|
HC MOTOR SPEECH CURRENT STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G8999
|
| Hospital Charge Code |
900018221
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC MOTOR SPEECH D/C STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9158
|
| Hospital Charge Code |
900018123
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC MOTOR SPEECH D/C STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9158
|
| Hospital Charge Code |
900018123
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
HC MOTOR SPEECH D/C STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9158
|
| Hospital Charge Code |
900018223
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
HC MOTOR SPEECH D/C STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9158
|
| Hospital Charge Code |
900018223
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC MOTOR SPEECH GOAL STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9186
|
| Hospital Charge Code |
900018222
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC MOTOR SPEECH GOAL STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9186
|
| Hospital Charge Code |
900018222
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
HC MOTOR SPEECH GOAL STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9186
|
| Hospital Charge Code |
900018122
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC MOTOR SPEECH GOAL STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9186
|
| Hospital Charge Code |
900018122
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
HC MP CONTROL LE PROS
|
Facility
|
OP
|
$50,000.00
|
|
|
Service Code
|
CPT L5999
|
| Hospital Charge Code |
915380021
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$12,000.00 |
| Max. Negotiated Rate |
$42,500.00 |
| Rate for Payer: Adventist Health Commercial |
$20,500.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42,500.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27,500.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37,500.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28,960.00
|
| Rate for Payer: Blue Shield of California Commercial |
$36,900.00
|
| Rate for Payer: Blue Shield of California EPN |
$24,300.00
|
| Rate for Payer: Cash Price |
$22,500.00
|
| Rate for Payer: Cigna of CA HMO |
$35,000.00
|
| Rate for Payer: Cigna of CA PPO |
$35,000.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42,500.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$42,500.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20,000.00
|
| Rate for Payer: Galaxy Health WC |
$42,500.00
|
| Rate for Payer: Global Benefits Group Commercial |
$30,000.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33,350.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19,050.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30,950.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,000.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35,000.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35,000.00
|
| Rate for Payer: Multiplan Commercial |
$40,000.00
|
| Rate for Payer: Networks By Design Commercial |
$25,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$42,500.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30,000.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$18,765.00
|
| Rate for Payer: United Healthcare All Other HMO |
$18,265.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,870.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,375.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42,500.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42,500.00
|
| Rate for Payer: Vantage Medical Group Senior |
$42,500.00
|
|
|
HC MP CONTROL LE PROS
|
Facility
|
OP
|
$50,000.00
|
|
|
Service Code
|
CPT L5999
|
| Hospital Charge Code |
905380021
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$12,000.00 |
| Max. Negotiated Rate |
$42,500.00 |
| Rate for Payer: Adventist Health Commercial |
$20,500.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42,500.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27,500.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37,500.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28,960.00
|
| Rate for Payer: Blue Shield of California Commercial |
$36,900.00
|
| Rate for Payer: Blue Shield of California EPN |
$24,300.00
|
| Rate for Payer: Cash Price |
$22,500.00
|
| Rate for Payer: Cigna of CA HMO |
$35,000.00
|
| Rate for Payer: Cigna of CA PPO |
$35,000.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42,500.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$42,500.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20,000.00
|
| Rate for Payer: Galaxy Health WC |
$42,500.00
|
| Rate for Payer: Global Benefits Group Commercial |
$30,000.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33,350.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19,050.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30,950.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,000.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35,000.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35,000.00
|
| Rate for Payer: Multiplan Commercial |
$40,000.00
|
| Rate for Payer: Networks By Design Commercial |
$25,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$42,500.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30,000.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$18,765.00
|
| Rate for Payer: United Healthcare All Other HMO |
$18,265.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,870.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,375.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42,500.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42,500.00
|
