|
HC CMRI MORPH/FUNCT W+W/O CONT
|
Facility
|
OP
|
$4,694.00
|
|
|
Service Code
|
CPT 75561
|
| Hospital Charge Code |
908801270
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$480.50 |
| Max. Negotiated Rate |
$3,989.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,328.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,796.69
|
| Rate for Payer: Blue Distinction Transplant |
$2,816.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,774.15
|
| Rate for Payer: Blue Shield of California EPN |
$2,201.49
|
| Rate for Payer: Cash Price |
$2,112.30
|
| Rate for Payer: Cash Price |
$2,112.30
|
| Rate for Payer: Cigna of CA HMO |
$3,004.16
|
| Rate for Payer: Cigna of CA PPO |
$3,473.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: Dignity Health Media |
$480.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$480.50
|
| Rate for Payer: Galaxy Health WC |
$3,989.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,816.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,520.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$788.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$788.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$778.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$778.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$480.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,130.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$685.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,126.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$605.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.87
|
| Rate for Payer: Multiplan Commercial |
$3,755.20
|
| Rate for Payer: Networks By Design Commercial |
$3,051.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,989.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,816.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,816.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,367.12
|
| Rate for Payer: United Healthcare All Other HMO |
$1,367.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1,367.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,367.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC CMRI MORPH/FUNCT W+W/O CONT
|
Facility
|
IP
|
$8,885.00
|
|
|
Service Code
|
CPT 75561
|
| Hospital Charge Code |
908801270
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,132.40 |
| Max. Negotiated Rate |
$7,552.25 |
| Rate for Payer: Cash Price |
$3,998.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,554.00
|
| Rate for Payer: Galaxy Health WC |
$7,552.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,331.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,926.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,385.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,132.40
|
| Rate for Payer: Multiplan Commercial |
$7,108.00
|
| Rate for Payer: Networks By Design Commercial |
$5,775.25
|
| Rate for Payer: Prime Health Services Commercial |
$7,552.25
|
|
|
HC CMRI W FLOW/VEL QUANT W/O CONT
|
Facility
|
OP
|
$1,027.00
|
|
| Hospital Charge Code |
908801261
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$246.48 |
| Max. Negotiated Rate |
$872.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$673.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$872.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$564.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$564.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$611.89
|
| Rate for Payer: Blue Distinction Transplant |
$616.20
|
| Rate for Payer: Blue Shield of California Commercial |
$606.96
|
| Rate for Payer: Blue Shield of California EPN |
$481.66
|
| Rate for Payer: Cash Price |
$462.15
|
| Rate for Payer: Cigna of CA HMO |
$657.28
|
| Rate for Payer: Cigna of CA PPO |
$759.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$872.95
|
| Rate for Payer: Dignity Health Media |
$872.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$872.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$410.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$410.80
|
| Rate for Payer: Galaxy Health WC |
$872.95
|
| Rate for Payer: Global Benefits Group Commercial |
$616.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$770.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$685.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$391.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.48
|
| Rate for Payer: Multiplan Commercial |
$821.60
|
| Rate for Payer: Networks By Design Commercial |
$667.55
|
| Rate for Payer: Prime Health Services Commercial |
$872.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$616.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$616.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$513.50
|
| Rate for Payer: United Healthcare All Other HMO |
$513.50
|
| Rate for Payer: United Healthcare HMO Rider |
$513.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$513.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$872.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$872.95
|
| Rate for Payer: Vantage Medical Group Senior |
$872.95
|
|
|
HC CMRI W FLOW/VEL QUANT W/O CONT
|
Facility
|
IP
|
$1,027.00
|
|
| Hospital Charge Code |
908801261
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$246.48 |
| Max. Negotiated Rate |
$872.95 |
| Rate for Payer: Cash Price |
$462.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$410.80
|
| Rate for Payer: Galaxy Health WC |
$872.95
|
| Rate for Payer: Global Benefits Group Commercial |
$616.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$685.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$391.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.48
|
| Rate for Payer: Multiplan Commercial |
$821.60
|
| Rate for Payer: Networks By Design Commercial |
$667.55
