|
HC CT ORB/SEL/PFOSSA/EAR W/WO CNT
|
Facility
|
OP
|
$3,266.00
|
|
|
Service Code
|
CPT 70482
|
| Hospital Charge Code |
909201905
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$2,939.40 |
| Rate for Payer: Adventist Health Commercial |
$653.20
|
| 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 |
$1,461.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,918.12
|
| Rate for Payer: Blue Shield of California Commercial |
$1,982.46
|
| Rate for Payer: Blue Shield of California EPN |
$1,296.60
|
| Rate for Payer: Cash Price |
$1,469.70
|
| Rate for Payer: Cash Price |
$1,469.70
|
| Rate for Payer: Cash Price |
$1,469.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,612.80
|
| Rate for Payer: Cigna of CA HMO |
$2,090.24
|
| Rate for Payer: Cigna of CA PPO |
$2,416.84
|
| 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 |
$2,776.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,959.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,939.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$354.80
|
| 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 |
$2,178.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$391.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$653.20
|
| 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 |
$2,449.50
|
| Rate for Payer: Networks By Design Commercial |
$2,122.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$226.19
|
| Rate for Payer: Prime Health Services Commercial |
$2,776.10
|
| 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 |
$1,959.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,959.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,633.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,633.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,633.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,633.00
|
| 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 PERFUSION W/CONTRAST, CBF
|
Facility
|
OP
|
$3,571.00
|
|
|
Service Code
|
CPT 0042T
|
| Hospital Charge Code |
909201812
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$714.20 |
| Max. Negotiated Rate |
$3,213.90 |
| Rate for Payer: Adventist Health Commercial |
$714.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,035.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,964.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,678.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,729.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,097.25
|
| Rate for Payer: Blue Shield of California Commercial |
$2,167.60
|
| Rate for Payer: Blue Shield of California EPN |
$1,417.69
|
| Rate for Payer: Cash Price |
$1,606.95
|
| Rate for Payer: Cash Price |
$1,606.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,856.80
|
| Rate for Payer: Cigna of CA HMO |
$2,285.44
|
| Rate for Payer: Cigna of CA PPO |
$2,642.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,035.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,035.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,035.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,428.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,428.40
|
| Rate for Payer: Galaxy Health WC |
$3,035.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,142.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,213.90
|
| Rate for Payer: InnovAge PACE Commercial |
$1,785.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,381.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,210.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$714.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,499.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,499.70
|
| Rate for Payer: Multiplan Commercial |
$2,678.25
|
| Rate for Payer: Networks By Design Commercial |
$2,321.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,035.35
|
| Rate for Payer: Riverside University Health System MISP |
$1,428.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,142.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,142.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,785.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,785.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,785.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,785.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,035.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,035.35
|
| Rate for Payer: Vantage Medical Group Senior |
$3,035.35
|
|
|
HC CT PERFUSION W/CONTRAST, CBF
|
Facility
|
IP
|
$5,452.00
|
|
|
Service Code
|
CPT 0042T
|
| Hospital Charge Code |
909201812
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,090.40 |
| Max. Negotiated Rate |
$4,906.80 |
| Rate for Payer: Adventist Health Commercial |
$1,090.40
|
| Rate for Payer: Cash Price |
$2,453.40
|
| Rate for Payer: Central Health Plan Commercial |
$4,361.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,180.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,180.80
|
| Rate for Payer: Galaxy Health WC |
$4,634.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,271.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,906.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,636.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,077.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,374.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,090.40
|
| Rate for Payer: Multiplan Commercial |
$4,089.00
|
| Rate for Payer: Networks By Design Commercial |
$3,543.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,634.20
|
|
|
HC CT RECONSTRUCTION FOR TRANSPLT
|
Facility
|
OP
|
$2,596.00
|
|
| Hospital Charge Code |
909201983
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$519.20 |
| Max. Negotiated Rate |
$2,336.40 |
| Rate for Payer: Adventist Health Commercial |
$519.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,576.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,206.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,427.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,947.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,256.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,524.63
|
| Rate for Payer: Blue Shield of California Commercial |
$1,575.77
|
| Rate for Payer: Blue Shield of California EPN |
$1,030.61
|
| Rate for Payer: Cash Price |
$1,168.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,076.80
|
| Rate for Payer: Cigna of CA HMO |