| Rate for Payer: Vantage Medical Group Senior |
$42,500.00
|
|
|
HC MP CONTROL LE PROS
|
Facility
|
IP
|
$50,000.00
|
|
|
Service Code
|
CPT L5999
|
| Hospital Charge Code |
905380021
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10,000.00 |
| Max. Negotiated Rate |
$42,500.00 |
| Rate for Payer: Adventist Health Commercial |
$10,000.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$22,500.00
|
| Rate for Payer: Cash Price |
$22,500.00
|
| Rate for Payer: Cigna of CA HMO |
$35,000.00
|
| Rate for Payer: Cigna of CA PPO |
$35,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20,000.00
|
| Rate for Payer: Galaxy Health WC |
$42,500.00
|
| Rate for Payer: Global Benefits Group Commercial |
$30,000.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33,350.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19,050.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30,950.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,000.00
|
| Rate for Payer: Multiplan Commercial |
$40,000.00
|
| Rate for Payer: Networks By Design Commercial |
$25,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$42,500.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$18,765.00
|
| Rate for Payer: United Healthcare All Other HMO |
$18,265.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,870.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,375.00
|
|
|
HC MP CONTROL LE PROS
|
Facility
|
IP
|
$50,000.00
|
|
|
Service Code
|
CPT L5999
|
| Hospital Charge Code |
915380021
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10,000.00 |
| Max. Negotiated Rate |
$42,500.00 |
| Rate for Payer: Adventist Health Commercial |
$10,000.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$22,500.00
|
| Rate for Payer: Cash Price |
$22,500.00
|
| Rate for Payer: Cigna of CA HMO |
$35,000.00
|
| Rate for Payer: Cigna of CA PPO |
$35,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20,000.00
|
| Rate for Payer: Galaxy Health WC |
$42,500.00
|
| Rate for Payer: Global Benefits Group Commercial |
$30,000.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33,350.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19,050.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30,950.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,000.00
|
| Rate for Payer: Multiplan Commercial |
$40,000.00
|
| Rate for Payer: Networks By Design Commercial |
$25,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$42,500.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$18,765.00
|
| Rate for Payer: United Healthcare All Other HMO |
$18,265.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,870.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,375.00
|
|
|
HC MR ANGIO ABDOMEN W CONTRAST
|
Facility
|
OP
|
$7,283.00
|
|
|
Service Code
|
CPT 74185
|
| Hospital Charge Code |
908801037
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$557.81 |
| Max. Negotiated Rate |
$6,190.55 |
| Rate for Payer: Adventist Health Commercial |
$1,456.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,190.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,005.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,462.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,472.49
|
| Rate for Payer: Blue Shield of California Commercial |
$4,457.20
|
| Rate for Payer: Blue Shield of California EPN |
$2,942.33
|
| Rate for Payer: Cash Price |
$3,277.35
|
| Rate for Payer: Cash Price |
$3,277.35
|
| Rate for Payer: Cash Price |
$3,277.35
|
| Rate for Payer: Cigna of CA HMO |
$4,661.12
|
| Rate for Payer: Cigna of CA PPO |
$5,389.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,190.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,190.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,190.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,913.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,913.20
|
| Rate for Payer: Galaxy Health WC |
$6,190.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4,369.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$557.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,857.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$630.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,508.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,747.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,098.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,098.10
|
| Rate for Payer: Multiplan Commercial |
$5,826.40
|
| Rate for Payer: Networks By Design Commercial |
$4,733.95
|
| Rate for Payer: Prime Health Services Commercial |
$6,190.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,369.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,369.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,111.86
|
| Rate for Payer: United Healthcare All Other HMO |
$1,111.86
|
| Rate for Payer: United Healthcare HMO Rider |
$1,111.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,111.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,190.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,190.55
|
| Rate for Payer: Vantage Medical Group Senior |
$6,190.55
|
|
|
HC MR ANGIO ABDOMEN W CONTRAST
|
Facility
|
IP
|
$9,184.00
|
|
|
Service Code
|
CPT 74185
|
| Hospital Charge Code |
908801037
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$1,836.80 |
| Max. Negotiated Rate |
$7,806.40 |
| Rate for Payer: Adventist Health Commercial |
$1,836.80
|
| Rate for Payer: Cash Price |
$4,132.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,673.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,673.60
|
| Rate for Payer: Galaxy Health WC |
$7,806.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,510.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,125.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,499.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,684.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,204.16
