|
HC CHEST FLUORO/PACEMKR
|
Facility
|
OP
|
$872.00
|
|
| Hospital Charge Code |
909001469
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$174.40 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$174.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$741.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$479.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$654.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$422.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$512.13
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$479.60
|
| Rate for Payer: Cash Price |
$479.60
|
| Rate for Payer: Central Health Plan Commercial |
$697.60
|
| Rate for Payer: Cigna of CA HMO |
$558.08
|
| Rate for Payer: Cigna of CA PPO |
$645.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$741.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$741.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$741.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.80
|
| Rate for Payer: EPIC Health Plan Senior |
$348.80
|
| Rate for Payer: Galaxy Health WC |
$741.20
|
| Rate for Payer: Global Benefits Group Commercial |
$523.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$784.80
|
| Rate for Payer: InnovAge PACE Commercial |
$436.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$581.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$332.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$539.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$174.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$610.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$610.40
|
| Rate for Payer: Multiplan Commercial |
$654.00
|
| Rate for Payer: Networks By Design Commercial |
$566.80
|
| Rate for Payer: Prime Health Services Commercial |
$741.20
|
| Rate for Payer: Riverside University Health System MISP |
$348.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$523.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$436.00
|
| Rate for Payer: United Healthcare All Other HMO |
$436.00
|
| Rate for Payer: United Healthcare HMO Rider |
$436.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$436.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$741.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$741.20
|
| Rate for Payer: Vantage Medical Group Senior |
$741.20
|
|
|
HC CHEST FOUR OR MORE VIEWS
|
Facility
|
IP
|
$1,002.00
|
|
|
Service Code
|
CPT 71048
|
| Hospital Charge Code |
909071048
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$200.40 |
| Max. Negotiated Rate |
$901.80 |
| Rate for Payer: Adventist Health Commercial |
$200.40
|
| Rate for Payer: Cash Price |
$551.10
|
| Rate for Payer: Central Health Plan Commercial |
$801.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$400.80
|
| Rate for Payer: EPIC Health Plan Senior |
$400.80
|
| Rate for Payer: Galaxy Health WC |
$851.70
|
| Rate for Payer: Global Benefits Group Commercial |
$601.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$901.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$668.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$381.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$620.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.40
|
| Rate for Payer: Multiplan Commercial |
$751.50
|
| Rate for Payer: Networks By Design Commercial |
$651.30
|
| Rate for Payer: Prime Health Services Commercial |
$851.70
|
|
|
HC CHEST FOUR OR MORE VIEWS
|
Facility
|
OP
|
$1,002.00
|
|
|
Service Code
|
CPT 71048
|
| Hospital Charge Code |
909071048
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$45.17 |
| Max. Negotiated Rate |
$901.80 |
| Rate for Payer: Adventist Health Commercial |
$200.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$608.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$222.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.17
|
| Rate for Payer: Blue Shield of California Commercial |
$608.21
|
| Rate for Payer: Blue Shield of California EPN |
$397.79
|
| Rate for Payer: Cash Price |
$551.10
|
| Rate for Payer: Cash Price |
$551.10
|
| Rate for Payer: Central Health Plan Commercial |
$801.60
|
| Rate for Payer: Cigna of CA HMO |
$641.28
|
| Rate for Payer: Cigna of CA PPO |
$741.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$851.70
|
| Rate for Payer: Global Benefits Group Commercial |
$601.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$901.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$64.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: InnovAge PACE Commercial |
$202.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$668.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$751.50
|
| Rate for Payer: Networks By Design Commercial |
$651.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$851.70
|
| Rate for Payer: Prime Health Services Medicare |
$143.23
|
| Rate for Payer: Riverside University Health System MISP |
$148.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$601.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$601.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$303.97
|
| Rate for Payer: United Healthcare All Other HMO |
$303.97
|
| Rate for Payer: United Healthcare HMO Rider |
$303.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$303.97
