|
HC MOTOR SPEECH D/C STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9158
|
| Hospital Charge Code |
900018423
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Riverside University Health System MISP |
$0.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC MOTOR SPEECH GOAL STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9186
|
| Hospital Charge Code |
900018122
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
HC MOTOR SPEECH GOAL STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9186
|
| Hospital Charge Code |
900018222
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
HC MOTOR SPEECH GOAL STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9186
|
| Hospital Charge Code |
900018222
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Riverside University Health System MISP |
$0.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC MOTOR SPEECH GOAL STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9186
|
| Hospital Charge Code |
900018422
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Riverside University Health System MISP |
$0.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC MOTOR SPEECH GOAL STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9186
|
| Hospital Charge Code |
900018122
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Riverside University Health System MISP |
$0.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC MOTOR SPEECH GOAL STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9186
|
| Hospital Charge Code |
900018422
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
HC MP CONTROL LE PROS
|
Facility
|
IP
|
$50,000.00
|
|
|
Service Code
|
CPT L5999
|
| Hospital Charge Code |
915380021
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10,000.00 |
| Max. Negotiated Rate |
$45,000.00 |
| Rate for Payer: Adventist Health Commercial |
$10,000.00
|
| Rate for Payer: Blue Shield of California Commercial |
$40,100.00
|
| Rate for Payer: Blue Shield of California EPN |
$25,200.00
|
| Rate for Payer: Cash Price |
$22,500.00
|
| Rate for Payer: Central Health Plan Commercial |
$40,000.00
|
| Rate for Payer: Cigna of CA HMO |
$35,000.00
|
| Rate for Payer: Cigna of CA PPO |
$35,000.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20,000.00
|
| Rate for Payer: Galaxy Health WC |
$42,500.00
|
| Rate for Payer: Global Benefits Group Commercial |
$30,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45,000.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31,750.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29,500.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$37,500.00
|
| Rate for Payer: Networks By Design Commercial |
$32,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$42,500.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$18,765.00
|
| Rate for Payer: United Healthcare All Other HMO |
$18,265.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,870.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,375.00
|
|
|
HC MP CONTROL LE PROS
|
Facility
|
OP
|
$50,000.00
|
|
|
Service Code
|
CPT L5999
|
| Hospital Charge Code |
915380021
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$16,375.00 |
| Max. Negotiated Rate |
$45,000.00 |
| Rate for Payer: Adventist Health Commercial |
$20,500.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42,500.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27,500.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37,500.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29,085.00
|
| Rate for Payer: Blue Shield of California Commercial |
$40,100.00
|
| Rate for Payer: Blue Shield of California EPN |
$25,200.00
|
| Rate for Payer: Cash Price |
$22,500.00
|
| Rate for Payer: Central Health Plan Commercial |
$40,000.00
|
| Rate for Payer: Cigna of CA HMO |
$35,000.00
|
| Rate for Payer: Cigna of CA PPO |
$35,000.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42,500.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$42,500.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42,500.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20,000.00
|
| Rate for Payer: Galaxy Health WC |
$42,500.00
|
| Rate for Payer: Global Benefits Group Commercial |
$30,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45,000.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31,750.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18,150.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29,500.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20,500.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$35,000.00
|
| Rate for Payer: Multiplan Commercial |
$37,500.00
|
| Rate for Payer: Networks By Design Commercial |
$25,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$42,500.00
|
| Rate for Payer: Riverside University Health System MISP |
$20,000.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30,000.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$18,765.00
|
| Rate for Payer: United Healthcare All Other HMO |
$18,265.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,870.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,375.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42,500.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42,500.00
|
| Rate for Payer: Vantage Medical Group Senior |
$42,500.00
|
|
|
HC MP CONTROL LE PROS
|
Facility
|
OP
|
$50,000.00
|
|
|
Service Code
|
CPT L5999
|
| Hospital Charge Code |
905380021
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$16,375.00 |
| Max. Negotiated Rate |
$45,000.00 |
| Rate for Payer: Adventist Health Commercial |
$20,500.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42,500.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27,500.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37,500.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29,085.00
|
| Rate for Payer: Blue Shield of California Commercial |
$40,100.00
|
| Rate for Payer: Blue Shield of California EPN |
$25,200.00
|
| Rate for Payer: Cash Price |
$22,500.00
|
| Rate for Payer: Central Health Plan Commercial |
$40,000.00
|
| Rate for Payer: Cigna of CA HMO |
$35,000.00
|
| Rate for Payer: Cigna of CA PPO |
$35,000.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42,500.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$42,500.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42,500.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20,000.00
|
| Rate for Payer: Galaxy Health WC |
$42,500.00
|
| Rate for Payer: Global Benefits Group Commercial |
