|
HC CHEMO PUSH INITIAL
|
Facility
|
IP
|
$744.00
|
|
|
Service Code
|
CPT 96409
|
| Hospital Charge Code |
911800804
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$148.80 |
| Max. Negotiated Rate |
$632.40 |
| Rate for Payer: Adventist Health Commercial |
$148.80
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$297.60
|
| Rate for Payer: EPIC Health Plan Senior |
$297.60
|
| Rate for Payer: Galaxy Health WC |
$632.40
|
| Rate for Payer: Global Benefits Group Commercial |
$446.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$496.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$283.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$460.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.56
|
| Rate for Payer: Multiplan Commercial |
$595.20
|
| Rate for Payer: Networks By Design Commercial |
$483.60
|
| Rate for Payer: Prime Health Services Commercial |
$632.40
|
|
|
HC CHEST 2 VIEWS
|
Facility
|
IP
|
$708.00
|
|
|
Service Code
|
CPT 71046
|
| Hospital Charge Code |
909001407
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$141.60 |
| Max. Negotiated Rate |
$601.80 |
| Rate for Payer: Adventist Health Commercial |
$141.60
|
| Rate for Payer: Cash Price |
$318.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$283.20
|
| Rate for Payer: EPIC Health Plan Senior |
$283.20
|
| Rate for Payer: Galaxy Health WC |
$601.80
|
| Rate for Payer: Global Benefits Group Commercial |
$424.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$472.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$269.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$438.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.92
|
| Rate for Payer: Multiplan Commercial |
$566.40
|
| Rate for Payer: Networks By Design Commercial |
$460.20
|
| Rate for Payer: Prime Health Services Commercial |
$601.80
|
|
|
HC CHEST 2 VIEWS
|
Facility
|
OP
|
$708.00
|
|
|
Service Code
|
CPT 71046
|
| Hospital Charge Code |
909001407
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$46.15 |
| Max. Negotiated Rate |
$601.80 |
| Rate for Payer: Adventist Health Commercial |
$141.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$464.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$230.41
|
| Rate for Payer: Blue Shield of California Commercial |
$433.30
|
| Rate for Payer: Blue Shield of California EPN |
$286.03
|
| Rate for Payer: Cash Price |
$318.60
|
| Rate for Payer: Cash Price |
$318.60
|
| Rate for Payer: Cigna of CA HMO |
$453.12
|
| Rate for Payer: Cigna of CA PPO |
$523.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$601.80
|
| Rate for Payer: Global Benefits Group Commercial |
$424.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$46.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$472.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$566.40
|
| Rate for Payer: Networks By Design Commercial |
$460.20
|
| Rate for Payer: Prime Health Services Commercial |
$601.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$424.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$424.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$159.01
|
| Rate for Payer: United Healthcare All Other HMO |
$159.01
|
| Rate for Payer: United Healthcare HMO Rider |
$159.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC CHEST COMP 4 VIEWS
|
Facility
|
OP
|
$852.00
|
|
|
Service Code
|
CPT 71048
|
| Hospital Charge Code |
909001402
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$63.47 |
| Max. Negotiated Rate |
$724.20 |
| Rate for Payer: Adventist Health Commercial |
$170.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$558.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$302.16
|
| Rate for Payer: Blue Shield of California Commercial |
$521.42
|
| Rate for Payer: Blue Shield of California EPN |
$344.21
|
| Rate for Payer: Cash Price |
$383.40
|
| Rate for Payer: Cash Price |
$383.40
|
| Rate for Payer: Cigna of CA HMO |
$545.28
|
| Rate for Payer: Cigna of CA PPO |
$630.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$724.20
|
| Rate for Payer: Global Benefits Group Commercial |
$511.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$63.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$568.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$681.60
|
| Rate for Payer: Networks By Design Commercial |
$553.80
|
| Rate for Payer: Prime Health Services Commercial |
$724.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$511.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$511.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$303.97
|
| Rate for Payer: United Healthcare All Other HMO |
$303.97
|
| Rate for Payer: United Healthcare HMO Rider |
$303.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$303.97
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC CHEST COMP 4 VIEWS
|
Facility
|
IP
|
$852.00
|
|
|
Service Code
|
CPT 71048
|
| Hospital Charge Code |
909001402
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$170.40 |
| Max. Negotiated Rate |
$724.20 |
| Rate for Payer: Adventist Health Commercial |
$170.40
|
| Rate for Payer: Cash Price |