|
| Rate for Payer: Prime Health Services Commercial |
$872.95
|
|
|
HC CMRI W FLOW/VEL QUANT W+W/O CO
|
Facility
|
IP
|
$1,027.00
|
|
| Hospital Charge Code |
908801271
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$246.48 |
| Max. Negotiated Rate |
$872.95 |
| Rate for Payer: Cash Price |
$462.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$410.80
|
| Rate for Payer: Galaxy Health WC |
$872.95
|
| Rate for Payer: Global Benefits Group Commercial |
$616.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$685.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$391.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.48
|
| Rate for Payer: Multiplan Commercial |
$821.60
|
| Rate for Payer: Networks By Design Commercial |
$667.55
|
| Rate for Payer: Prime Health Services Commercial |
$872.95
|
|
|
HC CMRI W FLOW/VEL QUANT W+W/O CO
|
Facility
|
OP
|
$1,027.00
|
|
| Hospital Charge Code |
908801271
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$246.48 |
| Max. Negotiated Rate |
$872.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$673.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$872.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$564.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$564.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$611.89
|
| Rate for Payer: Blue Distinction Transplant |
$616.20
|
| Rate for Payer: Blue Shield of California Commercial |
$606.96
|
| Rate for Payer: Blue Shield of California EPN |
$481.66
|
| Rate for Payer: Cash Price |
$462.15
|
| Rate for Payer: Cigna of CA HMO |
$657.28
|
| Rate for Payer: Cigna of CA PPO |
$759.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$872.95
|
| Rate for Payer: Dignity Health Media |
$872.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$872.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$410.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$410.80
|
| Rate for Payer: Galaxy Health WC |
$872.95
|
| Rate for Payer: Global Benefits Group Commercial |
$616.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$770.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$685.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$391.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.48
|
| Rate for Payer: Multiplan Commercial |
$821.60
|
| Rate for Payer: Networks By Design Commercial |
$667.55
|
| Rate for Payer: Prime Health Services Commercial |
$872.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$616.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$616.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$513.50
|
| Rate for Payer: United Healthcare All Other HMO |
$513.50
|
| Rate for Payer: United Healthcare HMO Rider |
$513.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$513.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$872.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$872.95
|
| Rate for Payer: Vantage Medical Group Senior |
$872.95
|
|
|
HC CMRI W FLOW/VEL+STRESS W/O CON
|
Facility
|
IP
|
$1,027.00
|
|
| Hospital Charge Code |
908801263
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$246.48 |
| Max. Negotiated Rate |
$872.95 |
| Rate for Payer: Cash Price |
$462.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$410.80
|
| Rate for Payer: Galaxy Health WC |
$872.95
|
| Rate for Payer: Global Benefits Group Commercial |
$616.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$685.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$391.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.48
|
| Rate for Payer: Multiplan Commercial |
$821.60
|
| Rate for Payer: Networks By Design Commercial |
$667.55
|
| Rate for Payer: Prime Health Services Commercial |
$872.95
|
|
|
HC CMRI W FLOW/VEL+STRESS W/O CON
|
Facility
|
OP
|
$1,027.00
|
|
| Hospital Charge Code |
908801263
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$246.48 |
| Max. Negotiated Rate |
$872.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$673.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$872.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$564.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$564.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$611.89
|
| Rate for Payer: Blue Distinction Transplant |
$616.20
|
| Rate for Payer: Blue Shield of California Commercial |
$606.96
|
| Rate for Payer: Blue Shield of California EPN |
$481.66
|
| Rate for Payer: Cash Price |
$462.15
|
| Rate for Payer: Cigna of CA HMO |
$657.28
|
| Rate for Payer: Cigna of CA PPO |
$759.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$872.95
|
| Rate for Payer: Dignity Health Media |
$872.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$872.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$410.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$410.80
|
| Rate for Payer: Galaxy Health WC |
$872.95
|
| Rate for Payer: Global Benefits Group Commercial |
$616.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$770.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$685.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$391.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.48
|
| Rate for Payer: Multiplan Commercial |
$821.60
|
| Rate for Payer: Networks By Design Commercial |
$667.55
|
| Rate for Payer: Prime Health Services Commercial |
$872.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$616.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$616.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$513.50
|
| Rate for Payer: United Healthcare All Other HMO |
$513.50
|
| Rate for Payer: United Healthcare HMO Rider |
$513.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$513.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$872.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$872.95