$30,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45,000.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31,750.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18,150.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29,500.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20,500.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$35,000.00
|
| Rate for Payer: Multiplan Commercial |
$37,500.00
|
| Rate for Payer: Networks By Design Commercial |
$25,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$42,500.00
|
| Rate for Payer: Riverside University Health System MISP |
$20,000.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30,000.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$18,765.00
|
| Rate for Payer: United Healthcare All Other HMO |
$18,265.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,870.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,375.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42,500.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42,500.00
|
| Rate for Payer: Vantage Medical Group Senior |
$42,500.00
|
|
|
HC MP CONTROL LE PROS
|
Facility
|
IP
|
$50,000.00
|
|
|
Service Code
|
CPT L5999
|
| Hospital Charge Code |
905380021
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10,000.00 |
| Max. Negotiated Rate |
$45,000.00 |
| Rate for Payer: Adventist Health Commercial |
$10,000.00
|
| Rate for Payer: Blue Shield of California Commercial |
$40,100.00
|
| Rate for Payer: Blue Shield of California EPN |
$25,200.00
|
| Rate for Payer: Cash Price |
$22,500.00
|
| Rate for Payer: Central Health Plan Commercial |
$40,000.00
|
| Rate for Payer: Cigna of CA HMO |
$35,000.00
|
| Rate for Payer: Cigna of CA PPO |
$35,000.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20,000.00
|
| Rate for Payer: Galaxy Health WC |
$42,500.00
|
| Rate for Payer: Global Benefits Group Commercial |
$30,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45,000.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31,750.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29,500.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$37,500.00
|
| Rate for Payer: Networks By Design Commercial |
$32,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$42,500.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$18,765.00
|
| Rate for Payer: United Healthcare All Other HMO |
$18,265.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,870.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,375.00
|
|
|
HC MR ANGIO ABDOMEN W CONTRAST
|
Facility
|
IP
|
$15,827.00
|
|
|
Service Code
|
CPT 74185
|
| Hospital Charge Code |
908801037
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$3,165.40 |
| Max. Negotiated Rate |
$14,244.30 |
| Rate for Payer: Adventist Health Commercial |
$3,165.40
|
| Rate for Payer: Cash Price |
$7,122.15
|
| Rate for Payer: Central Health Plan Commercial |
$12,661.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,078.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,330.80
|
| Rate for Payer: EPIC Health Plan Senior |
$6,330.80
|
| Rate for Payer: Galaxy Health WC |
$13,452.95
|
| Rate for Payer: Global Benefits Group Commercial |
$9,496.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,244.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,050.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,337.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,165.40
|
| Rate for Payer: Multiplan Commercial |
$11,870.25
|
| Rate for Payer: Networks By Design Commercial |
$10,287.55
|
| Rate for Payer: Prime Health Services Commercial |
$13,452.95
|
|
|
HC MR ANGIO ABDOMEN W CONTRAST
|
Facility
|
OP
|
$7,283.00
|
|
|
Service Code
|
CPT 74185
|
| Hospital Charge Code |
908801037
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$571.09 |
| Max. Negotiated Rate |
$6,554.70 |
| Rate for Payer: Adventist Health Commercial |
$1,456.60
|
| Rate for Payer: Adventist Health Commercial |
$3,165.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,452.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,190.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,005.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,704.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,462.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,870.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,308.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,308.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,206.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,236.52
|
| Rate for Payer: Blue Shield of California Commercial |
$9,971.01
|
| Rate for Payer: Blue Shield of California Commercial |
$4,588.29
|
| Rate for Payer: Blue Shield of California EPN |
$2,891.35
|
| Rate for Payer: Blue Shield of California EPN |
$6,283.32
|
| Rate for Payer: Cash Price |
$7,122.15
|
| Rate for Payer: Cash Price |
$7,122.15
|
| Rate for Payer: Cash Price |
$3,277.35
|
| Rate for Payer: Cash Price |
$3,277.35
|
| Rate for Payer: Cash Price |
$7,122.15
|
| Rate for Payer: Cash Price |
$3,277.35
|
| Rate for Payer: Central Health Plan Commercial |
$12,661.60
|
| Rate for Payer: Central Health Plan Commercial |
$5,826.40
|
| Rate for Payer: Cigna of CA HMO |
$10,129.28
|
| Rate for Payer: Cigna of CA HMO |
$4,661.12
|
| Rate for Payer: Cigna of CA PPO |
$11,711.98
|
| Rate for Payer: Cigna of CA PPO |
$5,389.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,452.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,190.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,190.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,452.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,452.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,190.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,098.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,078.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,330.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,913.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,913.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,330.80
|
| Rate for Payer: Galaxy Health WC |
$13,452.95
|
| Rate for Payer: Galaxy Health WC |
$6,190.55
|
| Rate for Payer: Global Benefits Group Commercial |
