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,368.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,726.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,726.45
|
| Rate for Payer: Vantage Medical Group Senior |
$5,726.45
|
|
|
HC CT GUIDNC VISCERAL TISS ABLATN
|
Facility
|
IP
|
$6,737.00
|
|
|
Service Code
|
CPT 77013
|
| Hospital Charge Code |
909201810
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,347.40 |
| Max. Negotiated Rate |
$6,063.30 |
| Rate for Payer: Adventist Health Commercial |
$1,347.40
|
| Rate for Payer: Cash Price |
$3,705.35
|
| Rate for Payer: Central Health Plan Commercial |
$5,389.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,694.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,694.80
|
| Rate for Payer: Galaxy Health WC |
$5,726.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,042.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,063.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,493.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,566.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,170.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,347.40
|
| Rate for Payer: Multiplan Commercial |
$5,052.75
|
| Rate for Payer: Networks By Design Commercial |
$4,379.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,726.45
|
|
|
HC CT GUID RAD THERAPY
|
Facility
|
OP
|
$1,391.00
|
|
|
Service Code
|
CPT 77014
|
| Hospital Charge Code |
909100165
|
|
Hospital Revenue Code
|
359
|
| Min. Negotiated Rate |
$114.55 |
| Max. Negotiated Rate |
$2,364.00 |
| Rate for Payer: Adventist Health Commercial |
$278.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,182.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$765.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,043.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$564.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.55
|
| Rate for Payer: Blue Shield of California Commercial |
$849.90
|
| Rate for Payer: Blue Shield of California EPN |
$555.01
|
| Rate for Payer: Cash Price |
$765.05
|
| Rate for Payer: Cash Price |
$765.05
|
| Rate for Payer: Cash Price |
$765.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,112.80
|
| Rate for Payer: Cigna of CA HMO |
$890.24
|
| Rate for Payer: Cigna of CA PPO |
$1,029.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,182.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,182.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,182.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$556.40
|
| Rate for Payer: EPIC Health Plan Senior |
$556.40
|
| Rate for Payer: Galaxy Health WC |
$1,182.35
|
| Rate for Payer: Global Benefits Group Commercial |
$834.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,251.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$180.88
|
| Rate for Payer: InnovAge PACE Commercial |
$695.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$927.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$199.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$861.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$278.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$973.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$973.70
|
| Rate for Payer: Multiplan Commercial |
$1,043.25
|
| Rate for Payer: Networks By Design Commercial |
$904.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,182.35
|
| Rate for Payer: Riverside University Health System MISP |
$556.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$834.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$834.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$695.50
|
| Rate for Payer: United Healthcare All Other HMO |
$695.50
|
| Rate for Payer: United Healthcare HMO Rider |
$695.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$695.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,182.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,182.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,182.35
|
|
|
HC CT GUID RAD THERAPY
|
Facility
|
IP
|
$1,391.00
|
|
|
Service Code
|
CPT 77014
|
| Hospital Charge Code |
909100165
|
|
Hospital Revenue Code
|
359
|
| Min. Negotiated Rate |
$278.20 |
| Max. Negotiated Rate |
$1,251.90 |
| Rate for Payer: Adventist Health Commercial |
$278.20
|
| Rate for Payer: Cash Price |
$765.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,112.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$556.40
|
| Rate for Payer: EPIC Health Plan Senior |
$556.40
|
| Rate for Payer: Galaxy Health WC |
$1,182.35
|
| Rate for Payer: Global Benefits Group Commercial |
$834.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,251.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$927.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$529.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$861.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$278.20
|
| Rate for Payer: Multiplan Commercial |
$1,043.25
|
| Rate for Payer: Networks By Design Commercial |
$904.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,182.35
|
|
|
HC CT HEAD NO CONTRAST
|
Facility
|
IP
|
$2,656.00
|
|
|
Service Code
|
CPT 70450
|
| Hospital Charge Code |
909201901
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$531.20 |
| Max. Negotiated Rate |
$2,390.40 |
| Rate for Payer: Adventist Health Commercial |
$531.20
|
| Rate for Payer: Cash Price |
$1,460.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,124.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,062.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,062.40
|
| Rate for Payer: Galaxy Health WC |
$2,257.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,593.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,390.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,771.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,011.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,644.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$531.20
