|
HC MOTOR SPEECH D/C STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9158
|
| Hospital Charge Code |
900018423
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA 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 D/C STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9158
|
| Hospital Charge Code |
900018223
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA 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 D/C STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9158
|
| Hospital Charge Code |
900018223
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$447.00 |
| 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 |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| 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: 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: InnovAge PACE Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA 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 D/C STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9158
|
| Hospital Charge Code |
900018423
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$447.00 |
| 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 |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| 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: 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: InnovAge PACE Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA 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 D/C STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9158
|
| Hospital Charge Code |
900018123
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA 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: 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 Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA 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 |
900018422
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$447.00 |
| 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 |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| 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: 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: InnovAge PACE Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA 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: 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 Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA 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 |
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: 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 Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA 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 |
900018122
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$447.00 |
| 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 |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| 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: 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: InnovAge PACE Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA 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 |
900018222
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$447.00 |
| 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 |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| 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: 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: InnovAge PACE Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$29,365.00
|
| Rate for Payer: Blue Shield of California Commercial |
$38,650.00
|
| 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: 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: InnovAge PACE Commercial |
$25,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33,350.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19,050.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30,950.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20,500.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35,000.00
|
| Rate for Payer: Molina Healthcare of CA 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 |
$38,650.00
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$33,350.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19,050.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30,950.00
|
| 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
|
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 |
$38,650.00
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$33,350.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19,050.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30,950.00
|
| 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 |
$29,365.00
|
| Rate for Payer: Blue Shield of California Commercial |
$38,650.00
|
| 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: 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: InnovAge PACE Commercial |
$25,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33,350.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19,050.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30,950.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20,500.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35,000.00
|
| Rate for Payer: Molina Healthcare of CA 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 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: 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 Permanente of CA Commercial/Self Funded |
$10,556.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,030.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,796.91
|
| 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: Aetna of CA HMO/PPO |
$2,954.00
|
| 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 Medicare Advantage/Dual Product |
$5,462.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,308.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,277.31
|
| Rate for Payer: Blue Shield of California Commercial |
$4,420.78
|
| Rate for Payer: Blue Shield of California EPN |
$2,891.35
|
| Rate for Payer: Cash Price |
$3,277.35
|
| Rate for Payer: Cash Price |
$3,277.35
|
| Rate for Payer: Cash Price |
$3,277.35
|
| Rate for Payer: Central Health Plan Commercial |
$5,826.40
|
| Rate for Payer: Cigna of CA HMO |
$4,661.12
|
| Rate for Payer: Cigna of CA PPO |
$5,389.42
|
| 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 Medicare Advantage |
$6,190.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,913.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,913.20
|
| Rate for Payer: Galaxy Health WC |
$6,190.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4,369.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,554.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$571.09
|
| Rate for Payer: InnovAge PACE Commercial |
$3,641.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,857.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$630.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,508.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,456.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,098.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,098.10
|
| Rate for Payer: Multiplan Commercial |
$5,462.25
|
| Rate for Payer: Networks By Design Commercial |
$4,733.95
|
| Rate for Payer: Prime Health Services Commercial |
$6,190.55
|
| 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: 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 HMO |
$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: 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 Senior |
$6,190.55
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$7,904.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,515.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,335.77
|
| 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: Aetna of CA HMO/PPO |
$2,954.00
|
| 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 Medicare Advantage/Dual Product |
$5,118.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,308.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,007.74
|
| Rate for Payer: Blue Shield of California Commercial |
$4,142.17
|
