|
HC CT MAXILLOFAC W CONT
|
Facility
|
IP
|
$5,098.00
|
|
|
Service Code
|
CPT 70487
|
| Hospital Charge Code |
909201907
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,019.60 |
| Max. Negotiated Rate |
$4,588.20 |
| Rate for Payer: Cash Price |
$2,294.10
|
| Rate for Payer: Central Health Plan Commercial |
$4,078.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,039.20
|
| Rate for Payer: Galaxy Health WC |
$4,333.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,058.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,588.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,400.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,942.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,019.60
|
| Rate for Payer: Multiplan Commercial |
$3,823.50
|
| Rate for Payer: Networks By Design Commercial |
$3,313.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,333.30
|
|
|
HC CT MAXILLOFAC W CONT
|
Facility
|
OP
|
$2,862.00
|
|
|
Service Code
|
CPT 70487
|
| Hospital Charge Code |
909201907
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$229.56 |
| Max. Negotiated Rate |
$2,575.80 |
| 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 |
$1,172.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,690.87
|
| Rate for Payer: Blue Distinction Transplant |
$1,717.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,768.72
|
| Rate for Payer: Blue Shield of California EPN |
$1,390.93
|
| Rate for Payer: Caremore Medicare Advantage |
$229.56
|
| Rate for Payer: Cash Price |
$1,287.90
|
| Rate for Payer: Cash Price |
$1,287.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,289.60
|
| Rate for Payer: Cigna of CA HMO |
$1,831.68
|
| Rate for Payer: Cigna of CA PPO |
$2,117.88
|
| 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 |
$2,432.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,717.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,575.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,146.50
|
| 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 |
$1,908.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$278.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$572.40
|
| 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 |
$2,146.50
|
| Rate for Payer: Networks By Design Commercial |
$1,860.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,432.70
|
| 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 |
$1,717.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,717.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,431.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,431.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,431.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,431.00
|
| 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 MAXILLOFAC W/O CO
|
Facility
|
OP
|
$2,499.00
|
|
|
Service Code
|
CPT 70486
|
| Hospital Charge Code |
909201906
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$2,364.00 |
| 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 |
$978.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,476.41
|
| Rate for Payer: Blue Distinction Transplant |
$1,499.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,544.38
|
| Rate for Payer: Blue Shield of California EPN |
$1,214.51
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$1,124.55
|
| Rate for Payer: Cash Price |
$1,124.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,999.20
|
| Rate for Payer: Cigna of CA HMO |
$1,599.36
|
| Rate for Payer: Cigna of CA PPO |
$1,849.26
|
| 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 |
$2,124.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,499.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,249.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,874.25
|
| 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 |
$1,666.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$234.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$499.80
|
| 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 |
$1,874.25
|
| Rate for Payer: Networks By Design Commercial |
$1,624.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,124.15
|
| 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 |
$1,499.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,499.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,249.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,249.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,249.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,249.50
|
| 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 MAXILLOFAC W/O CO
|
Facility
|
IP
|
$4,451.00
|
|
|
Service Code
|
CPT 70486
|
| Hospital Charge Code |
909201906
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$890.20 |
| Max. Negotiated Rate |
$4,005.90 |
| Rate for Payer: Cash Price |
$2,002.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,560.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,780.40
|
| Rate for Payer: Galaxy Health WC |
$3,783.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,670.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,005.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,968.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,695.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$890.20
|
| Rate for Payer: Multiplan Commercial |
$3,338.25
|
| Rate for Payer: Networks By Design Commercial |
$2,893.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,783.35
|
|
|
HC CT ORB/SEL/PFOSSA/EAR W CONTR
|
Facility
|
OP
|
$3,487.00
|
|
|
Service Code
|
CPT 70481
|
| Hospital Charge Code |
909201904
|
|
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 |
$1,172.71
|
| 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 |
$333.28
|
| 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 ORB/SEL/PFOSSA/EAR W CONTR
|
Facility
|
IP
|
$6,208.00
|
|
|
Service Code
|
CPT 70481
|
| Hospital Charge Code |
909201904
|
|
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 ORB/SEL/PFOSSA/EAR WO CONTR
|
Facility
|
OP
|
$3,125.00
|
|
|
Service Code
|
CPT 70480
|
| Hospital Charge Code |
909201903
|
|
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 |
$979.88
|
| 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 |
$289.45
|
| 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 ORB/SEL/PFOSSA/EAR WO CONTR
|
Facility
|
IP
|
$5,565.00
|
|
|
Service Code
|
CPT 70480
|
| Hospital Charge Code |
909201903
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,113.00 |
