|
HC FLUORO GUIDANCE CNTRL VNS ACCESS DVC
|
Facility
|
OP
|
$1,139.00
|
|
|
Service Code
|
CPT 77001
|
| Hospital Charge Code |
909081673
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$106.78 |
| Max. Negotiated Rate |
$968.15 |
| Rate for Payer: Adventist Health Commercial |
$227.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$747.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$968.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$626.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$854.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$375.18
|
| Rate for Payer: Blue Shield of California Commercial |
$697.07
|
| Rate for Payer: Blue Shield of California EPN |
$460.16
|
| Rate for Payer: Cash Price |
$512.55
|
| Rate for Payer: Cash Price |
$512.55
|
| Rate for Payer: Cigna of CA HMO |
$728.96
|
| Rate for Payer: Cigna of CA PPO |
$842.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$968.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$968.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$968.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$455.60
|
| Rate for Payer: EPIC Health Plan Senior |
$455.60
|
| Rate for Payer: Galaxy Health WC |
$968.15
|
| Rate for Payer: Global Benefits Group Commercial |
$683.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$106.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$759.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$705.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$273.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$797.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$797.30
|
| Rate for Payer: Multiplan Commercial |
$911.20
|
| Rate for Payer: Networks By Design Commercial |
$740.35
|
| Rate for Payer: Prime Health Services Commercial |
$968.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$683.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$683.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$569.50
|
| Rate for Payer: United Healthcare All Other HMO |
$569.50
|
| Rate for Payer: United Healthcare HMO Rider |
$569.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$569.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$968.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$968.15
|
| Rate for Payer: Vantage Medical Group Senior |
$968.15
|
|
|
HC FLUORO GUIDE NDL PLCMNT THRPY INJ
|
Facility
|
OP
|
$1,720.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
909001368
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$111.74 |
| Max. Negotiated Rate |
$1,462.00 |
| Rate for Payer: Adventist Health Commercial |
$344.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,128.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,462.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$946.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,290.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$475.45
|
| Rate for Payer: Blue Shield of California Commercial |
$1,052.64
|
| Rate for Payer: Blue Shield of California EPN |
$694.88
|
| Rate for Payer: Cash Price |
$774.00
|
| Rate for Payer: Cash Price |
$774.00
|
| Rate for Payer: Cigna of CA HMO |
$1,100.80
|
| Rate for Payer: Cigna of CA PPO |
$1,272.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,462.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,462.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,462.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$688.00
|
| Rate for Payer: EPIC Health Plan Senior |
$688.00
|
| Rate for Payer: Galaxy Health WC |
$1,462.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,032.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$111.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,147.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,064.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$412.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,204.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,204.00
|
| Rate for Payer: Multiplan Commercial |
$1,376.00
|
| Rate for Payer: Networks By Design Commercial |
$1,118.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,462.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,032.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,032.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$860.00
|
| Rate for Payer: United Healthcare All Other HMO |
$860.00
|
| Rate for Payer: United Healthcare HMO Rider |
$860.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$860.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,462.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,462.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,462.00
|
|
|
HC FLUORO GUIDE NDL PLCMNT THRPY INJ
|
Facility
|
IP
|
$1,720.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
909001368
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$344.00 |
| Max. Negotiated Rate |
$1,462.00 |
| Rate for Payer: Adventist Health Commercial |
$344.00
|
| Rate for Payer: Cash Price |
$774.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$688.00
|
| Rate for Payer: EPIC Health Plan Senior |
$688.00
|
| Rate for Payer: Galaxy Health WC |
$1,462.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,032.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,147.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$655.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,064.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$412.80
|