|
| Rate for Payer: Vantage Medical Group Senior |
$872.95
|
|
|
HC CMRI W FLOW/VEL+STRESS W+W/O C
|
Facility
|
OP
|
$1,027.00
|
|
| Hospital Charge Code |
908801273
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$246.48 |
| Max. Negotiated Rate |
$872.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$673.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$872.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$564.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$564.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$611.89
|
| Rate for Payer: Blue Distinction Transplant |
$616.20
|
| Rate for Payer: Blue Shield of California Commercial |
$606.96
|
| Rate for Payer: Blue Shield of California EPN |
$481.66
|
| Rate for Payer: Cash Price |
$462.15
|
| Rate for Payer: Cigna of CA HMO |
$657.28
|
| Rate for Payer: Cigna of CA PPO |
$759.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$872.95
|
| Rate for Payer: Dignity Health Media |
$872.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$872.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$410.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$410.80
|
| Rate for Payer: Galaxy Health WC |
$872.95
|
| Rate for Payer: Global Benefits Group Commercial |
$616.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$770.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$685.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$391.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.48
|
| Rate for Payer: Multiplan Commercial |
$821.60
|
| Rate for Payer: Networks By Design Commercial |
$667.55
|
| Rate for Payer: Prime Health Services Commercial |
$872.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$616.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$616.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$513.50
|
| Rate for Payer: United Healthcare All Other HMO |
$513.50
|
| Rate for Payer: United Healthcare HMO Rider |
$513.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$513.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$872.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$872.95
|
| Rate for Payer: Vantage Medical Group Senior |
$872.95
|
|
|
HC CMRI W FLOW/VEL+STRESS W+W/O C
|
Facility
|
IP
|
$1,027.00
|
|
| Hospital Charge Code |
908801273
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$246.48 |
| Max. Negotiated Rate |
$872.95 |
| Rate for Payer: Cash Price |
$462.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$410.80
|
| Rate for Payer: Galaxy Health WC |
$872.95
|
| Rate for Payer: Global Benefits Group Commercial |
$616.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$685.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$391.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.48
|
| Rate for Payer: Multiplan Commercial |
$821.60
|
| Rate for Payer: Networks By Design Commercial |
$667.55
|
| Rate for Payer: Prime Health Services Commercial |
$872.95
|
|
|
HC CMRI W STRESS W/O CONT
|
Facility
|
IP
|
$7,409.00
|
|
|
Service Code
|
CPT 75559
|
| Hospital Charge Code |
908801262
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,778.16 |
| Max. Negotiated Rate |
$6,297.65 |
| Rate for Payer: Cash Price |
$3,334.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,963.60
|
| Rate for Payer: Galaxy Health WC |
$6,297.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,445.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,941.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,822.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,778.16
|
| Rate for Payer: Multiplan Commercial |
$5,927.20
|
| Rate for Payer: Networks By Design Commercial |
$4,815.85
|
| Rate for Payer: Prime Health Services Commercial |
$6,297.65
|
|
|
HC CMRI W STRESS W/O CONT
|
Facility
|
OP
|
$4,332.00
|
|
|
Service Code
|
CPT 75559
|
| Hospital Charge Code |
908801262
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$689.28 |
| Max. Negotiated Rate |
$3,682.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,328.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$689.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,581.01
|
| Rate for Payer: Blue Distinction Transplant |
$2,599.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,560.21
|
| Rate for Payer: Blue Shield of California EPN |
$2,031.71
|
| Rate for Payer: Cash Price |
$1,949.40
|
| Rate for Payer: Cash Price |
$1,949.40
|
| Rate for Payer: Cigna of CA HMO |
$2,772.48
|
| Rate for Payer: Cigna of CA PPO |
$3,205.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Dignity Health Media |
$689.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$758.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$930.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$689.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$689.28
|
| Rate for Payer: Galaxy Health WC |
$3,682.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,599.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,249.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,130.42
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,130.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,116.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,116.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$689.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,889.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,650.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$689.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,039.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$868.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$923.64
|
| Rate for Payer: Multiplan Commercial |
$3,465.60
|
| Rate for Payer: Networks By Design Commercial |
