|
HC CL TRT MET FX W MANIPULATION EA
|
Facility
|
OP
|
$3,865.00
|
|
|
Service Code
|
CPT 28475
|
| Hospital Charge Code |
900501248
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$294.27 |
| Max. Negotiated Rate |
$3,478.50 |
| Rate for Payer: Adventist Health Commercial |
$773.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$485.64
|
| Rate for Payer: Cash Price |
$2,125.75
|
| Rate for Payer: Cash Price |
$2,125.75
|
| Rate for Payer: Cash Price |
$2,125.75
|
| Rate for Payer: Cash Price |
$2,125.75
|
| Rate for Payer: Central Health Plan Commercial |
$3,092.00
|
| Rate for Payer: Cigna of CA HMO |
$2,473.60
|
| Rate for Payer: Cigna of CA PPO |
$2,860.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$411.47
|
| Rate for Payer: EPIC Health Plan Senior |
$304.79
|
| Rate for Payer: Galaxy Health WC |
$3,285.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,319.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,478.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$499.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.79
|
| Rate for Payer: InnovAge PACE Commercial |
$457.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,577.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$294.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$773.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$408.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.42
|
| Rate for Payer: Multiplan Commercial |
$2,898.75
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$2,512.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$304.79
|
| Rate for Payer: Preferred Health Network WC |
$495.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,285.25
|
| Rate for Payer: Prime Health Services Medicare |
$323.08
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Riverside University Health System MISP |
$335.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,319.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,932.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,932.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,932.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$304.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Vantage Medical Group Senior |
$304.79
|
|
|
HC CL TRT MET FX W MANIPULATION EA
|
Facility
|
IP
|
$3,865.00
|
|
|
Service Code
|
CPT 28475
|
| Hospital Charge Code |
900501248
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$773.00 |
| Max. Negotiated Rate |
$3,478.50 |
| Rate for Payer: Adventist Health Commercial |
$773.00
|
| Rate for Payer: Cash Price |
$2,125.75
|
| Rate for Payer: Central Health Plan Commercial |
$3,092.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,546.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,546.00
|
| Rate for Payer: Galaxy Health WC |
$3,285.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,319.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,478.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,577.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,472.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,392.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$773.00
|
| Rate for Payer: Multiplan Commercial |
$2,898.75
|
| Rate for Payer: Networks By Design Commercial |
$2,512.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,285.25
|
|
|
HC CL TRT OF KNEE DISC W/O ANESTH
|
Facility
|
IP
|
$2,548.00
|
|
|
Service Code
|
CPT 27550
|
| Hospital Charge Code |
900501246
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$509.60 |
| Max. Negotiated Rate |
$2,293.20 |
| Rate for Payer: Adventist Health Commercial |
$509.60
|
| Rate for Payer: Cash Price |
$1,401.40
|
| Rate for Payer: Central Health Plan Commercial |
$2,038.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,019.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,019.20
|
| Rate for Payer: Galaxy Health WC |
$2,165.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,528.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,293.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,699.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$970.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,577.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$509.60
|
| Rate for Payer: Multiplan Commercial |
$1,911.00
|
| Rate for Payer: Networks By Design Commercial |
$1,656.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,165.80
|
|
|
HC CL TRT OF KNEE DISC W/O ANESTH
|
Facility
|
OP
|
$2,548.00
|
|
|
Service Code
|
CPT 27550
|
| Hospital Charge Code |
900501246
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$304.79 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$509.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$485.64
|
| Rate for Payer: Cash Price |
$1,401.40
|
| Rate for Payer: Cash Price |
$1,401.40
|
| Rate for Payer: Cash Price |
$1,401.40
|
| Rate for Payer: Cash Price |
$1,401.40
|
| Rate for Payer: Central Health Plan Commercial |
$2,038.40
|
| Rate for Payer: Cigna of CA HMO |
$1,630.72
|
| Rate for Payer: Cigna of CA PPO |
$1,885.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$411.47
|
| Rate for Payer: EPIC Health Plan Senior |
$304.79
|
| Rate for Payer: Galaxy Health WC |
$2,165.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,528.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,293.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$499.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.79
|
| Rate for Payer: InnovAge PACE Commercial |
$457.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,699.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$509.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$408.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.42
|
| Rate for Payer: Multiplan Commercial |
$1,911.00