|
| Rate for Payer: Multiplan Commercial |
$1,992.00
|
| Rate for Payer: Networks By Design Commercial |
$1,726.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,257.60
|
|
|
HC CT HEAD NO CONTRAST
|
Facility
|
OP
|
$2,656.00
|
|
|
Service Code
|
CPT 70450
|
| Hospital Charge Code |
909201901
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$2,390.40 |
| Rate for Payer: Adventist Health Commercial |
$531.20
|
| 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 |
$975.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,559.87
|
| Rate for Payer: Blue Shield of California Commercial |
$1,612.19
|
| Rate for Payer: Blue Shield of California EPN |
$1,054.43
|
| Rate for Payer: Cash Price |
$1,460.80
|
| Rate for Payer: Cash Price |
$1,460.80
|
| Rate for Payer: Cash Price |
$1,460.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,124.80
|
| Rate for Payer: Cigna of CA HMO |
$1,699.84
|
| Rate for Payer: Cigna of CA PPO |
$1,965.44
|
| 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 |
$2,257.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,593.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,390.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$174.18
|
| 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 |
$1,771.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$192.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$531.20
|
| 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 |
$1,992.00
|
| Rate for Payer: Networks By Design Commercial |
$1,726.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$2,257.60
|
| 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 |
$1,593.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,593.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,328.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,328.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,328.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,328.00
|
| 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 HEAD W CONTRAST
|
Facility
|
IP
|
$2,964.00
|
|
|
Service Code
|
CPT 70460
|
| Hospital Charge Code |
909201900
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$592.80 |
| Max. Negotiated Rate |
$2,667.60 |
| Rate for Payer: Adventist Health Commercial |
$592.80
|
| Rate for Payer: Cash Price |
$1,630.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,371.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,185.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,185.60
|
| Rate for Payer: Galaxy Health WC |
$2,519.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,778.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,667.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,976.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,129.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,834.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$592.80
|
| Rate for Payer: Multiplan Commercial |
$2,223.00
|
| Rate for Payer: Networks By Design Commercial |
$1,926.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,519.40
|
|
|
HC CT HEAD W CONTRAST
|
Facility
|
OP
|
$2,964.00
|
|
|
Service Code
|
CPT 70460
|
| Hospital Charge Code |
909201900
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$2,667.60 |
| Rate for Payer: Adventist Health Commercial |
$592.80
|
| 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 |
$1,169.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,740.76
|
| Rate for Payer: Blue Shield of California Commercial |
$1,799.15
|
| Rate for Payer: Blue Shield of California EPN |
$1,176.71
|
| Rate for Payer: Cash Price |
$1,630.20
|
| Rate for Payer: Cash Price |
$1,630.20
|
| Rate for Payer: Cash Price |
$1,630.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,371.20
|
| Rate for Payer: Cigna of CA HMO |
$1,896.96
|
| Rate for Payer: Cigna of CA PPO |
$2,193.36
|
| 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 |
$2,519.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,778.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,667.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$245.67
|
| 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 |
$1,976.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$271.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$592.80
|
| 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 |
$2,223.00
|
| Rate for Payer: Networks By Design Commercial |
$1,926.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$226.19
|
| Rate for Payer: Prime Health Services Commercial |
$2,519.40
|
| Rate for Payer: Prime Health Services Medicare |
$239.76
|
| Rate for Payer: Riverside University Health System MISP |
$248.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,778.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,778.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,482.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,482.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,482.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,482.00
|
| 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 HEAD W/WO CONTRAS
|
Facility
|
IP
|
$3,319.00
|
|
|
Service Code
|
CPT 70470
|
| Hospital Charge Code |
909201902
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$663.80 |
| Max. Negotiated Rate |
$2,987.10 |
| Rate for Payer: Adventist Health Commercial |
$663.80
|
| Rate for Payer: Cash Price |
$1,825.45
|
| Rate for Payer: Central Health Plan Commercial |
$2,655.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,327.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,327.60
|
| Rate for Payer: Galaxy Health WC |
$2,821.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,991.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,987.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,213.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,264.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,054.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$663.80
