|
HC FLEX VIDEOSCOPE AMBU LARGE
|
Facility
|
IP
|
$1,951.00
|
|
| Hospital Charge Code |
900800003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$390.20 |
| Max. Negotiated Rate |
$1,755.90 |
| Rate for Payer: Adventist Health Commercial |
$390.20
|
| Rate for Payer: Cash Price |
$877.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,560.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$780.40
|
| Rate for Payer: EPIC Health Plan Senior |
$780.40
|
| Rate for Payer: Galaxy Health WC |
$1,658.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,170.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,755.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,301.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$743.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,207.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$390.20
|
| Rate for Payer: Multiplan Commercial |
$1,463.25
|
| Rate for Payer: Networks By Design Commercial |
$1,268.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,658.35
|
|
|
HC FLEX VIDEOSCOPE AMBU LARGE
|
Facility
|
OP
|
$1,951.00
|
|
| Hospital Charge Code |
900800003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$390.20 |
| Max. Negotiated Rate |
$1,755.90 |
| Rate for Payer: Adventist Health Commercial |
$390.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,184.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,658.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,073.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,463.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$944.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,145.82
|
| Rate for Payer: Blue Shield of California Commercial |
$1,192.06
|
| Rate for Payer: Blue Shield of California EPN |
$778.45
|
| Rate for Payer: Cash Price |
$877.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,560.80
|
| Rate for Payer: Cigna of CA HMO |
$1,248.64
|
| Rate for Payer: Cigna of CA PPO |
$1,443.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,658.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,658.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,658.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$780.40
|
| Rate for Payer: EPIC Health Plan Senior |
$780.40
|
| Rate for Payer: Galaxy Health WC |
$1,658.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,170.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,755.90
|
| Rate for Payer: InnovAge PACE Commercial |
$975.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,301.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$743.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,207.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$390.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,365.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,365.70
|
| Rate for Payer: Multiplan Commercial |
$1,463.25
|
| Rate for Payer: Networks By Design Commercial |
$1,268.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,658.35
|
| Rate for Payer: Riverside University Health System MISP |
$780.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,170.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,170.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$975.50
|
| Rate for Payer: United Healthcare All Other HMO |
$975.50
|
| Rate for Payer: United Healthcare HMO Rider |
$975.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$975.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,658.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,658.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,658.35
|
|
|
HC FLEX VIDEOSCOPE AMBU SLIM
|
Facility
|
IP
|
$1,696.00
|
|
| Hospital Charge Code |
900800001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$339.20 |
| Max. Negotiated Rate |
$1,526.40 |
| Rate for Payer: Adventist Health Commercial |
$339.20
|
| Rate for Payer: Cash Price |
$763.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,356.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$678.40
|
| Rate for Payer: EPIC Health Plan Senior |
$678.40
|
| Rate for Payer: Galaxy Health WC |
$1,441.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,017.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,526.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,131.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$646.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,049.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.20
|
| Rate for Payer: Multiplan Commercial |
$1,272.00
|
| Rate for Payer: Networks By Design Commercial |
$1,102.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,441.60
|
|
|
HC FLEX VIDEOSCOPE AMBU SLIM
|
Facility
|
OP
|
$1,696.00
|
|
| Hospital Charge Code |
900800001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$339.20 |
| Max. Negotiated Rate |
$1,526.40 |
| Rate for Payer: Adventist Health Commercial |
$339.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,029.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,441.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$932.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,272.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$821.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$996.06
|
| Rate for Payer: Blue Shield of California Commercial |
$1,036.26
|
| Rate for Payer: Blue Shield of California EPN |
$676.70
|
| Rate for Payer: Cash Price |
$763.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,356.80
|
| Rate for Payer: Cigna of CA HMO |
$1,085.44
|
| Rate for Payer: Cigna of CA PPO |
$1,255.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,441.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,441.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,441.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$678.40
|
| Rate for Payer: EPIC Health Plan Senior |
$678.40
|
| Rate for Payer: Galaxy Health WC |
$1,441.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,017.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,526.40
|
| Rate for Payer: InnovAge PACE Commercial |
$848.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,131.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$646.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,049.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,187.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,187.20
|
| Rate for Payer: Multiplan Commercial |
$1,272.00
|
| Rate for Payer: Networks By Design Commercial |
$1,102.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,441.60
|
| Rate for Payer: Riverside University Health System MISP |
$678.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,017.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,017.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$848.00
|
| Rate for Payer: United Healthcare All Other HMO |
$848.00
|
| Rate for Payer: United Healthcare HMO Rider |
$848.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$848.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,441.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,441.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,441.60
|
|
|
HC FLOW VOLUME STUDY
|
Facility
|
OP
|
$569.00
|
|
|
Service Code
|
CPT 94375
|
| Hospital Charge Code |
900801022
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$39.94 |
| Max. Negotiated Rate |
