|
HC CT CHEST W CONTRAST
|
Facility
|
IP
|
$5,786.00
|
|
|
Service Code
|
CPT 71260
|
| Hospital Charge Code |
909201913
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,157.20 |
| Max. Negotiated Rate |
$5,207.40 |
| Rate for Payer: Cash Price |
$2,603.70
|
| Rate for Payer: Central Health Plan Commercial |
$4,628.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,314.40
|
| Rate for Payer: Galaxy Health WC |
$4,918.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,471.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,207.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,859.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,204.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,157.20
|
| Rate for Payer: Multiplan Commercial |
$4,339.50
|
| Rate for Payer: Networks By Design Commercial |
$3,760.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,918.10
|
|
|
HC CT CHEST W/O CONTRAST
|
Facility
|
IP
|
$4,712.00
|
|
|
Service Code
|
CPT 71250
|
| Hospital Charge Code |
909201912
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$942.40 |
| Max. Negotiated Rate |
$4,240.80 |
| Rate for Payer: Cash Price |
$2,120.40
|
| Rate for Payer: Central Health Plan Commercial |
$3,769.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,884.80
|
| Rate for Payer: Galaxy Health WC |
$4,005.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,827.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,240.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,142.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,795.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$942.40
|
| Rate for Payer: Multiplan Commercial |
$3,534.00
|
| Rate for Payer: Networks By Design Commercial |
$3,062.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,005.20
|
|
|
HC CT CHEST W/O CONTRAST
|
Facility
|
OP
|
$2,645.00
|
|
|
Service Code
|
CPT 71250
|
| Hospital Charge Code |
909201912
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$2,380.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,220.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,562.67
|
| Rate for Payer: Blue Distinction Transplant |
$1,587.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,634.61
|
| Rate for Payer: Blue Shield of California EPN |
$1,285.47
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$1,190.25
|
| Rate for Payer: Cash Price |
$1,190.25
|
| Rate for Payer: Center for Health Promotion Commercial |
$145.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,116.00
|
| Rate for Payer: Cigna of CA HMO |
$1,692.80
|
| Rate for Payer: Cigna of CA PPO |
$1,957.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$2,248.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,587.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,380.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,983.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$226.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: InnovAge PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,764.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$241.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$529.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,983.75
|
| Rate for Payer: Networks By Design Commercial |
$1,719.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,248.25
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Riverside University Health System MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,587.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,587.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC CT CHEST W WO CONTRA
|
Facility
|
OP
|
$3,852.00
|
|
|
Service Code
|
CPT 71270
|
| Hospital Charge Code |
909201914
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$229.56 |
| Max. Negotiated Rate |
$3,466.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$229.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,819.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,275.76
|
| Rate for Payer: Blue Distinction Transplant |
$2,311.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,380.54
|
| Rate for Payer: Blue Shield of California EPN |
$1,872.07
|
| Rate for Payer: Caremore Medicare Advantage |
$229.56
|
| Rate for Payer: Cash Price |
$1,733.40
|
| Rate for Payer: Cash Price |
$1,733.40
|
| Rate for Payer: Central Health Plan Commercial |
$3,081.60
|
| Rate for Payer: Cigna of CA HMO |
$2,465.28
|
| Rate for Payer: Cigna of CA PPO |
$2,850.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Media |
$229.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$229.56
|
| Rate for Payer: Galaxy Health WC |
$3,274.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,311.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,466.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,889.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$376.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$378.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: InnovAge PACE Commercial |
$344.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,569.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$364.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$770.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$307.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$307.61
|
| Rate for Payer: Multiplan Commercial |
$2,889.00
|
| Rate for Payer: Networks By Design Commercial |
$2,503.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,274.20
|
| Rate for Payer: Prime Health Services Medicare |
$243.33
|
| Rate for Payer: Riverside University Health System MISP |
$252.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,311.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,311.20
|
| 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: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC CT CHEST W WO CONTRA
|
Facility
|
IP
|
$6,862.00
|
|
|
Service Code
|
CPT 71270
|
| Hospital Charge Code |
909201914
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,372.40 |
| Max. Negotiated Rate |
$6,175.80 |
| Rate for Payer: Cash Price |
$3,087.90
|
| Rate for Payer: Central Health Plan Commercial |
$5,489.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,744.80
|
| Rate for Payer: Galaxy Health WC |