|
| Rate for Payer: Multiplan Commercial |
$2,489.25
|
| Rate for Payer: Networks By Design Commercial |
$2,157.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,821.15
|
|
|
HC CT HEAD W/WO CONTRAS
|
Facility
|
OP
|
$3,319.00
|
|
|
Service Code
|
CPT 70470
|
| Hospital Charge Code |
909201902
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$2,987.10 |
| Rate for Payer: Adventist Health Commercial |
$663.80
|
| 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 |
$1,459.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,949.25
|
| Rate for Payer: Blue Shield of California Commercial |
$2,014.63
|
| Rate for Payer: Blue Shield of California EPN |
$1,317.64
|
| Rate for Payer: Cash Price |
$1,825.45
|
| Rate for Payer: Cash Price |
$1,825.45
|
| Rate for Payer: Cash Price |
$1,825.45
|
| Rate for Payer: Central Health Plan Commercial |
$2,655.20
|
| Rate for Payer: Cigna of CA HMO |
$2,124.16
|
| Rate for Payer: Cigna of CA PPO |
$2,456.06
|
| 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 |
$2,821.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,991.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,987.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$289.03
|
| 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 |
$2,213.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$319.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$663.80
|
| 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 |
$2,489.25
|
| Rate for Payer: Networks By Design Commercial |
$2,157.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$226.19
|
| Rate for Payer: Prime Health Services Commercial |
$2,821.15
|
| 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 |
$1,991.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,991.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,659.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,659.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,659.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$226.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC CT LOWER EXT W CONT
|
Facility
|
OP
|
$2,853.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
909201958
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$2,567.70 |
| Rate for Payer: Adventist Health Commercial |
$570.60
|
| 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 |
$1,220.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,675.57
|
| Rate for Payer: Blue Shield of California Commercial |
$1,731.77
|
| Rate for Payer: Blue Shield of California EPN |
$1,132.64
|
| Rate for Payer: Cash Price |
$1,569.15
|
| Rate for Payer: Cash Price |
$1,569.15
|
| Rate for Payer: Cash Price |
$1,569.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,282.40
|
| Rate for Payer: Cigna of CA HMO |
$1,825.92
|
| Rate for Payer: Cigna of CA PPO |
$2,111.22
|
| 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 |
$2,425.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,711.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,567.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$277.40
|
| 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 |
$1,902.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$306.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$570.60
|
| 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 |
$2,139.75
|
| Rate for Payer: Networks By Design Commercial |
$1,854.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$226.19
|
| Rate for Payer: Prime Health Services Commercial |
$2,425.05
|
| 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 |
$1,711.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,711.80
|
| 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 LOWER EXT W CONT
|
Facility
|
IP
|
$2,853.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
909201958
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$570.60 |
| Max. Negotiated Rate |
$2,567.70 |
| Rate for Payer: Adventist Health Commercial |
$570.60
|
| Rate for Payer: Cash Price |
$1,569.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,282.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,141.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,141.20
|
| Rate for Payer: Galaxy Health WC |
$2,425.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,711.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,567.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,902.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,086.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,766.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$570.60
|
| Rate for Payer: Multiplan Commercial |
$2,139.75
|
| Rate for Payer: Networks By Design Commercial |
$1,854.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,425.05
|
|
|
HC CT LOWER EXT WO CONT
|
Facility
|
OP
|
$2,541.00
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
909201957
|
|
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 |
$1,026.17
|
| 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 |
$213.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: InnovAge PACE Commercial |
$202.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,694.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$236.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 LOWER EXT WO CONT
|
Facility
|
IP
|
$2,541.00
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
909201957
|
|
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 LOWR EXTR W/WO CONT
|
Facility
|
OP
|
$3,191.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
909201959
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$2,871.90 |
| Rate for Payer: Adventist Health Commercial |
$638.20
|
| 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 |
$1,531.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,874.07
|
| Rate for Payer: Blue Shield of California Commercial |
