|
HC CLUBFOOT WEDGE
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT L3380
|
| Hospital Charge Code |
905353380
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$17.77 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Adventist Health Commercial |
$41.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$85.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$58.17
|
| Rate for Payer: Blue Shield of California Commercial |
$80.20
|
| Rate for Payer: Blue Shield of California EPN |
$50.40
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Central Health Plan Commercial |
$80.00
|
| Rate for Payer: Cigna of CA HMO |
$70.00
|
| Rate for Payer: Cigna of CA PPO |
$70.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$85.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$63.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: Networks By Design Commercial |
$50.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: Riverside University Health System MISP |
$40.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.53
|
| Rate for Payer: United Healthcare All Other HMO |
$36.53
|
| Rate for Payer: United Healthcare HMO Rider |
$35.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$85.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.00
|
| Rate for Payer: Vantage Medical Group Senior |
$85.00
|
|
|
HC CLUBFOOT WEDGE
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT L3380
|
| Hospital Charge Code |
915353380
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$17.77 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Adventist Health Commercial |
$41.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$85.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$58.17
|
| Rate for Payer: Blue Shield of California Commercial |
$80.20
|
| Rate for Payer: Blue Shield of California EPN |
$50.40
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Central Health Plan Commercial |
$80.00
|
| Rate for Payer: Cigna of CA HMO |
$70.00
|
| Rate for Payer: Cigna of CA PPO |
$70.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$85.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$63.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: Networks By Design Commercial |
$50.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: Riverside University Health System MISP |
$40.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.53
|
| Rate for Payer: United Healthcare All Other HMO |
$36.53
|
| Rate for Payer: United Healthcare HMO Rider |
$35.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$85.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.00
|
| Rate for Payer: Vantage Medical Group Senior |
$85.00
|
|
|
HC CMRI MORPH/FUNCT W/O CONTRAST
|
Facility
|
IP
|
$12,208.00
|
|
|
Service Code
|
CPT 75557
|
| Hospital Charge Code |
908801260
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,441.60 |
| Max. Negotiated Rate |
$10,987.20 |
| Rate for Payer: Adventist Health Commercial |
$2,441.60
|
| Rate for Payer: Cash Price |
$5,493.60
|
| Rate for Payer: Central Health Plan Commercial |
$9,766.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,545.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,883.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,883.20
|
| Rate for Payer: Galaxy Health WC |
$10,376.80
|
| Rate for Payer: Global Benefits Group Commercial |
$7,324.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,987.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,752.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,202.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,441.60
|
| Rate for Payer: Multiplan Commercial |
$9,156.00
|
| Rate for Payer: Networks By Design Commercial |
$7,935.20
|
| Rate for Payer: Prime Health Services Commercial |
$10,376.80
|
|
|
HC CMRI MORPH/FUNCT W/O CONTRAST
|
Facility
|
OP
|
$12,208.00
|
|
|
Service Code
|
CPT 75557
|
| Hospital Charge Code |
908801260
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$306.88 |
| Max. Negotiated Rate |
$10,987.20 |
| Rate for Payer: Adventist Health Commercial |
$2,441.60
|
| Rate for Payer: Adventist Health Commercial |
$957.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$306.88
|
| Rate for Payer: Adventist Health Medi-Cal |
$306.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,055.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,055.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,086.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,086.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,784.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,101.39
|
| Rate for Payer: Blue Shield of California Commercial |
$3,015.81
|
| Rate for Payer: Blue Shield of California Commercial |
$7,691.04
|
| Rate for Payer: Blue Shield of California EPN |
$1,900.44
|
| Rate for Payer: Blue Shield of California EPN |
$4,846.58
|
| Rate for Payer: Cash Price |
$2,154.15
|
| Rate for Payer: Cash Price |
$5,493.60
|
| Rate for Payer: Cash Price |
$5,493.60
|
| Rate for Payer: Cash Price |
$2,154.15
|
| Rate for Payer: Central Health Plan Commercial |
$9,766.40
|
| Rate for Payer: Central Health Plan Commercial |
$3,829.60
|
| Rate for Payer: Cigna of CA HMO |
$7,813.12
|
| Rate for Payer: Cigna of CA HMO |
$3,063.68
|
| Rate for Payer: Cigna of CA PPO |
$9,033.92
|
| Rate for Payer: Cigna of CA PPO |
$3,542.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,350.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,545.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: Galaxy Health WC |
$10,376.80
|
| Rate for Payer: Galaxy Health WC |
$4,068.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,872.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7,324.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,308.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,987.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.28
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,039.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,752.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,431.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,737.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,441.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$957.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$9,156.00
|
| Rate for Payer: Multiplan Commercial |
$3,590.25
|
| Rate for Payer: Networks By Design Commercial |
$7,935.20
