|
HC FLUORO GUIDE NDL PLCMNT THRPY INJ
|
Facility
|
IP
|
$1,979.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
909001368
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$395.80 |
| Max. Negotiated Rate |
$1,781.10 |
| Rate for Payer: Adventist Health Commercial |
$395.80
|
| Rate for Payer: Cash Price |
$890.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,583.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,385.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$791.60
|
| Rate for Payer: EPIC Health Plan Senior |
$791.60
|
| Rate for Payer: Galaxy Health WC |
$1,682.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,187.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,781.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,256.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,167.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$395.80
|
| Rate for Payer: Multiplan Commercial |
$1,484.25
|
| Rate for Payer: Networks By Design Commercial |
$1,286.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,682.15
|
|
|
HC FLUORO GUIDE NDL PLCMNT THRPY INJ
|
Facility
|
OP
|
$1,979.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
909001368
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$114.40 |
| Max. Negotiated Rate |
$1,781.10 |
| Rate for Payer: Adventist Health Commercial |
$395.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$306.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,682.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,088.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,484.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$350.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$486.84
|
| Rate for Payer: Blue Shield of California Commercial |
$1,246.77
|
| Rate for Payer: Blue Shield of California EPN |
$785.66
|
| Rate for Payer: Cash Price |
$890.55
|
| Rate for Payer: Cash Price |
$890.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,583.20
|
| Rate for Payer: Cigna of CA HMO |
$1,266.56
|
| Rate for Payer: Cigna of CA PPO |
$1,464.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,682.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,682.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,682.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,385.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$791.60
|
| Rate for Payer: EPIC Health Plan Senior |
$791.60
|
| Rate for Payer: Galaxy Health WC |
$1,682.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,187.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,781.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$114.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,256.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$126.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,167.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$395.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,385.30
|
| Rate for Payer: Multiplan Commercial |
$1,484.25
|
| Rate for Payer: Networks By Design Commercial |
$1,286.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,682.15
|
| Rate for Payer: Riverside University Health System MISP |
$791.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,187.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,187.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$989.50
|
| Rate for Payer: United Healthcare All Other HMO |
$989.50
|
| Rate for Payer: United Healthcare HMO Rider |
$989.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$989.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,682.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,682.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,682.15
|
|
|
HC FLUORO GUIDE SPINE OR PARASPINOUS
|
Facility
|
OP
|
$1,409.00
|
|
|
Service Code
|
CPT 77003
|
| Hospital Charge Code |
909001358
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$97.83 |
| Max. Negotiated Rate |
$1,268.10 |
| Rate for Payer: Adventist Health Commercial |
$281.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$208.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,197.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$774.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,056.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$267.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$371.91
|
| Rate for Payer: Blue Shield of California Commercial |
$887.67
|
| Rate for Payer: Blue Shield of California EPN |
$559.37
|
| Rate for Payer: Cash Price |
$634.05
|
| Rate for Payer: Cash Price |
$634.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,127.20
|
| Rate for Payer: Cigna of CA HMO |
$901.76
|
| Rate for Payer: Cigna of CA PPO |
$1,042.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,197.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,197.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,197.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$986.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$563.60
|
| Rate for Payer: EPIC Health Plan Senior |
$563.60
|
| Rate for Payer: Galaxy Health WC |
$1,197.65
|
| Rate for Payer: Global Benefits Group Commercial |
$845.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,268.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$97.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$894.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$108.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$831.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$281.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$986.30
|
| Rate for Payer: Multiplan Commercial |
$1,056.75
|
| Rate for Payer: Networks By Design Commercial |
$915.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,197.65
|
| Rate for Payer: Riverside University Health System MISP |