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC CHEST PORT
|
Facility
|
OP
|
$2,139.00
|
|
|
Service Code
|
CPT C1788
|
| Hospital Charge Code |
909081700
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$427.80 |
| Max. Negotiated Rate |
$1,925.10 |
| Rate for Payer: Adventist Health Commercial |
$427.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,299.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,818.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,176.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,604.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,035.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,256.23
|
| Rate for Payer: Blue Shield of California Commercial |
$1,306.93
|
| Rate for Payer: Blue Shield of California EPN |
$853.46
|
| Rate for Payer: Cash Price |
$1,176.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,711.20
|
| Rate for Payer: Cigna of CA HMO |
$1,368.96
|
| Rate for Payer: Cigna of CA PPO |
$1,582.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,818.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,818.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,818.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$855.60
|
| Rate for Payer: EPIC Health Plan Senior |
$855.60
|
| Rate for Payer: Galaxy Health WC |
$1,818.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,283.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,925.10
|
| Rate for Payer: InnovAge PACE Commercial |
$1,069.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,426.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$814.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,324.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$427.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,497.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,497.30
|
| Rate for Payer: Multiplan Commercial |
$1,604.25
|
| Rate for Payer: Networks By Design Commercial |
$1,390.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,818.15
|
| Rate for Payer: Riverside University Health System MISP |
$855.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,283.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,283.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,069.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,069.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,069.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,069.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,818.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,818.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,818.15
|
|
|
HC CHEST PORT
|
Facility
|
IP
|
$2,139.00
|
|
|
Service Code
|
CPT C1788
|
| Hospital Charge Code |
909081700
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$427.80 |
| Max. Negotiated Rate |
$1,925.10 |
| Rate for Payer: Adventist Health Commercial |
$427.80
|
| Rate for Payer: Cash Price |
$1,176.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,711.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$855.60
|
| Rate for Payer: EPIC Health Plan Senior |
$855.60
|
| Rate for Payer: Galaxy Health WC |
$1,818.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,283.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,925.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,426.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$814.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,324.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$427.80
|
| Rate for Payer: Multiplan Commercial |
$1,604.25
|
| Rate for Payer: Networks By Design Commercial |
$1,390.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,818.15
|
|
|
HC CHEST SINGLE VIEW
|
Facility
|
OP
|
$830.00
|
|
|
Service Code
|
CPT 71045
|
| Hospital Charge Code |
909001408
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$18.63 |
| Max. Negotiated Rate |
$747.00 |
| Rate for Payer: Adventist Health Commercial |
$166.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$504.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$91.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.63
|
| Rate for Payer: Blue Shield of California Commercial |
$503.81
|
| Rate for Payer: Blue Shield of California EPN |
$329.51
|
| Rate for Payer: Cash Price |
$456.50
|
| Rate for Payer: Cash Price |
$456.50
|
| Rate for Payer: Central Health Plan Commercial |
$664.00
|
| Rate for Payer: Cigna of CA HMO |
$531.20
|
| Rate for Payer: Cigna of CA PPO |
$614.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$705.50
|
| Rate for Payer: Global Benefits Group Commercial |
$498.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$747.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$30.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: InnovAge PACE Commercial |
$167.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$553.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$622.50
|
| Rate for Payer: Networks By Design Commercial |
$539.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.88
|
| Rate for Payer: Prime Health Services Commercial |
$705.50
|
| Rate for Payer: Prime Health Services Medicare |
$118.59
|
| Rate for Payer: Riverside University Health System MISP |