$1,661.44
|
| Rate for Payer: Cigna of CA PPO |
$1,921.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,206.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,206.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,206.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,038.40
|
| Rate for Payer: Galaxy Health WC |
$2,206.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,557.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,336.40
|
| Rate for Payer: InnovAge PACE Commercial |
$1,298.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,731.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$989.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,606.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$519.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,817.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,817.20
|
| Rate for Payer: Multiplan Commercial |
$1,947.00
|
| Rate for Payer: Networks By Design Commercial |
$1,687.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,206.60
|
| Rate for Payer: Riverside University Health System MISP |
$1,038.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,557.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,557.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,298.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,298.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,298.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,206.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,206.60
|
| Rate for Payer: Vantage Medical Group Senior |
$2,206.60
|
|
|
HC CT RECONSTRUCTION FOR TRANSPLT
|
Facility
|
IP
|
$2,596.00
|
|
| Hospital Charge Code |
909201983
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$519.20 |
| Max. Negotiated Rate |
$2,336.40 |
| Rate for Payer: Adventist Health Commercial |
$519.20
|
| Rate for Payer: Cash Price |
$1,168.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,076.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,038.40
|
| Rate for Payer: Galaxy Health WC |
$2,206.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,557.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,336.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,731.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$989.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,606.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$519.20
|
| Rate for Payer: Multiplan Commercial |
$1,947.00
|
| Rate for Payer: Networks By Design Commercial |
$1,687.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,206.60
|
|
|
HC CT SOFT TIS NCK W CONTR
|
Facility
|
IP
|
$4,882.00
|
|
|
Service Code
|
CPT 70491
|
| Hospital Charge Code |
909201910
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$976.40 |
| Max. Negotiated Rate |
$4,393.80 |
| Rate for Payer: Adventist Health Commercial |
$976.40
|
| Rate for Payer: Cash Price |
$2,196.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,905.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,952.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,952.80
|
| Rate for Payer: Galaxy Health WC |
$4,149.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,929.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,393.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,256.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,860.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,021.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$976.40
|
| Rate for Payer: Multiplan Commercial |
$3,661.50
|
| Rate for Payer: Networks By Design Commercial |
$3,173.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,149.70
|
|
|
HC CT SOFT TIS NCK W CONTR
|
Facility
|
OP
|
$2,740.00
|
|
|
Service Code
|
CPT 70491
|
| Hospital Charge Code |
909201910
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$2,466.00 |
| Rate for Payer: Adventist Health Commercial |
$548.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$226.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,172.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,609.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,663.18
|
| Rate for Payer: Blue Shield of California EPN |
$1,087.78
|
| Rate for Payer: Cash Price |
$1,233.00
|
| Rate for Payer: Cash Price |
$1,233.00
|
| Rate for Payer: Cash Price |
$1,233.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,192.00
|
| Rate for Payer: Cigna of CA HMO |
$1,753.60
|
| Rate for Payer: Cigna of CA PPO |
$2,027.60
|
| 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 |
$2,329.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,644.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,466.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$307.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: InnovAge PACE Commercial |
$339.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,827.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$339.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$548.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$303.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.09
|
| Rate for Payer: Multiplan Commercial |
$2,055.00
|
| Rate for Payer: Networks By Design Commercial |
$1,781.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$226.19
|
| Rate for Payer: Prime Health Services Commercial |
$2,329.00
|
| 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 |
$1,644.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,644.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,370.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,370.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,370.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,370.00
|
| 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 SOFT TIS NCK WO CONTR
|
Facility
|
OP
|
$2,433.00
|
|
|
Service Code
|
CPT 70490
|
| Hospital Charge Code |
909201909
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$2,364.00 |
| Rate for Payer: Adventist Health Commercial |
$486.60
|
| 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 |
$979.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,428.90
|
| Rate for Payer: Blue Shield of California Commercial |
$1,476.83
|
| Rate for Payer: Blue Shield of California EPN |
$965.90
|
| Rate for Payer: Cash Price |
$1,094.85
|
| Rate for Payer: Cash Price |
$1,094.85
|
| Rate for Payer: Cash Price |