$5,832.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,117.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,175.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,576.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,614.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,372.40
|
| Rate for Payer: Multiplan Commercial |
$5,146.50
|
| Rate for Payer: Networks By Design Commercial |
$4,460.30
|
| Rate for Payer: Prime Health Services Commercial |
$5,832.70
|
|
|
HC CT COLONOGRAPHY SCREEN
|
Facility
|
IP
|
$2,457.00
|
|
|
Service Code
|
CPT 74263
|
| Hospital Charge Code |
909201813
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$491.40 |
| Max. Negotiated Rate |
$2,211.30 |
| Rate for Payer: Cash Price |
$1,105.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,965.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$982.80
|
| Rate for Payer: Galaxy Health WC |
$2,088.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,474.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,211.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,638.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$936.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$491.40
|
| Rate for Payer: Multiplan Commercial |
$1,842.75
|
| Rate for Payer: Networks By Design Commercial |
$1,597.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,088.45
|
|
|
HC CT COLONOGRAPHY SCREEN
|
Facility
|
OP
|
$1,379.00
|
|
|
Service Code
|
CPT 74263
|
| Hospital Charge Code |
909201813
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$275.80 |
| Max. Negotiated Rate |
$3,306.29 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,172.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$758.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$758.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,306.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$814.71
|
| Rate for Payer: Blue Distinction Transplant |
$827.40
|
| Rate for Payer: Blue Shield of California Commercial |
$852.22
|
| Rate for Payer: Blue Shield of California EPN |
$670.19
|
| Rate for Payer: Cash Price |
$620.55
|
| Rate for Payer: Cash Price |
$620.55
|
| Rate for Payer: Center for Health Promotion Commercial |
$286.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,103.20
|
| Rate for Payer: Cigna of CA HMO |
$882.56
|
| Rate for Payer: Cigna of CA PPO |
$1,020.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,172.15
|
| Rate for Payer: Dignity Health Media |
$1,172.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,172.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$551.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$551.60
|
| Rate for Payer: Galaxy Health WC |
$1,172.15
|
| Rate for Payer: Global Benefits Group Commercial |
$827.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,241.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,034.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$482.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$919.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$275.80
|
| Rate for Payer: Multiplan Commercial |
$1,034.25
|
| Rate for Payer: Networks By Design Commercial |
$896.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,172.15
|
| Rate for Payer: Riverside University Health System MISP |
$551.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$827.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$827.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,781.07
|
| Rate for Payer: United Healthcare All Other HMO |
$1,781.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1,781.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,781.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,172.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,172.15
|
|
|
HC CT COLONOGRAPHY W/CONTRAST
|
Facility
|
IP
|
$6,603.00
|
|
|
Service Code
|
CPT 74262
|
| Hospital Charge Code |
909202000
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,320.60 |
| Max. Negotiated Rate |
$5,942.70 |
| Rate for Payer: Cash Price |
$2,971.35
|
| Rate for Payer: Central Health Plan Commercial |
$5,282.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,641.20
|
| Rate for Payer: Galaxy Health WC |
$5,612.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,961.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,942.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,404.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,515.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,320.60
|
| Rate for Payer: Multiplan Commercial |
$4,952.25
|
| Rate for Payer: Networks By Design Commercial |
$4,291.95
|
| Rate for Payer: Prime Health Services Commercial |
$5,612.55
|
|
|
HC CT COLONOGRAPHY W/CONTRAST
|
Facility
|
OP
|
$4,099.00
|
|
|
Service Code
|
CPT 74262
|
| Hospital Charge Code |
909202000
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$229.56 |
| Max. Negotiated Rate |
$3,689.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$229.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,663.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,421.69
|
| Rate for Payer: Blue Distinction Transplant |
$2,459.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,533.18
|
| Rate for Payer: Blue Shield of California EPN |
$1,992.11
|
| Rate for Payer: Caremore Medicare Advantage |
$229.56
|
| Rate for Payer: Cash Price |
$1,844.55
|
| Rate for Payer: Cash Price |
$1,844.55
|
| Rate for Payer: Center for Health Promotion Commercial |
$286.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,279.20
|
| Rate for Payer: Cigna of CA HMO |
$2,623.36
|
| Rate for Payer: Cigna of CA PPO |
$3,033.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Media |
$229.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$229.56
|
| Rate for Payer: Galaxy Health WC |
$3,484.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,459.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,689.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,074.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$376.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$378.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: InnovAge PACE Commercial |
$344.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,734.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$890.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$819.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$307.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$307.61
|