| Rate for Payer: Blue Shield of California EPN |
$2,709.13
|
| Rate for Payer: Cash Price |
$3,070.80
|
| Rate for Payer: Cash Price |
$3,070.80
|
| Rate for Payer: Cash Price |
$3,070.80
|
| Rate for Payer: Central Health Plan Commercial |
$5,459.20
|
| Rate for Payer: Cigna of CA HMO |
$4,367.36
|
| Rate for Payer: Cigna of CA PPO |
$5,049.76
|
| 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 Medicare Advantage |
$5,800.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,729.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,729.60
|
| Rate for Payer: Galaxy Health WC |
$5,800.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,094.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,141.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$571.09
|
| Rate for Payer: InnovAge PACE Commercial |
$3,412.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,551.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$630.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,224.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,364.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,776.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,776.80
|
| Rate for Payer: Multiplan Commercial |
$5,118.00
|
| Rate for Payer: Networks By Design Commercial |
$4,435.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,800.40
|
| 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: 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 HMO |
$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: 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 Senior |
$5,800.40
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$9,039.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,163.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,389.31
|
| 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: Aetna of CA HMO/PPO |
$2,954.00
|
| 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 Medicare Advantage/Dual Product |
$4,804.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,307.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,762.24
|
| Rate for Payer: Blue Shield of California Commercial |
$3,888.44
|
| Rate for Payer: Blue Shield of California EPN |
$2,543.18
|
| Rate for Payer: Cash Price |
$2,882.70
|
| Rate for Payer: Cash Price |
$2,882.70
|
| Rate for Payer: Cash Price |
$2,882.70
|
| Rate for Payer: Central Health Plan Commercial |
$5,124.80
|
| Rate for Payer: Cigna of CA HMO |
$4,099.84
|
| Rate for Payer: Cigna of CA PPO |
$4,740.44
|
| 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 Medicare Advantage |
$5,445.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,562.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,562.40
|
| Rate for Payer: Galaxy Health WC |
$5,445.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,843.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,765.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$567.15
|
| Rate for Payer: InnovAge PACE Commercial |
$3,203.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,272.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$626.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,965.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,281.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,484.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,484.20
|
| Rate for Payer: Multiplan Commercial |
$4,804.50
|
| Rate for Payer: Networks By Design Commercial |
$4,163.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,445.10
|
| 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: 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 HMO |
$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: 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 Senior |
$5,445.10
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$8,217.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,693.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,626.08
|
| 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: Aetna of CA HMO/PPO |
$2,954.00
|
| 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 Medicare Advantage/Dual Product |
$4,464.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,307.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,495.61
|
| Rate for Payer: Blue Shield of California Commercial |
$3,612.86
|
| Rate for Payer: Blue Shield of California EPN |
$2,362.94
|
| Rate for Payer: Cash Price |
$2,678.40
|
| Rate for Payer: Cash Price |
$2,678.40
|
| Rate for Payer: Cash Price |
$2,678.40
|
| Rate for Payer: Central Health Plan Commercial |
$4,761.60
|
| Rate for Payer: Cigna of CA HMO |
$3,809.28
|
| Rate for Payer: Cigna of CA PPO |
$4,404.48
|
| 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 Medicare Advantage |
$5,059.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,380.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,380.80
|
| Rate for Payer: Galaxy Health WC |
$5,059.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,571.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,356.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$567.15
|
| Rate for Payer: InnovAge PACE Commercial |
$2,976.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,969.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$626.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,684.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,190.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,166.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,166.40
|
| Rate for Payer: Multiplan Commercial |
$4,464.00
|
| Rate for Payer: Networks By Design Commercial |
$3,868.80
|
| Rate for Payer: Prime Health Services Commercial |
$5,059.20
|
| 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: 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 HMO |
$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: 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 Senior |
$5,059.20
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$9,788.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,591.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,083.83
|
| 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: Aetna of CA HMO/PPO |
$2,954.00
|
| 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 Medicare Advantage/Dual Product |
$5,064.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,307.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,965.45
|
| Rate for Payer: Blue Shield of California Commercial |
$4,098.46
|
| Rate for Payer: Blue Shield of California EPN |
$2,680.54
|
| Rate for Payer: Cash Price |
$3,038.40
|
| Rate for Payer: Cash Price |
$3,038.40
|
| Rate for Payer: Cash Price |
$3,038.40
|
| Rate for Payer: Central Health Plan Commercial |
$5,401.60
|
| Rate for Payer: Cigna of CA HMO |
$4,321.28
|
| Rate for Payer: Cigna of CA PPO |
$4,996.48
|
| 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 Medicare Advantage |
$5,739.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,700.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,700.80
|
| Rate for Payer: Galaxy Health WC |
$5,739.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,051.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,076.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$567.15
|
| Rate for Payer: InnovAge PACE Commercial |
$3,376.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,503.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$626.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,179.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,350.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,726.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,726.40
|
| Rate for Payer: Multiplan Commercial |
$5,064.00
|
| Rate for Payer: Networks By Design Commercial |
$4,388.80
|
| Rate for Payer: Prime Health Services Commercial |
$5,739.20
|
| 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: 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 HMO |
$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: 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 Senior |
$5,739.20
|
|