| Rate for Payer: Multiplan Commercial |
$1,376.00
|
| Rate for Payer: Networks By Design Commercial |
$1,118.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,462.00
|
|
|
HC FLUORO GUIDE SPINE OR PARASPINOUS
|
Facility
|
IP
|
$1,226.00
|
|
|
Service Code
|
CPT 77003
|
| Hospital Charge Code |
909001358
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$245.20 |
| Max. Negotiated Rate |
$1,042.10 |
| Rate for Payer: Adventist Health Commercial |
$245.20
|
| Rate for Payer: Cash Price |
$551.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$490.40
|
| Rate for Payer: EPIC Health Plan Senior |
$490.40
|
| Rate for Payer: Galaxy Health WC |
$1,042.10
|
| Rate for Payer: Global Benefits Group Commercial |
$735.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$817.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$467.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$758.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$294.24
|
| Rate for Payer: Multiplan Commercial |
$980.80
|
| Rate for Payer: Networks By Design Commercial |
$796.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,042.10
|
|
|
HC FLUORO GUIDE SPINE OR PARASPINOUS
|
Facility
|
OP
|
$1,226.00
|
|
|
Service Code
|
CPT 77003
|
| Hospital Charge Code |
909001358
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$95.56 |
| Max. Negotiated Rate |
$1,042.10 |
| Rate for Payer: Adventist Health Commercial |
$245.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$804.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,042.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$674.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$919.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$363.21
|
| Rate for Payer: Blue Shield of California Commercial |
$750.31
|
| Rate for Payer: Blue Shield of California EPN |
$495.30
|
| Rate for Payer: Cash Price |
$551.70
|
| Rate for Payer: Cash Price |
$551.70
|
| Rate for Payer: Cigna of CA HMO |
$784.64
|
| Rate for Payer: Cigna of CA PPO |
$907.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,042.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,042.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,042.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$490.40
|
| Rate for Payer: EPIC Health Plan Senior |
$490.40
|
| Rate for Payer: Galaxy Health WC |
$1,042.10
|
| Rate for Payer: Global Benefits Group Commercial |
$735.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$95.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$817.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$758.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$294.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$858.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$858.20
|
| Rate for Payer: Multiplan Commercial |
$980.80
|
| Rate for Payer: Networks By Design Commercial |
$796.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,042.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$735.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$735.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$613.00
|
| Rate for Payer: United Healthcare All Other HMO |
$613.00
|
| Rate for Payer: United Healthcare HMO Rider |
$613.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$613.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,042.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,042.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,042.10
|
|
|
HC FLUORO IN RAD > 1 HR
|
Facility
|
OP
|
$1,617.00
|
|
|
Service Code
|
CPT 76001
|
| Hospital Charge Code |
909001670
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$323.40 |
| Max. Negotiated Rate |
$1,374.45 |
| Rate for Payer: Adventist Health Commercial |
$323.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,060.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,374.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$889.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,212.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$993.00
|
| Rate for Payer: Blue Shield of California Commercial |
$989.60
|
| Rate for Payer: Blue Shield of California EPN |
$653.27
|
| Rate for Payer: Cash Price |
$727.65
|
| Rate for Payer: Cigna of CA HMO |
$1,034.88
|
| Rate for Payer: Cigna of CA PPO |
$1,196.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,374.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,374.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,374.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$646.80
|
| Rate for Payer: EPIC Health Plan Senior |
$646.80
|
| Rate for Payer: Galaxy Health WC |
$1,374.45
|
| Rate for Payer: Global Benefits Group Commercial |
$970.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,078.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$616.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,000.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$388.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,131.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,131.90
|
| Rate for Payer: Multiplan Commercial |
$1,293.60
|
| Rate for Payer: Networks By Design Commercial |
$1,051.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,374.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$970.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$970.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$808.50
|
| Rate for Payer: United Healthcare All Other HMO |
$808.50
|