|
| Rate for Payer: Networks By Design Commercial |
$3,111.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$306.88
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$306.88
|
| Rate for Payer: Prime Health Services Commercial |
$4,068.95
|
| Rate for Payer: Prime Health Services Commercial |
$10,376.80
|
| Rate for Payer: Prime Health Services Medicare |
$325.29
|
| Rate for Payer: Prime Health Services Medicare |
$325.29
|
| Rate for Payer: Riverside University Health System MISP |
$337.57
|
| Rate for Payer: Riverside University Health System MISP |
$337.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,324.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,872.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,324.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,872.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| 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 All Other HMO |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$306.88
|
| Rate for Payer: Upland Medical Group Pediatric |
$306.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC CMRI MORPH/FUNCT W+W/O CONT
|
Facility
|
OP
|
$13,015.00
|
|
|
Service Code
|
CPT 75561
|
| Hospital Charge Code |
908801270
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$448.71 |
| Max. Negotiated Rate |
$11,713.50 |
| Rate for Payer: Adventist Health Commercial |
$2,603.00
|
| Rate for Payer: Adventist Health Commercial |
$1,135.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$448.71
|
| Rate for Payer: Adventist Health Medi-Cal |
$448.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,055.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,055.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,045.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,045.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,570.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,303.47
|
| Rate for Payer: Blue Shield of California Commercial |
$3,577.77
|
| Rate for Payer: Blue Shield of California Commercial |
$8,199.45
|
| Rate for Payer: Blue Shield of California EPN |
$2,254.56
|
| Rate for Payer: Blue Shield of California EPN |
$5,166.95
|
| Rate for Payer: Cash Price |
$5,856.75
|
| Rate for Payer: Cash Price |
$2,555.55
|
| Rate for Payer: Cash Price |
$5,856.75
|
| Rate for Payer: Cash Price |
$2,555.55
|
| Rate for Payer: Central Health Plan Commercial |
$10,412.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,543.20
|
| Rate for Payer: Cigna of CA HMO |
$8,329.60
|
| Rate for Payer: Cigna of CA HMO |
$3,634.56
|
| Rate for Payer: Cigna of CA PPO |
$4,202.46
|
| Rate for Payer: Cigna of CA PPO |
$9,631.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,110.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,975.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.37
|
| Rate for Payer: EPIC Health Plan Senior |
$493.58
|
| Rate for Payer: EPIC Health Plan Senior |
$493.58
|
| Rate for Payer: Galaxy Health WC |
$4,827.15
|
| Rate for Payer: Galaxy Health WC |
$11,062.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,407.40
|
| Rate for Payer: Global Benefits Group Commercial |
$7,809.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,111.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,713.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$735.88
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$735.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$620.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$620.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,264.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,606.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$685.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$685.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,603.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,135.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$601.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$601.27
|
| Rate for Payer: Multiplan Commercial |
$9,761.25
|
| Rate for Payer: Multiplan Commercial |
$4,259.25
|
| Rate for Payer: Networks By Design Commercial |
$8,459.75
|
| Rate for Payer: Networks By Design Commercial |
$3,691.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$448.71
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$448.71
|
| Rate for Payer: Prime Health Services Commercial |
$11,062.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,827.15
|
| Rate for Payer: Prime Health Services Medicare |
$475.63
|
| Rate for Payer: Prime Health Services Medicare |
$475.63
|
| Rate for Payer: Riverside University Health System MISP |
$493.58
|
| Rate for Payer: Riverside University Health System MISP |
$493.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,809.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,407.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,809.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,407.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,367.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,367.12
|
| Rate for Payer: United Healthcare All Other HMO |
$1,367.12
|
| Rate for Payer: United Healthcare All Other HMO |
$1,367.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1,367.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1,367.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,367.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,367.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$448.71
|
| Rate for Payer: Upland Medical Group Pediatric |
$448.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
|
|
HC CMRI MORPH/FUNCT W+W/O CONT
|
Facility
|
IP
|
$13,015.00
|
|
|
Service Code
|
CPT 75561
|
| Hospital Charge Code |
908801270
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,603.00 |
| Max. Negotiated Rate |
$11,713.50 |
| Rate for Payer: Adventist Health Commercial |
$2,603.00
|
| Rate for Payer: Cash Price |
$5,856.75
|
| Rate for Payer: Central Health Plan Commercial |
$10,412.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,110.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,206.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,206.00
|
| Rate for Payer: Galaxy Health WC |
$11,062.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7,809.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,713.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,264.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,678.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,603.00