$1,094.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,946.40
|
| Rate for Payer: Cigna of CA HMO |
$1,557.12
|
| Rate for Payer: Cigna of CA PPO |
$1,800.42
|
| 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 |
$2,068.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,459.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,189.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$247.70
|
| 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 |
$1,622.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$273.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$486.60
|
| 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 |
$1,824.75
|
| Rate for Payer: Networks By Design Commercial |
$1,581.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$2,068.05
|
| 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 |
$1,459.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,459.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,216.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,216.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,216.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,216.50
|
| 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 SOFT TIS NCK WO CONTR
|
Facility
|
IP
|
$4,333.00
|
|
|
Service Code
|
CPT 70490
|
| Hospital Charge Code |
909201909
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$866.60 |
| Max. Negotiated Rate |
$3,899.70 |
| Rate for Payer: Adventist Health Commercial |
$866.60
|
| Rate for Payer: Cash Price |
$1,949.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,466.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,733.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,733.20
|
| Rate for Payer: Galaxy Health WC |
$3,683.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,599.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,899.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,890.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,650.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,682.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$866.60
|
| Rate for Payer: Multiplan Commercial |
$3,249.75
|
| Rate for Payer: Networks By Design Commercial |
$2,816.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,683.05
|
|
|
HC CT SOFT TISSUE NECK W/WO CNTRST
|
Facility
|
OP
|
$3,266.00
|
|
|
Service Code
|
CPT 70492
|
| Hospital Charge Code |
909201911
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$2,939.40 |
| Rate for Payer: Adventist Health Commercial |
$653.20
|
| 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 |
$1,461.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,918.12
|
| Rate for Payer: Blue Shield of California Commercial |
$1,982.46
|
| Rate for Payer: Blue Shield of California EPN |
$1,296.60
|
| Rate for Payer: Cash Price |
$1,469.70
|
| Rate for Payer: Cash Price |
$1,469.70
|
| Rate for Payer: Cash Price |
$1,469.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,612.80
|
| Rate for Payer: Cigna of CA HMO |
$2,090.24
|
| Rate for Payer: Cigna of CA PPO |
$2,416.84
|
| 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 |
$2,776.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,959.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,939.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$369.52
|
| 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 |
$2,178.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$408.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$653.20
|
| 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 |
$2,449.50
|
| Rate for Payer: Networks By Design Commercial |
$2,122.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$226.19
|
| Rate for Payer: Prime Health Services Commercial |
$2,776.10
|
| 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 |
$1,959.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,959.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,633.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,633.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,633.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,633.00
|
| 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 SOFT TISSUE NECK W/WO CNTRST
|
Facility
|
IP
|
$4,959.00
|
|
|
Service Code
|
CPT 70492
|
| Hospital Charge Code |
909201911
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$991.80 |
| Max. Negotiated Rate |
$4,463.10 |
| Rate for Payer: Adventist Health Commercial |
$991.80
|
| Rate for Payer: Cash Price |
$2,231.55
|
| Rate for Payer: Central Health Plan Commercial |
$3,967.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,983.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,983.60
|
| Rate for Payer: Galaxy Health WC |
$4,215.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,975.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,463.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,307.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,889.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,069.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$991.80
|
| Rate for Payer: Multiplan Commercial |
$3,719.25
|
| Rate for Payer: Networks By Design Commercial |
$3,223.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,215.15
|
|
|
HC CT STEREOTACTIC LOCALIZATION
|
Facility
|
IP
|
$2,248.00
|
|
|
Service Code
|
CPT 77011
|
| Hospital Charge Code |
909001159
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$449.60 |
| Max. Negotiated Rate |
$2,023.20 |
| Rate for Payer: Adventist Health Commercial |
$449.60
|
| Rate for Payer: Cash Price |
$1,011.60
|
| 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 STEREOTACTIC LOCALIZATION
|
Facility
|
OP
|
$1,578.00
|
|
|
Service Code
|
CPT 77011
|
| Hospital Charge Code |
909001159
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$315.60 |
| Max. Negotiated Rate |
$2,364.00 |
| Rate for Payer: Adventist Health Commercial |
$315.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,341.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$867.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,183.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,718.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$926.76
|
| Rate for Payer: Blue Shield of California Commercial |
$957.85
|
| Rate for Payer: Blue Shield of California EPN |
$626.47
|
| Rate for Payer: Cash Price |
$710.10