$563.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$845.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$845.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$704.50
|
| Rate for Payer: United Healthcare All Other HMO |
$704.50
|
| Rate for Payer: United Healthcare HMO Rider |
$704.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$704.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,197.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,197.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1,197.65
|
|
|
HC FLUORO GUIDE SPINE OR PARASPINOUS
|
Facility
|
IP
|
$1,409.00
|
|
|
Service Code
|
CPT 77003
|
| Hospital Charge Code |
909001358
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$281.80 |
| Max. Negotiated Rate |
$1,268.10 |
| Rate for Payer: Adventist Health Commercial |
$281.80
|
| Rate for Payer: Cash Price |
$634.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,127.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$986.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$563.60
|
| Rate for Payer: EPIC Health Plan Senior |
$563.60
|
| Rate for Payer: Galaxy Health WC |
$1,197.65
|
| Rate for Payer: Global Benefits Group Commercial |
$845.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,268.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$894.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$831.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$281.80
|
| Rate for Payer: Multiplan Commercial |
$1,056.75
|
| Rate for Payer: Networks By Design Commercial |
$915.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,197.65
|
|
|
HC FLUORO IN RAD > 1 HR
|
Facility
|
OP
|
$1,859.00
|
|
|
Service Code
|
CPT 76001
|
| Hospital Charge Code |
909001670
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$371.80 |
| Max. Negotiated Rate |
$1,673.10 |
| Rate for Payer: Adventist Health Commercial |
$371.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,128.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,580.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,022.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,394.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$546.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$759.14
|
| Rate for Payer: Blue Shield of California Commercial |
$1,171.17
|
| Rate for Payer: Blue Shield of California EPN |
$738.02
|
| Rate for Payer: Cash Price |
$836.55
|
| Rate for Payer: Cash Price |
$836.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,487.20
|
| Rate for Payer: Cigna of CA HMO |
$1,189.76
|
| Rate for Payer: Cigna of CA PPO |
$1,375.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,580.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,580.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,580.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,301.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$743.60
|
| Rate for Payer: EPIC Health Plan Senior |
$743.60
|
| Rate for Payer: Galaxy Health WC |
$1,580.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,115.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,673.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,180.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$674.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,096.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$371.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,301.30
|
| Rate for Payer: Multiplan Commercial |
$1,394.25
|
| Rate for Payer: Networks By Design Commercial |
$1,208.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,580.15
|
| Rate for Payer: Riverside University Health System MISP |
$743.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,115.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,115.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$929.50
|
| Rate for Payer: United Healthcare All Other HMO |
$929.50
|
| Rate for Payer: United Healthcare HMO Rider |
$929.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$929.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,580.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,580.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,580.15
|
|
|
HC FLUORO IN RAD > 1 HR
|
Facility
|
IP
|
$1,859.00
|
|
|
Service Code
|
CPT 76001
|
| Hospital Charge Code |
909001670
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$371.80 |
| Max. Negotiated Rate |
$1,673.10 |
| Rate for Payer: Adventist Health Commercial |
$371.80
|
| Rate for Payer: Cash Price |
$836.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,487.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,301.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$743.60
|
| Rate for Payer: EPIC Health Plan Senior |
$743.60
|
| Rate for Payer: Galaxy Health WC |
$1,580.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,115.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,673.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,180.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,096.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$371.80
|
| Rate for Payer: Multiplan Commercial |
$1,394.25
|
| Rate for Payer: Networks By Design Commercial |
$1,208.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,580.15
|
|
|
HC FLUOROSCOPY LT 1HR
|
Facility
|
OP
|
$1,551.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
906811312
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$48.09 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$310.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$306.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$236.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$902.22
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$697.95
|
| Rate for Payer: Cash Price |
$697.95
|
| Rate for Payer: Cash Price |
$697.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,240.80
|
| Rate for Payer: Cigna of CA HMO |