|
| Rate for Payer: Multiplan Commercial |
$9,761.25
|
| Rate for Payer: Networks By Design Commercial |
$8,459.75
|
| Rate for Payer: Prime Health Services Commercial |
$11,062.75
|
|
|
HC CMRI W FLOW/VEL QUANT W/O CONT
|
Facility
|
OP
|
$1,120.00
|
|
| Hospital Charge Code |
908801261
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$224.00 |
| Max. Negotiated Rate |
$1,008.00 |
| Rate for Payer: Adventist Health Commercial |
$224.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$680.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$952.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$616.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$840.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$542.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$651.50
|
| Rate for Payer: Blue Shield of California Commercial |
$705.60
|
| Rate for Payer: Blue Shield of California EPN |
$444.64
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Central Health Plan Commercial |
$896.00
|
| Rate for Payer: Cigna of CA HMO |
$716.80
|
| Rate for Payer: Cigna of CA PPO |
$828.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$952.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$952.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$952.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$784.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$448.00
|
| Rate for Payer: EPIC Health Plan Senior |
$448.00
|
| Rate for Payer: Galaxy Health WC |
$952.00
|
| Rate for Payer: Global Benefits Group Commercial |
$672.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,008.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$711.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$406.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$660.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$224.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$784.00
|
| Rate for Payer: Multiplan Commercial |
$840.00
|
| Rate for Payer: Networks By Design Commercial |
$728.00
|
| Rate for Payer: Prime Health Services Commercial |
$952.00
|
| Rate for Payer: Riverside University Health System MISP |
$448.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$672.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$672.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$560.00
|
| Rate for Payer: United Healthcare All Other HMO |
$560.00
|
| Rate for Payer: United Healthcare HMO Rider |
$560.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$560.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$952.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$952.00
|
| Rate for Payer: Vantage Medical Group Senior |
$952.00
|
|
|
HC CMRI W FLOW/VEL QUANT W/O CONT
|
Facility
|
IP
|
$1,120.00
|
|
| Hospital Charge Code |
908801261
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$224.00 |
| Max. Negotiated Rate |
$1,008.00 |
| Rate for Payer: Adventist Health Commercial |
$224.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Central Health Plan Commercial |
$896.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$784.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$448.00
|
| Rate for Payer: EPIC Health Plan Senior |
$448.00
|
| Rate for Payer: Galaxy Health WC |
$952.00
|
| Rate for Payer: Global Benefits Group Commercial |
$672.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,008.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$711.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$660.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$224.00
|
| Rate for Payer: Multiplan Commercial |
$840.00
|
| Rate for Payer: Networks By Design Commercial |
$728.00
|
| Rate for Payer: Prime Health Services Commercial |
$952.00
|
|
|
HC CMRI W FLOW/VEL QUANT W+W/O CO
|
Facility
|
IP
|
$1,120.00
|
|
| Hospital Charge Code |
908801271
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$224.00 |
| Max. Negotiated Rate |
$1,008.00 |
| Rate for Payer: Adventist Health Commercial |
$224.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Central Health Plan Commercial |
$896.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$784.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$448.00
|
| Rate for Payer: EPIC Health Plan Senior |
$448.00
|
| Rate for Payer: Galaxy Health WC |
$952.00
|
| Rate for Payer: Global Benefits Group Commercial |
$672.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,008.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$711.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$660.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$224.00
|
| Rate for Payer: Multiplan Commercial |
$840.00
|
| Rate for Payer: Networks By Design Commercial |
$728.00
|
| Rate for Payer: Prime Health Services Commercial |
$952.00
|
|
|
HC CMRI W FLOW/VEL QUANT W+W/O CO
|
Facility
|
OP
|
$1,120.00
|
|
| Hospital Charge Code |
908801271
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$224.00 |
| Max. Negotiated Rate |
$1,008.00 |
| Rate for Payer: Adventist Health Commercial |
$224.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$680.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$952.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$616.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$840.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$542.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$651.50
|
| Rate for Payer: Blue Shield of California Commercial |
$705.60
|
| Rate for Payer: Blue Shield of California EPN |
$444.64
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Central Health Plan Commercial |
$896.00
|
| Rate for Payer: Cigna of CA HMO |
$716.80
|
| Rate for Payer: Cigna of CA PPO |
$828.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$952.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$952.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$952.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$784.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$448.00
|
| Rate for Payer: EPIC Health Plan Senior |
$448.00
|
| Rate for Payer: Galaxy Health WC |
$952.00
|
| Rate for Payer: Global Benefits Group Commercial |
$672.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,008.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$711.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$406.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$660.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$224.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$784.00