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,656.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$304.79
|
| Rate for Payer: Preferred Health Network WC |
$495.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,165.80
|
| Rate for Payer: Prime Health Services Medicare |
$323.08
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Riverside University Health System MISP |
$335.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,528.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,274.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,274.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,274.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,274.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$304.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Vantage Medical Group Senior |
$304.79
|
|
|
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 |
$58.73
|
| Rate for Payer: Blue Shield of California Commercial |
$77.30
|
| Rate for Payer: Blue Shield of California EPN |
$50.40
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cash Price |
$55.00
|
| 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: 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: InnovAge PACE Commercial |
$50.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$70.00
|
| Rate for Payer: Molina Healthcare of CA 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
|
IP
|
$100.00
|
|
|
Service Code
|
CPT L3380
|
| Hospital Charge Code |
915353380
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Blue Shield of California Commercial |
$77.30
|
| Rate for Payer: Blue Shield of California EPN |
$50.40
|
| Rate for Payer: Cash Price |
$55.00
|
| 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: 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: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.00
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| 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
|
|
|
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 |
$58.73
|
| Rate for Payer: Blue Shield of California Commercial |
$77.30
|
| Rate for Payer: Blue Shield of California EPN |
$50.40
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cash Price |
$55.00
|
| 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: 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: InnovAge PACE Commercial |
$50.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$70.00
|
| Rate for Payer: Molina Healthcare of CA 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
|
IP
|
$100.00
|
|
|
Service Code
|
CPT L3380
|
| Hospital Charge Code |
905353380
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Blue Shield of California Commercial |
$77.30
|
| Rate for Payer: Blue Shield of California EPN |
$50.40
|
| Rate for Payer: Cash Price |
$55.00
|
| 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: 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: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.00
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| 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
|
|
|
HC CMRI MORPH/FUNCT W/O CONTRAST
|
Facility
|
OP
|
$4,787.00
|
|
|
Service Code
|
CPT 75557
|
| Hospital Charge Code |
908801260
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$4,308.30 |
| Rate for Payer: Adventist Health Commercial |
$957.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$307.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,907.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,086.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,811.41
|
| Rate for Payer: Blue Shield of California Commercial |
$2,905.71
|
| Rate for Payer: Blue Shield of California EPN |
$1,900.44
|
| Rate for Payer: Cash Price |
$2,632.85
|
| Rate for Payer: Cash Price |
$2,632.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,829.60
|
| Rate for Payer: Cigna of CA HMO |
$3,063.68
|
| Rate for Payer: Cigna of CA PPO |
$3,542.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$4,068.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,872.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,308.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: InnovAge PACE Commercial |
$460.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,192.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,823.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$957.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$411.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$3,590.25
|
| Rate for Payer: Networks By Design Commercial |
$3,111.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$307.13
|
| Rate for Payer: Prime Health Services Commercial |
$4,068.95
|
| Rate for Payer: Prime Health Services Medicare |
$325.56
|
| Rate for Payer: Riverside University Health System MISP |
$337.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,872.20
|
| 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 HMO |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC CMRI MORPH/FUNCT W/O CONTRAST
|
Facility
|
IP
|
$4,787.00
|
|
|
Service Code
|
CPT 75557
|
| Hospital Charge Code |
908801260
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$957.40 |
| Max. Negotiated Rate |
$4,308.30 |
| Rate for Payer: Adventist Health Commercial |
$957.40
|
| Rate for Payer: Cash Price |
$2,632.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,829.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,914.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,914.80
|
| Rate for Payer: Galaxy Health WC |
$4,068.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,872.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,308.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,192.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,823.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,963.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$957.40