$764.00 |
| Rate for Payer: Adventist Health Commercial |
$113.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$395.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$345.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$395.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$125.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.17
|
| Rate for Payer: Blue Shield of California Commercial |
$345.38
|
| Rate for Payer: Blue Shield of California EPN |
$225.89
|
| Rate for Payer: Cash Price |
$256.05
|
| Rate for Payer: Cash Price |
$256.05
|
| Rate for Payer: Cash Price |
$256.05
|
| Rate for Payer: Central Health Plan Commercial |
$455.20
|
| Rate for Payer: Cigna of CA HMO |
$364.16
|
| Rate for Payer: Cigna of CA PPO |
$421.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$435.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$395.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$534.14
|
| Rate for Payer: EPIC Health Plan Senior |
$395.66
|
| Rate for Payer: Galaxy Health WC |
$483.65
|
| Rate for Payer: Global Benefits Group Commercial |
$341.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$512.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$648.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$39.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$395.66
|
| Rate for Payer: InnovAge PACE Commercial |
$593.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$379.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$395.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$530.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$530.18
|
| Rate for Payer: Multiplan Commercial |
$426.75
|
| Rate for Payer: Networks By Design Commercial |
$369.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$395.66
|
| Rate for Payer: Prime Health Services Commercial |
$483.65
|
| Rate for Payer: Prime Health Services Medicare |
$419.40
|
| Rate for Payer: Riverside University Health System MISP |
$435.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$341.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$341.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$395.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Vantage Medical Group Senior |
$395.66
|
|
|
HC FLOW VOLUME STUDY
|
Facility
|
IP
|
$569.00
|
|
|
Service Code
|
CPT 94375
|
| Hospital Charge Code |
900801022
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$113.80 |
| Max. Negotiated Rate |
$512.10 |
| Rate for Payer: Adventist Health Commercial |
$113.80
|
| Rate for Payer: Cash Price |
$256.05
|
| Rate for Payer: Central Health Plan Commercial |
$455.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.60
|
| Rate for Payer: EPIC Health Plan Senior |
$227.60
|
| Rate for Payer: Galaxy Health WC |
$483.65
|
| Rate for Payer: Global Benefits Group Commercial |
$341.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$512.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$379.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$216.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$352.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.80
|
| Rate for Payer: Multiplan Commercial |
$426.75
|
| Rate for Payer: Networks By Design Commercial |
$369.85
|
| Rate for Payer: Prime Health Services Commercial |
$483.65
|
|
|
HC FLUORESCENT STAIN FUNGI
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
900912418
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Adventist Health Commercial |
$11.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.93
|
| Rate for Payer: Blue Shield of California Commercial |
$34.60
|
| Rate for Payer: Blue Shield of California EPN |
$22.63
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Central Health Plan Commercial |
$45.60
|
| Rate for Payer: Cigna of CA HMO |
$36.48
|
| Rate for Payer: Cigna of CA PPO |
$42.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.28
|
| Rate for Payer: EPIC Health Plan Senior |
$5.39
|
| Rate for Payer: Galaxy Health WC |
$48.45
|
| Rate for Payer: Global Benefits Group Commercial |
$34.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$51.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.39
|
| Rate for Payer: InnovAge PACE Commercial |
$8.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.22
|
| Rate for Payer: Multiplan Commercial |
$42.75
|
| Rate for Payer: Networks By Design Commercial |
$37.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.39
|
| Rate for Payer: Prime Health Services Commercial |
$48.45
|
| Rate for Payer: Prime Health Services Medicare |
$5.71
|
| Rate for Payer: Riverside University Health System MISP |
$5.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.37
|
| Rate for Payer: United Healthcare All Other HMO |
$4.37
|
| Rate for Payer: United Healthcare HMO Rider |
$4.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.37
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: Vantage Medical Group Senior |
$5.39
|
|
|
HC FLUORESCENT STAIN FUNGI
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
900912418
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Central Health Plan Commercial |
$124.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.40
|
| Rate for Payer: EPIC Health Plan Senior |
$62.40
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$140.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$96.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.20
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
|
|
HC FLUORO GUIDANCE CNTRL VNS ACCESS DVC
|
Facility
|
OP
|
$1,310.00
|
|
|
Service Code
|
CPT 77001
|
| Hospital Charge Code |
909081673
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$56.08 |
| Max. Negotiated Rate |
$1,179.00 |
| Rate for Payer: Adventist Health Commercial |
$262.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$795.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,113.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$720.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$982.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$276.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$56.08
|
| Rate for Payer: Blue Shield of California Commercial |
$795.17
|
| Rate for Payer: Blue Shield of California EPN |
$520.07
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,048.00
|
| Rate for Payer: Cigna of CA HMO |
$838.40
|
| Rate for Payer: Cigna of CA PPO |
$969.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,113.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,113.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,113.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$524.00
|
| Rate for Payer: EPIC Health Plan Senior |
$524.00
|
| Rate for Payer: Galaxy Health WC |
$1,113.50
|
| Rate for Payer: Global Benefits Group Commercial |
$786.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,179.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$109.32
|
| Rate for Payer: InnovAge PACE Commercial |
$655.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$873.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$810.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$917.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$917.00
|
| Rate for Payer: Multiplan Commercial |
$982.50
|
| Rate for Payer: Networks By Design Commercial |