$992.64
|
| Rate for Payer: Cigna of CA PPO |
$1,147.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,085.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: Galaxy Health WC |
$1,318.35
|
| Rate for Payer: Global Benefits Group Commercial |
$930.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,395.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$48.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$984.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$53.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$310.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$1,163.25
|
| Rate for Payer: Networks By Design Commercial |
$1,008.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$306.88
|
| Rate for Payer: Prime Health Services Commercial |
$1,318.35
|
| Rate for Payer: Prime Health Services Medicare |
$325.29
|
| Rate for Payer: Riverside University Health System MISP |
$337.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$930.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$368.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$775.50
|
| Rate for Payer: United Healthcare All Other HMO |
$775.50
|
| Rate for Payer: United Healthcare HMO Rider |
$775.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$775.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$306.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC FLUOROSCOPY LT 1HR
|
Facility
|
IP
|
$1,551.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
906811312
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$310.20 |
| Max. Negotiated Rate |
$1,395.90 |
| Rate for Payer: Adventist Health Commercial |
$310.20
|
| Rate for Payer: Cash Price |
$697.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,240.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,085.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$620.40
|
| Rate for Payer: EPIC Health Plan Senior |
$620.40
|
| Rate for Payer: Galaxy Health WC |
$1,318.35
|
| Rate for Payer: Global Benefits Group Commercial |
$930.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,395.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$984.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$915.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$310.20
|
| Rate for Payer: Multiplan Commercial |
$1,163.25
|
| Rate for Payer: Networks By Design Commercial |
$1,008.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,318.35
|
|
|
HC FLUOROSCOPY LT 1HR
|
Facility
|
IP
|
$1,551.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
906811312
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$310.20 |
| Max. Negotiated Rate |
$1,395.90 |
| Rate for Payer: Adventist Health Commercial |
$310.20
|
| Rate for Payer: Cash Price |
$697.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,240.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,085.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$620.40
|
| Rate for Payer: EPIC Health Plan Senior |
$620.40
|
| Rate for Payer: Galaxy Health WC |
$1,318.35
|
| Rate for Payer: Global Benefits Group Commercial |
$930.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,395.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$984.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$915.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$310.20
|
| Rate for Payer: Multiplan Commercial |
$1,163.25
|
| Rate for Payer: Networks By Design Commercial |
$1,008.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,318.35
|
|
|
HC FLUOROSCOPY LT 1HR
|
Facility
|
OP
|
$1,551.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
906811312
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$48.09 |
| Max. Negotiated Rate |
$1,395.90 |
| Rate for Payer: Adventist Health Commercial |
$310.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$306.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$440.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$236.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$329.22
|
| Rate for Payer: Blue Shield of California Commercial |
$977.13
|
| Rate for Payer: Blue Shield of California EPN |
$615.75
|
| Rate for Payer: Cash Price |
$697.95
|
| Rate for Payer: Cash Price |
$697.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,240.80
|
| Rate for Payer: Cigna of CA HMO |
$992.64
|
| Rate for Payer: Cigna of CA PPO |
$1,147.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,085.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: Galaxy Health WC |
$1,318.35
|
| Rate for Payer: Global Benefits Group Commercial |
$930.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,395.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$48.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$984.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$53.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$310.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$1,163.25
|
| Rate for Payer: Networks By Design Commercial |
$1,008.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$306.88
|
| Rate for Payer: Prime Health Services Commercial |
$1,318.35
|
| Rate for Payer: Prime Health Services Medicare |
$325.29
|
| Rate for Payer: Riverside University Health System MISP |
$337.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$930.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$930.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$225.63
|
| Rate for Payer: United Healthcare All Other HMO |
$225.63
|
| Rate for Payer: United Healthcare HMO Rider |
$225.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$225.63
|
| Rate for Payer: Upland Medical Group Pediatric |
$306.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC FLUORO XM G/COLON TUBE
|
Facility
|
OP
|
$3,602.00
|
|
|
Service Code
|
CPT 49465
|
| Hospital Charge Code |
906749465