|
| Rate for Payer: Cash Price |
$710.10
|
| Rate for Payer: Cash Price |
$710.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,262.40
|
| Rate for Payer: Cigna of CA HMO |
$1,009.92
|
| Rate for Payer: Cigna of CA PPO |
$1,167.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,341.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,341.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,341.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$631.20
|
| Rate for Payer: EPIC Health Plan Senior |
$631.20
|
| Rate for Payer: Galaxy Health WC |
$1,341.30
|
| Rate for Payer: Global Benefits Group Commercial |
$946.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,420.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$343.11
|
| Rate for Payer: InnovAge PACE Commercial |
$789.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,052.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$379.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$976.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$315.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,104.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,104.60
|
| Rate for Payer: Multiplan Commercial |
$1,183.50
|
| Rate for Payer: Networks By Design Commercial |
$1,025.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,341.30
|
| Rate for Payer: Riverside University Health System MISP |
$631.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$946.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$946.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$789.00
|
| Rate for Payer: United Healthcare All Other HMO |
$789.00
|
| Rate for Payer: United Healthcare HMO Rider |
$789.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$789.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,341.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,341.30
|
| Rate for Payer: Vantage Medical Group Senior |
$1,341.30
|
|
|
HC CT, THX, LD FOR LC SCRN WO CON
|
Facility
|
OP
|
$406.00
|
|
|
Service Code
|
CPT 71271
|
| Hospital Charge Code |
909201271
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$2,364.00 |
| Rate for Payer: Adventist Health Commercial |
$81.20
|
| 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 |
$534.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$238.44
|
| Rate for Payer: Blue Shield of California Commercial |
$246.44
|
| Rate for Payer: Blue Shield of California EPN |
$161.18
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: Central Health Plan Commercial |
$324.80
|
| Rate for Payer: Cigna of CA HMO |
$259.84
|
| Rate for Payer: Cigna of CA PPO |
$300.44
|
| 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 |
$345.10
|
| Rate for Payer: Global Benefits Group Commercial |
$243.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$365.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$226.68
|
| 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 |
$270.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$250.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.20
|
| 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 |
$304.50
|
| Rate for Payer: Networks By Design Commercial |
$263.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$345.10
|
| 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 |
$243.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$243.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$203.00
|
| Rate for Payer: United Healthcare All Other HMO |
$203.00
|
| Rate for Payer: United Healthcare HMO Rider |
$203.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$203.00
|
| 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, THX, LD FOR LC SCRN WO CON
|
Facility
|
IP
|
$406.00
|
|
|
Service Code
|
CPT 71271
|
| Hospital Charge Code |
909201271
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$365.40 |
| Rate for Payer: Adventist Health Commercial |
$81.20
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: Central Health Plan Commercial |
$324.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.40
|
| Rate for Payer: EPIC Health Plan Senior |
$162.40
|
| Rate for Payer: Galaxy Health WC |
$345.10
|
| Rate for Payer: Global Benefits Group Commercial |
$243.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$365.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$251.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.20
|
| Rate for Payer: Multiplan Commercial |
$304.50
|
| Rate for Payer: Networks By Design Commercial |
$263.90
|
| Rate for Payer: Prime Health Services Commercial |
$345.10
|
|
|
HC CT TSPINE W CONTRAST
|
Facility
|
OP
|
$2,523.00
|
|
|
Service Code
|
CPT 72129
|
| Hospital Charge Code |
909201918
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$2,364.00 |
| Rate for Payer: Adventist Health Commercial |
$504.60
|
| 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 |
$1,458.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,481.76
|
| Rate for Payer: Blue Shield of California Commercial |
$1,531.46
|
| Rate for Payer: Blue Shield of California EPN |
$1,001.63
|
| Rate for Payer: Cash Price |
$1,135.35
|
| Rate for Payer: Cash Price |
$1,135.35
|
| Rate for Payer: Cash Price |
$1,135.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,018.40
|
| Rate for Payer: Cigna of CA HMO |
$1,614.72
|
| Rate for Payer: Cigna of CA PPO |
$1,867.02
|
| 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 |
$2,144.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,513.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,270.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$282.66
|
| 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 |
$1,682.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$312.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$504.60
|
| 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 |
$1,892.25
|
| Rate for Payer: Networks By Design Commercial |
$1,639.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$226.19
|
| Rate for Payer: Prime Health Services Commercial |
$2,144.55
|
| 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 |
$1,513.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,513.80
|
| 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 TSPINE W CONTRAST
|
Facility
|
IP
|
$4,873.00
|
|
|
Service Code
|
CPT 72129
|
| Hospital Charge Code |
909201918
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$974.60 |