$9,496.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,369.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,554.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,244.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$571.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$571.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,624.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,050.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$630.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$630.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,296.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,337.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,456.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,165.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11,078.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,098.10
|
| Rate for Payer: Multiplan Commercial |
$5,462.25
|
| Rate for Payer: Multiplan Commercial |
$11,870.25
|
| Rate for Payer: Networks By Design Commercial |
$10,287.55
|
| Rate for Payer: Networks By Design Commercial |
$4,733.95
|
| Rate for Payer: Prime Health Services Commercial |
$6,190.55
|
| Rate for Payer: Prime Health Services Commercial |
$13,452.95
|
| Rate for Payer: Riverside University Health System MISP |
$6,330.80
|
| Rate for Payer: Riverside University Health System MISP |
$2,913.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,369.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,496.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,496.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,369.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,111.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,111.86
|
| Rate for Payer: United Healthcare All Other HMO |
$1,111.86
|
| Rate for Payer: United Healthcare All Other HMO |
$1,111.86
|
| Rate for Payer: United Healthcare HMO Rider |
$1,111.86
|
| Rate for Payer: United Healthcare HMO Rider |
$1,111.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,111.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,111.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,452.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,190.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,190.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,452.95
|
| Rate for Payer: Vantage Medical Group Senior |
$6,190.55
|
| Rate for Payer: Vantage Medical Group Senior |
$13,452.95
|
|
|
HC MR ANGIO ABD W/O CONTRAST
|
Facility
|
IP
|
$11,851.00
|
|
|
Service Code
|
CPT 74185
|
| Hospital Charge Code |
908801089
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$2,370.20 |
| Max. Negotiated Rate |
$10,665.90 |
| Rate for Payer: Adventist Health Commercial |
$2,370.20
|
| Rate for Payer: Cash Price |
$5,332.95
|
| Rate for Payer: Central Health Plan Commercial |
$9,480.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,295.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,740.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,740.40
|
| Rate for Payer: Galaxy Health WC |
$10,073.35
|
| Rate for Payer: Global Benefits Group Commercial |
$7,110.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,665.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,525.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,992.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,370.20
|
| Rate for Payer: Multiplan Commercial |
$8,888.25
|
| Rate for Payer: Networks By Design Commercial |
$7,703.15
|
| Rate for Payer: Prime Health Services Commercial |
$10,073.35
|
|
|
HC MR ANGIO ABD W/O CONTRAST
|
Facility
|
OP
|
$6,824.00
|
|
|
Service Code
|
CPT 74185
|
| Hospital Charge Code |
908801089
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$571.09 |
| Max. Negotiated Rate |
$6,141.60 |
| Rate for Payer: Adventist Health Commercial |
$1,364.80
|
| Rate for Payer: Adventist Health Commercial |
$2,370.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,073.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,800.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,753.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,518.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,118.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,888.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,308.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,308.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,893.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,969.52
|
| Rate for Payer: Blue Shield of California Commercial |
$7,466.13
|
| Rate for Payer: Blue Shield of California Commercial |
$4,299.12
|
| Rate for Payer: Blue Shield of California EPN |
$2,709.13
|
| Rate for Payer: Blue Shield of California EPN |
$4,704.85
|
| Rate for Payer: Cash Price |
$5,332.95
|
| Rate for Payer: Cash Price |
$5,332.95
|
| Rate for Payer: Cash Price |
$3,070.80
|
| Rate for Payer: Cash Price |
$3,070.80
|
| Rate for Payer: Cash Price |
$5,332.95
|
| Rate for Payer: Cash Price |
$3,070.80
|
| Rate for Payer: Central Health Plan Commercial |
$9,480.80
|
| Rate for Payer: Central Health Plan Commercial |
$5,459.20
|
| Rate for Payer: Cigna of CA HMO |
$7,584.64
|
| Rate for Payer: Cigna of CA HMO |
$4,367.36
|
| Rate for Payer: Cigna of CA PPO |
$8,769.74
|
| Rate for Payer: Cigna of CA PPO |
$5,049.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,073.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,800.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,800.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,073.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,073.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,800.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,776.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,295.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,740.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,729.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,729.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,740.40
|
| Rate for Payer: Galaxy Health WC |
$10,073.35
|
| Rate for Payer: Galaxy Health WC |
$5,800.40
|
| Rate for Payer: Global Benefits Group Commercial |
$7,110.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,094.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,141.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,665.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$571.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$571.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,333.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,525.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$630.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$630.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,026.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,992.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,364.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,370.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8,295.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,776.80