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$242.69 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$720.40
|
| Rate for Payer: Adventist Health Commercial |
$457.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$306.88
|
| Rate for Payer: Adventist Health Medi-Cal |
$306.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$489.35
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$489.35
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,028.70
|
| Rate for Payer: Cash Price |
$1,028.70
|
| Rate for Payer: Cash Price |
$1,028.70
|
| Rate for Payer: Cash Price |
$1,620.90
|
| Rate for Payer: Cash Price |
$1,620.90
|
| Rate for Payer: Cash Price |
$1,620.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,881.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,828.80
|
| Rate for Payer: Cigna of CA HMO |
$1,463.04
|
| Rate for Payer: Cigna of CA HMO |
$2,305.28
|
| Rate for Payer: Cigna of CA PPO |
$2,665.48
|
| Rate for Payer: Cigna of CA PPO |
$1,691.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,600.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,521.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: Galaxy Health WC |
$3,061.70
|
| Rate for Payer: Galaxy Health WC |
$1,943.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,161.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,371.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,057.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,241.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.28
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$242.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$242.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,287.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,451.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$268.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$268.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$457.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$720.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$2,701.50
|
| Rate for Payer: Multiplan Commercial |
$1,714.50
|
| Rate for Payer: Multiplan WC |
$489.35
|
| Rate for Payer: Multiplan WC |
$489.35
|
| Rate for Payer: Networks By Design Commercial |
$1,485.90
|
| Rate for Payer: Networks By Design Commercial |
$2,341.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$306.88
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$306.88
|
| Rate for Payer: Preferred Health Network WC |
$499.34
|
| Rate for Payer: Preferred Health Network WC |
$499.34
|
| Rate for Payer: Prime Health Services Commercial |
$3,061.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,943.10
|
| Rate for Payer: Prime Health Services Medicare |
$325.29
|
| Rate for Payer: Prime Health Services Medicare |
$325.29
|
| Rate for Payer: Prime Health Services WC |
$484.36
|
| Rate for Payer: Prime Health Services WC |
$484.36
|
| Rate for Payer: Riverside University Health System MISP |
$337.57
|
| Rate for Payer: Riverside University Health System MISP |
$337.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,161.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,371.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,143.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,801.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$306.88
|
| Rate for Payer: Upland Medical Group Pediatric |
$306.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC FLUORO XM G/COLON TUBE
|
Facility
|
IP
|
$3,602.00
|
|
|
Service Code
|
CPT 49465
|
| Hospital Charge Code |
906749465
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$720.40 |
| Max. Negotiated Rate |
$3,241.80 |
| Rate for Payer: Adventist Health Commercial |
$720.40
|
| Rate for Payer: Cash Price |
$1,620.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,881.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,521.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,440.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,440.80
|
| Rate for Payer: Galaxy Health WC |
$3,061.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,161.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,241.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,287.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,125.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$720.40
|
| Rate for Payer: Multiplan Commercial |
$2,701.50
|
| Rate for Payer: Networks By Design Commercial |
$2,341.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,061.70
|
|
|
HC FLUORO XM G/COLON TUBE
|
Facility
|
IP
|
$3,602.00
|
|
|
Service Code
|
CPT 49465
|
| Hospital Charge Code |
906749465
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$720.40 |
| Max. Negotiated Rate |
$3,241.80 |
| Rate for Payer: Adventist Health Commercial |
$720.40
|
| Rate for Payer: Cash Price |
$1,620.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,881.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,521.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,440.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,440.80
|
| Rate for Payer: Galaxy Health WC |
$3,061.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,161.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,241.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,287.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,125.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$720.40
|
| Rate for Payer: Multiplan Commercial |
$2,701.50
|
| Rate for Payer: Networks By Design Commercial |
$2,341.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,061.70
|
|
|
HC FLUORO XM G/COLON TUBE
|
Facility
|
OP
|
$3,602.00
|
|
|
Service Code
|
CPT 49465
|
| Hospital Charge Code |
906749465
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$242.69 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$720.40
|
| Rate for Payer: Adventist Health Commercial |