|
| Rate for Payer: Multiplan Commercial |
$840.00
|
| Rate for Payer: Networks By Design Commercial |
$728.00
|
| Rate for Payer: Prime Health Services Commercial |
$952.00
|
| Rate for Payer: Riverside University Health System MISP |
$448.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$672.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$672.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$560.00
|
| Rate for Payer: United Healthcare All Other HMO |
$560.00
|
| Rate for Payer: United Healthcare HMO Rider |
$560.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$560.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$952.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$952.00
|
| Rate for Payer: Vantage Medical Group Senior |
$952.00
|
|
|
HC CMRI W FLOW/VEL+STRESS W/O CON
|
Facility
|
IP
|
$1,120.00
|
|
| Hospital Charge Code |
908801263
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$224.00 |
| Max. Negotiated Rate |
$1,008.00 |
| Rate for Payer: Adventist Health Commercial |
$224.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Central Health Plan Commercial |
$896.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$784.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$448.00
|
| Rate for Payer: EPIC Health Plan Senior |
$448.00
|
| Rate for Payer: Galaxy Health WC |
$952.00
|
| Rate for Payer: Global Benefits Group Commercial |
$672.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,008.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$711.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$660.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$224.00
|
| Rate for Payer: Multiplan Commercial |
$840.00
|
| Rate for Payer: Networks By Design Commercial |
$728.00
|
| Rate for Payer: Prime Health Services Commercial |
$952.00
|
|
|
HC CMRI W FLOW/VEL+STRESS W/O CON
|
Facility
|
OP
|
$1,120.00
|
|
| Hospital Charge Code |
908801263
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$224.00 |
| Max. Negotiated Rate |
$1,008.00 |
| Rate for Payer: Adventist Health Commercial |
$224.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$680.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$952.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$616.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$840.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$542.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$651.50
|
| Rate for Payer: Blue Shield of California Commercial |
$705.60
|
| Rate for Payer: Blue Shield of California EPN |
$444.64
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Central Health Plan Commercial |
$896.00
|
| Rate for Payer: Cigna of CA HMO |
$716.80
|
| Rate for Payer: Cigna of CA PPO |
$828.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$952.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$952.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$952.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$784.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$448.00
|
| Rate for Payer: EPIC Health Plan Senior |
$448.00
|
| Rate for Payer: Galaxy Health WC |
$952.00
|
| Rate for Payer: Global Benefits Group Commercial |
$672.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,008.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$711.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$406.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$660.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$224.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$784.00
|
| Rate for Payer: Multiplan Commercial |
$840.00
|
| Rate for Payer: Networks By Design Commercial |
$728.00
|
| Rate for Payer: Prime Health Services Commercial |
$952.00
|
| Rate for Payer: Riverside University Health System MISP |
$448.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$672.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$672.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$560.00
|
| Rate for Payer: United Healthcare All Other HMO |
$560.00
|
| Rate for Payer: United Healthcare HMO Rider |
$560.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$560.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$952.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$952.00
|
| Rate for Payer: Vantage Medical Group Senior |
$952.00
|
|
|
HC CMRI W FLOW/VEL+STRESS W+W/O C
|
Facility
|
OP
|
$1,120.00
|
|
| Hospital Charge Code |
908801273
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$224.00 |
| Max. Negotiated Rate |
$1,008.00 |
| Rate for Payer: Adventist Health Commercial |
$224.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$680.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$952.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$616.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$840.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$542.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$651.50
|
| Rate for Payer: Blue Shield of California Commercial |
$705.60
|
| Rate for Payer: Blue Shield of California EPN |
$444.64
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Central Health Plan Commercial |
$896.00
|
| Rate for Payer: Cigna of CA HMO |
$716.80
|
| Rate for Payer: Cigna of CA PPO |
$828.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$952.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$952.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$952.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$784.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$448.00
|
| Rate for Payer: EPIC Health Plan Senior |
$448.00
|
| Rate for Payer: Galaxy Health WC |
$952.00
|
| Rate for Payer: Global Benefits Group Commercial |
$672.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,008.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$711.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$406.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$660.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$224.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$784.00
|
| Rate for Payer: Multiplan Commercial |
$840.00
|
| Rate for Payer: Networks By Design Commercial |
$728.00
|
| Rate for Payer: Prime Health Services Commercial |
$952.00
|