$123.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$498.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$498.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$159.01
|
| Rate for Payer: United Healthcare All Other HMO |
$159.01
|
| Rate for Payer: United Healthcare HMO Rider |
$159.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC CHEST SINGLE VIEW
|
Facility
|
IP
|
$830.00
|
|
|
Service Code
|
CPT 71045
|
| Hospital Charge Code |
909001408
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$166.00 |
| Max. Negotiated Rate |
$747.00 |
| Rate for Payer: Adventist Health Commercial |
$166.00
|
| Rate for Payer: Cash Price |
$456.50
|
| Rate for Payer: Central Health Plan Commercial |
$664.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$332.00
|
| Rate for Payer: EPIC Health Plan Senior |
$332.00
|
| Rate for Payer: Galaxy Health WC |
$705.50
|
| Rate for Payer: Global Benefits Group Commercial |
$498.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$747.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$553.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$316.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$513.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.00
|
| Rate for Payer: Multiplan Commercial |
$622.50
|
| Rate for Payer: Networks By Design Commercial |
$539.50
|
| Rate for Payer: Prime Health Services Commercial |
$705.50
|
|
|
HC CHEST THREE VIEWS
|
Facility
|
IP
|
$922.00
|
|
|
Service Code
|
CPT 71047
|
| Hospital Charge Code |
909071047
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$184.40 |
| Max. Negotiated Rate |
$829.80 |
| Rate for Payer: Adventist Health Commercial |
$184.40
|
| Rate for Payer: Cash Price |
$507.10
|
| Rate for Payer: Central Health Plan Commercial |
$737.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$368.80
|
| Rate for Payer: EPIC Health Plan Senior |
$368.80
|
| Rate for Payer: Galaxy Health WC |
$783.70
|
| Rate for Payer: Global Benefits Group Commercial |
$553.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$829.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$614.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$351.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$570.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.40
|
| Rate for Payer: Multiplan Commercial |
$691.50
|
| Rate for Payer: Networks By Design Commercial |
$599.30
|
| Rate for Payer: Prime Health Services Commercial |
$783.70
|
|
|
HC CHEST THREE VIEWS
|
Facility
|
OP
|
$922.00
|
|
|
Service Code
|
CPT 71047
|
| Hospital Charge Code |
909071047
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$43.90 |
| Max. Negotiated Rate |
$829.80 |
| Rate for Payer: Adventist Health Commercial |
$184.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$559.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$216.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.90
|
| Rate for Payer: Blue Shield of California Commercial |
$559.65
|
| Rate for Payer: Blue Shield of California EPN |
$366.03
|
| Rate for Payer: Cash Price |
$507.10
|
| Rate for Payer: Cash Price |
$507.10
|
| Rate for Payer: Central Health Plan Commercial |
$737.60
|
| Rate for Payer: Cigna of CA HMO |
$590.08
|
| Rate for Payer: Cigna of CA PPO |
$682.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$783.70
|
| Rate for Payer: Global Benefits Group Commercial |
$553.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$829.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$60.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: InnovAge PACE Commercial |
$167.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$614.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$691.50
|
| Rate for Payer: Networks By Design Commercial |
$599.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.88
|
| Rate for Payer: Prime Health Services Commercial |
$783.70
|
| Rate for Payer: Prime Health Services Medicare |
$118.59
|
| Rate for Payer: Riverside University Health System MISP |
$123.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$553.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$553.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$159.01
|
| Rate for Payer: United Healthcare All Other HMO |
$159.01
|
| Rate for Payer: United Healthcare HMO Rider |
$159.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC CHEST TOMO FULL LUNG
|
Facility
|
OP
|
$892.00
|
|
|
Service Code
|
CPT 76102
|
| Hospital Charge Code |
909001465
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$73.24 |
| Max. Negotiated Rate |
$802.80 |
| Rate for Payer: Adventist Health Commercial |
$178.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$541.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$758.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$490.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$669.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$360.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$73.24
|
| Rate for Payer: Blue Shield of California Commercial |
$541.44
|
| Rate for Payer: Blue Shield of California EPN |
$354.12
|
| Rate for Payer: Cash Price |
$490.60
|
| Rate for Payer: Cash Price |
$490.60
|