$457.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$306.88
|
| Rate for Payer: Adventist Health Medi-Cal |
$306.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,620.90
|
| Rate for Payer: Cash Price |
$1,620.90
|
| Rate for Payer: Cash Price |
$1,028.70
|
| Rate for Payer: Cash Price |
$1,620.90
|
| Rate for Payer: Cash Price |
$1,028.70
|
| Rate for Payer: Cash Price |
$1,028.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,828.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,881.60
|
| Rate for Payer: Cigna of CA HMO |
$1,463.04
|
| Rate for Payer: Cigna of CA HMO |
$2,305.28
|
| Rate for Payer: Cigna of CA PPO |
$2,665.48
|
| Rate for Payer: Cigna of CA PPO |
$1,691.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,600.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,521.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: Galaxy Health WC |
$3,061.70
|
| Rate for Payer: Galaxy Health WC |
$1,943.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,371.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,161.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,057.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,241.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.28
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$242.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$242.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,451.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,287.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$268.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$268.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$720.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$457.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$2,701.50
|
| Rate for Payer: Multiplan Commercial |
$1,714.50
|
| Rate for Payer: Networks By Design Commercial |
$2,341.30
|
| Rate for Payer: Networks By Design Commercial |
$1,485.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$306.88
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$306.88
|
| Rate for Payer: Prime Health Services Commercial |
$1,943.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,061.70
|
| Rate for Payer: Prime Health Services Medicare |
$325.29
|
| Rate for Payer: Prime Health Services Medicare |
$325.29
|
| Rate for Payer: Riverside University Health System MISP |
$337.57
|
| Rate for Payer: Riverside University Health System MISP |
$337.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,371.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,161.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$368.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$368.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,801.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,143.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$306.88
|
| Rate for Payer: Upland Medical Group Pediatric |
$306.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC FMRI BRAIN BY PHYS/PSYCH
|
Facility
|
IP
|
$3,529.00
|
|
|
Service Code
|
CPT 70555
|
| Hospital Charge Code |
908801023
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$705.80 |
| Max. Negotiated Rate |
$3,176.10 |
| Rate for Payer: Adventist Health Commercial |
$705.80
|
| Rate for Payer: Cash Price |
$1,588.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,823.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,470.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,411.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,411.60
|
| Rate for Payer: Galaxy Health WC |
$2,999.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,117.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,176.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,240.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,082.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$705.80
|
| Rate for Payer: Multiplan Commercial |
$2,646.75
|
| Rate for Payer: Networks By Design Commercial |
$2,293.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,999.65
|
|
|
HC FMRI BRAIN BY PHYS/PSYCH
|
Facility
|
OP
|
$1,636.00
|
|
|
Service Code
|
CPT 70555
|
| Hospital Charge Code |
908801023
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$170.30 |
| Max. Negotiated Rate |
$3,311.29 |
| Rate for Payer: Adventist Health Commercial |
$327.20
|
| Rate for Payer: Adventist Health Commercial |
$705.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$306.88
|
| Rate for Payer: Adventist Health Medi-Cal |
$306.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,055.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,055.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,311.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,311.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$951.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,052.82
|
| Rate for Payer: Blue Shield of California Commercial |
$2,223.27
|
| Rate for Payer: Blue Shield of California Commercial |
$1,030.68
|
| Rate for Payer: Blue Shield of California EPN |
$1,401.01
|
| Rate for Payer: Blue Shield of California EPN |
$649.49
|
| Rate for Payer: Cash Price |
$736.20
|
| Rate for Payer: Cash Price |
$1,588.05
|
| Rate for Payer: Cash Price |
$736.20
|
| Rate for Payer: Cash Price |
$1,588.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,308.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,823.20
|
| Rate for Payer: Cigna of CA HMO |
$1,047.04
|
| Rate for Payer: Cigna of CA HMO |
$2,258.56
|
| Rate for Payer: Cigna of CA PPO |
$2,611.46
|
| Rate for Payer: Cigna of CA PPO |
$1,210.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,145.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,470.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: Galaxy Health WC |
$2,999.65
|
| Rate for Payer: Galaxy Health WC |