| Rate for Payer: Multiplan Commercial |
$3,074.25
|
| Rate for Payer: Networks By Design Commercial |
$2,664.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,484.15
|
| Rate for Payer: Prime Health Services Medicare |
$243.33
|
| Rate for Payer: Riverside University Health System MISP |
$252.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,459.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,459.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$769.25
|
| Rate for Payer: United Healthcare All Other HMO |
$769.25
|
| Rate for Payer: United Healthcare HMO Rider |
$769.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$769.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC CT COLONOGRAPHY W/O CONTRAST
|
Facility
|
OP
|
$3,707.00
|
|
|
Service Code
|
CPT 74261
|
| Hospital Charge Code |
909201811
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$3,336.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,093.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,190.10
|
| Rate for Payer: Blue Distinction Transplant |
$2,224.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,290.93
|
| Rate for Payer: Blue Shield of California EPN |
$1,801.60
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$1,668.15
|
| Rate for Payer: Cash Price |
$1,668.15
|
| Rate for Payer: Center for Health Promotion Commercial |
$145.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,965.60
|
| Rate for Payer: Cigna of CA HMO |
$2,372.48
|
| Rate for Payer: Cigna of CA PPO |
$2,743.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$3,150.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,224.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,336.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,780.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$226.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: InnovAge PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,472.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$786.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$741.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$2,780.25
|
| Rate for Payer: Networks By Design Commercial |
$2,409.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,150.95
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Riverside University Health System MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,224.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,224.20
|
| 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: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC CT COLONOGRAPHY W/O CONTRAST
|
Facility
|
IP
|
$5,842.00
|
|
|
Service Code
|
CPT 74261
|
| Hospital Charge Code |
909201811
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,168.40 |
| Max. Negotiated Rate |
$5,257.80 |
| Rate for Payer: Cash Price |
$2,628.90
|
| Rate for Payer: Central Health Plan Commercial |
$4,673.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,336.80
|
| Rate for Payer: Galaxy Health WC |
$4,965.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,505.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,257.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,896.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,225.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,168.40
|
| Rate for Payer: Multiplan Commercial |
$4,381.50
|
| Rate for Payer: Networks By Design Commercial |
$3,797.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,965.70
|
|
|
HC CT CSPINE WITH CONTRAST
|
Facility
|
IP
|
$6,055.00
|
|
|
Service Code
|
CPT 72126
|
| Hospital Charge Code |
909201916
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,211.00 |
| Max. Negotiated Rate |
$5,449.50 |
| Rate for Payer: Cash Price |
$2,724.75
|
| Rate for Payer: Central Health Plan Commercial |
$4,844.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,422.00
|
| Rate for Payer: Galaxy Health WC |
$5,146.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,633.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,449.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,038.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,306.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,211.00
|
| Rate for Payer: Multiplan Commercial |
$4,541.25
|
| Rate for Payer: Networks By Design Commercial |
$3,935.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,146.75
|
|
|
HC CT CSPINE WITH CONTRAST
|
Facility
|
OP
|
$3,399.00
|
|
|
Service Code
|
CPT 72126
|
| Hospital Charge Code |
909201916
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$309.85 |
| Max. Negotiated Rate |
$3,059.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$480.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,458.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,008.13
|
| Rate for Payer: Blue Distinction Transplant |
$2,039.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,100.58
|
| Rate for Payer: Blue Shield of California EPN |
$1,651.91
|
| Rate for Payer: Caremore Medicare Advantage |
$480.50
|
| Rate for Payer: Cash Price |
$1,529.55
|
| Rate for Payer: Cash Price |
$1,529.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,719.20
|
| Rate for Payer: Cigna of CA HMO |
$2,175.36
|
| Rate for Payer: Cigna of CA PPO |
$2,515.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: Dignity Health Media |
$480.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$480.50
|
| Rate for Payer: Galaxy Health WC |
$2,889.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,039.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,059.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,549.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$788.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$792.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$480.50
|
| Rate for Payer: InnovAge PACE Commercial |
$720.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,267.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$309.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$679.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.87
|
| Rate for Payer: Multiplan Commercial |
$2,549.25
|
| Rate for Payer: Networks By Design Commercial |
$2,209.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,889.15
|
| Rate for Payer: Prime Health Services Medicare |
$509.33
|
| Rate for Payer: Riverside University Health System MISP |