| Rate for Payer: Central Health Plan Commercial |
$713.60
|
| Rate for Payer: Cigna of CA HMO |
$570.88
|
| Rate for Payer: Cigna of CA PPO |
$660.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$758.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$758.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$758.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$356.80
|
| Rate for Payer: EPIC Health Plan Senior |
$356.80
|
| Rate for Payer: Galaxy Health WC |
$758.20
|
| Rate for Payer: Global Benefits Group Commercial |
$535.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$802.80
|
| Rate for Payer: InnovAge PACE Commercial |
$446.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$594.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$339.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$552.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$624.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$624.40
|
| Rate for Payer: Multiplan Commercial |
$669.00
|
| Rate for Payer: Networks By Design Commercial |
$579.80
|
| Rate for Payer: Prime Health Services Commercial |
$758.20
|
| Rate for Payer: Riverside University Health System MISP |
$356.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$535.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$535.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$446.00
|
| Rate for Payer: United Healthcare All Other HMO |
$446.00
|
| Rate for Payer: United Healthcare HMO Rider |
$446.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$446.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$758.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$758.20
|
| Rate for Payer: Vantage Medical Group Senior |
$758.20
|
|
|
HC CHEST TOMO FULL LUNG
|
Facility
|
IP
|
$892.00
|
|
|
Service Code
|
CPT 76102
|
| Hospital Charge Code |
909001465
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$178.40 |
| Max. Negotiated Rate |
$802.80 |
| Rate for Payer: Adventist Health Commercial |
$178.40
|
| Rate for Payer: Cash Price |
$490.60
|
| Rate for Payer: Central Health Plan Commercial |
$713.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$356.80
|
| Rate for Payer: EPIC Health Plan Senior |
$356.80
|
| Rate for Payer: Galaxy Health WC |
$758.20
|
| Rate for Payer: Global Benefits Group Commercial |
$535.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$802.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$594.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$339.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$552.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.40
|
| Rate for Payer: Multiplan Commercial |
$669.00
|
| Rate for Payer: Networks By Design Commercial |
$579.80
|
| Rate for Payer: Prime Health Services Commercial |
$758.20
|
|
|
HC CHEST WALL MANIPULATION INIT
|
Facility
|
OP
|
$699.00
|
|
|
Service Code
|
CPT 94667
|
| Hospital Charge Code |
900800390
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$34.23 |
| Max. Negotiated Rate |
$629.10 |
| Rate for Payer: Adventist Health Commercial |
$139.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$163.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$424.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$149.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$384.45
|
| Rate for Payer: Cash Price |
$384.45
|
| Rate for Payer: Cash Price |
$384.45
|
| Rate for Payer: Cash Price |
$384.45
|
| Rate for Payer: Central Health Plan Commercial |
$559.20
|
| Rate for Payer: Cigna of CA HMO |
$447.36
|
| Rate for Payer: Cigna of CA PPO |
$517.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$594.15
|
| Rate for Payer: Global Benefits Group Commercial |
$419.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$629.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$34.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: InnovAge PACE Commercial |
$245.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$466.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$219.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$524.25
|
| Rate for Payer: Networks By Design Commercial |
$454.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$163.78
|
| Rate for Payer: Prime Health Services Commercial |
$594.15
|
| Rate for Payer: Prime Health Services Medicare |
$173.61
|
| Rate for Payer: Riverside University Health System MISP |
$180.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$419.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$419.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC CHEST WALL MANIPULATION INIT
|
Facility
|
IP
|
$699.00
|
|
|
Service Code
|
CPT 94667
|
| Hospital Charge Code |
900800390
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$139.80 |
| Max. Negotiated Rate |
$629.10 |
| Rate for Payer: Adventist Health Commercial |
$139.80
|
| Rate for Payer: Cash Price |
$384.45
|
| Rate for Payer: Central Health Plan Commercial |
$559.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$279.60
|
| Rate for Payer: EPIC Health Plan Senior |
$279.60
|
| Rate for Payer: Galaxy Health WC |
$594.15
|
| Rate for Payer: Global Benefits Group Commercial |