$1,936.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,266.83
|
| Rate for Payer: Cash Price |
$1,755.05
|
| Rate for Payer: Cash Price |
$1,755.05
|
| Rate for Payer: Cash Price |
$1,755.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,552.80
|
| Rate for Payer: Cigna of CA HMO |
$2,042.24
|
| Rate for Payer: Cigna of CA PPO |
$2,361.34
|
| 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 |
$2,712.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,914.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,871.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$325.89
|
| 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 |
$2,128.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$359.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$638.20
|
| 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 |
$2,393.25
|
| Rate for Payer: Networks By Design Commercial |
$2,074.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$226.19
|
| Rate for Payer: Prime Health Services Commercial |
$2,712.35
|
| 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 |
$1,914.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,914.60
|
| 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 LOWR EXTR W/WO CONT
|
Facility
|
IP
|
$3,191.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
909201959
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$638.20 |
| Max. Negotiated Rate |
$2,871.90 |
| Rate for Payer: Adventist Health Commercial |
$638.20
|
| Rate for Payer: Cash Price |
$1,755.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,552.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,276.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,276.40
|
| Rate for Payer: Galaxy Health WC |
$2,712.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,914.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,871.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,128.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,215.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,975.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$638.20
|
| Rate for Payer: Multiplan Commercial |
$2,393.25
|
| Rate for Payer: Networks By Design Commercial |
$2,074.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,712.35
|
|
|
HC CTLSO AXILLARY SLING
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
CPT L1010
|
| Hospital Charge Code |
915351010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.05 |
| Max. Negotiated Rate |
$145.80 |
| Rate for Payer: Adventist Health Commercial |
$66.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$137.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$89.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$121.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$95.14
|
| Rate for Payer: Blue Shield of California Commercial |
$125.23
|
| Rate for Payer: Blue Shield of California EPN |
$81.65
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Central Health Plan Commercial |
$129.60
|
| Rate for Payer: Cigna of CA HMO |
$113.40
|
| Rate for Payer: Cigna of CA PPO |
$113.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$137.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$137.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$137.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.80
|
| Rate for Payer: EPIC Health Plan Senior |
$64.80
|
| Rate for Payer: Galaxy Health WC |
$137.70
|
| Rate for Payer: Global Benefits Group Commercial |
$97.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$145.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$53.85
|
| Rate for Payer: InnovAge PACE Commercial |
$81.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$100.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$113.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$113.40
|
| Rate for Payer: Multiplan Commercial |
$121.50
|
| Rate for Payer: Networks By Design Commercial |
$81.00
|
| Rate for Payer: Prime Health Services Commercial |
$137.70
|
| Rate for Payer: Riverside University Health System MISP |
$64.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$97.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$97.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.80
|
| Rate for Payer: United Healthcare All Other HMO |
$59.18
|
| Rate for Payer: United Healthcare HMO Rider |
$57.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$137.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$137.70
|
| Rate for Payer: Vantage Medical Group Senior |
$137.70
|
|
|
HC CTLSO AXILLARY SLING
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
CPT L1010
|
| Hospital Charge Code |
915351010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$145.80 |
| Rate for Payer: Adventist Health Commercial |
$32.40
|
| Rate for Payer: Blue Shield of California Commercial |
$125.23
|
| Rate for Payer: Blue Shield of California EPN |
$81.65
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Central Health Plan Commercial |
$129.60
|
| Rate for Payer: Cigna of CA HMO |
$113.40
|
| Rate for Payer: Cigna of CA PPO |
$113.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.80
|
| Rate for Payer: EPIC Health Plan Senior |
$64.80
|
| Rate for Payer: Galaxy Health WC |
$137.70
|
| Rate for Payer: Global Benefits Group Commercial |
$97.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$145.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$100.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.40
|
| Rate for Payer: Multiplan Commercial |
$121.50
|
| Rate for Payer: Networks By Design Commercial |
$105.30
|
| Rate for Payer: Prime Health Services Commercial |
$137.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.80
|
| Rate for Payer: United Healthcare All Other HMO |
$59.18
|
| Rate for Payer: United Healthcare HMO Rider |
$57.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.05
|
|