| Rate for Payer: United Healthcare HMO Rider |
$808.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$808.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,374.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,374.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,374.45
|
|
|
HC FLUORO IN RAD > 1 HR
|
Facility
|
IP
|
$1,617.00
|
|
|
Service Code
|
CPT 76001
|
| Hospital Charge Code |
909001670
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$323.40 |
| Max. Negotiated Rate |
$1,374.45 |
| Rate for Payer: Adventist Health Commercial |
$323.40
|
| Rate for Payer: Cash Price |
$727.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$646.80
|
| Rate for Payer: EPIC Health Plan Senior |
$646.80
|
| Rate for Payer: Galaxy Health WC |
$1,374.45
|
| Rate for Payer: Global Benefits Group Commercial |
$970.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,078.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$616.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,000.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$388.08
|
| Rate for Payer: Multiplan Commercial |
$1,293.60
|
| Rate for Payer: Networks By Design Commercial |
$1,051.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,374.45
|
|
|
HC FLUOROSCOPY LT 1HR
|
Facility
|
OP
|
$1,825.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
906820105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.97 |
| Max. Negotiated Rate |
$1,551.25 |
| Rate for Payer: Adventist Health Commercial |
$365.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,197.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$321.51
|
| Rate for Payer: Blue Shield of California Commercial |
$1,116.90
|
| Rate for Payer: Blue Shield of California EPN |
$737.30
|
| Rate for Payer: Cash Price |
$821.25
|
| Rate for Payer: Cash Price |
$821.25
|
| Rate for Payer: Cigna of CA HMO |
$1,168.00
|
| Rate for Payer: Cigna of CA PPO |
$1,350.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$1,551.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,095.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$46.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,217.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$1,460.00
|
| Rate for Payer: Networks By Design Commercial |
$1,186.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,551.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,095.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,095.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$225.63
|
| Rate for Payer: United Healthcare All Other HMO |
$225.63
|
| Rate for Payer: United Healthcare HMO Rider |
$225.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$225.63
|
| Rate for Payer: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC FLUOROSCOPY LT 1HR
|
Facility
|
IP
|
$1,825.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
906820105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$365.00 |
| Max. Negotiated Rate |
$1,551.25 |
| Rate for Payer: Adventist Health Commercial |
$365.00
|
| Rate for Payer: Cash Price |
$821.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$730.00
|
| Rate for Payer: EPIC Health Plan Senior |
$730.00
|
| Rate for Payer: Galaxy Health WC |
$1,551.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,095.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,217.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$695.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,129.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.00
|
| Rate for Payer: Multiplan Commercial |
$1,460.00
|
| Rate for Payer: Networks By Design Commercial |
$1,186.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,551.25
|
|
|
HC FLUOROSCOPY LT 1HR
|
Facility
|
IP
|
$1,349.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
906811312
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$269.80 |
| Max. Negotiated Rate |
$1,146.65 |
| Rate for Payer: Adventist Health Commercial |
$269.80
|
| Rate for Payer: Cash Price |
$607.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$539.60
|
| Rate for Payer: EPIC Health Plan Senior |
$539.60
|
| Rate for Payer: Galaxy Health WC |
$1,146.65
|
| Rate for Payer: Global Benefits Group Commercial |
$809.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$899.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$513.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$835.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$323.76
|
| Rate for Payer: Multiplan Commercial |
$1,079.20
|
| Rate for Payer: Networks By Design Commercial |
$876.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,146.65
|
|
|
HC FLUOROSCOPY LT 1HR
|
Facility
|
OP
|
$1,349.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
906811312
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.97 |
| Max. Negotiated Rate |
$1,146.65 |
| Rate for Payer: Adventist Health Commercial |
$269.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$884.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$321.51
|
| Rate for Payer: Blue Shield of California Commercial |
$825.59
|
| Rate for Payer: Blue Shield of California EPN |
$545.00
|
| Rate for Payer: Cash Price |
$607.05
|
| Rate for Payer: Cash Price |
$607.05
|
| Rate for Payer: Cigna of CA HMO |
$863.36
|
| Rate for Payer: Cigna of CA PPO |
$998.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$1,146.65
|
| Rate for Payer: Global Benefits Group Commercial |