$2,815.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,682.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,599.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,599.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| Rate for Payer: United Healthcare All Other HMO |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: Vantage Medical Group Senior |
$689.28
|
|
|
HC CMRI W STRESS W+W/O CONT
|
Facility
|
OP
|
$5,088.00
|
|
|
Service Code
|
CPT 75563
|
| Hospital Charge Code |
908801272
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,000.40 |
| Max. Negotiated Rate |
$4,324.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,328.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,000.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,031.43
|
| Rate for Payer: Blue Distinction Transplant |
$3,052.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,007.01
|
| Rate for Payer: Blue Shield of California EPN |
$2,386.27
|
| Rate for Payer: Cash Price |
$2,289.60
|
| Rate for Payer: Cash Price |
$2,289.60
|
| Rate for Payer: Cigna of CA HMO |
$3,256.32
|
| Rate for Payer: Cigna of CA PPO |
$3,765.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Dignity Health Media |
$1,000.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,100.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,350.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,000.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,000.40
|
| Rate for Payer: Galaxy Health WC |
$4,324.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,052.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,816.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,640.66
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,640.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,620.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,620.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,000.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,393.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,938.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,000.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,221.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,260.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,340.54
|
| Rate for Payer: Multiplan Commercial |
$4,070.40
|
| Rate for Payer: Networks By Design Commercial |
$3,307.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,324.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,052.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,052.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,367.12
|
| Rate for Payer: United Healthcare All Other HMO |
$1,367.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1,367.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,367.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: Vantage Medical Group Senior |
$1,000.40
|
|
|
HC CMRI W STRESS W+W/O CONT
|
Facility
|
IP
|
$10,876.00
|
|
|
Service Code
|
CPT 75563
|
| Hospital Charge Code |
908801272
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,610.24 |
| Max. Negotiated Rate |
$9,244.60 |
| Rate for Payer: Cash Price |
$4,894.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,350.40
|
| Rate for Payer: Galaxy Health WC |
$9,244.60
|
| Rate for Payer: Global Benefits Group Commercial |
$6,525.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,254.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,143.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,610.24
|
| Rate for Payer: Multiplan Commercial |
$8,700.80
|
| Rate for Payer: Networks By Design Commercial |
$7,069.40
|
| Rate for Payer: Prime Health Services Commercial |
$9,244.60
|
|
|
HC CMV AB IGG
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 86644
|
| Hospital Charge Code |
900910987
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$130.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$119.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.89
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$25.19
|
| Rate for Payer: Blue Shield of California EPN |
$19.97
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.58
|
| Rate for Payer: Dignity Health Media |
$14.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$14.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.39
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.60
|
| Rate for Payer: Heritage Provider Network Transplant |
$23.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$23.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.28
|
| Rate for Payer: Multiplan Commercial |
$31.20
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.66
|
| Rate for Payer: United Healthcare All Other HMO |
$11.66
|
| Rate for Payer: United Healthcare HMO Rider |
$11.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Vantage Medical Group Senior |
$14.39
|
|
|
HC CMV AB IGM
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 86645
|
| Hospital Charge Code |
900910959
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$147.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$140.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.17
|
| Rate for Payer: Blue Distinction Transplant |
$30.00
|
| Rate for Payer: Blue Shield of California Commercial |
$32.30
|
| Rate for Payer: Blue Shield of California EPN |
$25.60
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.28
|
| Rate for Payer: Dignity Health Media |
$16.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.75
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$16.85
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.85
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$37.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.63
|
| Rate for Payer: Heritage Provider Network Transplant |