$1,390.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,117.40
|
| Rate for Payer: Global Benefits Group Commercial |
$981.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,176.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,472.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.28
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$170.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$170.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,038.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,240.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$188.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$188.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$327.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$705.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$1,227.00
|
| Rate for Payer: Multiplan Commercial |
$2,646.75
|
| Rate for Payer: Networks By Design Commercial |
$1,063.40
|
| Rate for Payer: Networks By Design Commercial |
$2,293.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$306.88
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$306.88
|
| Rate for Payer: Prime Health Services Commercial |
$1,390.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,999.65
|
| Rate for Payer: Prime Health Services Medicare |
$325.29
|
| Rate for Payer: Prime Health Services Medicare |
$325.29
|
| Rate for Payer: Riverside University Health System MISP |
$337.57
|
| Rate for Payer: Riverside University Health System MISP |
$337.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$981.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,117.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$981.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,117.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| Rate for Payer: United Healthcare All Other HMO |
$866.34
|
| Rate for Payer: United Healthcare All Other HMO |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$306.88
|
| Rate for Payer: Upland Medical Group Pediatric |
$306.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC FMRI BRAIN BY TECH
|
Facility
|
IP
|
$2,950.00
|
|
|
Service Code
|
CPT 70554
|
| Hospital Charge Code |
908801022
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$590.00 |
| Max. Negotiated Rate |
$2,655.00 |
| Rate for Payer: Adventist Health Commercial |
$590.00
|
| Rate for Payer: Cash Price |
$1,327.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,360.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,065.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,180.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,180.00
|
| Rate for Payer: Galaxy Health WC |
$2,507.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,770.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,655.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,873.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,740.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$590.00
|
| Rate for Payer: Multiplan Commercial |
$2,212.50
|
| Rate for Payer: Networks By Design Commercial |
$1,917.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,507.50
|
|
|
HC FMRI BRAIN BY TECH
|
Facility
|
OP
|
$1,710.00
|
|
|
Service Code
|
CPT 70554
|
| Hospital Charge Code |
908801022
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$306.88 |
| Max. Negotiated Rate |
$2,711.02 |
| Rate for Payer: Adventist Health Commercial |
$342.00
|
| Rate for Payer: Adventist Health Commercial |
$590.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$306.88
|
| Rate for Payer: Adventist Health Medi-Cal |
$306.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,055.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,055.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,711.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,711.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$994.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,716.02
|
| Rate for Payer: Blue Shield of California Commercial |
$1,858.50
|
| Rate for Payer: Blue Shield of California Commercial |
$1,077.30
|
| Rate for Payer: Blue Shield of California EPN |
$1,171.15
|
| Rate for Payer: Blue Shield of California EPN |
$678.87
|
| Rate for Payer: Cash Price |
$769.50
|
| Rate for Payer: Cash Price |
$1,327.50
|
| Rate for Payer: Cash Price |
$769.50
|
| Rate for Payer: Cash Price |
$1,327.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,368.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,360.00
|
| Rate for Payer: Cigna of CA HMO |
$1,094.40
|
| Rate for Payer: Cigna of CA HMO |
$1,888.00
|
| Rate for Payer: Cigna of CA PPO |
$2,183.00
|
| Rate for Payer: Cigna of CA PPO |
$1,265.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,197.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,065.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: Galaxy Health WC |
$2,507.50
|
| Rate for Payer: Galaxy Health WC |
$1,453.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,770.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,026.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,655.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,539.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.28
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$643.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$643.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,085.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,873.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$710.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$710.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$590.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$1,282.50
|
| Rate for Payer: Multiplan Commercial |
$2,212.50
|
| Rate for Payer: Networks By Design Commercial |
$1,111.50
|
| Rate for Payer: Networks By Design Commercial |