|
| Rate for Payer: Multiplan Commercial |
$5,118.00
|
| Rate for Payer: Multiplan Commercial |
$8,888.25
|
| Rate for Payer: Networks By Design Commercial |
$7,703.15
|
| Rate for Payer: Networks By Design Commercial |
$4,435.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,800.40
|
| Rate for Payer: Prime Health Services Commercial |
$10,073.35
|
| Rate for Payer: Riverside University Health System MISP |
$4,740.40
|
| Rate for Payer: Riverside University Health System MISP |
$2,729.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,094.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,110.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,110.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,094.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,111.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,111.86
|
| Rate for Payer: United Healthcare All Other HMO |
$1,111.86
|
| Rate for Payer: United Healthcare All Other HMO |
$1,111.86
|
| Rate for Payer: United Healthcare HMO Rider |
$1,111.86
|
| Rate for Payer: United Healthcare HMO Rider |
$1,111.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,111.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,111.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,073.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,800.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,800.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,073.35
|
| Rate for Payer: Vantage Medical Group Senior |
$5,800.40
|
| Rate for Payer: Vantage Medical Group Senior |
$10,073.35
|
|
|
HC MR ANGIO CHEST W CONTRAST
|
Facility
|
IP
|
$13,553.00
|
|
|
Service Code
|
CPT 71555
|
| Hospital Charge Code |
908801090
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$2,710.60 |
| Max. Negotiated Rate |
$12,197.70 |
| Rate for Payer: Adventist Health Commercial |
$2,710.60
|
| Rate for Payer: Cash Price |
$6,098.85
|
| Rate for Payer: Central Health Plan Commercial |
$10,842.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,487.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,421.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,421.20
|
| Rate for Payer: Galaxy Health WC |
$11,520.05
|
| Rate for Payer: Global Benefits Group Commercial |
$8,131.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,197.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,606.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,996.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,710.60
|
| Rate for Payer: Multiplan Commercial |
$10,164.75
|
| Rate for Payer: Networks By Design Commercial |
$8,809.45
|
| Rate for Payer: Prime Health Services Commercial |
$11,520.05
|
|
|
HC MR ANGIO CHEST W CONTRAST
|
Facility
|
OP
|
$6,406.00
|
|
|
Service Code
|
CPT 71555
|
| Hospital Charge Code |
908801090
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$567.15 |
| Max. Negotiated Rate |
$5,765.40 |
| Rate for Payer: Adventist Health Commercial |
$1,281.20
|
| Rate for Payer: Adventist Health Commercial |
$2,710.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,520.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,445.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,523.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,454.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,804.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,164.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,307.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,307.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,883.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,726.37
|
| Rate for Payer: Blue Shield of California Commercial |
$8,538.39
|
| Rate for Payer: Blue Shield of California Commercial |
$4,035.78
|
| Rate for Payer: Blue Shield of California EPN |
$2,543.18
|
| Rate for Payer: Blue Shield of California EPN |
$5,380.54
|
| Rate for Payer: Cash Price |
$6,098.85
|
| Rate for Payer: Cash Price |
$6,098.85
|
| Rate for Payer: Cash Price |
$2,882.70
|
| Rate for Payer: Cash Price |
$2,882.70
|
| Rate for Payer: Cash Price |
$6,098.85
|
| Rate for Payer: Cash Price |
$2,882.70
|
| Rate for Payer: Central Health Plan Commercial |
$10,842.40
|
| Rate for Payer: Central Health Plan Commercial |
$5,124.80
|
| Rate for Payer: Cigna of CA HMO |
$8,673.92
|
| Rate for Payer: Cigna of CA HMO |
$4,099.84
|
| Rate for Payer: Cigna of CA PPO |
$10,029.22
|
| Rate for Payer: Cigna of CA PPO |
$4,740.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,520.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,445.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,445.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,520.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,520.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,445.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,484.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,487.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,421.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,562.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,562.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,421.20
|
| Rate for Payer: Galaxy Health WC |
$11,520.05
|
| Rate for Payer: Galaxy Health WC |
$5,445.10
|
| Rate for Payer: Global Benefits Group Commercial |
$8,131.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,843.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,765.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,197.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$567.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$567.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,067.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,606.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$626.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$626.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,779.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,996.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,281.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,710.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,487.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,484.20
|
| Rate for Payer: Multiplan Commercial |
$4,804.50
|
| Rate for Payer: Multiplan Commercial |
$10,164.75
|
| Rate for Payer: Networks By Design Commercial |
$8,809.45
|