$27.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$27.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.58
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.65
|
| Rate for Payer: United Healthcare All Other HMO |
$13.65
|
| Rate for Payer: United Healthcare HMO Rider |
$13.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.54
|
| Rate for Payer: Vantage Medical Group Senior |
$16.85
|
|
|
HC CMV ANTIBODY IGG
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 86644
|
| Hospital Charge Code |
900913650
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$130.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$119.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.89
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$25.19
|
| Rate for Payer: Blue Shield of California EPN |
$19.97
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.58
|
| Rate for Payer: Dignity Health Media |
$14.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$14.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.39
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.60
|
| Rate for Payer: Heritage Provider Network Transplant |
$23.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$23.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.28
|
| Rate for Payer: Multiplan Commercial |
$31.20
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.66
|
| Rate for Payer: United Healthcare All Other HMO |
$11.66
|
| Rate for Payer: United Healthcare HMO Rider |
$11.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Vantage Medical Group Senior |
$14.39
|
|
|
HC CMV ANTIBODY IGM
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 86645
|
| Hospital Charge Code |
900913651
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$147.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$140.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.17
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$25.19
|
| Rate for Payer: Blue Shield of California EPN |
$19.97
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.28
|
| Rate for Payer: Dignity Health Media |
$16.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.75
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$16.85
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.85
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.63
|
| Rate for Payer: Heritage Provider Network Transplant |
$27.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$27.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.58
|
| Rate for Payer: Multiplan Commercial |
$31.20
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.65
|
| Rate for Payer: United Healthcare All Other HMO |
$13.65
|
| Rate for Payer: United Healthcare HMO Rider |
$13.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.54
|
| Rate for Payer: Vantage Medical Group Senior |
$16.85
|
|
|
HC CNP VENTILATION
|
Facility
|
OP
|
$3,359.00
|
|
|
Service Code
|
CPT 94662
|
| Hospital Charge Code |
900800105
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$2,855.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$232.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,174.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$861.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$782.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,015.40
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$1,511.55
|
| Rate for Payer: Cash Price |
$1,511.55
|
| Rate for Payer: Cash Price |
$1,511.55
|
| Rate for Payer: Cash Price |
$1,511.55
|
| Rate for Payer: Cigna of CA HMO |
$2,149.76
|
| Rate for Payer: Cigna of CA PPO |
$2,485.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,174.46
|
| Rate for Payer: Dignity Health Media |
$782.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$861.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,057.01
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$782.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$782.97
|
| Rate for Payer: Galaxy Health WC |
$2,855.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,015.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,519.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,284.07
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,284.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,268.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,268.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$782.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,240.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$782.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$806.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$986.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,049.18
|
| Rate for Payer: Multiplan Commercial |
$2,687.20
|
| Rate for Payer: Networks By Design Commercial |
$2,183.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,855.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,015.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,015.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.00
|
| Rate for Payer: United Healthcare All Other HMO |
$478.00
|
| Rate for Payer: United Healthcare HMO Rider |
$428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$391.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,174.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$861.27
|
| Rate for Payer: Vantage Medical Group Senior |
$782.97
|
|
|
HC CNP VENTILATION
|
Facility
|
IP
|
$3,359.00
|
|
|
Service Code
|
CPT 94662
|
| Hospital Charge Code |
900800105
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$806.16 |
| Max. Negotiated Rate |
$2,855.15 |
| Rate for Payer: Cash Price |
$1,511.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,343.60
|
| Rate for Payer: Galaxy Health WC |