| Rate for Payer: Riverside University Health System MISP |
$448.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$672.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$672.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$560.00
|
| Rate for Payer: United Healthcare All Other HMO |
$560.00
|
| Rate for Payer: United Healthcare HMO Rider |
$560.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$560.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$952.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$952.00
|
| Rate for Payer: Vantage Medical Group Senior |
$952.00
|
|
|
HC CMRI W FLOW/VEL+STRESS W+W/O C
|
Facility
|
IP
|
$1,120.00
|
|
| Hospital Charge Code |
908801273
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$224.00 |
| Max. Negotiated Rate |
$1,008.00 |
| Rate for Payer: Adventist Health Commercial |
$224.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Central Health Plan Commercial |
$896.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$784.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$448.00
|
| Rate for Payer: EPIC Health Plan Senior |
$448.00
|
| Rate for Payer: Galaxy Health WC |
$952.00
|
| Rate for Payer: Global Benefits Group Commercial |
$672.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,008.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$711.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$660.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$224.00
|
| Rate for Payer: Multiplan Commercial |
$840.00
|
| Rate for Payer: Networks By Design Commercial |
$728.00
|
| Rate for Payer: Prime Health Services Commercial |
$952.00
|
|
|
HC CMRI W STRESS W/O CONT
|
Facility
|
OP
|
$10,853.00
|
|
|
Service Code
|
CPT 75559
|
| Hospital Charge Code |
908801262
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$702.78 |
| Max. Negotiated Rate |
$9,767.70 |
| Rate for Payer: Adventist Health Commercial |
$2,170.60
|
| Rate for Payer: Adventist Health Commercial |
$1,048.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$702.78
|
| Rate for Payer: Adventist Health Medi-Cal |
$702.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,055.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,055.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$773.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$773.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$702.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$702.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,237.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,237.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,049.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,313.19
|
| Rate for Payer: Blue Shield of California Commercial |
$3,302.46
|
| Rate for Payer: Blue Shield of California Commercial |
$6,837.39
|
| Rate for Payer: Blue Shield of California EPN |
$2,081.07
|
| Rate for Payer: Blue Shield of California EPN |
$4,308.64
|
| Rate for Payer: Cash Price |
$2,358.90
|
| Rate for Payer: Cash Price |
$4,883.85
|
| Rate for Payer: Cash Price |
$4,883.85
|
| Rate for Payer: Cash Price |
$2,358.90
|
| Rate for Payer: Central Health Plan Commercial |
$8,682.40
|
| Rate for Payer: Central Health Plan Commercial |
$4,193.60
|
| Rate for Payer: Cigna of CA HMO |
$6,945.92
|
| Rate for Payer: Cigna of CA HMO |
$3,354.88
|
| Rate for Payer: Cigna of CA PPO |
$8,031.22
|
| Rate for Payer: Cigna of CA PPO |
$3,879.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$773.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$773.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$702.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$702.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,669.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,597.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,159.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,159.59
|
| Rate for Payer: EPIC Health Plan Senior |
$773.06
|
| Rate for Payer: EPIC Health Plan Senior |
$773.06
|
| Rate for Payer: Galaxy Health WC |
$9,225.05
|
| Rate for Payer: Galaxy Health WC |
$4,455.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,145.20
|
| Rate for Payer: Global Benefits Group Commercial |
$6,511.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,717.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,767.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,152.56
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,152.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$702.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$702.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,328.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,891.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,939.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,902.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$983.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$983.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,170.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,048.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$941.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$941.73
|
| Rate for Payer: Multiplan Commercial |
$8,139.75
|
| Rate for Payer: Multiplan Commercial |
$3,931.50
|
| Rate for Payer: Networks By Design Commercial |
$7,054.45
|
| Rate for Payer: Networks By Design Commercial |
$3,407.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$702.78
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$702.78
|
| Rate for Payer: Prime Health Services Commercial |
$4,455.70
|
| Rate for Payer: Prime Health Services Commercial |
$9,225.05
|
| Rate for Payer: Prime Health Services Medicare |
$744.95
|
| Rate for Payer: Prime Health Services Medicare |
$744.95
|
| Rate for Payer: Riverside University Health System MISP |
$773.06
|
| Rate for Payer: Riverside University Health System MISP |
$773.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,511.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,145.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,511.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,145.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| 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 All Other HMO |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$702.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$702.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$773.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$773.06
