|
HC CT GUID RAD THERAPY
|
Facility
|
IP
|
$2,916.00
|
|
|
Service Code
|
CPT 77014
|
| Hospital Charge Code |
909100165
|
|
Hospital Revenue Code
|
359
|
| Min. Negotiated Rate |
$583.20 |
| Max. Negotiated Rate |
$2,624.40 |
| Rate for Payer: Cash Price |
$1,312.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,332.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.40
|
| Rate for Payer: Galaxy Health WC |
$2,478.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,749.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,624.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,944.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,111.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$583.20
|
| Rate for Payer: Multiplan Commercial |
$2,187.00
|
| Rate for Payer: Networks By Design Commercial |
$1,895.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,478.60
|
|
|
HC CT GUID RAD THERAPY
|
Facility
|
OP
|
$1,637.00
|
|
|
Service Code
|
CPT 77014
|
| Hospital Charge Code |
909100165
|
|
Hospital Revenue Code
|
359
|
| Min. Negotiated Rate |
$199.80 |
| 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 |
$1,391.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$900.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$900.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$564.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$688.44
|
| Rate for Payer: Blue Distinction Transplant |
$982.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,029.67
|
| Rate for Payer: Blue Shield of California EPN |
$800.49
|
| Rate for Payer: Cash Price |
$736.65
|
| Rate for Payer: Cash Price |
$736.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,309.60
|
| Rate for Payer: Cigna of CA HMO |
$1,047.68
|
| Rate for Payer: Cigna of CA PPO |
$1,211.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,391.45
|
| Rate for Payer: Dignity Health Media |
$1,391.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,391.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$654.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$654.80
|
| Rate for Payer: Galaxy Health WC |
$1,391.45
|
| Rate for Payer: Global Benefits Group Commercial |
$982.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,473.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,227.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$572.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,091.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$199.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$327.40
|
| Rate for Payer: Multiplan Commercial |
$1,227.75
|
| Rate for Payer: Networks By Design Commercial |
$1,064.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,391.45
|
| Rate for Payer: Riverside University Health System MISP |
$654.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$982.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$982.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$818.50
|
| Rate for Payer: United Healthcare All Other HMO |
$818.50
|
| Rate for Payer: United Healthcare HMO Rider |
$818.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$818.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,391.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,391.45
|
|
|
HC CT HEAD NO CONTRAST
|
Facility
|
OP
|
$3,125.00
|
|
|
Service Code
|
CPT 70450
|
| Hospital Charge Code |
909201901
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$2,812.50 |
| 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 |
$975.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,846.25
|
| Rate for Payer: Blue Distinction Transplant |
$1,875.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,931.25
|
| Rate for Payer: Blue Shield of California EPN |
$1,518.75
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$1,406.25
|
| Rate for Payer: Cash Price |
$1,406.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,500.00
|
| Rate for Payer: Cigna of CA HMO |
$2,000.00
|
| Rate for Payer: Cigna of CA PPO |
$2,312.50
|
| 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 |
$2,656.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,875.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,812.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,343.75
|
| 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 |
$2,084.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$192.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$625.00
|
| 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 |
$2,343.75
|
| Rate for Payer: Networks By Design Commercial |
$2,031.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,656.25
|
| 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 |
$1,875.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,875.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,562.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,562.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,562.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,562.50
|
| 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 HEAD NO CONTRAST
|
Facility
|
IP
|
$5,320.00
|
|
|
Service Code
|
CPT 70450
|
| Hospital Charge Code |
909201901
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,064.00 |
| Max. Negotiated Rate |
$4,788.00 |
| Rate for Payer: Cash Price |
$2,394.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,256.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,128.00
|
| Rate for Payer: Galaxy Health WC |