|
| Rate for Payer: Multiplan Commercial |
$3,590.25
|
| Rate for Payer: Networks By Design Commercial |
$3,111.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,068.95
|
|
|
HC CMRI MORPH/FUNCT W+W/O CONT
|
Facility
|
IP
|
$5,679.00
|
|
|
Service Code
|
CPT 75561
|
| Hospital Charge Code |
908801270
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,135.80 |
| Max. Negotiated Rate |
$5,111.10 |
| Rate for Payer: Adventist Health Commercial |
$1,135.80
|
| Rate for Payer: Cash Price |
$3,123.45
|
| Rate for Payer: Central Health Plan Commercial |
$4,543.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,271.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,271.60
|
| Rate for Payer: Galaxy Health WC |
$4,827.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,407.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,111.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,787.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,163.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,515.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,135.80
|
| Rate for Payer: Multiplan Commercial |
$4,259.25
|
| Rate for Payer: Networks By Design Commercial |
$3,691.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,827.15
|
|
|
HC CMRI MORPH/FUNCT W+W/O CONT
|
Facility
|
OP
|
$5,679.00
|
|
|
Service Code
|
CPT 75561
|
| Hospital Charge Code |
908801270
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$453.77 |
| Max. Negotiated Rate |
$5,111.10 |
| Rate for Payer: Adventist Health Commercial |
$1,135.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$453.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,448.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,045.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,335.28
|
| Rate for Payer: Blue Shield of California Commercial |
$3,447.15
|
| Rate for Payer: Blue Shield of California EPN |
$2,254.56
|
| Rate for Payer: Cash Price |
$3,123.45
|
| Rate for Payer: Cash Price |
$3,123.45
|
| Rate for Payer: Central Health Plan Commercial |
$4,543.20
|
| Rate for Payer: Cigna of CA HMO |
$3,634.56
|
| Rate for Payer: Cigna of CA PPO |
$4,202.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.59
|
| Rate for Payer: EPIC Health Plan Senior |
$453.77
|
| Rate for Payer: Galaxy Health WC |
$4,827.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,407.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,111.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$620.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: InnovAge PACE Commercial |
$680.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,787.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$685.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,135.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$608.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$608.05
|
| Rate for Payer: Multiplan Commercial |
$4,259.25
|
| Rate for Payer: Networks By Design Commercial |
$3,691.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$453.77
|
| Rate for Payer: Prime Health Services Commercial |
$4,827.15
|
| Rate for Payer: Prime Health Services Medicare |
$481.00
|
| Rate for Payer: Riverside University Health System MISP |
$499.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,407.40
|
| 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 HMO |
$1,367.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1,367.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,367.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$453.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
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 |
$657.78
|
| Rate for Payer: Blue Shield of California Commercial |
$679.84
|
| Rate for Payer: Blue Shield of California EPN |
$444.64
|
| Rate for Payer: Cash Price |
$616.00
|
| 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: 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: InnovAge PACE Commercial |
$560.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$747.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$426.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$693.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$224.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$784.00
|
| Rate for Payer: Molina Healthcare of CA 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 |
$616.00
|
| Rate for Payer: Central Health Plan Commercial |
$896.00
|
| 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 Permanente of CA Commercial/Self Funded |
$747.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$426.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$693.28
|
| 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 |
$657.78
|
| Rate for Payer: Blue Shield of California Commercial |
$679.84
|
| Rate for Payer: Blue Shield of California EPN |
$444.64
|
| Rate for Payer: Cash Price |
$616.00
|
| 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: 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: InnovAge PACE Commercial |
$560.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$747.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$426.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$693.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$224.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$784.00
|
| Rate for Payer: Molina Healthcare of CA 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+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 |
$616.00
|
| Rate for Payer: Central Health Plan Commercial |
$896.00
|
| 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 Permanente of CA Commercial/Self Funded |