$809.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$46.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$899.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$323.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$1,079.20
|
| Rate for Payer: Networks By Design Commercial |
$876.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,146.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$809.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$809.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$225.63
|
| Rate for Payer: United Healthcare All Other HMO |
$225.63
|
| Rate for Payer: United Healthcare HMO Rider |
$225.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$225.63
|
| Rate for Payer: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC FLUORO XM G/COLON TUBE
|
Facility
|
IP
|
$3,706.00
|
|
|
Service Code
|
CPT 49465
|
| Hospital Charge Code |
906749465
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$741.20 |
| Max. Negotiated Rate |
$3,150.10 |
| Rate for Payer: Adventist Health Commercial |
$741.20
|
| Rate for Payer: Cash Price |
$1,667.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,482.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,482.40
|
| Rate for Payer: Galaxy Health WC |
$3,150.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,223.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,471.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,411.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,294.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$889.44
|
| Rate for Payer: Multiplan Commercial |
$2,964.80
|
| Rate for Payer: Networks By Design Commercial |
$2,408.90
|
| Rate for Payer: Prime Health Services Commercial |
$3,150.10
|
|
|
HC FLUORO XM G/COLON TUBE
|
Facility
|
IP
|
$3,706.00
|
|
|
Service Code
|
CPT 49465
|
| Hospital Charge Code |
906749465
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$741.20 |
| Max. Negotiated Rate |
$3,150.10 |
| Rate for Payer: Adventist Health Commercial |
$741.20
|
| Rate for Payer: Cash Price |
$1,667.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,482.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,482.40
|
| Rate for Payer: Galaxy Health WC |
$3,150.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,223.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,471.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,411.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,294.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$889.44
|
| Rate for Payer: Multiplan Commercial |
$2,964.80
|
| Rate for Payer: Networks By Design Commercial |
$2,408.90
|
| Rate for Payer: Prime Health Services Commercial |
$3,150.10
|
|
|
HC FLUORO XM G/COLON TUBE
|
Facility
|
OP
|
$2,286.00
|
|
|
Service Code
|
CPT 49465
|
| Hospital Charge Code |
906749465
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$237.05 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$457.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$1,028.70
|
| Rate for Payer: Cash Price |
$1,028.70
|
| Rate for Payer: Cash Price |
$1,028.70
|
| Rate for Payer: Cigna of CA HMO |
$1,463.04
|
| Rate for Payer: Cigna of CA PPO |
$1,691.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$1,943.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,371.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$237.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,524.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$268.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$548.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$1,828.80
|
| Rate for Payer: Multiplan WC |
$489.35
|
| Rate for Payer: Networks By Design Commercial |
$1,485.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,943.10
|
| Rate for Payer: Prime Health Services WC |
$484.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,371.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC FLUORO XM G/COLON TUBE
|
Facility
|
OP
|
$2,286.00
|
|
|
Service Code
|
CPT 49465
|
| Hospital Charge Code |
906749465
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$237.05 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$457.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$1,028.70
|
| Rate for Payer: Cash Price |
$1,028.70
|
| Rate for Payer: Cash Price |
$1,028.70
|
| Rate for Payer: Cigna of CA HMO |
$1,463.04
|
| Rate for Payer: Cigna of CA PPO |
$1,691.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$1,943.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,371.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$237.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,524.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$268.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$548.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$1,828.80
|
| Rate for Payer: Networks By Design Commercial |
$1,485.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,943.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,371.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$368.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC FMRI BRAIN BY PHYS/PSYCH
|
Facility
|
OP
|
$1,636.00
|
|
|
Service Code
|
CPT 70555
|
| Hospital Charge Code |
908801023
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$166.34 |
| Max. Negotiated Rate |
$1,390.60 |
| Rate for Payer: Adventist Health Commercial |
$327.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,073.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,004.67