|
| Rate for Payer: Vantage Medical Group Senior |
$702.78
|
| Rate for Payer: Vantage Medical Group Senior |
$702.78
|
|
|
HC CMRI W STRESS W/O CONT
|
Facility
|
IP
|
$10,853.00
|
|
|
Service Code
|
CPT 75559
|
| Hospital Charge Code |
908801262
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,170.60 |
| Max. Negotiated Rate |
$9,767.70 |
| Rate for Payer: Adventist Health Commercial |
$2,170.60
|
| Rate for Payer: Cash Price |
$4,883.85
|
| Rate for Payer: Central Health Plan Commercial |
$8,682.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,597.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,341.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,341.20
|
| Rate for Payer: Galaxy Health WC |
$9,225.05
|
| Rate for Payer: Global Benefits Group Commercial |
$6,511.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,767.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,891.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,403.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,170.60
|
| Rate for Payer: Multiplan Commercial |
$8,139.75
|
| Rate for Payer: Networks By Design Commercial |
$7,054.45
|
| Rate for Payer: Prime Health Services Commercial |
$9,225.05
|
|
|
HC CMRI W STRESS W+W/O CONT
|
Facility
|
IP
|
$15,930.00
|
|
|
Service Code
|
CPT 75563
|
| Hospital Charge Code |
908801272
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,186.00 |
| Max. Negotiated Rate |
$14,337.00 |
| Rate for Payer: Adventist Health Commercial |
$3,186.00
|
| Rate for Payer: Cash Price |
$7,168.50
|
| Rate for Payer: Central Health Plan Commercial |
$12,744.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,151.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,372.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,372.00
|
| Rate for Payer: Galaxy Health WC |
$13,540.50
|
| Rate for Payer: Global Benefits Group Commercial |
$9,558.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,337.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,115.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,398.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,186.00
|
| Rate for Payer: Multiplan Commercial |
$11,947.50
|
| Rate for Payer: Networks By Design Commercial |
$10,354.50
|
| Rate for Payer: Prime Health Services Commercial |
$13,540.50
|
|
|
HC CMRI W STRESS W+W/O CONT
|
Facility
|
OP
|
$15,930.00
|
|
|
Service Code
|
CPT 75563
|
| Hospital Charge Code |
908801272
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,008.25 |
| Max. Negotiated Rate |
$14,337.00 |
| Rate for Payer: Adventist Health Commercial |
$3,186.00
|
| Rate for Payer: Adventist Health Commercial |
$1,231.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,008.25
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,008.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,055.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,055.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,512.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,512.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,109.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,109.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,008.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,008.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,806.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,806.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,581.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,266.48
|
| Rate for Payer: Blue Shield of California Commercial |
$3,878.91
|
| Rate for Payer: Blue Shield of California Commercial |
$10,035.90
|
| Rate for Payer: Blue Shield of California EPN |
$2,444.33
|
| Rate for Payer: Blue Shield of California EPN |
$6,324.21
|
| Rate for Payer: Cash Price |
$2,770.65
|
| Rate for Payer: Cash Price |
$7,168.50
|
| Rate for Payer: Cash Price |
$7,168.50
|
| Rate for Payer: Cash Price |
$2,770.65
|
| Rate for Payer: Central Health Plan Commercial |
$12,744.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,925.60
|
| Rate for Payer: Cigna of CA HMO |
$10,195.20
|
| Rate for Payer: Cigna of CA HMO |
$3,940.48
|
| Rate for Payer: Cigna of CA PPO |
$11,788.20
|
| Rate for Payer: Cigna of CA PPO |
$4,556.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,512.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,512.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,109.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,109.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,008.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,008.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,309.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,151.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,663.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,663.61
|
| Rate for Payer: EPIC Health Plan Senior |
$1,109.08
|
| Rate for Payer: EPIC Health Plan Senior |
$1,109.08
|
| Rate for Payer: Galaxy Health WC |
$13,540.50
|
| Rate for Payer: Galaxy Health WC |
$5,233.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,694.20
|
| Rate for Payer: Global Benefits Group Commercial |
$9,558.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,541.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,337.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,653.53
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,653.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,008.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,008.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,909.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,115.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,782.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,234.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,411.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,411.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,186.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,231.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,351.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,351.06
|
| Rate for Payer: Multiplan Commercial |
$11,947.50
|
| Rate for Payer: Multiplan Commercial |
$4,617.75
|
| Rate for Payer: Networks By Design Commercial |
$10,354.50
|
| Rate for Payer: Networks By Design Commercial |