$4,522.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,192.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,788.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,548.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,026.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,064.00
|
| Rate for Payer: Multiplan Commercial |
$3,990.00
|
| Rate for Payer: Networks By Design Commercial |
$3,458.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,522.00
|
|
|
HC CT HEAD W CONTRAST
|
Facility
|
OP
|
$3,487.00
|
|
|
Service Code
|
CPT 70460
|
| Hospital Charge Code |
909201900
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$229.56 |
| Max. Negotiated Rate |
$3,138.30 |
| 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 |
$1,169.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,060.12
|
| Rate for Payer: Blue Distinction Transplant |
$2,092.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,154.97
|
| Rate for Payer: Blue Shield of California EPN |
$1,694.68
|
| Rate for Payer: Caremore Medicare Advantage |
$229.56
|
| Rate for Payer: Cash Price |
$1,569.15
|
| Rate for Payer: Cash Price |
$1,569.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,789.60
|
| Rate for Payer: Cigna of CA HMO |
$2,231.68
|
| Rate for Payer: Cigna of CA PPO |
$2,580.38
|
| 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 |
$2,963.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,092.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,138.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,615.25
|
| 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 |
$2,325.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$271.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$697.40
|
| 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 |
$2,615.25
|
| Rate for Payer: Networks By Design Commercial |
$2,266.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,963.95
|
| 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 |
$2,092.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,092.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,743.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,743.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,743.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,743.50
|
| 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 HEAD W CONTRAST
|
Facility
|
IP
|
$6,208.00
|
|
|
Service Code
|
CPT 70460
|
| Hospital Charge Code |
909201900
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,241.60 |
| Max. Negotiated Rate |
$5,587.20 |
| Rate for Payer: Cash Price |
$2,793.60
|
| Rate for Payer: Central Health Plan Commercial |
$4,966.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,483.20
|
| Rate for Payer: Galaxy Health WC |
$5,276.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,724.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,587.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,140.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,365.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,241.60
|
| Rate for Payer: Multiplan Commercial |
$4,656.00
|
| Rate for Payer: Networks By Design Commercial |
$4,035.20
|
| Rate for Payer: Prime Health Services Commercial |
$5,276.80
|
|
|
HC CT HEAD W/WO CONTRAS
|
Facility
|
OP
|
$3,905.00
|
|
|
Service Code
|
CPT 70470
|
| Hospital Charge Code |
909201902
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$229.56 |
| Max. Negotiated Rate |
$3,514.50 |
| 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 |
$1,459.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,307.07
|
| Rate for Payer: Blue Distinction Transplant |
$2,343.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,413.29
|
| Rate for Payer: Blue Shield of California EPN |
$1,897.83
|
| Rate for Payer: Caremore Medicare Advantage |
$229.56
|
| Rate for Payer: Cash Price |
$1,757.25
|
| Rate for Payer: Cash Price |
$1,757.25
|
| Rate for Payer: Central Health Plan Commercial |
$3,124.00
|
| Rate for Payer: Cigna of CA HMO |
$2,499.20
|
| Rate for Payer: Cigna of CA PPO |
$2,889.70
|
| 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 |
$3,319.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,343.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,514.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,928.75
|
| 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 |
$2,604.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$319.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$781.00
|
| 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 |
$2,928.75
|
| Rate for Payer: Networks By Design Commercial |
$2,538.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,319.25
|
| 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 |
$2,343.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,343.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,952.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,952.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,952.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,952.50
|
| 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 HEAD W/WO CONTRAS
|
Facility
|
IP
|
$6,450.00
|
|
|
Service Code
|
CPT 70470
|
| Hospital Charge Code |
909201902
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,290.00 |
| Max. Negotiated Rate |
$5,805.00 |
| Rate for Payer: Cash Price |
$2,902.50
|
| Rate for Payer: Central Health Plan Commercial |
$5,160.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,580.00