| Rate for Payer: Networks By Design Commercial |
$4,163.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,445.10
|
| Rate for Payer: Prime Health Services Commercial |
$11,520.05
|
| Rate for Payer: Riverside University Health System MISP |
$5,421.20
|
| Rate for Payer: Riverside University Health System MISP |
$2,562.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,843.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,131.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,131.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,843.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,110.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,110.11
|
| Rate for Payer: United Healthcare All Other HMO |
$1,110.11
|
| Rate for Payer: United Healthcare All Other HMO |
$1,110.11
|
| Rate for Payer: United Healthcare HMO Rider |
$1,110.11
|
| Rate for Payer: United Healthcare HMO Rider |
$1,110.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,110.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,110.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,520.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,445.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,445.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,520.05
|
| Rate for Payer: Vantage Medical Group Senior |
$5,445.10
|
| Rate for Payer: Vantage Medical Group Senior |
$11,520.05
|
|
|
HC MR ANGIO CHEST W/O CONTRAST
|
Facility
|
IP
|
$12,320.00
|
|
|
Service Code
|
CPT 71555
|
| Hospital Charge Code |
908801091
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$2,464.00 |
| Max. Negotiated Rate |
$11,088.00 |
| Rate for Payer: Adventist Health Commercial |
$2,464.00
|
| Rate for Payer: Cash Price |
$5,544.00
|
| Rate for Payer: Central Health Plan Commercial |
$9,856.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,624.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,928.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,928.00
|
| Rate for Payer: Galaxy Health WC |
$10,472.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,392.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,088.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,823.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,268.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,464.00
|
| Rate for Payer: Multiplan Commercial |
$9,240.00
|
| Rate for Payer: Networks By Design Commercial |
$8,008.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,472.00
|
|
|
HC MR ANGIO CHEST W/O CONTRAST
|
Facility
|
OP
|
$5,952.00
|
|
|
Service Code
|
CPT 71555
|
| Hospital Charge Code |
908801091
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$567.15 |
| Max. Negotiated Rate |
$5,356.80 |
| Rate for Payer: Adventist Health Commercial |
$1,190.40
|
| Rate for Payer: Adventist Health Commercial |
$2,464.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,472.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,059.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,273.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,776.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,464.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,240.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,307.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,307.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,166.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,462.28
|
| Rate for Payer: Blue Shield of California Commercial |
$7,761.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,749.76
|
| Rate for Payer: Blue Shield of California EPN |
$2,362.94
|
| Rate for Payer: Blue Shield of California EPN |
$4,891.04
|
| Rate for Payer: Cash Price |
$5,544.00
|
| Rate for Payer: Cash Price |
$5,544.00
|
| Rate for Payer: Cash Price |
$2,678.40
|
| Rate for Payer: Cash Price |
$2,678.40
|
| Rate for Payer: Cash Price |
$5,544.00
|
| Rate for Payer: Cash Price |
$2,678.40
|
| Rate for Payer: Central Health Plan Commercial |
$9,856.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,761.60
|
| Rate for Payer: Cigna of CA HMO |
$7,884.80
|
| Rate for Payer: Cigna of CA HMO |
$3,809.28
|
| Rate for Payer: Cigna of CA PPO |
$9,116.80
|
| Rate for Payer: Cigna of CA PPO |
$4,404.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,472.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,059.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,059.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,472.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,472.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,059.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,166.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,624.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,928.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,380.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,380.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,928.00
|
| Rate for Payer: Galaxy Health WC |
$10,472.00
|
| Rate for Payer: Galaxy Health WC |
$5,059.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7,392.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,571.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,356.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,088.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$567.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$567.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,779.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,823.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$626.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$626.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,511.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,268.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,190.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,464.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8,624.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,166.40
|
| Rate for Payer: Multiplan Commercial |
$4,464.00
|
| Rate for Payer: Multiplan Commercial |
$9,240.00
|
| Rate for Payer: Networks By Design Commercial |
$8,008.00
|
| Rate for Payer: Networks By Design Commercial |
$3,868.80
|
| Rate for Payer: Prime Health Services Commercial |
$5,059.20
|
| Rate for Payer: Prime Health Services Commercial |
$10,472.00
|
| Rate for Payer: Riverside University Health System MISP |
$4,928.00
|
| Rate for Payer: Riverside University Health System MISP |