| Max. Negotiated Rate |
$5,008.50 |
| Rate for Payer: Cash Price |
$2,504.25
|
| Rate for Payer: Central Health Plan Commercial |
$4,452.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,226.00
|
| Rate for Payer: Galaxy Health WC |
$4,730.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,339.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,008.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,711.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,120.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,113.00
|
| Rate for Payer: Multiplan Commercial |
$4,173.75
|
| Rate for Payer: Networks By Design Commercial |
$3,617.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,730.25
|
|
|
HC CT ORB/SEL/PFOSSA/EAR W/WO CNT
|
Facility
|
OP
|
$3,842.00
|
|
|
Service Code
|
CPT 70482
|
| Hospital Charge Code |
909201905
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$229.56 |
| Max. Negotiated Rate |
$3,457.80 |
| 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 |
$1,461.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,269.85
|
| Rate for Payer: Blue Distinction Transplant |
$2,305.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,374.36
|
| Rate for Payer: Blue Shield of California EPN |
$1,867.21
|
| Rate for Payer: Caremore Medicare Advantage |
$229.56
|
| Rate for Payer: Cash Price |
$1,728.90
|
| Rate for Payer: Cash Price |
$1,728.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,073.60
|
| Rate for Payer: Cigna of CA HMO |
$2,458.88
|
| Rate for Payer: Cigna of CA PPO |
$2,843.08
|
| 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 |
$3,265.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,305.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,457.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,881.50
|
| 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 |
$2,562.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$391.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$768.40
|
| 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 |
$2,881.50
|
| Rate for Payer: Networks By Design Commercial |
$2,497.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,265.70
|
| 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 |
$2,305.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,305.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,921.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,921.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,921.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,921.00
|
| 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 ORB/SEL/PFOSSA/EAR W/WO CNT
|
Facility
|
IP
|
$6,517.00
|
|
|
Service Code
|
CPT 70482
|
| Hospital Charge Code |
909201905
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,303.40 |
| Max. Negotiated Rate |
$5,865.30 |
| Rate for Payer: Cash Price |
$2,932.65
|
| Rate for Payer: Central Health Plan Commercial |
$5,213.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,606.80
|
| Rate for Payer: Galaxy Health WC |
$5,539.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,910.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,865.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,346.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,482.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,303.40
|
| Rate for Payer: Multiplan Commercial |
$4,887.75
|
| Rate for Payer: Networks By Design Commercial |
$4,236.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,539.45
|
|
|
HC CT PERFUSION W/CONTRAST, CBF
|
Facility
|
OP
|
$4,201.00
|
|
|
Service Code
|
CPT 0042T
|
| Hospital Charge Code |
909201812
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$840.20 |
| Max. Negotiated Rate |
$3,780.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,570.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,310.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,310.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,034.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,481.95
|
| Rate for Payer: Blue Distinction Transplant |
$2,520.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,596.22
|
| Rate for Payer: Blue Shield of California EPN |
$2,041.69
|
| Rate for Payer: Cash Price |
$1,890.45
|
| Rate for Payer: Cash Price |
$1,890.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,360.80
|
| Rate for Payer: Cigna of CA HMO |
$2,688.64
|
| Rate for Payer: Cigna of CA PPO |
$3,108.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,570.85
|
| Rate for Payer: Dignity Health Media |
$3,570.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,570.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,680.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,680.40
|
| Rate for Payer: Galaxy Health WC |
$3,570.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,520.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,780.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,150.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,470.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,802.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$840.20
|
| Rate for Payer: Multiplan Commercial |
$3,150.75
|
| Rate for Payer: Networks By Design Commercial |
$2,730.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,570.85
|
| Rate for Payer: Riverside University Health System MISP |
$1,680.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,520.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,520.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,100.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,100.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,100.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,100.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,570.85
|
| Rate for Payer: Vantage Medical Group Senior |
$3,570.85
|
|
|
HC CT PERFUSION W/CONTRAST, CBF
|
Facility
|
IP
|
$6,414.00
|
|
|
Service Code
|
CPT 0042T
|
| Hospital Charge Code |
909201812
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,282.80 |
| Max. Negotiated Rate |
$5,772.60 |
| Rate for Payer: Cash Price |
$2,886.30
|
| Rate for Payer: Central Health Plan Commercial |
$5,131.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,565.60
|
| Rate for Payer: Galaxy Health WC |
$5,451.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,848.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,772.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,278.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,443.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,282.80