$4,002.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,008.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,008.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,233.45
|
| Rate for Payer: Prime Health Services Commercial |
$13,540.50
|
| Rate for Payer: Prime Health Services Medicare |
$1,068.74
|
| Rate for Payer: Prime Health Services Medicare |
$1,068.74
|
| Rate for Payer: Riverside University Health System MISP |
$1,109.08
|
| Rate for Payer: Riverside University Health System MISP |
$1,109.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,558.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,694.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,558.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,694.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,367.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,367.12
|
| Rate for Payer: United Healthcare All Other HMO |
$1,367.12
|
| Rate for Payer: United Healthcare All Other HMO |
$1,367.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1,367.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1,367.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,367.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,367.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,008.25
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,008.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,512.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,512.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,109.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,109.08
|
| Rate for Payer: Vantage Medical Group Senior |
$1,008.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,008.25
|
|
|
HC CM SVCS BH AT LST 20 MIN CLIN PSYCH OR CLIN SW PER MNTH
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT G0323
|
| Hospital Charge Code |
907800323
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$17.40 |
| Max. Negotiated Rate |
$78.30 |
| Rate for Payer: Adventist Health Commercial |
$17.40
|
| Rate for Payer: Cash Price |
$39.15
|
| Rate for Payer: Central Health Plan Commercial |
$69.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$60.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.80
|
| Rate for Payer: EPIC Health Plan Senior |
$34.80
|
| Rate for Payer: Galaxy Health WC |
$73.95
|
| Rate for Payer: Global Benefits Group Commercial |
$52.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$78.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.33
|
| Rate for Payer: Multiplan Commercial |
$65.25
|
| Rate for Payer: Networks By Design Commercial |
$56.55
|
| Rate for Payer: Prime Health Services Commercial |
$73.95
|
|
|
HC CM SVCS BH AT LST 20 MIN CLIN PSYCH OR CLIN SW PER MNTH
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT G0323
|
| Hospital Charge Code |
907800323
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$17.40 |
| Max. Negotiated Rate |
$291.32 |
| Rate for Payer: Adventist Health Commercial |
$17.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$48.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$291.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$42.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.61
|
| Rate for Payer: Blue Shield of California Commercial |
$55.16
|
| Rate for Payer: Blue Shield of California EPN |
$34.71
|
| Rate for Payer: Cash Price |
$39.15
|
| Rate for Payer: Cash Price |
$39.15
|
| Rate for Payer: Central Health Plan Commercial |
$69.60
|
| Rate for Payer: Cigna of CA HMO |
$55.68
|
| Rate for Payer: Cigna of CA PPO |
$64.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$60.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.51
|
| Rate for Payer: EPIC Health Plan Senior |
$53.01
|
| Rate for Payer: Galaxy Health WC |
$73.95
|
| Rate for Payer: Global Benefits Group Commercial |
$52.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$78.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$79.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$67.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$74.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$64.57
|
| Rate for Payer: Multiplan Commercial |
$65.25
|
| Rate for Payer: Networks By Design Commercial |
$56.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$48.19
|
| Rate for Payer: Prime Health Services Commercial |
$73.95
|
| Rate for Payer: Prime Health Services Medicare |
$51.08
|
| Rate for Payer: Riverside University Health System MISP |
$53.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.20
|
| Rate for Payer: Upland Medical Group Pediatric |
$48.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.01
|
| Rate for Payer: Vantage Medical Group Senior |
$48.19
|
|
|
HC CMVABG
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
CPT 86644
|
| Hospital Charge Code |
900913699
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$16.20 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Central Health Plan Commercial |
$14.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7.20
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: Networks By Design Commercial |
$11.70
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
|
|
HC CMVABG
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 86644
|
| Hospital Charge Code |
900913699
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$145.10 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$14.39
|
| Rate for Payer: Adventist Health Medi-Cal |
$14.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$105.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$105.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$104.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$104.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145.10
|
| Rate for Payer: Blue Shield of California Commercial |
$11.34
|
| Rate for Payer: Blue Shield of California Commercial |
$9.45
|
| Rate for Payer: Blue Shield of California EPN |
$7.15
|
| Rate for Payer: Blue Shield of California EPN |
$5.96
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Central Health Plan Commercial |
$12.00
|
| Rate for Payer: Central Health Plan Commercial |
$14.40
|
| Rate for Payer: Cigna of CA HMO |
$11.52
|
| Rate for Payer: Cigna of CA HMO |
$9.60
|
| Rate for Payer: Cigna of CA PPO |
$13.32
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.74
|
| Rate for Payer: EPIC Health Plan Senior |
$15.83
|
| Rate for Payer: EPIC Health Plan Senior |
$15.83