$2,380.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,571.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,392.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,392.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,571.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,110.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,110.11
|
| Rate for Payer: United Healthcare All Other HMO |
$1,110.11
|
| Rate for Payer: United Healthcare All Other HMO |
$1,110.11
|
| Rate for Payer: United Healthcare HMO Rider |
$1,110.11
|
| Rate for Payer: United Healthcare HMO Rider |
$1,110.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,110.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,110.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,472.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,059.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,059.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,472.00
|
| Rate for Payer: Vantage Medical Group Senior |
$5,059.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10,472.00
|
|
|
HC MR ANGIO CHEST W WO CONTRAST
|
Facility
|
IP
|
$14,675.00
|
|
|
Service Code
|
CPT 71555
|
| Hospital Charge Code |
908801032
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$2,935.00 |
| Max. Negotiated Rate |
$13,207.50 |
| Rate for Payer: Adventist Health Commercial |
$2,935.00
|
| Rate for Payer: Cash Price |
$6,603.75
|
| Rate for Payer: Central Health Plan Commercial |
$11,740.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,272.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,870.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,870.00
|
| Rate for Payer: Galaxy Health WC |
$12,473.75
|
| Rate for Payer: Global Benefits Group Commercial |
$8,805.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,207.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,318.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,658.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,935.00
|
| Rate for Payer: Multiplan Commercial |
$11,006.25
|
| Rate for Payer: Networks By Design Commercial |
$9,538.75
|
| Rate for Payer: Prime Health Services Commercial |
$12,473.75
|
|
|
HC MR ANGIO CHEST W WO CONTRAST
|
Facility
|
OP
|
$6,752.00
|
|
|
Service Code
|
CPT 71555
|
| Hospital Charge Code |
908801032
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$567.15 |
| Max. Negotiated Rate |
$6,076.80 |
| Rate for Payer: Adventist Health Commercial |
$1,350.40
|
| Rate for Payer: Adventist Health Commercial |
$2,935.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,954.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,473.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,739.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,713.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,071.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,064.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,006.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,307.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,307.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,536.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,927.64
|
| Rate for Payer: Blue Shield of California Commercial |
$9,245.25
|
| Rate for Payer: Blue Shield of California Commercial |
$4,253.76
|
| Rate for Payer: Blue Shield of California EPN |
$2,680.54
|
| Rate for Payer: Blue Shield of California EPN |
$5,825.98
|
| Rate for Payer: Cash Price |
$6,603.75
|
| Rate for Payer: Cash Price |
$6,603.75
|
| Rate for Payer: Cash Price |
$3,038.40
|
| Rate for Payer: Cash Price |
$3,038.40
|
| Rate for Payer: Cash Price |
$6,603.75
|
| Rate for Payer: Cash Price |
$3,038.40
|
| Rate for Payer: Central Health Plan Commercial |
$11,740.00
|
| Rate for Payer: Central Health Plan Commercial |
$5,401.60
|
| Rate for Payer: Cigna of CA HMO |
$9,392.00
|
| Rate for Payer: Cigna of CA HMO |
$4,321.28
|
| Rate for Payer: Cigna of CA PPO |
$10,859.50
|
| Rate for Payer: Cigna of CA PPO |
$4,996.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,473.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,739.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,739.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,473.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12,473.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,739.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,726.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,272.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,870.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,700.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,700.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5,870.00
|
| Rate for Payer: Galaxy Health WC |
$12,473.75
|
| Rate for Payer: Galaxy Health WC |
$5,739.20
|
| Rate for Payer: Global Benefits Group Commercial |
$8,805.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,051.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,076.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,207.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$567.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$567.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,287.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,318.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$626.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$626.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,983.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,658.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,350.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,935.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,272.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,726.40
|
| Rate for Payer: Multiplan Commercial |
$5,064.00
|
| Rate for Payer: Multiplan Commercial |
$11,006.25
|
| Rate for Payer: Networks By Design Commercial |
$9,538.75
|
| Rate for Payer: Networks By Design Commercial |
$4,388.80
|
| Rate for Payer: Prime Health Services Commercial |
$5,739.20
|
| Rate for Payer: Prime Health Services Commercial |
$12,473.75
|
| Rate for Payer: Riverside University Health System MISP |
$5,870.00
|
| Rate for Payer: Riverside University Health System MISP |
$2,700.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,051.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,805.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,805.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,051.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,110.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,110.11
|
| Rate for Payer: United Healthcare All Other HMO |
