|
HC CT MAXILLOFAC W/O CO
|
Facility
|
OP
|
$2,124.00
|
|
|
Service Code
|
CPT 70486
|
| Hospital Charge Code |
909201906
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$2,364.00 |
| Rate for Payer: Adventist Health Commercial |
$424.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$978.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,247.43
|
| Rate for Payer: Blue Shield of California Commercial |
$1,289.27
|
| Rate for Payer: Blue Shield of California EPN |
$843.23
|
| Rate for Payer: Cash Price |
$1,168.20
|
| Rate for Payer: Cash Price |
$1,168.20
|
| Rate for Payer: Cash Price |
$1,168.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,699.20
|
| Rate for Payer: Cigna of CA HMO |
$1,359.36
|
| Rate for Payer: Cigna of CA PPO |
$1,571.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$1,805.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,274.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,911.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$212.16
|
| 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 |
$1,416.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$234.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$424.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$1,593.00
|
| Rate for Payer: Networks By Design Commercial |
$1,380.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,805.40
|
| Rate for Payer: Prime Health Services Medicare |
$143.23
|
| Rate for Payer: Riverside University Health System MISP |
$148.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,274.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,274.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,062.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,062.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,062.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,062.00
|
| 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 ORB/SEL/PFOSSA/EAR W CONTR
|
Facility
|
IP
|
$2,964.00
|
|
|
Service Code
|
CPT 70481
|
| Hospital Charge Code |
909201904
|
|
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 ORB/SEL/PFOSSA/EAR W CONTR
|
Facility
|
OP
|
$2,964.00
|
|
|
Service Code
|
CPT 70481
|
| Hospital Charge Code |
909201904
|
|
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 |
$1,172.71
|
| 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 |
$301.71
|
| 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 |
$333.28
|
| 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 ORB/SEL/PFOSSA/EAR WO CONTR
|
Facility
|
OP
|
$2,656.00
|
|
|
Service Code
|
CPT 70480
|
| Hospital Charge Code |
909201903
|
|
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 |
$979.88
|
| 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 |
$262.02
|
| 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 |
$289.45
|
| 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 ORB/SEL/PFOSSA/EAR WO CONTR
|
Facility
|
IP
|
$2,656.00
|
|
|
Service Code
|
CPT 70480
|
| Hospital Charge Code |
909201903
|
|
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 ORB/SEL/PFOSSA/EAR W/WO CNT
|
Facility
|
IP
|
$3,266.00
|
|
|
Service Code
|
CPT 70482
|
| Hospital Charge Code |
909201905
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$653.20 |
| Max. Negotiated Rate |
$2,939.40 |
| Rate for Payer: Adventist Health Commercial |
$653.20
|
| Rate for Payer: Cash Price |
$1,796.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,612.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,306.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,306.40
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$2,178.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,244.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,021.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$653.20
|
| Rate for Payer: Multiplan Commercial |
$2,449.50
|
| Rate for Payer: Networks By Design Commercial |
$2,122.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,776.10
|
|
|
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 |
$1,796.30
|
| Rate for Payer: Cash Price |
$1,796.30
|
| Rate for Payer: Cash Price |
$1,796.30
|
| 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
|
IP
|
$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: Cash Price |
$1,964.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,856.80
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$2,381.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,360.55
|
| 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: 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
|
|
|
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 |
$1,964.05
|
| Rate for Payer: Cash Price |
$1,964.05
|
| 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 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 |
$1,427.80
|
| 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 |
$1,427.80
|
| 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
|
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 |
$1,507.00
|
| Rate for Payer: Cash Price |
$1,507.00
|
| Rate for Payer: Cash Price |
$1,507.00
|
| 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 W CONTR
|
Facility
|
IP
|
$2,740.00
|
|
|
Service Code
|
CPT 70491
|
| Hospital Charge Code |
909201910
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$548.00 |
| Max. Negotiated Rate |
$2,466.00 |
| Rate for Payer: Adventist Health Commercial |
$548.00
|
| Rate for Payer: Cash Price |
$1,507.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,192.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,096.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,096.00