$2,855.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,015.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,240.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,279.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$806.16
|
| Rate for Payer: Multiplan Commercial |
$2,687.20
|
| Rate for Payer: Networks By Design Commercial |
$2,183.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,855.15
|
|
|
HC CNTRL NASAL HEMORRHAGE COMPLEX
|
Facility
|
IP
|
$1,021.00
|
|
|
Service Code
|
CPT 30903
|
| Hospital Charge Code |
900501115
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$245.04 |
| Max. Negotiated Rate |
$867.85 |
| Rate for Payer: Cash Price |
$459.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$408.40
|
| Rate for Payer: Galaxy Health WC |
$867.85
|
| Rate for Payer: Global Benefits Group Commercial |
$612.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$681.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$389.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$245.04
|
| Rate for Payer: Multiplan Commercial |
$816.80
|
| Rate for Payer: Networks By Design Commercial |
$663.65
|
| Rate for Payer: Prime Health Services Commercial |
$867.85
|
|
|
HC CNTRL NASAL HEMORRHAGE COMPLEX
|
Facility
|
OP
|
$1,021.00
|
|
|
Service Code
|
CPT 30903
|
| Hospital Charge Code |
900501115
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$159.60 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$612.60
|
| Rate for Payer: Cash Price |
$459.45
|
| Rate for Payer: Cash Price |
$459.45
|
| Rate for Payer: Cash Price |
$459.45
|
| Rate for Payer: Cigna of CA PPO |
$755.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Media |
$159.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.46
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$159.60
|
| Rate for Payer: Galaxy Health WC |
$867.85
|
| Rate for Payer: Global Benefits Group Commercial |
$612.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$765.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$261.74
|
| Rate for Payer: Heritage Provider Network Transplant |
$261.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$681.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$439.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$245.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$213.86
|
| Rate for Payer: Multiplan Commercial |
$816.80
|
| Rate for Payer: Networks By Design Commercial |
$663.65
|
| Rate for Payer: Prime Health Services Commercial |
$867.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$612.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$510.50
|
| Rate for Payer: United Healthcare All Other HMO |
$510.50
|
| Rate for Payer: United Healthcare HMO Rider |
$510.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$510.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC CNTRL NASAL HEMORRHAGE SIMPLE
|
Facility
|
OP
|
$1,116.00
|
|
|
Service Code
|
CPT 30901
|
| Hospital Charge Code |
900501114
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$103.99 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$669.60
|
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Cigna of CA PPO |
$825.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Media |
$159.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.46
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$159.60
|
| Rate for Payer: Galaxy Health WC |
$948.60
|
| Rate for Payer: Global Benefits Group Commercial |
$669.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$837.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$261.74
|
| Rate for Payer: Heritage Provider Network Transplant |
$261.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$744.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$267.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$213.86
|
| Rate for Payer: Multiplan Commercial |
$892.80
|
| Rate for Payer: Networks By Design Commercial |
$725.40
|
| Rate for Payer: Prime Health Services Commercial |
$948.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$669.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$558.00
|
| Rate for Payer: United Healthcare All Other HMO |
$558.00
|
| Rate for Payer: United Healthcare HMO Rider |
$558.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$558.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC CNTRL NASAL HEMORRHAGE SIMPLE
|
Facility
|
IP
|
$1,116.00
|
|
|
Service Code
|
CPT 30901
|
| Hospital Charge Code |
900501114
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$267.84 |
| Max. Negotiated Rate |
$948.60 |
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$446.40
|
| Rate for Payer: Galaxy Health WC |
$948.60
|
| Rate for Payer: Global Benefits Group Commercial |
$669.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$744.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$425.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$267.84
|
| Rate for Payer: Multiplan Commercial |
$892.80
|
| Rate for Payer: Networks By Design Commercial |
$725.40
|
| Rate for Payer: Prime Health Services Commercial |
$948.60
|
|
|
HC CNTRL NASAL HEM POSTERIOR
|
Facility
|
IP
|
$1,116.00
|
|
|
Service Code
|
CPT 30905
|
| Hospital Charge Code |
900501116
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$267.84 |
| Max. Negotiated Rate |
$948.60 |
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$446.40
|
| Rate for Payer: Galaxy Health WC |
$948.60
|
| Rate for Payer: Global Benefits Group Commercial |
$669.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$744.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$425.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$267.84
|
| Rate for Payer: Multiplan Commercial |
$892.80
|
| Rate for Payer: Networks By Design Commercial |
$725.40
|
| Rate for Payer: Prime Health Services Commercial |
$948.60
|
|