$1,917.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$306.88
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$306.88
|
| Rate for Payer: Prime Health Services Commercial |
$1,453.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,507.50
|
| Rate for Payer: Prime Health Services Medicare |
$325.29
|
| Rate for Payer: Prime Health Services Medicare |
$325.29
|
| Rate for Payer: Riverside University Health System MISP |
$337.57
|
| Rate for Payer: Riverside University Health System MISP |
$337.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,026.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,770.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,026.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,770.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| Rate for Payer: United Healthcare All Other HMO |
$866.34
|
| Rate for Payer: United Healthcare All Other HMO |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$306.88
|
| Rate for Payer: Upland Medical Group Pediatric |
$306.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC FNA BX W/CT GDN 1ST LESION
|
Facility
|
OP
|
$2,838.00
|
|
|
Service Code
|
CPT 10009
|
| Hospital Charge Code |
909010009
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$567.60 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$567.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$910.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,424.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$1,277.10
|
| Rate for Payer: Cash Price |
$1,277.10
|
| Rate for Payer: Cash Price |
$1,277.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,270.40
|
| Rate for Payer: Cigna of CA HMO |
$1,816.32
|
| Rate for Payer: Cigna of CA PPO |
$2,100.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,986.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,502.79
|
| Rate for Payer: EPIC Health Plan Senior |
$1,001.86
|
| Rate for Payer: Galaxy Health WC |
$2,412.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,702.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,554.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,493.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$737.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,802.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$814.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,275.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$567.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,220.45
|
| Rate for Payer: Multiplan Commercial |
$2,128.50
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$1,844.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$910.78
|
| Rate for Payer: Preferred Health Network WC |
$1,453.47
|
| Rate for Payer: Prime Health Services Commercial |
$2,412.30
|
| Rate for Payer: Prime Health Services Medicare |
$965.43
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Riverside University Health System MISP |
$1,001.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,702.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,419.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$910.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
HC FNA BX W/CT GDN 1ST LESION
|
Facility
|
IP
|
$2,838.00
|
|
|
Service Code
|
CPT 10009
|
| Hospital Charge Code |
909010009
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$567.60 |
| Max. Negotiated Rate |
$2,554.20 |
| Rate for Payer: Adventist Health Commercial |
$567.60
|
| Rate for Payer: Cash Price |
$1,277.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,270.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,986.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,135.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,135.20
|
| Rate for Payer: Galaxy Health WC |
$2,412.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,702.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,554.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,802.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,674.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$567.60
|
| Rate for Payer: Multiplan Commercial |
$2,128.50
|
| Rate for Payer: Networks By Design Commercial |
$1,844.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,412.30
|
|
|
HC FNA BX W/CT GDN EA ADDL LSN
|
Facility
|
IP
|
$1,419.00
|
|
|
Service Code
|
CPT 10010
|
| Hospital Charge Code |
909010010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$283.80 |
| Max. Negotiated Rate |
$1,277.10 |
| Rate for Payer: Adventist Health Commercial |
$283.80
|
| Rate for Payer: Cash Price |
$638.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,135.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$993.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$567.60
|
| Rate for Payer: EPIC Health Plan Senior |
$567.60
|
| Rate for Payer: Galaxy Health WC |
$1,206.15
|
| Rate for Payer: Global Benefits Group Commercial |
$851.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,277.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$901.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$837.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$283.80
|
| Rate for Payer: Multiplan Commercial |
$1,064.25
|
| Rate for Payer: Networks By Design Commercial |
$922.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,206.15
|
|
|
HC FNA BX W/CT GDN EA ADDL LSN
|
Facility
|
OP
|
$1,419.00
|
|
|
Service Code
|
CPT 10010
|
| Hospital Charge Code |
909010010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$283.80 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$283.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,206.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$780.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,064.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$638.55
|
| Rate for Payer: Cash Price |
$638.55
|