|
| Rate for Payer: Galaxy Health WC |
$5,482.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,870.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,805.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,302.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,457.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,290.00
|
| Rate for Payer: Multiplan Commercial |
$4,837.50
|
| Rate for Payer: Networks By Design Commercial |
$4,192.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,482.50
|
|
|
HC CT LOWER EXT W CONT
|
Facility
|
OP
|
$3,357.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
909201958
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$229.56 |
| Max. Negotiated Rate |
$3,021.30 |
| 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 |
$1,220.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,983.32
|
| Rate for Payer: Blue Distinction Transplant |
$2,014.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,074.63
|
| Rate for Payer: Blue Shield of California EPN |
$1,631.50
|
| Rate for Payer: Caremore Medicare Advantage |
$229.56
|
| Rate for Payer: Cash Price |
$1,510.65
|
| Rate for Payer: Cash Price |
$1,510.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,685.60
|
| Rate for Payer: Cigna of CA HMO |
$2,148.48
|
| Rate for Payer: Cigna of CA PPO |
$2,484.18
|
| 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 |
$2,853.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,014.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,021.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,517.75
|
| 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 |
$2,239.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$306.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$671.40
|
| 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 |
$2,517.75
|
| Rate for Payer: Networks By Design Commercial |
$2,182.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,853.45
|
| 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 |
$2,014.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,014.20
|
| 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 LOWER EXT W CONT
|
Facility
|
IP
|
$5,978.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
909201958
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,195.60 |
| Max. Negotiated Rate |
$5,380.20 |
| Rate for Payer: Cash Price |
$2,690.10
|
| Rate for Payer: Central Health Plan Commercial |
$4,782.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,391.20
|
| Rate for Payer: Galaxy Health WC |
$5,081.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,586.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,380.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,987.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,277.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,195.60
|
| Rate for Payer: Multiplan Commercial |
$4,483.50
|
| Rate for Payer: Networks By Design Commercial |
$3,885.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,081.30
|
|
|
HC CT LOWER EXT WO CONT
|
Facility
|
IP
|
$5,324.00
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
909201957
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,064.80 |
| Max. Negotiated Rate |
$4,791.60 |
| Rate for Payer: Cash Price |
$2,395.80
|
| Rate for Payer: Central Health Plan Commercial |
$4,259.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,129.60
|
| Rate for Payer: Galaxy Health WC |
$4,525.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,194.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,791.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,551.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,028.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,064.80
|
| Rate for Payer: Multiplan Commercial |
$3,993.00
|
| Rate for Payer: Networks By Design Commercial |
$3,460.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,525.40
|
|
|
HC CT LOWER EXT WO CONT
|
Facility
|
OP
|
$2,989.00
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
909201957
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$2,690.10 |
| 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 |
$1,026.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,765.90
|
| Rate for Payer: Blue Distinction Transplant |
$1,793.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,847.20
|
| Rate for Payer: Blue Shield of California EPN |
$1,452.65
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$1,345.05
|
| Rate for Payer: Cash Price |
$1,345.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,391.20
|
| Rate for Payer: Cigna of CA HMO |
$1,912.96
|
| Rate for Payer: Cigna of CA PPO |
$2,211.86
|
| 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 |
$2,540.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,793.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,690.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,241.75
|
| 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 |
$1,993.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$236.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$597.80
|
| 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 |
$2,241.75
|
| Rate for Payer: Networks By Design Commercial |
$1,942.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,540.65
|
| 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 |
$1,793.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,793.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$491.23