$419.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$629.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$466.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$266.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$432.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.80
|
| Rate for Payer: Multiplan Commercial |
$524.25
|
| Rate for Payer: Networks By Design Commercial |
$454.35
|
| Rate for Payer: Prime Health Services Commercial |
$594.15
|
|
|
HC CHEST WALL MANIPULATION SUB
|
Facility
|
OP
|
$435.00
|
|
|
Service Code
|
CPT 94668
|
| Hospital Charge Code |
900800391
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$20.12 |
| Max. Negotiated Rate |
$536.00 |
| Rate for Payer: Adventist Health Commercial |
$87.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$163.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$264.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$92.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$239.25
|
| Rate for Payer: Cash Price |
$239.25
|
| Rate for Payer: Cash Price |
$239.25
|
| Rate for Payer: Cash Price |
$239.25
|
| Rate for Payer: Central Health Plan Commercial |
$348.00
|
| Rate for Payer: Cigna of CA HMO |
$278.40
|
| Rate for Payer: Cigna of CA PPO |
$321.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$369.75
|
| Rate for Payer: Global Benefits Group Commercial |
$261.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$391.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: InnovAge PACE Commercial |
$245.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$290.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$219.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$326.25
|
| Rate for Payer: Networks By Design Commercial |
$282.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$163.78
|
| Rate for Payer: Prime Health Services Commercial |
$369.75
|
| Rate for Payer: Prime Health Services Medicare |
$173.61
|
| Rate for Payer: Riverside University Health System MISP |
$180.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$261.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$261.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC CHEST WALL MANIPULATION SUB
|
Facility
|
IP
|
$435.00
|
|
|
Service Code
|
CPT 94668
|
| Hospital Charge Code |
900800391
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$87.00 |
| Max. Negotiated Rate |
$391.50 |
| Rate for Payer: Adventist Health Commercial |
$87.00
|
| Rate for Payer: Cash Price |
$239.25
|
| Rate for Payer: Central Health Plan Commercial |
$348.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$174.00
|
| Rate for Payer: EPIC Health Plan Senior |
$174.00
|
| Rate for Payer: Galaxy Health WC |
$369.75
|
| Rate for Payer: Global Benefits Group Commercial |
$261.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$391.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$290.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$269.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.00
|
| Rate for Payer: Multiplan Commercial |
$326.25
|
| Rate for Payer: Networks By Design Commercial |
$282.75
|
| Rate for Payer: Prime Health Services Commercial |
$369.75
|
|
|
HC CHICKEN FEATHERS IGE
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913634
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$59.40 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Central Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.40
|
| Rate for Payer: EPIC Health Plan Senior |
$26.40
|
| Rate for Payer: Galaxy Health WC |
$56.10
|
| Rate for Payer: Global Benefits Group Commercial |
$39.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$59.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.20
|
| Rate for Payer: Multiplan Commercial |
$49.50
|
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: Prime Health Services Commercial |
$56.10
|
|
|
HC CHICKEN FEATHERS IGE
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913634
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$115.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.34
|
| Rate for Payer: Blue Shield of California Commercial |
$40.06
|
| Rate for Payer: Blue Shield of California EPN |
$26.20
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Central Health Plan Commercial |
$52.80
|
| Rate for Payer: Cigna of CA HMO |
$42.24
|
| Rate for Payer: Cigna of CA PPO |
$48.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.05
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$56.10
|
| Rate for Payer: Global Benefits Group Commercial |
$39.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$59.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: InnovAge PACE Commercial |
$7.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$49.50
|
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.22
|
| Rate for Payer: Prime Health Services Commercial |
$56.10
|
| Rate for Payer: Prime Health Services Medicare |
$5.53
|
| Rate for Payer: Riverside University Health System MISP |
$5.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Other HMO |
$4.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC CHILI PEPPER IGE
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913635
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$115.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.34