$747.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$426.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$693.28
|
| 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 |
$657.78
|
| Rate for Payer: Blue Shield of California Commercial |
$679.84
|
| Rate for Payer: Blue Shield of California EPN |
$444.64
|
| Rate for Payer: Cash Price |
$616.00
|
| 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: 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: InnovAge PACE Commercial |
$560.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$747.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$426.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$693.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$224.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$784.00
|
| Rate for Payer: Molina Healthcare of CA 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 |
$616.00
|
| Rate for Payer: Central Health Plan Commercial |
$896.00
|
| 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 Permanente of CA Commercial/Self Funded |
$747.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$426.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$693.28
|
| 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+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 |
$616.00
|
| Rate for Payer: Central Health Plan Commercial |
$896.00
|
| 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 Permanente of CA Commercial/Self Funded |
$747.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$426.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$693.28
|
| 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+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 |
$657.78
|
| Rate for Payer: Blue Shield of California Commercial |
$679.84
|
| Rate for Payer: Blue Shield of California EPN |
$444.64
|
| Rate for Payer: Cash Price |
$616.00
|
| 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: 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: InnovAge PACE Commercial |
$560.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$747.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$426.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$693.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$224.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$784.00
|
| Rate for Payer: Molina Healthcare of CA 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 STRESS W/O CONT
|
Facility
|
IP
|
$5,242.00
|
|
|
Service Code
|
CPT 75559
|
| Hospital Charge Code |
908801262
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,048.40 |
| Max. Negotiated Rate |
$4,717.80 |
| Rate for Payer: Adventist Health Commercial |
$1,048.40
|
| Rate for Payer: Cash Price |
$2,883.10
|
| Rate for Payer: Central Health Plan Commercial |
$4,193.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,096.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,096.80
|
| Rate for Payer: Galaxy Health WC |
$4,455.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,145.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,717.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,496.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,997.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,244.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,048.40
|
| Rate for Payer: Multiplan Commercial |
$3,931.50
|
| Rate for Payer: Networks By Design Commercial |
$3,407.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,455.70
|
|
|
HC CMRI W STRESS W/O CONT
|
Facility
|
OP
|
$5,242.00
|
|
|
Service Code
|
CPT 75559
|
| Hospital Charge Code |
908801262
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$696.67 |
| Max. Negotiated Rate |
$4,717.80 |
| Rate for Payer: Adventist Health Commercial |
$1,048.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$696.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,183.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$766.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$696.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,237.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,078.63
|
| Rate for Payer: Blue Shield of California Commercial |
$3,181.89
|
| Rate for Payer: Blue Shield of California EPN |
$2,081.07
|
| Rate for Payer: Cash Price |
$2,883.10
|
| Rate for Payer: Cash Price |
$2,883.10
|
| Rate for Payer: Central Health Plan Commercial |
$4,193.60
|
| Rate for Payer: Cigna of CA HMO |
$3,354.88
|
| Rate for Payer: Cigna of CA PPO |
$3,879.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$766.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$696.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$940.50
|
| Rate for Payer: EPIC Health Plan Senior |
$696.67
|
| Rate for Payer: Galaxy Health WC |
$4,455.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,145.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,717.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,142.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$696.67
|
| Rate for Payer: InnovAge PACE Commercial |
$1,045.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,496.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,997.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$696.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,048.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$933.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$933.54
|
| Rate for Payer: Multiplan Commercial |
$3,931.50
|
| Rate for Payer: Networks By Design Commercial |
$3,407.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$696.67
|
| Rate for Payer: Prime Health Services Commercial |
$4,455.70
|
| Rate for Payer: Prime Health Services Medicare |
$738.47
|
| Rate for Payer: Riverside University Health System MISP |