$851.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,113.50
|
| Rate for Payer: Riverside University Health System MISP |
$524.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$786.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$786.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$655.00
|
| Rate for Payer: United Healthcare All Other HMO |
$655.00
|
| Rate for Payer: United Healthcare HMO Rider |
$655.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$655.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,113.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,113.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,113.50
|
|
|
HC FLUORO GUIDANCE CNTRL VNS ACCESS DVC
|
Facility
|
IP
|
$1,310.00
|
|
|
Service Code
|
CPT 77001
|
| Hospital Charge Code |
909081673
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$262.00 |
| Max. Negotiated Rate |
$1,179.00 |
| Rate for Payer: Adventist Health Commercial |
$262.00
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,048.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$524.00
|
| Rate for Payer: EPIC Health Plan Senior |
$524.00
|
| Rate for Payer: Galaxy Health WC |
$1,113.50
|
| Rate for Payer: Global Benefits Group Commercial |
$786.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,179.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$873.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$499.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$810.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.00
|
| Rate for Payer: Multiplan Commercial |
$982.50
|
| Rate for Payer: Networks By Design Commercial |
$851.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,113.50
|
|
|
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 |
$71.07 |
| Max. Negotiated Rate |
$1,781.10 |
| Rate for Payer: Adventist Health Commercial |
$395.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,201.85
|
| 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 |
$71.07
|
| Rate for Payer: Blue Shield of California Commercial |
$1,201.25
|
| 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: 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: InnovAge PACE Commercial |
$989.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,319.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,225.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$395.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,385.30
|
| Rate for Payer: Molina Healthcare of CA 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 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: 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 Permanente of CA Commercial/Self Funded |
$1,319.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$754.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,225.00
|
| 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 SPINE OR PARASPINOUS
|
Facility
|
OP
|
$1,409.00
|
|
|
Service Code
|
CPT 77003
|
| Hospital Charge Code |
909001358
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$54.29 |
| Max. Negotiated Rate |
$1,268.10 |
| Rate for Payer: Adventist Health Commercial |
$281.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$855.69
|
| 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 |
$54.29
|
| Rate for Payer: Blue Shield of California Commercial |
$855.26
|
| 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: 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: InnovAge PACE Commercial |
$704.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$939.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$872.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$281.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$986.30
|
| Rate for Payer: Molina Healthcare of CA 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: 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 Permanente of CA Commercial/Self Funded |
$939.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$536.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$872.17
|
| 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 |
$900.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,091.79
|
| Rate for Payer: Blue Shield of California Commercial |
$1,128.41
|
| Rate for Payer: Blue Shield of California EPN |
$738.02
|
| 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: 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: InnovAge PACE Commercial |
$929.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,239.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$708.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,150.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$371.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,301.30
|
| Rate for Payer: Molina Healthcare of CA 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: 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 Permanente of CA Commercial/Self Funded |
$1,239.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$708.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,150.72
|
| 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
|
IP
|
$1,825.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
906820105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$365.00 |
| Max. Negotiated Rate |
$1,642.50 |
| Rate for Payer: Adventist Health Commercial |
$365.00
|
| Rate for Payer: Cash Price |
$821.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,460.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$730.00
|
| Rate for Payer: EPIC Health Plan Senior |
$730.00
|
| Rate for Payer: Galaxy Health WC |
$1,551.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,095.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,642.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,217.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$695.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,129.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$365.00
|
| Rate for Payer: Multiplan Commercial |
$1,368.75
|
| Rate for Payer: Networks By Design Commercial |
$1,186.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,551.25
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$1,034.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$590.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$960.07
|
| 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
|
$1,825.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
906820105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$48.06 |
| Max. Negotiated Rate |
$1,642.50 |
| Rate for Payer: Adventist Health Commercial |
$365.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$307.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,108.32
|
| 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 |
$236.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.06
|
| Rate for Payer: Blue Shield of California Commercial |
$1,107.78
|
| Rate for Payer: Blue Shield of California EPN |
$724.52
|
| Rate for Payer: Cash Price |
$821.25
|
| Rate for Payer: Cash Price |
$821.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,460.00
|
| Rate for Payer: Cigna of CA HMO |
$1,168.00
|
| Rate for Payer: Cigna of CA PPO |
$1,350.50
|
| 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 |
$1,551.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,095.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,642.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$48.09