|
| Rate for Payer: Blue Shield of California Commercial |
$1,001.23
|
| Rate for Payer: Blue Shield of California EPN |
$660.94
|
| Rate for Payer: Cash Price |
$736.20
|
| Rate for Payer: Cash Price |
$736.20
|
| Rate for Payer: Cigna of CA HMO |
$1,047.04
|
| Rate for Payer: Cigna of CA PPO |
$1,210.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$1,390.60
|
| Rate for Payer: Global Benefits Group Commercial |
$981.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$166.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,091.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$1,308.80
|
| Rate for Payer: Networks By Design Commercial |
$1,063.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,390.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$981.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$981.60
|
| 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: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC FMRI BRAIN BY PHYS/PSYCH
|
Facility
|
IP
|
$1,945.00
|
|
|
Service Code
|
CPT 70555
|
| Hospital Charge Code |
908801023
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$389.00 |
| Max. Negotiated Rate |
$1,653.25 |
| Rate for Payer: Adventist Health Commercial |
$389.00
|
| Rate for Payer: Cash Price |
$875.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$778.00
|
| Rate for Payer: EPIC Health Plan Senior |
$778.00
|
| Rate for Payer: Galaxy Health WC |
$1,653.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,167.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,297.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$741.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,203.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$466.80
|
| Rate for Payer: Multiplan Commercial |
$1,556.00
|
| Rate for Payer: Networks By Design Commercial |
$1,264.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,653.25
|
|
|
HC FMRI BRAIN BY TECH
|
Facility
|
OP
|
$1,710.00
|
|
|
Service Code
|
CPT 70554
|
| Hospital Charge Code |
908801022
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$1,453.50 |
| Rate for Payer: Adventist Health Commercial |
$342.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,121.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,050.11
|
| Rate for Payer: Blue Shield of California Commercial |
$1,046.52
|
| Rate for Payer: Blue Shield of California EPN |
$690.84
|
| Rate for Payer: Cash Price |
$769.50
|
| Rate for Payer: Cash Price |
$769.50
|
| Rate for Payer: Cigna of CA HMO |
$1,094.40
|
| Rate for Payer: Cigna of CA PPO |
$1,265.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$1,453.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,026.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$628.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,140.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$710.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$410.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$1,368.00
|
| Rate for Payer: Networks By Design Commercial |
$1,111.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,453.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,026.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,026.00
|
| 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: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC FMRI BRAIN BY TECH
|
Facility
|
IP
|
$1,556.00
|
|
|
Service Code
|
CPT 70554
|
| Hospital Charge Code |
908801022
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$311.20 |
| Max. Negotiated Rate |
$1,322.60 |
| Rate for Payer: Adventist Health Commercial |
$311.20
|
| Rate for Payer: Cash Price |
$700.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$622.40
|
| Rate for Payer: EPIC Health Plan Senior |
$622.40
|
| Rate for Payer: Galaxy Health WC |
$1,322.60
|
| Rate for Payer: Global Benefits Group Commercial |
$933.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,037.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$592.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$963.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$373.44
|
| Rate for Payer: Multiplan Commercial |
$1,244.80
|
| Rate for Payer: Networks By Design Commercial |
$1,011.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,322.60
|
|
|
HC FNA BX W/US GDN 1ST LESION
|
Facility
|
OP
|
$2,097.00
|
|
|
Service Code
|
CPT 10005
|
| Hospital Charge Code |
909010005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$187.64 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$419.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$943.65
|
| Rate for Payer: Cash Price |
$943.65
|
| Rate for Payer: Cash Price |
$943.65
|
| Rate for Payer: Cigna of CA HMO |
$1,342.08
|
| Rate for Payer: Cigna of CA PPO |
$1,551.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,206.87
|
| Rate for Payer: EPIC Health Plan Senior |
$893.98
|
| Rate for Payer: Galaxy Health WC |
$1,782.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,258.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$187.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,398.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$212.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$503.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,126.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| Rate for Payer: Multiplan Commercial |
$1,677.60