$766.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,145.20
|
| 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 HMO |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$696.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$766.34
|
| Rate for Payer: Vantage Medical Group Senior |
$696.67
|
|
|
HC CMRI W STRESS W+W/O CONT
|
Facility
|
OP
|
$6,157.00
|
|
|
Service Code
|
CPT 75563
|
| Hospital Charge Code |
908801272
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,003.85 |
| Max. Negotiated Rate |
$5,541.30 |
| Rate for Payer: Adventist Health Commercial |
$1,231.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,003.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,739.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,104.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,003.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,806.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,616.01
|
| Rate for Payer: Blue Shield of California Commercial |
$3,737.30
|
| Rate for Payer: Blue Shield of California EPN |
$2,444.33
|
| Rate for Payer: Cash Price |
$3,386.35
|
| Rate for Payer: Cash Price |
$3,386.35
|
| Rate for Payer: Central Health Plan Commercial |
$4,925.60
|
| Rate for Payer: Cigna of CA HMO |
$3,940.48
|
| Rate for Payer: Cigna of CA PPO |
$4,556.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,104.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,003.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,355.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,003.85
|
| Rate for Payer: Galaxy Health WC |
$5,233.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,694.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,541.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,646.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,003.85
|
| Rate for Payer: InnovAge PACE Commercial |
$1,505.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,106.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,345.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,003.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,231.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,345.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,345.16
|
| Rate for Payer: Multiplan Commercial |
$4,617.75
|
| Rate for Payer: Networks By Design Commercial |
$4,002.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,003.85
|
| Rate for Payer: Prime Health Services Commercial |
$5,233.45
|
| Rate for Payer: Prime Health Services Medicare |
$1,064.08
|
| Rate for Payer: Riverside University Health System MISP |
$1,104.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,694.20
|
| 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 HMO |
$1,367.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1,367.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,367.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,003.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,104.23
|
| Rate for Payer: Vantage Medical Group Senior |
$1,003.85
|
|
|
HC CMRI W STRESS W+W/O CONT
|
Facility
|
IP
|
$6,157.00
|
|
|
Service Code
|
CPT 75563
|
| Hospital Charge Code |
908801272
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,231.40 |
| Max. Negotiated Rate |
$5,541.30 |
| Rate for Payer: Adventist Health Commercial |
$1,231.40
|
| Rate for Payer: Cash Price |
$3,386.35
|
| Rate for Payer: Central Health Plan Commercial |
$4,925.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,462.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,462.80
|
| Rate for Payer: Galaxy Health WC |
$5,233.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,694.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,541.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,106.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,345.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,811.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,231.40
|
| Rate for Payer: Multiplan Commercial |
$4,617.75
|
| Rate for Payer: Networks By Design Commercial |
$4,002.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,233.45
|
|
|
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 |
$78.30 |
| Rate for Payer: Adventist Health Commercial |
$17.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$37.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$52.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$42.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.10
|
| Rate for Payer: Blue Shield of California Commercial |
$53.16
|
| Rate for Payer: Blue Shield of California EPN |
$34.71
|
| Rate for Payer: Cash Price |
$47.85
|
| Rate for Payer: Cash Price |
$47.85
|
| 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 |
$56.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.10
|
| Rate for Payer: EPIC Health Plan Senior |
$37.85
|
| 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 |
$62.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$67.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.85
|
| Rate for Payer: InnovAge PACE Commercial |
$56.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$50.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50.72
|
| 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 |
$37.85
|
| Rate for Payer: Prime Health Services Commercial |
$73.95
|
| Rate for Payer: Prime Health Services Medicare |
$40.12
|
| Rate for Payer: Riverside University Health System MISP |
$41.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$43.50
|
| Rate for Payer: United Healthcare All Other HMO |
$43.50
|
| Rate for Payer: United Healthcare HMO Rider |
$43.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$37.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.63
|
| Rate for Payer: Vantage Medical Group Senior |
$37.85
|
|