$528.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,039.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,039.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$769.25
|
| Rate for Payer: United Healthcare All Other HMO |
$769.25
|
| Rate for Payer: United Healthcare HMO Rider |
$769.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$769.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC CT CSPINE WO CONTRAST
|
Facility
|
IP
|
$5,624.00
|
|
|
Service Code
|
CPT 72125
|
| Hospital Charge Code |
909201915
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,124.80 |
| Max. Negotiated Rate |
$5,061.60 |
| Rate for Payer: Cash Price |
$2,530.80
|
| Rate for Payer: Central Health Plan Commercial |
$4,499.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,249.60
|
| Rate for Payer: Galaxy Health WC |
$4,780.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,374.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,061.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,751.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,142.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,124.80
|
| Rate for Payer: Multiplan Commercial |
$4,218.00
|
| Rate for Payer: Networks By Design Commercial |
$3,655.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,780.40
|
|
|
HC CT CSPINE WO CONTRAST
|
Facility
|
OP
|
$3,158.00
|
|
|
Service Code
|
CPT 72125
|
| Hospital Charge Code |
909201915
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$2,842.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,220.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,865.75
|
| Rate for Payer: Blue Distinction Transplant |
$1,894.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,951.64
|
| Rate for Payer: Blue Shield of California EPN |
$1,534.79
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$1,421.10
|
| Rate for Payer: Cash Price |
$1,421.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,526.40
|
| Rate for Payer: Cigna of CA HMO |
$2,021.12
|
| Rate for Payer: Cigna of CA PPO |
$2,336.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$2,684.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,894.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,842.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,368.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$226.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: InnovAge PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,106.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$237.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$631.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$2,368.50
|
| Rate for Payer: Networks By Design Commercial |
$2,052.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,684.30
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Riverside University Health System MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,894.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,894.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$491.23
|
| Rate for Payer: United Healthcare All Other HMO |
$491.23
|
| Rate for Payer: United Healthcare HMO Rider |
$491.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$491.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC CT C SPINE W/WO CONTRAST
|
Facility
|
OP
|
$3,550.00
|
|
|
Service Code
|
CPT 72127
|
| Hospital Charge Code |
909201967
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$229.56 |
| Max. Negotiated Rate |
$3,195.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$229.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,817.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,097.34
|
| Rate for Payer: Blue Distinction Transplant |
$2,130.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,193.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,725.30
|
| Rate for Payer: Caremore Medicare Advantage |
$229.56
|
| Rate for Payer: Cash Price |
$1,597.50
|
| Rate for Payer: Cash Price |
$1,597.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,840.00
|
| Rate for Payer: Cigna of CA HMO |
$2,272.00
|
| Rate for Payer: Cigna of CA PPO |
$2,627.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Media |
$229.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$229.56
|
| Rate for Payer: Galaxy Health WC |
$3,017.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,130.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,195.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,662.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$376.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$378.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: InnovAge PACE Commercial |
$344.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,367.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$365.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$710.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$307.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$307.61
|
| Rate for Payer: Multiplan Commercial |
$2,662.50
|
| Rate for Payer: Networks By Design Commercial |
$2,307.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,017.50
|
| Rate for Payer: Prime Health Services Medicare |
$243.33
|
| Rate for Payer: Riverside University Health System MISP |
$252.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,130.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,130.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC CT C SPINE W/WO CONTRAST
|
Facility
|
IP
|
$6,357.00
|
|
|
Service Code
|
CPT 72127
|
| Hospital Charge Code |
909201967
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,271.40 |
| Max. Negotiated Rate |
$5,721.30 |
| Rate for Payer: Cash Price |
$2,860.65
|
| Rate for Payer: Central Health Plan Commercial |
$5,085.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,542.80
|
| Rate for Payer: Galaxy Health WC |
$5,403.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,814.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,721.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,240.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,422.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,271.40
|
| Rate for Payer: Multiplan Commercial |
$4,767.75
|
| Rate for Payer: Networks By Design Commercial |
$4,132.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,403.45
|
|
|
HC CT GUID ABCESS DRAIN
|
Facility
|
OP
|