|
| Rate for Payer: Multiplan Commercial |
$7,347.20
|
| Rate for Payer: Networks By Design Commercial |
$5,969.60
|
| Rate for Payer: Prime Health Services Commercial |
$7,806.40
|
|
|
HC MR ANGIO ABD W/O CONTRAST
|
Facility
|
OP
|
$6,824.00
|
|
|
Service Code
|
CPT 74185
|
| Hospital Charge Code |
908801089
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$557.81 |
| Max. Negotiated Rate |
$5,800.40 |
| Rate for Payer: Adventist Health Commercial |
$1,364.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,800.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,753.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,118.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,190.62
|
| Rate for Payer: Blue Shield of California Commercial |
$4,176.29
|
| Rate for Payer: Blue Shield of California EPN |
$2,756.90
|
| Rate for Payer: Cash Price |
$3,070.80
|
| Rate for Payer: Cash Price |
$3,070.80
|
| Rate for Payer: Cash Price |
$3,070.80
|
| Rate for Payer: Cigna of CA HMO |
$4,367.36
|
| Rate for Payer: Cigna of CA PPO |
$5,049.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,800.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,800.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,800.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,729.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,729.60
|
| Rate for Payer: Galaxy Health WC |
$5,800.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,094.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$557.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,551.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$630.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,224.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,637.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,776.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,776.80
|
| Rate for Payer: Multiplan Commercial |
$5,459.20
|
| Rate for Payer: Networks By Design Commercial |
$4,435.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,800.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,094.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,094.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,111.86
|
| Rate for Payer: United Healthcare All Other HMO |
$1,111.86
|
| Rate for Payer: United Healthcare HMO Rider |
$1,111.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,111.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,800.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,800.40
|
| Rate for Payer: Vantage Medical Group Senior |
$5,800.40
|
|
|
HC MR ANGIO ABD W/O CONTRAST
|
Facility
|
IP
|
$8,746.00
|
|
|
Service Code
|
CPT 74185
|
| Hospital Charge Code |
908801089
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$1,749.20 |
| Max. Negotiated Rate |
$7,434.10 |
| Rate for Payer: Adventist Health Commercial |
$1,749.20
|
| Rate for Payer: Cash Price |
$3,935.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,498.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,498.40
|
| Rate for Payer: Galaxy Health WC |
$7,434.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,247.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,833.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,332.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,413.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,099.04
|
| Rate for Payer: Multiplan Commercial |
$6,996.80
|
| Rate for Payer: Networks By Design Commercial |
$5,684.90
|
| Rate for Payer: Prime Health Services Commercial |
$7,434.10
|
|
|
HC MR ANGIO CHEST W CONTRAST
|
Facility
|
IP
|
$7,865.00
|
|
|
Service Code
|
CPT 71555
|
| Hospital Charge Code |
908801090
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$1,573.00 |
| Max. Negotiated Rate |
$6,685.25 |
| Rate for Payer: Adventist Health Commercial |
$1,573.00
|
| Rate for Payer: Cash Price |
$3,539.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,146.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,146.00
|
| Rate for Payer: Galaxy Health WC |
$6,685.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,719.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,245.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,996.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,868.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,887.60
|
| Rate for Payer: Multiplan Commercial |
$6,292.00
|
| Rate for Payer: Networks By Design Commercial |
$5,112.25
|
| Rate for Payer: Prime Health Services Commercial |
$6,685.25
|
|
|
HC MR ANGIO CHEST W CONTRAST
|
Facility
|
OP
|
$6,406.00
|
|
|
Service Code
|
CPT 71555
|
| Hospital Charge Code |
908801090
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$553.96 |
| Max. Negotiated Rate |
$5,445.10 |
| Rate for Payer: Adventist Health Commercial |
$1,281.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,445.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,523.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,804.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,933.92
|
| Rate for Payer: Blue Shield of California Commercial |
$3,920.47
|
| Rate for Payer: Blue Shield of California EPN |
$2,588.02
|
| Rate for Payer: Cash Price |
$2,882.70
|
| Rate for Payer: Cash Price |
$2,882.70
|
| Rate for Payer: Cash Price |
$2,882.70
|
| Rate for Payer: Cigna of CA HMO |
$4,099.84
|
| Rate for Payer: Cigna of CA PPO |
$4,740.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,445.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,445.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,445.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,562.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,562.40