| Max. Negotiated Rate |
$4,385.70 |
| Rate for Payer: Adventist Health Commercial |
$974.60
|
| Rate for Payer: Cash Price |
$2,192.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,898.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,949.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,949.20
|
| Rate for Payer: Galaxy Health WC |
$4,142.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,923.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,385.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,250.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,856.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,016.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$974.60
|
| Rate for Payer: Multiplan Commercial |
$3,654.75
|
| Rate for Payer: Networks By Design Commercial |
$3,167.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,142.05
|
|
|
HC CT TSPINE WO CONTRAST
|
Facility
|
IP
|
$4,543.00
|
|
|
Service Code
|
CPT 72128
|
| Hospital Charge Code |
909201917
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$908.60 |
| Max. Negotiated Rate |
$4,088.70 |
| Rate for Payer: Adventist Health Commercial |
$908.60
|
| Rate for Payer: Cash Price |
$2,044.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,634.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,817.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,817.20
|
| Rate for Payer: Galaxy Health WC |
$3,861.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,725.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,088.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,030.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,730.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,812.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$908.60
|
| Rate for Payer: Multiplan Commercial |
$3,407.25
|
| Rate for Payer: Networks By Design Commercial |
$2,952.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,861.55
|
|
|
HC CT TSPINE WO CONTRAST
|
Facility
|
OP
|
$2,550.00
|
|
|
Service Code
|
CPT 72128
|
| Hospital Charge Code |
909201917
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$2,364.00 |
| Rate for Payer: Adventist Health Commercial |
$510.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,220.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,497.62
|
| Rate for Payer: Blue Shield of California Commercial |
$1,547.85
|
| Rate for Payer: Blue Shield of California EPN |
$1,012.35
|
| Rate for Payer: Cash Price |
$1,147.50
|
| Rate for Payer: Cash Price |
$1,147.50
|
| Rate for Payer: Cash Price |
$1,147.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,040.00
|
| Rate for Payer: Cigna of CA HMO |
$1,632.00
|
| Rate for Payer: Cigna of CA PPO |
$1,887.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$2,167.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,530.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,295.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$214.45
|
| 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 |
$1,700.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$236.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$510.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$1,912.50
|
| Rate for Payer: Networks By Design Commercial |
$1,657.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$2,167.50
|
| Rate for Payer: Prime Health Services Medicare |
$143.23
|
| Rate for Payer: Riverside University Health System MISP |
$148.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,530.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,530.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$491.23
|
| Rate for Payer: United Healthcare All Other HMO |
$491.23
|
| Rate for Payer: United Healthcare HMO Rider |
$491.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$491.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC CT TSPINE W W/O CONTRAST
|
Facility
|
OP
|
$3,004.00
|
|
|
Service Code
|
CPT 72130
|
| Hospital Charge Code |
909201966
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$2,703.60 |
| Rate for Payer: Adventist Health Commercial |
$600.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$226.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,817.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,764.25
|
| Rate for Payer: Blue Shield of California Commercial |
$1,823.43
|
| Rate for Payer: Blue Shield of California EPN |
$1,192.59
|
| Rate for Payer: Cash Price |
$1,351.80
|
| Rate for Payer: Cash Price |
$1,351.80
|
| Rate for Payer: Cash Price |
$1,351.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,403.20
|
| Rate for Payer: Cigna of CA HMO |
$1,922.56
|
| Rate for Payer: Cigna of CA PPO |
$2,222.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.36
|
| Rate for Payer: EPIC Health Plan Senior |
$226.19
|
| Rate for Payer: Galaxy Health WC |
$2,553.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,802.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,703.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$332.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: InnovAge PACE Commercial |
$339.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,003.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$366.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$600.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$303.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.09
|
| Rate for Payer: Multiplan Commercial |
$2,253.00
|
| Rate for Payer: Networks By Design Commercial |
$1,952.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$226.19
|
| Rate for Payer: Prime Health Services Commercial |
$2,553.40
|
| Rate for Payer: Prime Health Services Medicare |
$239.76
|
| Rate for Payer: Riverside University Health System MISP |
$248.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,802.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,802.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$855.26
|
| Rate for Payer: United Healthcare All Other HMO |
$855.26
|
| Rate for Payer: United Healthcare HMO Rider |
$855.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$855.26
|
| Rate for Payer: Upland Medical Group Pediatric |
$226.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC CT TSPINE W W/O CONTRAST
|
Facility
|
IP
|
$5,116.00
|
|
|
Service Code
|
CPT 72130
|
| Hospital Charge Code |