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$1,363.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,782.45
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,258.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$893.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC FNA BX W/US GDN 1ST LESION
|
Facility
|
IP
|
$2,097.00
|
|
|
Service Code
|
CPT 10005
|
| Hospital Charge Code |
909010005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$419.40 |
| Max. Negotiated Rate |
$1,782.45 |
| Rate for Payer: Adventist Health Commercial |
$419.40
|
| Rate for Payer: Cash Price |
$943.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$838.80
|
| Rate for Payer: EPIC Health Plan Senior |
$838.80
|
| Rate for Payer: Galaxy Health WC |
$1,782.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,258.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,398.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$798.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,298.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$503.28
|
| Rate for Payer: Multiplan Commercial |
$1,677.60
|
| Rate for Payer: Networks By Design Commercial |
$1,363.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,782.45
|
|
|
HC FNA BX W/US GDN EA ADDL LSN
|
Facility
|
IP
|
$1,048.00
|
|
|
Service Code
|
CPT 10006
|
| Hospital Charge Code |
909010006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$209.60 |
| Max. Negotiated Rate |
$890.80 |
| Rate for Payer: Adventist Health Commercial |
$209.60
|
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$419.20
|
| Rate for Payer: EPIC Health Plan Senior |
$419.20
|
| Rate for Payer: Galaxy Health WC |
$890.80
|
| Rate for Payer: Global Benefits Group Commercial |
$628.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$699.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$399.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$648.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$251.52
|
| Rate for Payer: Multiplan Commercial |
$838.40
|
| Rate for Payer: Networks By Design Commercial |
$681.20
|
| Rate for Payer: Prime Health Services Commercial |
$890.80
|
|
|
HC FNA BX W/US GDN EA ADDL LSN
|
Facility
|
OP
|
$1,048.00
|
|
|
Service Code
|
CPT 10006
|
| Hospital Charge Code |
909010006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$86.94 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$209.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$890.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$576.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$786.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Cigna of CA HMO |
$670.72
|
| Rate for Payer: Cigna of CA PPO |
$775.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$890.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$890.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$890.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$419.20
|
| Rate for Payer: EPIC Health Plan Senior |
$419.20
|
| Rate for Payer: Galaxy Health WC |
$890.80
|
| Rate for Payer: Global Benefits Group Commercial |
$628.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$86.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$699.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$648.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$251.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$733.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$733.60
|
| Rate for Payer: Multiplan Commercial |
$838.40
|
| Rate for Payer: Networks By Design Commercial |
$681.20
|
| Rate for Payer: Prime Health Services Commercial |
$890.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$628.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$890.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$890.80
|
| Rate for Payer: Vantage Medical Group Senior |
$890.80
|
|
|
HC FNA INTERP & RPT PG
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 88173
|
| Hospital Charge Code |
903800218
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$99.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.99
|
| Rate for Payer: Blue Shield of California Commercial |
$101.69
|
| Rate for Payer: Blue Shield of California EPN |
$67.18
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna of CA HMO |
$97.28
|
| Rate for Payer: Cigna of CA PPO |
$112.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.65
|
| Rate for Payer: EPIC Health Plan Senior |
$67.89
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$111.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$87.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$85.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90.97
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$91.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.11
|
| Rate for Payer: United Healthcare All Other HMO |
$41.11
|
| Rate for Payer: United Healthcare HMO Rider |
$41.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.11
|
| Rate for Payer: Upland Medical Group Pediatric |
$67.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.68
|
| Rate for Payer: Vantage Medical Group Senior |
$67.89
|
|
|
HC FNA INTERP & RPT PG
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 88173
|
| Hospital Charge Code |
903800218
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Senior |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$94.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.48
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
|