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$1,827.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,043.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,696.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$548.00
|
| Rate for Payer: Multiplan Commercial |
$2,055.00
|
| Rate for Payer: Networks By Design Commercial |
$1,781.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,329.00
|
|
|
HC CT SOFT TIS NCK WO CONTR
|
Facility
|
IP
|
$2,433.00
|
|
|
Service Code
|
CPT 70490
|
| Hospital Charge Code |
909201909
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$486.60 |
| Max. Negotiated Rate |
$2,189.70 |
| Rate for Payer: Adventist Health Commercial |
$486.60
|
| Rate for Payer: Cash Price |
$1,338.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,946.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$973.20
|
| Rate for Payer: EPIC Health Plan Senior |
$973.20
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$1,622.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$926.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,506.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$486.60
|
| Rate for Payer: Multiplan Commercial |
$1,824.75
|
| Rate for Payer: Networks By Design Commercial |
$1,581.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,068.05
|
|
|
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 |
$1,338.15
|
| Rate for Payer: Cash Price |
$1,338.15
|
| Rate for Payer: Cash Price |
$1,338.15
|
| 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 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 |
$1,796.30
|
| Rate for Payer: Cash Price |
$1,796.30
|
| Rate for Payer: Cash Price |
$1,796.30
|
| 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
|
$3,266.00
|
|
|
Service Code
|
CPT 70492
|
| Hospital Charge Code |
909201911
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$653.20 |
| Max. Negotiated Rate |
$2,939.40 |
| Rate for Payer: Adventist Health Commercial |
$653.20
|
| Rate for Payer: Cash Price |
$1,796.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,612.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,306.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,306.40
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$2,178.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,244.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,021.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$653.20
|
| Rate for Payer: Multiplan Commercial |
$2,449.50
|
| Rate for Payer: Networks By Design Commercial |
$2,122.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,776.10
|
|
|
HC CT STEREOTACTIC LOCALIZATION
|
Facility
|
IP
|
$1,578.00
|
|
|
Service Code
|
CPT 77011
|
| Hospital Charge Code |
909001159
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$315.60 |
| Max. Negotiated Rate |
$1,420.20 |
| Rate for Payer: Adventist Health Commercial |
$315.60
|
| Rate for Payer: Cash Price |
$867.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,262.40
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$1,052.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$601.22
|
| 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: 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
|
|
|
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 |
$867.90
|
| Rate for Payer: Cash Price |
$867.90
|
| Rate for Payer: Cash Price |
$867.90
|
| 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 |
$223.30
|
| Rate for Payer: Cash Price |
$223.30
|
| Rate for Payer: Cash Price |
$223.30
|
| 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 |
$223.30
|
| 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 |
$1,387.65
|
| Rate for Payer: Cash Price |
$1,387.65
|
| Rate for Payer: Cash Price |
$1,387.65
|
| 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
|
$2,523.00
|
|
|
Service Code
|
CPT 72129
|
| Hospital Charge Code |
909201918
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$504.60 |
| Max. Negotiated Rate |
$2,270.70 |
| Rate for Payer: Adventist Health Commercial |
$504.60
|
| Rate for Payer: Cash Price |
$1,387.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,018.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,009.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,009.20
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$1,682.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$961.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,561.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$504.60
|
| Rate for Payer: Multiplan Commercial |
$1,892.25
|
| Rate for Payer: Networks By Design Commercial |
$1,639.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,144.55
|
|
|
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 |
$1,402.50
|
| Rate for Payer: Cash Price |
$1,402.50
|
| Rate for Payer: Cash Price |
$1,402.50
|
| 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 WO CONTRAST
|
Facility
|
IP
|
$2,550.00
|
|
|
Service Code
|
CPT 72128
|
| Hospital Charge Code |
909201917
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$510.00 |
| Max. Negotiated Rate |
$2,295.00 |
| Rate for Payer: Adventist Health Commercial |
$510.00
|
| Rate for Payer: Cash Price |
$1,402.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,040.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,020.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,020.00
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$1,700.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$971.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,578.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$510.00
|
| Rate for Payer: Multiplan Commercial |
$1,912.50
|
| Rate for Payer: Networks By Design Commercial |
$1,657.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,167.50
|
|