|
| Rate for Payer: Multiplan Commercial |
$4,810.50
|
| Rate for Payer: Networks By Design Commercial |
$4,169.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,451.90
|
|
|
HC CT RECONSTRUCTION FOR TRANSPLT
|
Facility
|
OP
|
$2,449.00
|
|
| Hospital Charge Code |
909201983
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$489.80 |
| Max. Negotiated Rate |
$2,204.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,487.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,081.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,346.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,346.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,185.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,446.87
|
| Rate for Payer: Blue Distinction Transplant |
$1,469.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,513.48
|
| Rate for Payer: Blue Shield of California EPN |
$1,190.21
|
| Rate for Payer: Cash Price |
$1,102.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,959.20
|
| Rate for Payer: Cigna of CA HMO |
$1,567.36
|
| Rate for Payer: Cigna of CA PPO |
$1,812.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,081.65
|
| Rate for Payer: Dignity Health Media |
$2,081.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,081.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$979.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$979.60
|
| Rate for Payer: Galaxy Health WC |
$2,081.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,469.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,204.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,836.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$857.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,633.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$933.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$489.80
|
| Rate for Payer: Multiplan Commercial |
$1,836.75
|
| Rate for Payer: Networks By Design Commercial |
$1,591.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,081.65
|
| Rate for Payer: Riverside University Health System MISP |
$979.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,469.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,469.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,224.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,224.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,224.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,224.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,081.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,081.65
|
|
|
HC CT RECONSTRUCTION FOR TRANSPLT
|
Facility
|
IP
|
$2,449.00
|
|
| Hospital Charge Code |
909201983
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$489.80 |
| Max. Negotiated Rate |
$2,204.10 |
| Rate for Payer: Cash Price |
$1,102.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,959.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$979.60
|
| Rate for Payer: Galaxy Health WC |
$2,081.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,469.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,204.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,633.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$933.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$489.80
|
| Rate for Payer: Multiplan Commercial |
$1,836.75
|
| Rate for Payer: Networks By Design Commercial |
$1,591.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,081.65
|
|
|
HC CT SOFT TIS NCK W CONTR
|
Facility
|
OP
|
$3,224.00
|
|
|
Service Code
|
CPT 70491
|
| Hospital Charge Code |
909201910
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$229.56 |
| Max. Negotiated Rate |
$2,901.60 |
| 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 |
$1,172.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,904.74
|
| Rate for Payer: Blue Distinction Transplant |
$1,934.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,992.43
|
| Rate for Payer: Blue Shield of California EPN |
$1,566.86
|
| Rate for Payer: Caremore Medicare Advantage |
$229.56
|
| Rate for Payer: Cash Price |
$1,450.80
|
| Rate for Payer: Cash Price |
$1,450.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,579.20
|
| Rate for Payer: Cigna of CA HMO |
$2,063.36
|
| Rate for Payer: Cigna of CA PPO |
$2,385.76
|
| 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 |
$2,740.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,934.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,901.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,418.00
|
| 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 |
$2,150.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$339.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$644.80
|
| 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 |
$2,418.00
|
| Rate for Payer: Networks By Design Commercial |
$2,095.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,740.40
|
| 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 |
$1,934.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,934.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,612.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,612.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,612.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,612.00
|
| 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 SOFT TIS NCK W CONTR
|
Facility
|
IP
|
$5,744.00
|
|
|
Service Code
|
CPT 70491
|
| Hospital Charge Code |
909201910
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,148.80 |
| Max. Negotiated Rate |
$5,169.60 |
| Rate for Payer: Cash Price |
$2,584.80
|
| Rate for Payer: Central Health Plan Commercial |
$4,595.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,297.60
|
| Rate for Payer: Galaxy Health WC |
$4,882.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,446.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,169.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,831.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,188.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,148.80
|
| Rate for Payer: Multiplan Commercial |
$4,308.00
|
| Rate for Payer: Networks By Design Commercial |
$3,733.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,882.40
|
|
|
HC CT SOFT TIS NCK WO CONTR
|
Facility
|
OP
|
$2,862.00
|
|
|
Service Code
|
CPT 70490
|
| Hospital Charge Code |
909201909