|
| Rate for Payer: Galaxy Health WC |
$5,445.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,843.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$553.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,272.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$626.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,965.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,537.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,484.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,484.20
|
| Rate for Payer: Multiplan Commercial |
$5,124.80
|
| Rate for Payer: Networks By Design Commercial |
$4,163.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,445.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,843.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,843.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,110.11
|
| Rate for Payer: United Healthcare All Other HMO |
$1,110.11
|
| Rate for Payer: United Healthcare HMO Rider |
$1,110.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,110.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,445.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,445.10
|
| Rate for Payer: Vantage Medical Group Senior |
$5,445.10
|
|
|
HC MR ANGIO CHEST W/O CONTRAST
|
Facility
|
OP
|
$5,952.00
|
|
|
Service Code
|
CPT 71555
|
| Hospital Charge Code |
908801091
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$553.96 |
| Max. Negotiated Rate |
$5,059.20 |
| Rate for Payer: Adventist Health Commercial |
$1,190.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,059.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,273.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,464.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,655.12
|
| Rate for Payer: Blue Shield of California Commercial |
$3,642.62
|
| Rate for Payer: Blue Shield of California EPN |
$2,404.61
|
| Rate for Payer: Cash Price |
$2,678.40
|
| Rate for Payer: Cash Price |
$2,678.40
|
| Rate for Payer: Cash Price |
$2,678.40
|
| Rate for Payer: Cigna of CA HMO |
$3,809.28
|
| Rate for Payer: Cigna of CA PPO |
$4,404.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,059.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,059.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,059.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,380.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,380.80
|
| Rate for Payer: Galaxy Health WC |
$5,059.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,571.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$553.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,969.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$626.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,684.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,428.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,166.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,166.40
|
| Rate for Payer: Multiplan Commercial |
$4,761.60
|
| Rate for Payer: Networks By Design Commercial |
$3,868.80
|
| Rate for Payer: Prime Health Services Commercial |
$5,059.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,571.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,571.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,110.11
|
| Rate for Payer: United Healthcare All Other HMO |
$1,110.11
|
| Rate for Payer: United Healthcare HMO Rider |
$1,110.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,110.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,059.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,059.20
|
| Rate for Payer: Vantage Medical Group Senior |
$5,059.20
|
|
|
HC MR ANGIO CHEST W/O CONTRAST
|
Facility
|
IP
|
$7,149.00
|
|
|
Service Code
|
CPT 71555
|
| Hospital Charge Code |
908801091
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$1,429.80 |
| Max. Negotiated Rate |
$6,076.65 |
| Rate for Payer: Adventist Health Commercial |
$1,429.80
|
| Rate for Payer: Cash Price |
$3,217.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,859.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,859.60
|
| Rate for Payer: Galaxy Health WC |
$6,076.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,289.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,768.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,723.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,425.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,715.76
|
| Rate for Payer: Multiplan Commercial |
$5,719.20
|
| Rate for Payer: Networks By Design Commercial |
$4,646.85
|
| Rate for Payer: Prime Health Services Commercial |
$6,076.65
|
|
|
HC MR ANGIO CHEST W WO CONTRAST
|
Facility
|
IP
|
$8,516.00
|
|
|
Service Code
|
CPT 71555
|
| Hospital Charge Code |
908801032
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$1,703.20 |
| Max. Negotiated Rate |
$7,238.60 |
| Rate for Payer: Galaxy Health WC |
$7,238.60
|
| Rate for Payer: Adventist Health Commercial |
$1,703.20
|
| Rate for Payer: Cash Price |
$3,832.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,406.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,406.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,109.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,680.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,244.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,271.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,043.84
|
| Rate for Payer: Multiplan Commercial |
$6,812.80
|
| Rate for Payer: Networks By Design Commercial |
$5,535.40
|
| Rate for Payer: Prime Health Services Commercial |
$7,238.60
|
|
|
HC MR ANGIO CHEST W WO CONTRAST
|
Facility
|
OP
|
$6,752.00
|
|
|
Service Code
|
