|
HC FLUORESCENT STAIN FUNGI
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
900912418
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Adventist Health Commercial |
$11.40
|
| Rate for Payer: Cash Price |
$31.35
|
| Rate for Payer: Central Health Plan Commercial |
$45.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.80
|
| Rate for Payer: EPIC Health Plan Senior |
$22.80
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$38.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.40
|
| Rate for Payer: Multiplan Commercial |
$42.75
|
| Rate for Payer: Networks By Design Commercial |
$37.05
|
| Rate for Payer: Prime Health Services Commercial |
$48.45
|
|
|
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 |
$720.50
|
| 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 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 |
$720.50
|
| Rate for Payer: Cash Price |
$720.50
|
| 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 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 |
$1,088.45
|
| 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 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 |
$1,088.45
|
| Rate for Payer: Cash Price |
$1,088.45
|
| 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 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 |
$774.95
|
| 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 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 |
$774.95
|
| Rate for Payer: Cash Price |
$774.95
|
| 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 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 |
$1,022.45
|
| 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 |
$1,022.45
|
| 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
|
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 |
$853.05
|
| Rate for Payer: Cash Price |
$853.05
|
| 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
|
$1,825.00
|
|
|
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 |
$1,003.75
|
| Rate for Payer: Cash Price |
$1,003.75
|
| 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
|
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 |
$1,003.75
|
| 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 |
$853.05
|
| 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
|
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 |
$853.05
|
| 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
|
$1,551.00
|
|
|
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 |
$853.05
|
| Rate for Payer: Cash Price |
$853.05
|
| Rate for Payer: Cash Price |
$853.05
|
| 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 FLUORO XM G/COLON TUBE
|
Facility
|
IP
|
$2,286.00
|
|
|
Service Code
|
CPT 49465
|
| Hospital Charge Code |
906749465
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$457.20 |
| Max. Negotiated Rate |
$2,057.40 |
| Rate for Payer: Adventist Health Commercial |
$457.20
|
| Rate for Payer: Cash Price |
$1,257.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,828.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$914.40
|
| Rate for Payer: EPIC Health Plan Senior |
$914.40
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$1,524.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$870.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,415.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$457.20
|
| Rate for Payer: Multiplan Commercial |
$1,714.50
|
| Rate for Payer: Networks By Design Commercial |
$1,485.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,943.10
|
|
|
HC FLUORO XM G/COLON TUBE
|
Facility
|
IP
|
$2,286.00
|
|
|
Service Code
|
CPT 49465
|
| Hospital Charge Code |
906749465
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$457.20 |
| Max. Negotiated Rate |
$2,057.40 |
| Rate for Payer: Adventist Health Commercial |
$457.20
|
| Rate for Payer: Cash Price |
$1,257.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,828.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$914.40
|
| Rate for Payer: EPIC Health Plan Senior |
$914.40
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$1,524.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$870.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,415.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$457.20
|
| Rate for Payer: Multiplan Commercial |
$1,714.50
|
| Rate for Payer: Networks By Design Commercial |
$1,485.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,943.10
|
|
|
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 |
$1,257.30
|
| Rate for Payer: Cash Price |
$1,257.30
|
| Rate for Payer: Cash Price |
$1,257.30
|
| 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
|
|
|
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 |
$1,257.30
|
| Rate for Payer: Cash Price |
$1,257.30
|
| Rate for Payer: Cash Price |
$1,257.30
|
| 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 FMRI BRAIN BY PHYS/PSYCH
|
Facility
|
IP
|
$1,636.00
|
|
|
Service Code
|
CPT 70555
|
| Hospital Charge Code |
908801023
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$327.20 |
| Max. Negotiated Rate |
$1,472.40 |
| Rate for Payer: Adventist Health Commercial |
$327.20
|
| Rate for Payer: Cash Price |
$899.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,308.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$654.40
|
| Rate for Payer: EPIC Health Plan Senior |
$654.40
|
| Rate for Payer: Galaxy Health WC |
$1,390.60
|
| Rate for Payer: Global Benefits Group Commercial |
$981.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,472.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,091.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$623.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,012.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$327.20
|
| Rate for Payer: Multiplan Commercial |
$1,227.00
|
| Rate for Payer: Networks By Design Commercial |
$1,063.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,390.60
|
|
|
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 Medi-Cal |
$307.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$993.54
|
| 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 |