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$2,575.80 |
| 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 |
$979.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,690.87
|
| Rate for Payer: Blue Distinction Transplant |
$1,717.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,768.72
|
| Rate for Payer: Blue Shield of California EPN |
$1,390.93
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$1,287.90
|
| Rate for Payer: Cash Price |
$1,287.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,289.60
|
| Rate for Payer: Cigna of CA HMO |
$1,831.68
|
| Rate for Payer: Cigna of CA PPO |
$2,117.88
|
| 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 |
$2,432.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,717.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,575.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,146.50
|
| 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 |
$1,908.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$273.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$572.40
|
| 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 |
$2,146.50
|
| Rate for Payer: Networks By Design Commercial |
$1,860.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,432.70
|
| 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 |
$1,717.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,717.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,431.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,431.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,431.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,431.00
|
| 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 SOFT TIS NCK WO CONTR
|
Facility
|
IP
|
$5,098.00
|
|
|
Service Code
|
CPT 70490
|
| Hospital Charge Code |
909201909
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,019.60 |
| Max. Negotiated Rate |
$4,588.20 |
| Rate for Payer: Cash Price |
$2,294.10
|
| Rate for Payer: Central Health Plan Commercial |
$4,078.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,039.20
|
| Rate for Payer: Galaxy Health WC |
$4,333.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,058.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,588.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,400.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,942.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,019.60
|
| Rate for Payer: Multiplan Commercial |
$3,823.50
|
| Rate for Payer: Networks By Design Commercial |
$3,313.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,333.30
|
|
|
HC CT SOFT TISSUE NECK W/WO CNTRST
|
Facility
|
IP
|
$5,834.00
|
|
|
Service Code
|
CPT 70492
|
| Hospital Charge Code |
909201911
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,166.80 |
| Max. Negotiated Rate |
$5,250.60 |
| Rate for Payer: Cash Price |
$2,625.30
|
| Rate for Payer: Central Health Plan Commercial |
$4,667.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,333.60
|
| Rate for Payer: Galaxy Health WC |
$4,958.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,500.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,250.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,891.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,222.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,166.80
|
| Rate for Payer: Multiplan Commercial |
$4,375.50
|
| Rate for Payer: Networks By Design Commercial |
$3,792.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,958.90
|
|
|
HC CT SOFT TISSUE NECK W/WO CNTRST
|
Facility
|
OP
|
$3,842.00
|
|
|
Service Code
|
CPT 70492
|
| Hospital Charge Code |
909201911
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$229.56 |
| Max. Negotiated Rate |
$3,457.80 |
| 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 |
$1,461.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,269.85
|
| Rate for Payer: Blue Distinction Transplant |
$2,305.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,374.36
|
| Rate for Payer: Blue Shield of California EPN |
$1,867.21
|
| Rate for Payer: Caremore Medicare Advantage |
$229.56
|
| Rate for Payer: Cash Price |
$1,728.90
|
| Rate for Payer: Cash Price |
$1,728.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,073.60
|
| Rate for Payer: Cigna of CA HMO |
$2,458.88
|
| Rate for Payer: Cigna of CA PPO |
$2,843.08
|
| 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 |
$3,265.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,305.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,457.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,881.50
|
| 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 |
$2,562.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$408.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$768.40
|
| 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 |
$2,881.50
|
| Rate for Payer: Networks By Design Commercial |
$2,497.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,265.70
|
| 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 |
$2,305.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,305.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,921.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,921.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,921.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,921.00
|
| 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 STEREOTACTIC LOCALIZATION
|
Facility
|
IP
|
$2,645.00
|
|
|
Service Code
|
CPT 77011
|
| Hospital Charge Code |
909001159
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$529.00 |
| Max. Negotiated Rate |
$2,380.50 |
| Rate for Payer: Cash Price |
$1,190.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,116.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,058.00
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$1,764.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,007.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$529.00
|
| 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
|
|
|
HC CT STEREOTACTIC LOCALIZATION
|
Facility
|
OP
|
$1,856.00
|
|
|
Service Code
|
CPT 77011
|
| Hospital Charge Code |
909001159
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$371.20 |
| 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 |
$1,577.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,020.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,020.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,718.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,096.52