|
| Rate for Payer: United Healthcare All Other HMO |
$491.23
|
| Rate for Payer: United Healthcare HMO Rider |
$491.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$491.23
|
| Rate for Payer: 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 LOWR EXTR W/WO CONT
|
Facility
|
OP
|
$3,754.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
909201959
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$229.56 |
| Max. Negotiated Rate |
$3,378.60 |
| 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 |
$1,531.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,217.86
|
| Rate for Payer: Blue Distinction Transplant |
$2,252.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,319.97
|
| Rate for Payer: Blue Shield of California EPN |
$1,824.44
|
| Rate for Payer: Caremore Medicare Advantage |
$229.56
|
| Rate for Payer: Cash Price |
$1,689.30
|
| Rate for Payer: Cash Price |
$1,689.30
|
| Rate for Payer: Central Health Plan Commercial |
$3,003.20
|
| Rate for Payer: Cigna of CA HMO |
$2,402.56
|
| Rate for Payer: Cigna of CA PPO |
$2,777.96
|
| 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 |
$3,190.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,252.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,378.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,815.50
|
| 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 |
$2,503.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$359.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$750.80
|
| 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 |
$2,815.50
|
| Rate for Payer: Networks By Design Commercial |
$2,440.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,190.90
|
| 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 |
$2,252.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,252.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$855.26
|
| Rate for Payer: United Healthcare All Other HMO |
$855.26
|
| Rate for Payer: United Healthcare HMO Rider |
$855.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$855.26
|
| Rate for Payer: 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 LOWR EXTR W/WO CONT
|
Facility
|
IP
|
$6,278.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
909201959
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,255.60 |
| Max. Negotiated Rate |
$5,650.20 |
| Rate for Payer: Cash Price |
$2,825.10
|
| Rate for Payer: Central Health Plan Commercial |
$5,022.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,511.20
|
| Rate for Payer: Galaxy Health WC |
$5,336.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,766.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,650.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,187.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,391.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,255.60
|
| Rate for Payer: Multiplan Commercial |
$4,708.50
|
| Rate for Payer: Networks By Design Commercial |
$4,080.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,336.30
|
|
|
HC CTLSO AXILLARY SLING
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
CPT L1010
|
| Hospital Charge Code |
905351010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$56.70 |
| Max. Negotiated Rate |
$145.80 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$137.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$89.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$89.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$78.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$95.71
|
| Rate for Payer: Blue Distinction Transplant |
$97.20
|
| Rate for Payer: Blue Shield of California Commercial |
$121.50
|
| Rate for Payer: Blue Shield of California EPN |
$88.13
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Central Health Plan Commercial |
$129.60
|
| Rate for Payer: Cigna of CA HMO |
$113.40
|
| Rate for Payer: Cigna of CA PPO |
$113.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$137.70
|
| Rate for Payer: Dignity Health Media |
$137.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$137.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$64.80
|
| Rate for Payer: Galaxy Health WC |
$137.70
|
| Rate for Payer: Global Benefits Group Commercial |
$97.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$145.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$121.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$56.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.42
|
| Rate for Payer: Multiplan Commercial |
$121.50
|
| Rate for Payer: Networks By Design Commercial |
$81.00
|
| Rate for Payer: Prime Health Services Commercial |
$137.70
|
| Rate for Payer: Riverside University Health System MISP |
$64.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$97.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$97.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$81.00
|
| Rate for Payer: United Healthcare All Other HMO |
$81.00
|
| Rate for Payer: United Healthcare HMO Rider |
$81.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$137.70
|
| Rate for Payer: Vantage Medical Group Senior |
$137.70
|
|
|
HC CTLSO AXILLARY SLING
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
CPT L1010
|
| Hospital Charge Code |
905351010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$145.80 |
| Rate for Payer: Blue Shield of California EPN |
$86.51
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Central Health Plan Commercial |
$129.60