$3,311.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$960.82
|
| Rate for Payer: Blue Shield of California Commercial |
$993.05
|
| Rate for Payer: Blue Shield of California EPN |
$649.49
|
| Rate for Payer: Cash Price |
$899.80
|
| Rate for Payer: Cash Price |
$899.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,308.80
|
| Rate for Payer: Cigna of CA HMO |
$1,047.04
|
| Rate for Payer: Cigna of CA PPO |
$1,210.64
|
| 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 |
$1,390.60
|
| Rate for Payer: Global Benefits Group Commercial |
$981.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,472.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$170.30
|
| 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 |
$1,091.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$327.20
|
| 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 |
$1,227.00
|
| Rate for Payer: Networks By Design Commercial |
$1,063.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$307.13
|
| Rate for Payer: Prime Health Services Commercial |
$1,390.60
|
| 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 |
$981.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$981.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| Rate for Payer: United Healthcare All Other HMO |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC FMRI BRAIN BY TECH
|
Facility
|
IP
|
$1,710.00
|
|
|
Service Code
|
CPT 70554
|
| Hospital Charge Code |
908801022
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$342.00 |
| Max. Negotiated Rate |
$1,539.00 |
| Rate for Payer: Adventist Health Commercial |
$342.00
|
| Rate for Payer: Cash Price |
$940.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,368.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$684.00
|
| Rate for Payer: EPIC Health Plan Senior |
$684.00
|
| Rate for Payer: Galaxy Health WC |
$1,453.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,026.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,539.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,140.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$651.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,058.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.00
|
| Rate for Payer: Multiplan Commercial |
$1,282.50
|
| Rate for Payer: Networks By Design Commercial |
$1,111.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,453.50
|
|
|
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 |
$307.13 |
| Max. Negotiated Rate |
$2,711.02 |
| Rate for Payer: Adventist Health Commercial |
$342.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$307.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,038.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,711.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,004.28
|
| Rate for Payer: Blue Shield of California Commercial |
$1,037.97
|
| Rate for Payer: Blue Shield of California EPN |
$678.87
|
| Rate for Payer: Cash Price |
$940.50
|
| Rate for Payer: Cash Price |
$940.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,368.00
|
| Rate for Payer: Cigna of CA HMO |
$1,094.40
|
| Rate for Payer: Cigna of CA PPO |
$1,265.40
|
| 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 |
$1,453.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,026.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,539.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$643.25
|
| 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 |
$1,140.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$710.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.00
|
| 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 |
$1,282.50
|
| Rate for Payer: Networks By Design Commercial |
$1,111.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$307.13
|
| Rate for Payer: Prime Health Services Commercial |
$1,453.50
|
| 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 |
$1,026.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,026.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| Rate for Payer: United Healthcare All Other HMO |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC 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 |
$4,460.00 |
| Rate for Payer: Adventist Health Commercial |
$567.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$893.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,374.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,666.76
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,424.40
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$1,560.90
|
| Rate for Payer: Cash Price |
$1,560.90
|
| Rate for Payer: Cash Price |
$1,560.90
|
| 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 |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,206.87
|
| Rate for Payer: EPIC Health Plan Senior |
$893.98
|
| 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 |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$737.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: InnovAge PACE Commercial |
$1,340.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,892.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$814.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$567.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,197.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| 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 |
$893.98
|
| 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 |
$947.62
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Riverside University Health System MISP |
$983.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,702.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$893.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
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 |
$1,560.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,270.40
|
| 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 Permanente of CA Commercial/Self Funded |
$1,892.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,081.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,756.72
|
| 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
|
|