|
| Rate for Payer: Blue Shield of California Commercial |
$40.06
|
| Rate for Payer: Blue Shield of California EPN |
$26.20
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Central Health Plan Commercial |
$52.80
|
| Rate for Payer: Cigna of CA HMO |
$42.24
|
| Rate for Payer: Cigna of CA PPO |
$48.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.05
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$56.10
|
| Rate for Payer: Global Benefits Group Commercial |
$39.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$59.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: InnovAge PACE Commercial |
$7.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$49.50
|
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.22
|
| Rate for Payer: Prime Health Services Commercial |
$56.10
|
| Rate for Payer: Prime Health Services Medicare |
$5.53
|
| Rate for Payer: Riverside University Health System MISP |
$5.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Other HMO |
$4.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC CHILI PEPPER IGE
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913635
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$59.40 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Central Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.40
|
| Rate for Payer: EPIC Health Plan Senior |
$26.40
|
| Rate for Payer: Galaxy Health WC |
$56.10
|
| Rate for Payer: Global Benefits Group Commercial |
$39.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$59.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.20
|
| Rate for Payer: Multiplan Commercial |
$49.50
|
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: Prime Health Services Commercial |
$56.10
|
|
|
HC CHLAMYDIA AMPLIFICATION
|
Facility
|
IP
|
$115.05
|
|
|
Service Code
|
CPT 87491
|
| Hospital Charge Code |
900912304
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.01 |
| Max. Negotiated Rate |
$103.55 |
| Rate for Payer: Adventist Health Commercial |
$23.01
|
| Rate for Payer: Cash Price |
$63.28
|
| Rate for Payer: Central Health Plan Commercial |
$92.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.02
|
| Rate for Payer: EPIC Health Plan Senior |
$46.02
|
| Rate for Payer: Galaxy Health WC |
$97.79
|
| Rate for Payer: Global Benefits Group Commercial |
$69.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$103.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$71.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.01
|
| Rate for Payer: Multiplan Commercial |
$86.29
|
| Rate for Payer: Networks By Design Commercial |
$74.78
|
| Rate for Payer: Prime Health Services Commercial |
$97.79
|
|
|
HC CHLAMYDIA AMPLIFICATION
|
Facility
|
OP
|
$115.05
|
|
|
Service Code
|
CPT 87491
|
| Hospital Charge Code |
900912304
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.01 |
| Max. Negotiated Rate |
$247.04 |
| Rate for Payer: Adventist Health Commercial |
$23.01
|
| Rate for Payer: Adventist Health Medi-Cal |
$35.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$69.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$247.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.14
|
| Rate for Payer: Blue Shield of California Commercial |
$69.84
|
| Rate for Payer: Blue Shield of California EPN |
$45.67
|
| Rate for Payer: Cash Price |
$63.28
|
| Rate for Payer: Cash Price |
$63.28
|
| Rate for Payer: Central Health Plan Commercial |
$92.04
|
| Rate for Payer: Cigna of CA HMO |
$73.63
|
| Rate for Payer: Cigna of CA PPO |
$85.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.37
|
| Rate for Payer: EPIC Health Plan Senior |
$35.09
|
| Rate for Payer: Galaxy Health WC |
$97.79
|
| Rate for Payer: Global Benefits Group Commercial |
$69.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$103.55
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$44.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: InnovAge PACE Commercial |
$52.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$86.29
|
| Rate for Payer: Networks By Design Commercial |
$74.78
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$35.09
|
| Rate for Payer: Prime Health Services Commercial |
$97.79
|
| Rate for Payer: Prime Health Services Medicare |
$37.20
|
| Rate for Payer: Riverside University Health System MISP |
$38.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$69.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$69.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC CHLAMYDIA PNEU CULTR SOURCE SO
|
Facility
|
OP
|
$21.09
|
|
|
Service Code
|
CPT 87140
|
| Hospital Charge Code |
900914083
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$40.60 |
| Rate for Payer: Adventist Health Commercial |
$4.22
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$40.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.24
|
| Rate for Payer: Blue Shield of California Commercial |
$12.80
|
| Rate for Payer: Blue Shield of California EPN |
$8.37
|
| Rate for Payer: Cash Price |
$11.60
|
| Rate for Payer: Cash Price |
$11.60
|
| Rate for Payer: Central Health Plan Commercial |
$16.87
|
| Rate for Payer: Cigna of CA HMO |
$13.50
|
| Rate for Payer: Cigna of CA PPO |