$1,110.11
|
| Rate for Payer: United Healthcare All Other HMO |
$1,110.11
|
| Rate for Payer: United Healthcare HMO Rider |
$1,110.11
|
| Rate for Payer: United Healthcare HMO Rider |
$1,110.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,110.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,110.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,473.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,739.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,739.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,473.75
|
| Rate for Payer: Vantage Medical Group Senior |
$5,739.20
|
| Rate for Payer: Vantage Medical Group Senior |
$12,473.75
|
|
|
HC MR ANGIO LOW EXT W CONTRAST
|
Facility
|
OP
|
$11,156.00
|
|
|
Service Code
|
CPT 73725
|
| Hospital Charge Code |
908801092
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$567.69 |
| Max. Negotiated Rate |
$10,040.40 |
| Rate for Payer: Adventist Health Commercial |
$2,231.20
|
| Rate for Payer: Adventist Health Commercial |
$1,071.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,055.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,055.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,552.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,482.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,135.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,945.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,017.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,367.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,308.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,308.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,489.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,115.59
|
| Rate for Payer: Blue Shield of California Commercial |
$3,374.28
|
| Rate for Payer: Blue Shield of California Commercial |
$7,028.28
|
| Rate for Payer: Blue Shield of California EPN |
$2,126.33
|
| Rate for Payer: Blue Shield of California EPN |
$4,428.93
|
| Rate for Payer: Cash Price |
$5,020.20
|
| Rate for Payer: Cash Price |
$2,410.20
|
| Rate for Payer: Cash Price |
$2,410.20
|
| Rate for Payer: Cash Price |
$5,020.20
|
| Rate for Payer: Central Health Plan Commercial |
$4,284.80
|
| Rate for Payer: Central Health Plan Commercial |
$8,924.80
|
| Rate for Payer: Cigna of CA HMO |
$7,139.84
|
| Rate for Payer: Cigna of CA HMO |
$3,427.84
|
| Rate for Payer: Cigna of CA PPO |
$3,963.44
|
| Rate for Payer: Cigna of CA PPO |
$8,255.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,482.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,552.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,482.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,552.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,482.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,552.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,749.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,809.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,462.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,142.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,142.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,462.40
|
| Rate for Payer: Galaxy Health WC |
$9,482.60
|
| Rate for Payer: Galaxy Health WC |
$4,552.60
|
| Rate for Payer: Global Benefits Group Commercial |
$6,693.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,213.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,040.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,820.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$567.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$567.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,401.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,084.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$627.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$627.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,160.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,582.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,071.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,231.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,749.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7,809.20
|
| Rate for Payer: Multiplan Commercial |
$8,367.00
|
| Rate for Payer: Multiplan Commercial |
$4,017.00
|
| Rate for Payer: Networks By Design Commercial |
$3,481.40
|
| Rate for Payer: Networks By Design Commercial |
$7,251.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,552.60
|
| Rate for Payer: Prime Health Services Commercial |
$9,482.60
|
| Rate for Payer: Riverside University Health System MISP |
$4,462.40
|
| Rate for Payer: Riverside University Health System MISP |
$2,142.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,693.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,213.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,213.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,693.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,114.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,114.46
|
| Rate for Payer: United Healthcare All Other HMO |
$1,114.46
|
| Rate for Payer: United Healthcare All Other HMO |
$1,114.46
|
| Rate for Payer: United Healthcare HMO Rider |
$1,114.46
|
| Rate for Payer: United Healthcare HMO Rider |
$1,114.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,114.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,114.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,482.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,552.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,482.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,552.60
|
| Rate for Payer: Vantage Medical Group Senior |
$9,482.60
|
| Rate for Payer: Vantage Medical Group Senior |
$4,552.60
|
|
|
HC MR ANGIO LOW EXT W CONTRAST
|
Facility
|
IP
|
$11,156.00
|
|
|
Service Code
|
CPT 73725
|
| Hospital Charge Code |
908801092
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$2,231.20 |
| Max. Negotiated Rate |
$10,040.40 |
| Rate for Payer: Adventist Health Commercial |
$2,231.20
|
| Rate for Payer: Cash Price |
$5,020.20
|
| Rate for Payer: Central Health Plan Commercial |
$8,924.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,809.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,462.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,462.40
|
| Rate for Payer: Galaxy Health WC |
$9,482.60
|
| Rate for Payer: Global Benefits Group Commercial |