| Rate for Payer: Cash Price |
$638.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,135.20
|
| Rate for Payer: Cigna of CA HMO |
$908.16
|
| Rate for Payer: Cigna of CA PPO |
$1,050.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,206.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,206.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,206.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$993.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$567.60
|
| Rate for Payer: EPIC Health Plan Senior |
$567.60
|
| Rate for Payer: Galaxy Health WC |
$1,206.15
|
| Rate for Payer: Global Benefits Group Commercial |
$851.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,277.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$441.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$901.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$488.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$837.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$283.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$993.30
|
| Rate for Payer: Multiplan Commercial |
$1,064.25
|
| Rate for Payer: Networks By Design Commercial |
$922.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,206.15
|
| Rate for Payer: Riverside University Health System MISP |
$567.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$851.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$709.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,206.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,206.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,206.15
|
|
|
HC FNA BX W/FLUOR GDN 1ST LESION
|
Facility
|
IP
|
$2,838.00
|
|
|
Service Code
|
CPT 10007
|
| Hospital Charge Code |
909010007
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$567.60 |
| Max. Negotiated Rate |
$2,554.20 |
| Rate for Payer: Adventist Health Commercial |
$567.60
|
| Rate for Payer: Cash Price |
$1,277.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,270.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,986.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,135.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,135.20
|
| Rate for Payer: Galaxy Health WC |
$2,412.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,702.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,554.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,802.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,674.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$567.60
|
| Rate for Payer: Multiplan Commercial |
$2,128.50
|
| Rate for Payer: Networks By Design Commercial |
$1,844.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,412.30
|
|
|
HC FNA BX W/FLUOR GDN 1ST LESION
|
Facility
|
OP
|
$2,838.00
|
|
|
Service Code
|
CPT 10007
|
| Hospital Charge Code |
909010007
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$446.32 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$567.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$910.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,424.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$1,277.10
|
| Rate for Payer: Cash Price |
$1,277.10
|
| Rate for Payer: Cash Price |
$1,277.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,270.40
|
| Rate for Payer: Cigna of CA HMO |
$1,816.32
|
| Rate for Payer: Cigna of CA PPO |
$2,100.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,986.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,502.79
|
| Rate for Payer: EPIC Health Plan Senior |
$1,001.86
|
| Rate for Payer: Galaxy Health WC |
$2,412.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,702.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,554.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,493.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$446.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,802.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$493.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,275.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$567.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,220.45
|
| Rate for Payer: Multiplan Commercial |
$2,128.50
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$1,844.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$910.78
|
| Rate for Payer: Preferred Health Network WC |
$1,453.47
|
| Rate for Payer: Prime Health Services Commercial |
$2,412.30
|
| Rate for Payer: Prime Health Services Medicare |
$965.43
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Riverside University Health System MISP |
$1,001.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,702.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,419.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$910.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
HC FNA BX W/FLUOR GDN EA ADDL LSN
|
Facility
|
IP
|
$1,419.00
|
|
|
Service Code
|
CPT 10008
|
| Hospital Charge Code |
909010008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$283.80 |
| Max. Negotiated Rate |
$1,277.10 |
| Rate for Payer: Adventist Health Commercial |
$283.80
|
| Rate for Payer: Cash Price |
$638.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,135.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$993.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$567.60
|
| Rate for Payer: EPIC Health Plan Senior |
$567.60
|
| Rate for Payer: Galaxy Health WC |
$1,206.15
|
| Rate for Payer: Global Benefits Group Commercial |
$851.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,277.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$901.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$837.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$283.80
|
| Rate for Payer: Multiplan Commercial |
$1,064.25
|
| Rate for Payer: Networks By Design Commercial |
$922.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,206.15
|
|