|
| Rate for Payer: Blue Distinction Transplant |
$1,113.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,147.01
|
| Rate for Payer: Blue Shield of California EPN |
$902.02
|
| Rate for Payer: Cash Price |
$835.20
|
| Rate for Payer: Cash Price |
$835.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,484.80
|
| Rate for Payer: Cigna of CA HMO |
$1,187.84
|
| Rate for Payer: Cigna of CA PPO |
$1,373.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,577.60
|
| Rate for Payer: Dignity Health Media |
$1,577.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,577.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$742.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$742.40
|
| Rate for Payer: Galaxy Health WC |
$1,577.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,113.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,670.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,392.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$649.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,237.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$379.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$371.20
|
| Rate for Payer: Multiplan Commercial |
$1,392.00
|
| Rate for Payer: Networks By Design Commercial |
$1,206.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,577.60
|
| Rate for Payer: Riverside University Health System MISP |
$742.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,113.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,113.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$928.00
|
| Rate for Payer: United Healthcare All Other HMO |
$928.00
|
| Rate for Payer: United Healthcare HMO Rider |
$928.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$928.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,577.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,577.60
|
|
|
HC CT, THX, LD FOR LC SCRN WO CON
|
Facility
|
OP
|
$353.00
|
|
|
Service Code
|
CPT 71271
|
| Hospital Charge Code |
909201271
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$70.60 |
| Max. Negotiated Rate |
$2,364.00 |
| 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 |
$534.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$208.55
|
| Rate for Payer: Blue Distinction Transplant |
$211.80
|
| Rate for Payer: Blue Shield of California Commercial |
$218.15
|
| Rate for Payer: Blue Shield of California EPN |
$171.56
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$158.85
|
| Rate for Payer: Cash Price |
$158.85
|
| Rate for Payer: Central Health Plan Commercial |
$282.40
|
| Rate for Payer: Cigna of CA HMO |
$225.92
|
| Rate for Payer: Cigna of CA PPO |
$261.22
|
| 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 |
$300.05
|
| Rate for Payer: Global Benefits Group Commercial |
$211.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$317.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$264.75
|
| 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 |
$235.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$250.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.60
|
| 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 |
$264.75
|
| Rate for Payer: Networks By Design Commercial |
$229.45
|
| Rate for Payer: Prime Health Services Commercial |
$300.05
|
| 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 |
$211.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$211.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$176.50
|
| Rate for Payer: United Healthcare All Other HMO |
$176.50
|
| Rate for Payer: United Healthcare HMO Rider |
$176.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$176.50
|
| 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, THX, LD FOR LC SCRN WO CON
|
Facility
|
IP
|
$353.00
|
|
|
Service Code
|
CPT 71271
|
| Hospital Charge Code |
909201271
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$70.60 |
| Max. Negotiated Rate |
$317.70 |
| Rate for Payer: Cash Price |
$158.85
|
| Rate for Payer: Central Health Plan Commercial |
$282.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$141.20
|
| Rate for Payer: Galaxy Health WC |
$300.05
|
| Rate for Payer: Global Benefits Group Commercial |
$211.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$317.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$235.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.60
|
| Rate for Payer: Multiplan Commercial |
$264.75
|
| Rate for Payer: Networks By Design Commercial |
$229.45
|
| Rate for Payer: Prime Health Services Commercial |
$300.05
|
|
|
HC CT TSPINE W CONTRAST
|
Facility
|
OP
|
$2,968.00
|
|
|
Service Code
|
CPT 72129
|
| Hospital Charge Code |
909201918
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$229.56 |
| Max. Negotiated Rate |
$2,671.20 |
| 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 |
$1,458.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,753.49
|
| Rate for Payer: Blue Distinction Transplant |
$1,780.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,834.22
|
| Rate for Payer: Blue Shield of California EPN |
$1,442.45
|
| Rate for Payer: Caremore Medicare Advantage |
$229.56
|
| Rate for Payer: Cash Price |
$1,335.60
|
| Rate for Payer: Cash Price |
$1,335.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,374.40
|
| Rate for Payer: Cigna of CA HMO |
$1,899.52
|
| Rate for Payer: Cigna of CA PPO |
$2,196.32
|
| 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 |
$2,522.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,780.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,671.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,226.00
|
| 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 |
$1,979.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$312.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$593.60
|
| 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 |
$2,226.00
|
| Rate for Payer: Networks By Design Commercial |
$1,929.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,522.80
|
| 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 |
$1,780.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,780.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$769.25
|
| Rate for Payer: United Healthcare All Other HMO |
$769.25
|
| Rate for Payer: United Healthcare HMO Rider |
$769.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$769.25
|
| Rate for Payer: 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
|
|