$2,187.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
909201944
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$198.59 |
| Max. Negotiated Rate |
$2,364.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,858.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,202.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,202.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$651.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,292.08
|
| Rate for Payer: Blue Distinction Transplant |
$1,312.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,351.57
|
| Rate for Payer: Blue Shield of California EPN |
$1,062.88
|
| Rate for Payer: Cash Price |
$984.15
|
| Rate for Payer: Cash Price |
$984.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,749.60
|
| Rate for Payer: Cigna of CA HMO |
$1,399.68
|
| Rate for Payer: Cigna of CA PPO |
$1,618.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,858.95
|
| Rate for Payer: Dignity Health Media |
$1,858.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,858.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$874.80
|
| Rate for Payer: Galaxy Health WC |
$1,858.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,312.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,968.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,640.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$765.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,458.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$437.40
|
| Rate for Payer: Multiplan Commercial |
$1,640.25
|
| Rate for Payer: Networks By Design Commercial |
$1,421.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,858.95
|
| Rate for Payer: Riverside University Health System MISP |
$874.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,312.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,312.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,093.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,093.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,093.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,858.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,858.95
|
|
|
HC CT GUID ABCESS DRAIN
|
Facility
|
IP
|
$2,187.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
909201944
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$437.40 |
| Max. Negotiated Rate |
$1,968.30 |
| Rate for Payer: Cash Price |
$984.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,749.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.80
|
| Rate for Payer: Galaxy Health WC |
$1,858.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,312.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,968.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,458.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$833.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$437.40
|
| Rate for Payer: Multiplan Commercial |
$1,640.25
|
| Rate for Payer: Networks By Design Commercial |
$1,421.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,858.95
|
|
|
HC CT GUIDANCE/NEEDLE PLACEMENT
|
Facility
|
IP
|
$4,461.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
909201935
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$892.20 |
| Max. Negotiated Rate |
$4,014.90 |
| Rate for Payer: Cash Price |
$2,007.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,568.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,784.40
|
| Rate for Payer: Galaxy Health WC |
$3,791.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,676.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,014.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,975.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,699.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$892.20
|
| Rate for Payer: Multiplan Commercial |
$3,345.75
|
| Rate for Payer: Networks By Design Commercial |
$2,899.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,791.85
|
|
|
HC CT GUIDANCE/NEEDLE PLACEMENT
|
Facility
|
IP
|
$4,461.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
909201935
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$892.20 |
| Max. Negotiated Rate |
$4,014.90 |
| Rate for Payer: Cash Price |
$2,007.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,568.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,784.40
|
| Rate for Payer: Galaxy Health WC |
$3,791.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,676.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,014.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,975.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,699.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$892.20
|
| Rate for Payer: Multiplan Commercial |
$3,345.75
|
| Rate for Payer: Networks By Design Commercial |
$2,899.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,791.85
|
|
|
HC CT GUIDANCE/NEEDLE PLACEMENT
|
Facility
|
OP
|
$4,461.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
909201935
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$211.00 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,791.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,453.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,453.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,708.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,635.56
|
| Rate for Payer: Blue Distinction Transplant |
$2,676.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$2,007.45
|
| Rate for Payer: Cash Price |
$2,007.45
|
| Rate for Payer: Cash Price |
$2,007.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,568.80
|
| Rate for Payer: Cigna of CA PPO |
$3,301.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,791.85
|
| Rate for Payer: Dignity Health Media |
$3,791.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,791.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,784.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,784.40
|
| Rate for Payer: Galaxy Health WC |
$3,791.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,676.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,014.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,345.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,561.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,975.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$211.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$892.20
|