909201966
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,023.20 |
| Max. Negotiated Rate |
$4,604.40 |
| Rate for Payer: Adventist Health Commercial |
$1,023.20
|
| Rate for Payer: Cash Price |
$2,302.20
|
| Rate for Payer: Central Health Plan Commercial |
$4,092.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,046.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,046.40
|
| Rate for Payer: Galaxy Health WC |
$4,348.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,069.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,604.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,412.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,949.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,166.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,023.20
|
| Rate for Payer: Multiplan Commercial |
$3,837.00
|
| Rate for Payer: Networks By Design Commercial |
$3,325.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,348.60
|
|
|
HC CT UPPER EXT W CONT
|
Facility
|
IP
|
$4,553.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
909201955
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$910.60 |
| Max. Negotiated Rate |
$4,097.70 |
| Rate for Payer: Adventist Health Commercial |
$910.60
|
| Rate for Payer: Cash Price |
$2,048.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,642.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,821.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,821.20
|
| Rate for Payer: Galaxy Health WC |
$3,870.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,731.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,097.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,036.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,734.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,818.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$910.60
|
| Rate for Payer: Multiplan Commercial |
$3,414.75
|
| Rate for Payer: Networks By Design Commercial |
$2,959.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,870.05
|
|
|
HC CT UPPER EXT W CONT
|
Facility
|
OP
|
$2,355.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
909201955
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$338.44 |
| Max. Negotiated Rate |
$2,364.00 |
| Rate for Payer: Adventist Health Commercial |
$471.00
|
| 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 |
$1,220.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,383.09
|
| Rate for Payer: Blue Shield of California Commercial |
$1,429.48
|
| Rate for Payer: Blue Shield of California EPN |
$934.93
|
| Rate for Payer: Cash Price |
$1,059.75
|
| Rate for Payer: Cash Price |
$1,059.75
|
| Rate for Payer: Cash Price |
$1,059.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,884.00
|
| Rate for Payer: Cigna of CA HMO |
$1,507.20
|
| Rate for Payer: Cigna of CA PPO |
$1,742.70
|
| 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 |
$2,001.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,413.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,119.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$338.44
|
| 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 |
$1,570.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$373.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$471.00
|
| 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 |
$1,766.25
|
| Rate for Payer: Networks By Design Commercial |
$1,530.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$453.77
|
| Rate for Payer: Prime Health Services Commercial |
$2,001.75
|
| 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 |
$1,413.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,413.00
|
| 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 UPPER EXT W/WO CONT
|
Facility
|
OP
|
$2,751.00
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
909201956
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$2,475.90 |
| Rate for Payer: Adventist Health Commercial |
$550.20
|
| 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 |
$1,615.66
|
| Rate for Payer: Blue Shield of California Commercial |
$1,669.86
|
| Rate for Payer: Blue Shield of California EPN |
$1,092.15
|
| Rate for Payer: Cash Price |
$1,237.95
|
| Rate for Payer: Cash Price |
$1,237.95
|
| Rate for Payer: Cash Price |
$1,237.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,200.80
|
| Rate for Payer: Cigna of CA HMO |
$1,760.64
|
| Rate for Payer: Cigna of CA PPO |
$2,035.74
|
| 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 |
$2,338.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,650.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,475.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$425.44
|
| 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 |
$1,834.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$469.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$550.20
|
| 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 |
$2,063.25
|
| Rate for Payer: Networks By Design Commercial |
$1,788.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$226.19
|
| Rate for Payer: Prime Health Services Commercial |
$2,338.35
|
| 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 |
$1,650.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,650.60
|
| 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 UPPER EXT W/WO CONT
|
Facility
|
IP
|
$4,900.00
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
909201956
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$980.00 |
| Max. Negotiated Rate |
$4,410.00 |
| Rate for Payer: Adventist Health Commercial |
$980.00
|
| Rate for Payer: Cash Price |
$2,205.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,920.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,960.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,960.00
|
| Rate for Payer: Galaxy Health WC |
$4,165.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,940.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,410.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,268.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,866.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,033.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$980.00
|
| Rate for Payer: Multiplan Commercial |
$3,675.00
|
| Rate for Payer: Networks By Design Commercial |
$3,185.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,165.00
|
|