|
| Rate for Payer: Cigna of CA HMO |
$113.40
|
| Rate for Payer: Cigna of CA PPO |
$113.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$64.80
|
| Rate for Payer: Galaxy Health WC |
$137.70
|
| Rate for Payer: Global Benefits Group Commercial |
$97.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$145.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.40
|
| Rate for Payer: Multiplan Commercial |
$121.50
|
| Rate for Payer: Networks By Design Commercial |
$81.00
|
| Rate for Payer: Prime Health Services Commercial |
$137.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$61.17
|
| Rate for Payer: United Healthcare All Other HMO |
$59.75
|
| Rate for Payer: United Healthcare HMO Rider |
$58.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.46
|
|
|
HC CTLSO BILAT OUTRIGGER
|
Facility
|
OP
|
$367.00
|
|
|
Service Code
|
CPT L1085
|
| Hospital Charge Code |
905351085
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$128.45 |
| Max. Negotiated Rate |
$330.30 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$311.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$201.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$201.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$177.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$216.82
|
| Rate for Payer: Blue Distinction Transplant |
$220.20
|
| Rate for Payer: Blue Shield of California Commercial |
$275.25
|
| Rate for Payer: Blue Shield of California EPN |
$199.65
|
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: Central Health Plan Commercial |
$293.60
|
| Rate for Payer: Cigna of CA HMO |
$256.90
|
| Rate for Payer: Cigna of CA PPO |
$256.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$311.95
|
| Rate for Payer: Dignity Health Media |
$311.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$311.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$146.80
|
| Rate for Payer: Galaxy Health WC |
$311.95
|
| Rate for Payer: Global Benefits Group Commercial |
$220.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$330.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$275.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$128.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$244.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$150.47
|
| Rate for Payer: Multiplan Commercial |
$275.25
|
| Rate for Payer: Networks By Design Commercial |
$183.50
|
| Rate for Payer: Prime Health Services Commercial |
$311.95
|
| Rate for Payer: Riverside University Health System MISP |
$146.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$220.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$220.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$183.50
|
| Rate for Payer: United Healthcare All Other HMO |
$183.50
|
| Rate for Payer: United Healthcare HMO Rider |
$183.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$183.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$311.95
|
| Rate for Payer: Vantage Medical Group Senior |
$311.95
|
|
|
HC CTLSO BILAT OUTRIGGER
|
Facility
|
IP
|
$367.00
|
|
|
Service Code
|
CPT L1085
|
| Hospital Charge Code |
905351085
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$73.40 |
| Max. Negotiated Rate |
$330.30 |
| Rate for Payer: Blue Shield of California EPN |
$195.98
|
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: Central Health Plan Commercial |
$293.60
|
| Rate for Payer: Cigna of CA HMO |
$256.90
|
| Rate for Payer: Cigna of CA PPO |
$256.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$146.80
|
| Rate for Payer: Galaxy Health WC |
$311.95
|
| Rate for Payer: Global Benefits Group Commercial |
$220.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$330.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$244.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.40
|
| Rate for Payer: Multiplan Commercial |
$275.25
|
| Rate for Payer: Networks By Design Commercial |
$183.50
|
| Rate for Payer: Prime Health Services Commercial |
$311.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$138.58
|
| Rate for Payer: United Healthcare All Other HMO |
$135.35
|
| Rate for Payer: United Healthcare HMO Rider |
$132.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.11
|
|
|
HC CTLSO KYPHOSIS PAD
|
Facility
|
IP
|
$187.00
|
|
|
Service Code
|
CPT L1020
|
| Hospital Charge Code |
905351020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$37.40 |
| Max. Negotiated Rate |
$168.30 |
| Rate for Payer: Blue Shield of California EPN |
$99.86
|
| Rate for Payer: Cash Price |
$84.15
|
| Rate for Payer: Central Health Plan Commercial |
$149.60
|
| Rate for Payer: Cigna of CA HMO |
$130.90
|
| Rate for Payer: Cigna of CA PPO |
$130.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$74.80
|
| Rate for Payer: Galaxy Health WC |
$158.95
|
| Rate for Payer: Global Benefits Group Commercial |
$112.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$168.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$124.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.40
|
| Rate for Payer: Multiplan Commercial |
$140.25
|
| Rate for Payer: Networks By Design Commercial |
$93.50
|
| Rate for Payer: Prime Health Services Commercial |
$158.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$70.61
|
| Rate for Payer: United Healthcare All Other HMO |
$68.97
|
| Rate for Payer: United Healthcare HMO Rider |
$67.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$61.71
|
|
|
HC CTLSO KYPHOSIS PAD
|
Facility