CPT 71555
|
| Hospital Charge Code |
908801032
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$553.96 |
| Max. Negotiated Rate |
$5,739.20 |
| Rate for Payer: Adventist Health Commercial |
$1,350.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,443.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,739.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,713.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,064.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,146.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4,132.22
|
| Rate for Payer: Blue Shield of California EPN |
$2,727.81
|
| Rate for Payer: Cash Price |
$3,038.40
|
| Rate for Payer: Cash Price |
$3,038.40
|
| Rate for Payer: Cash Price |
$3,038.40
|
| Rate for Payer: Cigna of CA HMO |
$4,321.28
|
| Rate for Payer: Cigna of CA PPO |
$4,996.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,739.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,739.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,739.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,700.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,700.80
|
| Rate for Payer: Galaxy Health WC |
$5,739.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,051.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$553.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,503.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$626.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,179.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,620.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,726.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,726.40
|
| Rate for Payer: Multiplan Commercial |
$5,401.60
|
| Rate for Payer: Networks By Design Commercial |
$4,388.80
|
| Rate for Payer: Prime Health Services Commercial |
$5,739.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,051.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,051.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,110.11
|
| Rate for Payer: United Healthcare All Other HMO |
$1,110.11
|
| Rate for Payer: United Healthcare HMO Rider |
$1,110.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,110.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,739.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,739.20
|
| Rate for Payer: Vantage Medical Group Senior |
$5,739.20
|
|
|
HC MR ANGIO LOW EXT W CONTRAST
|
Facility
|
OP
|
$5,356.00
|
|
|
Service Code
|
CPT 73725
|
| Hospital Charge Code |
908801092
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$554.48 |
| Max. Negotiated Rate |
$4,552.60 |
| Rate for Payer: Adventist Health Commercial |
$1,071.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,513.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,552.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,945.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,017.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,289.12
|
| Rate for Payer: Blue Shield of California Commercial |
$3,277.87
|
| Rate for Payer: Blue Shield of California EPN |
$2,163.82
|
| Rate for Payer: Cash Price |
$2,410.20
|
| Rate for Payer: Cash Price |
$2,410.20
|
| Rate for Payer: Cigna of CA HMO |
$3,427.84
|
| Rate for Payer: Cigna of CA PPO |
$3,963.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,552.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,552.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,552.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,142.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,142.40
|
| Rate for Payer: Galaxy Health WC |
$4,552.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,213.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$554.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,572.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$627.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,315.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,285.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,749.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,749.20
|
| Rate for Payer: Multiplan Commercial |
$4,284.80
|
| Rate for Payer: Networks By Design Commercial |
$3,481.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,552.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,213.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,213.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,114.46
|
| Rate for Payer: United Healthcare All Other HMO |
$1,114.46
|
| Rate for Payer: United Healthcare HMO Rider |
$1,114.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,114.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,552.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,552.60
|
| Rate for Payer: Vantage Medical Group Senior |
$4,552.60
|
|
|
HC MR ANGIO LOW EXT W CONTRAST
|
Facility
|
IP
|
$6,474.00
|
|
|
Service Code
|
CPT 73725
|
| Hospital Charge Code |
908801092
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$1,294.80 |
| Max. Negotiated Rate |
$5,502.90 |
| Rate for Payer: Adventist Health Commercial |
$1,294.80
|
| Rate for Payer: Cash Price |
$2,913.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,589.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,589.60
|
| Rate for Payer: Galaxy Health WC |
$5,502.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,884.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,318.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,466.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,007.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,553.76
|
| Rate for Payer: Multiplan Commercial |
$5,179.20
|
| Rate for Payer: Networks By Design Commercial |
$4,208.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,502.90
|
|