|
| 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 |
$1,217.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$365.00
|
| 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 |
$1,368.75
|
| Rate for Payer: Networks By Design Commercial |
$1,186.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$307.13
|
| Rate for Payer: Prime Health Services Commercial |
$1,551.25
|
| 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 |
$1,095.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,095.00
|
| 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 |
$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 FLUOROSCOPY LT 1HR
|
Facility
|
OP
|
$1,551.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
906811312
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$48.06 |
| Max. Negotiated Rate |
$1,395.90 |
| Rate for Payer: Adventist Health Commercial |
$310.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$307.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$941.92
|
| 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 |
$236.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.06
|
| Rate for Payer: Blue Shield of California Commercial |
$941.46
|
| 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 |
$460.69
|
| 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 |
$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 |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$48.09
|
| 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 |
$1,034.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$310.20
|
| 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 |
$1,163.25
|
| Rate for Payer: Networks By Design Commercial |
$1,008.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$307.13
|
| Rate for Payer: Prime Health Services Commercial |
$1,318.35
|
| 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 |
$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 |
$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 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 |
$307.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 |
$236.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$910.90
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$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 |
$460.69
|
| 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 |
$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 |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$48.09
|
| 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 |
$1,034.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$310.20
|
| 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 |
$1,163.25
|
| Rate for Payer: Networks By Design Commercial |
$1,008.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$307.13
|
| Rate for Payer: Prime Health Services Commercial |
$1,318.35
|
| 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 |
$930.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$368.56
|
| 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 |
$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 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: 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 Permanente of CA Commercial/Self Funded |
$1,034.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$590.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$960.07
|
| 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 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: 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 Permanente of CA Commercial/Self Funded |
$2,402.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,372.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,229.64
|
| 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
|
$2,286.00
|
|
|
Service Code
|
CPT 49465
|
| Hospital Charge Code |
906749465
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$242.69 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$457.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$307.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| 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 |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,028.70
|
| 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: Cigna of CA HMO |
$1,463.04
|
| Rate for Payer: Cigna of CA PPO |
$1,691.64
|
| 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 |
$1,943.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,371.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,057.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$242.69
|
| 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 |
$1,524.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$268.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$457.20
|
| 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 |
$1,714.50
|
| Rate for Payer: Networks By Design Commercial |
$1,485.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$307.13
|
| Rate for Payer: Prime Health Services Commercial |
$1,943.10
|
| 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 |
$1,371.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$368.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| 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 Select/Navigate/Core |
$1,000.00
|
| 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 FLUORO XM G/COLON TUBE
|
Facility
|
OP
|
$2,286.00
|
|
|
Service Code
|
CPT 49465
|
| Hospital Charge Code |
906749465
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$242.69 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$457.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$307.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| 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 |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$489.35
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,028.70
|
| 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: Cigna of CA HMO |
$1,463.04
|
| Rate for Payer: Cigna of CA PPO |
$1,691.64
|
| 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 |
$1,943.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,371.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,057.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$242.69
|
| 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 |
$1,524.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$268.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$457.20
|
| 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 |
$1,714.50
|
| Rate for Payer: Multiplan WC |
$489.35
|
| Rate for Payer: Networks By Design Commercial |
$1,485.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$307.13
|
| Rate for Payer: Preferred Health Network WC |
$499.34
|
| Rate for Payer: Prime Health Services Commercial |
$1,943.10
|
| Rate for Payer: Prime Health Services Medicare |
$325.56
|
| Rate for Payer: Prime Health Services WC |
$484.36
|
| Rate for Payer: Riverside University Health System MISP |
$337.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,371.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| 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 Select/Navigate/Core |
$1,000.00
|
| 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
|
|