|
OP
|
$187.00
|
|
|
Service Code
|
CPT L1020
|
| Hospital Charge Code |
905351020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$65.45 |
| Max. Negotiated Rate |
$168.30 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$158.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$102.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$102.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$90.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.48
|
| Rate for Payer: Blue Distinction Transplant |
$112.20
|
| Rate for Payer: Blue Shield of California Commercial |
$140.25
|
| Rate for Payer: Blue Shield of California EPN |
$101.73
|
| Rate for Payer: Cash Price |
$84.15
|
| Rate for Payer: Cash Price |
$84.15
|
| Rate for Payer: Central Health Plan Commercial |
$149.60
|
| Rate for Payer: Cigna of CA HMO |
$130.90
|
| Rate for Payer: Cigna of CA PPO |
$130.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$158.95
|
| Rate for Payer: Dignity Health Media |
$158.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$158.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$74.80
|
| Rate for Payer: Galaxy Health WC |
$158.95
|
| Rate for Payer: Global Benefits Group Commercial |
$112.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$168.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$140.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$65.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$124.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.67
|
| Rate for Payer: Multiplan Commercial |
$140.25
|
| Rate for Payer: Networks By Design Commercial |
$93.50
|
| Rate for Payer: Prime Health Services Commercial |
$158.95
|
| Rate for Payer: Riverside University Health System MISP |
$74.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$112.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$112.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.50
|
| Rate for Payer: United Healthcare All Other HMO |
$93.50
|
| Rate for Payer: United Healthcare HMO Rider |
$93.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$93.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$158.95
|
| Rate for Payer: Vantage Medical Group Senior |
$158.95
|
|
|
HC CTLSO KYPH PAD, FLOATING
|
Facility
|
OP
|
$342.00
|
|
|
Service Code
|
CPT L1025
|
| Hospital Charge Code |
905351025
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$119.70 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$290.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$188.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$165.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$202.05
|
| Rate for Payer: Blue Distinction Transplant |
$205.20
|
| Rate for Payer: Blue Shield of California Commercial |
$256.50
|
| Rate for Payer: Blue Shield of California EPN |
$186.05
|
| Rate for Payer: Cash Price |
$153.90
|
| Rate for Payer: Cash Price |
$153.90
|
| Rate for Payer: Central Health Plan Commercial |
$273.60
|
| Rate for Payer: Cigna of CA HMO |
$239.40
|
| Rate for Payer: Cigna of CA PPO |
$239.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$290.70
|
| Rate for Payer: Dignity Health Media |
$290.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$290.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$136.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$136.80
|
| Rate for Payer: Galaxy Health WC |
$290.70
|
| Rate for Payer: Global Benefits Group Commercial |
$205.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$307.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$256.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$119.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$228.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.22
|
| Rate for Payer: Multiplan Commercial |
$256.50
|
| Rate for Payer: Networks By Design Commercial |
$171.00
|
| Rate for Payer: Prime Health Services Commercial |
$290.70
|
| Rate for Payer: Riverside University Health System MISP |
$136.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$205.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$205.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$171.00
|
| Rate for Payer: United Healthcare All Other HMO |
$171.00
|
| Rate for Payer: United Healthcare HMO Rider |
$171.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$171.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$290.70
|
| Rate for Payer: Vantage Medical Group Senior |
$290.70
|
|
|
HC CTLSO KYPH PAD, FLOATING
|
Facility
|
IP
|
$342.00
|
|
|
Service Code
|
CPT L1025
|
| Hospital Charge Code |
905351025
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$68.40 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Blue Shield of California EPN |
$182.63
|
| Rate for Payer: Cash Price |
$153.90
|
| Rate for Payer: Central Health Plan Commercial |
$273.60
|
| Rate for Payer: Cigna of CA HMO |
$239.40
|
| Rate for Payer: Cigna of CA PPO |
$239.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$136.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$136.80
|
| Rate for Payer: Galaxy Health WC |
$290.70
|
| Rate for Payer: Global Benefits Group Commercial |
$205.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$307.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$228.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.40
|
| Rate for Payer: Multiplan Commercial |
$256.50
|
| Rate for Payer: Networks By Design Commercial |
$171.00
|
| Rate for Payer: Prime Health Services Commercial |