$15.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.52
|
| Rate for Payer: EPIC Health Plan Senior |
$5.57
|
| Rate for Payer: Galaxy Health WC |
$17.93
|
| Rate for Payer: Global Benefits Group Commercial |
$12.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.98
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.57
|
| Rate for Payer: InnovAge PACE Commercial |
$8.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.46
|
| Rate for Payer: Multiplan Commercial |
$15.82
|
| Rate for Payer: Networks By Design Commercial |
$13.71
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.57
|
| Rate for Payer: Prime Health Services Commercial |
$17.93
|
| Rate for Payer: Prime Health Services Medicare |
$5.90
|
| Rate for Payer: Riverside University Health System MISP |
$6.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.51
|
| Rate for Payer: United Healthcare All Other HMO |
$4.51
|
| Rate for Payer: United Healthcare HMO Rider |
$4.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.51
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.13
|
| Rate for Payer: Vantage Medical Group Senior |
$5.57
|
|
|
HC CHLAMYDIA PNEU CULTR SOURCE SO
|
Facility
|
IP
|
$21.09
|
|
|
Service Code
|
CPT 87140
|
| Hospital Charge Code |
900914083
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$18.98 |
| Rate for Payer: Adventist Health Commercial |
$4.22
|
| Rate for Payer: Cash Price |
$11.60
|
| Rate for Payer: Central Health Plan Commercial |
$16.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.44
|
| Rate for Payer: EPIC Health Plan Senior |
$8.44
|
| Rate for Payer: Galaxy Health WC |
$17.93
|
| Rate for Payer: Global Benefits Group Commercial |
$12.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.22
|
| Rate for Payer: Multiplan Commercial |
$15.82
|
| Rate for Payer: Networks By Design Commercial |
$13.71
|
| Rate for Payer: Prime Health Services Commercial |
$17.93
|
|
|
HC CHLDCHTMY OR CHLDCHSTMY W EXP DRNG W TD SPNCTMY
|
Facility
|
OP
|
$6,278.00
|
|
|
Service Code
|
CPT 47425
|
| Hospital Charge Code |
906747425
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$275.35 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,255.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,336.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,452.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,708.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$3,452.90
|
| Rate for Payer: Cash Price |
$3,452.90
|
| Rate for Payer: Cash Price |
$3,452.90
|
| Rate for Payer: Central Health Plan Commercial |
$5,022.40
|
| Rate for Payer: Cigna of CA HMO |
$4,017.92
|
| Rate for Payer: Cigna of CA PPO |
$4,645.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,336.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,336.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,336.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,511.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,511.20
|
| Rate for Payer: Galaxy Health WC |
$5,336.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,766.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,650.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$275.35
|
| Rate for Payer: InnovAge PACE Commercial |
$3,139.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,187.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$304.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,886.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,255.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,394.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,394.60
|
| Rate for Payer: Multiplan Commercial |
$4,708.50
|
| Rate for Payer: Networks By Design Commercial |
$4,080.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,336.30
|
| Rate for Payer: Riverside University Health System MISP |
$2,511.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,766.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,766.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,336.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,336.30
|
| Rate for Payer: Vantage Medical Group Senior |
$5,336.30
|
|
|
HC CHLDCHTMY OR CHLDCHSTMY W EXP DRNG W TD SPNCTMY
|
Facility
|
IP
|
$6,278.00
|
|
|
Service Code
|
CPT 47425
|
| Hospital Charge Code |
906747425
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,255.60 |
| Max. Negotiated Rate |
$5,650.20 |
| Rate for Payer: Adventist Health Commercial |
$1,255.60
|
| Rate for Payer: Cash Price |
$3,452.90
|
| Rate for Payer: Central Health Plan Commercial |
$5,022.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,511.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,511.20
|
| Rate for Payer: Galaxy Health WC |
$5,336.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,766.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,650.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,187.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,391.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,886.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,255.60
|
| Rate for Payer: Multiplan Commercial |
$4,708.50
|
| Rate for Payer: Networks By Design Commercial |
$4,080.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,336.30
|
|