| Rate for Payer: Multiplan Commercial |
$3,345.75
|
| Rate for Payer: Networks By Design Commercial |
$2,899.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,791.85
|
| Rate for Payer: Riverside University Health System MISP |
$1,784.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,676.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,230.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,230.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,230.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,230.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,791.85
|
| Rate for Payer: Vantage Medical Group Senior |
$3,791.85
|
|
|
HC CT GUIDANCE/NEEDLE PLACEMENT
|
Facility
|
OP
|
$4,461.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
909201935
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$211.00 |
| Max. Negotiated Rate |
$4,014.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,791.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,453.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,453.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,708.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,635.56
|
| Rate for Payer: Blue Distinction Transplant |
$2,676.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,756.90
|
| Rate for Payer: Blue Shield of California EPN |
$2,168.05
|
| Rate for Payer: Cash Price |
$2,007.45
|
| Rate for Payer: Cash Price |
$2,007.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,568.80
|
| Rate for Payer: Cigna of CA HMO |
$2,855.04
|
| Rate for Payer: Cigna of CA PPO |
$3,301.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,791.85
|
| Rate for Payer: Dignity Health Media |
$3,791.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,791.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,784.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,784.40
|
| Rate for Payer: Galaxy Health WC |
$3,791.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,676.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,014.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,345.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,561.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,975.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$211.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$892.20
|
| Rate for Payer: Multiplan Commercial |
$3,345.75
|
| Rate for Payer: Networks By Design Commercial |
$2,899.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,791.85
|
| Rate for Payer: Riverside University Health System MISP |
$1,784.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,676.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,676.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,230.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,230.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,230.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,230.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,791.85
|
| Rate for Payer: Vantage Medical Group Senior |
$3,791.85
|
|
|
HC CT GUIDNC VISCERAL TISS ABLATN
|
Facility
|
IP
|
$11,296.00
|
|
|
Service Code
|
CPT 77013
|
| Hospital Charge Code |
909201810
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,259.20 |
| Max. Negotiated Rate |
$10,166.40 |
| Rate for Payer: Cash Price |
$5,083.20
|
| Rate for Payer: Central Health Plan Commercial |
$9,036.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,518.40
|
| Rate for Payer: Galaxy Health WC |
$9,601.60
|
| Rate for Payer: Global Benefits Group Commercial |
$6,777.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,166.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,534.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,303.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,259.20
|
| Rate for Payer: Multiplan Commercial |
$8,472.00
|
| Rate for Payer: Networks By Design Commercial |
$7,342.40
|
| Rate for Payer: Prime Health Services Commercial |
$9,601.60
|
|
|
HC CT GUIDNC VISCERAL TISS ABLATN
|
Facility
|
OP
|
$7,926.00
|
|
|
Service Code
|
CPT 77013
|
| Hospital Charge Code |
909201810
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$305.56 |
| Max. Negotiated Rate |
$7,133.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,737.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,359.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,359.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,794.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,682.68
|
| Rate for Payer: Blue Distinction Transplant |
$4,755.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,898.27
|
| Rate for Payer: Blue Shield of California EPN |
$3,852.04
|
| Rate for Payer: Cash Price |
$3,566.70
|
| Rate for Payer: Cash Price |
$3,566.70
|
| Rate for Payer: Central Health Plan Commercial |
$6,340.80
|
| Rate for Payer: Cigna of CA HMO |
$5,072.64
|
| Rate for Payer: Cigna of CA PPO |
$5,865.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,737.10
|
| Rate for Payer: Dignity Health Media |
$6,737.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,737.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,170.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,170.40
|
| Rate for Payer: Galaxy Health WC |
$6,737.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,755.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,133.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,944.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,774.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,286.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$305.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,585.20
|
| Rate for Payer: Multiplan Commercial |
$5,944.50
|
| Rate for Payer: Networks By Design Commercial |
$5,151.90
|
| Rate for Payer: Prime Health Services Commercial |
$6,737.10
|
| Rate for Payer: Riverside University Health System MISP |
$3,170.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,755.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,755.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,963.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,963.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,963.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,963.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,737.10
|
| Rate for Payer: Vantage Medical Group Senior |
$6,737.10
|
|