$290.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$129.14
|
| Rate for Payer: United Healthcare All Other HMO |
$126.13
|
| Rate for Payer: United Healthcare HMO Rider |
$123.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$112.86
|
|
|
HC CTLSO LUMBAR BOISTER PAD
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
CPT L1030
|
| Hospital Charge Code |
905351030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$18.80 |
| Max. Negotiated Rate |
$84.60 |
| Rate for Payer: Blue Shield of California EPN |
$50.20
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Central Health Plan Commercial |
$75.20
|
| Rate for Payer: Cigna of CA HMO |
$65.80
|
| Rate for Payer: Cigna of CA PPO |
$65.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$37.60
|
| Rate for Payer: Galaxy Health WC |
$79.90
|
| Rate for Payer: Global Benefits Group Commercial |
$56.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$84.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$62.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.80
|
| Rate for Payer: Multiplan Commercial |
$70.50
|
| Rate for Payer: Networks By Design Commercial |
$47.00
|
| Rate for Payer: Prime Health Services Commercial |
$79.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.49
|
| Rate for Payer: United Healthcare All Other HMO |
$34.67
|
| Rate for Payer: United Healthcare HMO Rider |
$33.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.02
|
|
|
HC CTLSO LUMBAR BOISTER PAD
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
CPT L1030
|
| Hospital Charge Code |
905351030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.90 |
| Max. Negotiated Rate |
$84.60 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$79.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$51.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$45.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.54
|
| Rate for Payer: Blue Distinction Transplant |
$56.40
|
| Rate for Payer: Blue Shield of California Commercial |
$70.50
|
| Rate for Payer: Blue Shield of California EPN |
$51.14
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Central Health Plan Commercial |
$75.20
|
| Rate for Payer: Cigna of CA HMO |
$65.80
|
| Rate for Payer: Cigna of CA PPO |
$65.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.90
|
| Rate for Payer: Dignity Health Media |
$79.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$79.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$37.60
|
| Rate for Payer: Galaxy Health WC |
$79.90
|
| Rate for Payer: Global Benefits Group Commercial |
$56.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$84.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$70.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$32.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$62.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.54
|
| Rate for Payer: Multiplan Commercial |
$70.50
|
| Rate for Payer: Networks By Design Commercial |
$47.00
|
| Rate for Payer: Prime Health Services Commercial |
$79.90
|
| Rate for Payer: Riverside University Health System MISP |
$37.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$56.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$56.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$47.00
|
| Rate for Payer: United Healthcare All Other HMO |
$47.00
|
| Rate for Payer: United Healthcare HMO Rider |
$47.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$47.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$79.90
|
| Rate for Payer: Vantage Medical Group Senior |
$79.90
|
|
|
HC CTLSO LUMBAR RIB PAD
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
CPT L1040
|
| Hospital Charge Code |
905351040
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$98.00 |
| Max. Negotiated Rate |
$252.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$238.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$154.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$135.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$165.42
|
| Rate for Payer: Blue Distinction Transplant |
$168.00
|
| Rate for Payer: Blue Shield of California Commercial |
$210.00
|
| Rate for Payer: Blue Shield of California EPN |
$152.32
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Central Health Plan Commercial |
$224.00
|
| Rate for Payer: Cigna of CA HMO |
$196.00
|
| Rate for Payer: Cigna of CA PPO |
$196.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$238.00
|
| Rate for Payer: Dignity Health Media |
$238.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$238.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$112.00
|
| Rate for Payer: Galaxy Health WC |
$238.00
|
| Rate for Payer: Global Benefits Group Commercial |
$168.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$210.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$98.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.80
|
| Rate for Payer: Multiplan Commercial |
$210.00
|
| Rate for Payer: Networks By Design Commercial |
$140.00
|
| Rate for Payer: Prime Health Services Commercial |
$238.00
|
| Rate for Payer: Riverside University Health System MISP |
$112.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$140.00
|
| Rate for Payer: United Healthcare All Other HMO |
$140.00
|
| Rate for Payer: United Healthcare HMO Rider |
$140.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$238.00
|
| Rate for Payer: Vantage Medical Group Senior |
$238.00
|
|