$6,693.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,040.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,084.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,582.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,231.20
|
| Rate for Payer: Multiplan Commercial |
$8,367.00
|
| Rate for Payer: Networks By Design Commercial |
$7,251.40
|
| Rate for Payer: Prime Health Services Commercial |
$9,482.60
|
|
|
HC MR ANGIO LOW EXT WO CONT
|
Facility
|
OP
|
$10,141.00
|
|
|
Service Code
|
CPT 73725
|
| Hospital Charge Code |
908801094
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$567.69 |
| Max. Negotiated Rate |
$9,126.90 |
| Rate for Payer: Adventist Health Commercial |
$2,028.20
|
| Rate for Payer: Adventist Health Commercial |
$979.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,055.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,055.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,163.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,619.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,577.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,693.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,673.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,605.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,308.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,308.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,899.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,849.17
|
| Rate for Payer: Blue Shield of California Commercial |
$3,085.74
|
| Rate for Payer: Blue Shield of California Commercial |
$6,388.83
|
| Rate for Payer: Blue Shield of California EPN |
$1,944.51
|
| Rate for Payer: Blue Shield of California EPN |
$4,025.98
|
| Rate for Payer: Cash Price |
$4,563.45
|
| Rate for Payer: Cash Price |
$2,204.10
|
| Rate for Payer: Cash Price |
$2,204.10
|
| Rate for Payer: Cash Price |
$4,563.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,918.40
|
| Rate for Payer: Central Health Plan Commercial |
$8,112.80
|
| Rate for Payer: Cigna of CA HMO |
$6,490.24
|
| Rate for Payer: Cigna of CA HMO |
$3,134.72
|
| Rate for Payer: Cigna of CA PPO |
$3,624.52
|
| Rate for Payer: Cigna of CA PPO |
$7,504.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,619.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,163.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,619.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,163.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,619.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,163.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,428.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,098.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,056.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,959.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,959.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,056.40
|
| Rate for Payer: Galaxy Health WC |
$8,619.85
|
| Rate for Payer: Galaxy Health WC |
$4,163.30
|
| Rate for Payer: Global Benefits Group Commercial |
$6,084.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,938.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,126.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,408.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$567.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$567.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,110.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,439.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$627.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$627.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,889.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,983.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$979.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,028.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,428.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7,098.70
|
| Rate for Payer: Multiplan Commercial |
$7,605.75
|
| Rate for Payer: Multiplan Commercial |
$3,673.50
|
| Rate for Payer: Networks By Design Commercial |
$3,183.70
|
| Rate for Payer: Networks By Design Commercial |
$6,591.65
|
| Rate for Payer: Prime Health Services Commercial |
$4,163.30
|
| Rate for Payer: Prime Health Services Commercial |
$8,619.85
|
| Rate for Payer: Riverside University Health System MISP |
$4,056.40
|
| Rate for Payer: Riverside University Health System MISP |
$1,959.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,084.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,938.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,938.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,084.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,114.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,114.46
|
| Rate for Payer: United Healthcare All Other HMO |
$1,114.46
|
| Rate for Payer: United Healthcare All Other HMO |
$1,114.46
|
| Rate for Payer: United Healthcare HMO Rider |
$1,114.46
|
| Rate for Payer: United Healthcare HMO Rider |
$1,114.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,114.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,114.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,619.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,163.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,619.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,163.30
|
| Rate for Payer: Vantage Medical Group Senior |
$8,619.85
|
| Rate for Payer: Vantage Medical Group Senior |
$4,163.30
|
|
|
HC MR ANGIO LOW EXT WO CONT
|
Facility
|
IP
|
$10,141.00
|
|
|
Service Code
|
CPT 73725
|
| Hospital Charge Code |
908801094
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$2,028.20 |
| Max. Negotiated Rate |
$9,126.90 |
| Rate for Payer: Adventist Health Commercial |
$2,028.20
|
| Rate for Payer: Cash Price |
$4,563.45
|
| Rate for Payer: Central Health Plan Commercial |
$8,112.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,098.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,056.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,056.40
|
| Rate for Payer: Galaxy Health WC |
$8,619.85
|
| Rate for Payer: Global Benefits Group Commercial |
$6,084.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,126.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,439.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,983.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,028.20
|
| Rate for Payer: Multiplan Commercial |
$7,605.75
|
| Rate for Payer: Networks By Design Commercial |
$6,591.65
|
| Rate for Payer: Prime Health Services Commercial |
$8,619.85
|
|