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.28
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Networks By Design Commercial |
$11.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14.39
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14.39
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Prime Health Services Medicare |
$15.25
|
| Rate for Payer: Prime Health Services Medicare |
$15.25
|
| Rate for Payer: Riverside University Health System MISP |
$15.83
|
| Rate for Payer: Riverside University Health System MISP |
$15.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.65
|
| Rate for Payer: United Healthcare All Other HMO |
$11.65
|
| Rate for Payer: United Healthcare All Other HMO |
$11.65
|
| Rate for Payer: United Healthcare HMO Rider |
$11.65
|
| Rate for Payer: United Healthcare HMO Rider |
$11.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.39
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Vantage Medical Group Senior |
$14.39
|
| Rate for Payer: Vantage Medical Group Senior |
$14.39
|
|
|
HC CMV AB IGG
|
Facility
|
IP
|
$273.00
|
|
|
Service Code
|
CPT 86644
|
| Hospital Charge Code |
900910987
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$245.70 |
| Rate for Payer: Adventist Health Commercial |
$54.60
|
| Rate for Payer: Cash Price |
$122.85
|
| Rate for Payer: Central Health Plan Commercial |
$218.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$191.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.20
|
| Rate for Payer: EPIC Health Plan Senior |
$109.20
|
| Rate for Payer: Galaxy Health WC |
$232.05
|
| Rate for Payer: Global Benefits Group Commercial |
$163.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$245.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$173.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$161.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.60
|
| Rate for Payer: Multiplan Commercial |
$204.75
|
| Rate for Payer: Networks By Design Commercial |
$177.45
|
| Rate for Payer: Prime Health Services Commercial |
$232.05
|
|
|
HC CMV AB IGG
|
Facility
|
OP
|
$273.00
|
|
|
Service Code
|
CPT 86644
|
| Hospital Charge Code |
900910987
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.65 |
| Max. Negotiated Rate |
$245.70 |
| Rate for Payer: Adventist Health Commercial |
$54.60
|
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$14.39
|
| Rate for Payer: Adventist Health Medi-Cal |
$14.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$105.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$105.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$104.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$104.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145.10
|
| Rate for Payer: Blue Shield of California Commercial |
$61.74
|
| Rate for Payer: Blue Shield of California Commercial |
$171.99
|
| Rate for Payer: Blue Shield of California EPN |
$38.91
|
| Rate for Payer: Blue Shield of California EPN |
$108.38
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$122.85
|
| Rate for Payer: Cash Price |
$122.85
|
| Rate for Payer: Central Health Plan Commercial |
$218.40
|
| Rate for Payer: Central Health Plan Commercial |
$78.40
|
| Rate for Payer: Cigna of CA HMO |
$62.72
|
| Rate for Payer: Cigna of CA HMO |
$174.72
|
| Rate for Payer: Cigna of CA PPO |
$72.52
|
| Rate for Payer: Cigna of CA PPO |
$202.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$191.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$68.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.74
|
| Rate for Payer: EPIC Health Plan Senior |
$15.83
|
| Rate for Payer: EPIC Health Plan Senior |
$15.83
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Galaxy Health WC |
$232.05
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Global Benefits Group Commercial |
$163.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$88.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$245.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$173.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$62.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.28
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: Multiplan Commercial |
$204.75
|
| Rate for Payer: Networks By Design Commercial |
$177.45
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14.39
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14.39
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
| Rate for Payer: Prime Health Services Commercial |
$232.05
|
| Rate for Payer: Prime Health Services Medicare |
$15.25
|
| Rate for Payer: Prime Health Services Medicare |
$15.25
|
| Rate for Payer: Riverside University Health System MISP |
$15.83
|
| Rate for Payer: Riverside University Health System MISP |
$15.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$163.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$163.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.65
|
| Rate for Payer: United Healthcare All Other HMO |
$11.65
|
| Rate for Payer: United Healthcare All Other HMO |
$11.65
|
| Rate for Payer: United Healthcare HMO Rider |
$11.65
|
| Rate for Payer: United Healthcare HMO Rider |
$11.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.39
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Vantage Medical Group Senior |
$14.39
|
| Rate for Payer: Vantage Medical Group Senior |
$14.39
|
|
|
HC CMV AB IGM
|
Facility
|
IP
|
$314.00
|
|
|
Service Code
|
CPT 86645
|
| Hospital Charge Code |
900910959
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$62.80 |
| Max. Negotiated Rate |
$282.60 |
| Rate for Payer: Adventist Health Commercial |
$62.80
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Central Health Plan Commercial |
$251.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$219.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.60
|
| Rate for Payer: EPIC Health Plan Senior |
$125.60
|
| Rate for Payer: Galaxy Health WC |
$266.90
|
| Rate for Payer: Global Benefits Group Commercial |
$188.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$282.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$199.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$185.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.80
|
| Rate for Payer: Multiplan Commercial |
$235.50
|
| Rate for Payer: Networks By Design Commercial |
$204.10
|
| Rate for Payer: Prime Health Services Commercial |
$266.90
|
|