$383.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.80
|
| Rate for Payer: EPIC Health Plan Senior |
$340.80
|
| Rate for Payer: Galaxy Health WC |
$724.20
|
| Rate for Payer: Global Benefits Group Commercial |
$511.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$568.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$324.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$527.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.48
|
| Rate for Payer: Multiplan Commercial |
$681.60
|
| Rate for Payer: Networks By Design Commercial |
$553.80
|
| Rate for Payer: Prime Health Services Commercial |
$724.20
|
|
|
HC CHEST FLUORO/PACEMKR
|
Facility
|
IP
|
$822.00
|
|
| Hospital Charge Code |
909001469
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$164.40 |
| Max. Negotiated Rate |
$698.70 |
| Rate for Payer: Adventist Health Commercial |
$164.40
|
| Rate for Payer: Cash Price |
$369.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$328.80
|
| Rate for Payer: EPIC Health Plan Senior |
$328.80
|
| Rate for Payer: Galaxy Health WC |
$698.70
|
| Rate for Payer: Global Benefits Group Commercial |
$493.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$548.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$313.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$508.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$197.28
|
| Rate for Payer: Multiplan Commercial |
$657.60
|
| Rate for Payer: Networks By Design Commercial |
$534.30
|
| Rate for Payer: Prime Health Services Commercial |
$698.70
|
|
|
HC CHEST FLUORO/PACEMKR
|
Facility
|
OP
|
$822.00
|
|
| Hospital Charge Code |
909001469
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$164.40 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$164.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$698.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$452.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$616.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$504.79
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$369.90
|
| Rate for Payer: Cash Price |
$369.90
|
| Rate for Payer: Cigna of CA HMO |
$526.08
|
| Rate for Payer: Cigna of CA PPO |
$608.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$698.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$698.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$698.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$328.80
|
| Rate for Payer: EPIC Health Plan Senior |
$328.80
|
| Rate for Payer: Galaxy Health WC |
$698.70
|
| Rate for Payer: Global Benefits Group Commercial |
$493.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$548.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$313.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$508.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$197.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$575.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$575.40
|
| Rate for Payer: Multiplan Commercial |
$657.60
|
| Rate for Payer: Networks By Design Commercial |
$534.30
|
| Rate for Payer: Prime Health Services Commercial |
$698.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$493.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$411.00
|
| Rate for Payer: United Healthcare All Other HMO |
$411.00
|
| Rate for Payer: United Healthcare HMO Rider |
$411.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$411.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$698.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$698.70
|
| Rate for Payer: Vantage Medical Group Senior |
$698.70
|
|
|
HC CHEST FOUR OR MORE VIEWS
|
Facility
|
IP
|
$852.00
|
|
|
Service Code
|
CPT 71048
|
| Hospital Charge Code |
909071048
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$170.40 |
| Max. Negotiated Rate |
$724.20 |
| Rate for Payer: Adventist Health Commercial |
$170.40
|
| Rate for Payer: Cash Price |
$383.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.80
|
| Rate for Payer: EPIC Health Plan Senior |
$340.80
|
| Rate for Payer: Galaxy Health WC |
$724.20
|
| Rate for Payer: Global Benefits Group Commercial |
$511.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$568.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$324.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$527.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.48
|
| Rate for Payer: Multiplan Commercial |
$681.60
|
| Rate for Payer: Networks By Design Commercial |
$553.80
|
| Rate for Payer: Prime Health Services Commercial |
$724.20
|
|
|
HC CHEST FOUR OR MORE VIEWS
|
Facility
|
OP
|
$852.00
|
|
|
Service Code
|
CPT 71048
|
| Hospital Charge Code |
909071048
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$63.47 |
| Max. Negotiated Rate |
$724.20 |
| Rate for Payer: Adventist Health Commercial |
$170.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$558.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$302.16
|
| Rate for Payer: Blue Shield of California Commercial |
$521.42
|
| Rate for Payer: Blue Shield of California EPN |
$344.21
|
| Rate for Payer: Cash Price |
$383.40
|
| Rate for Payer: Cash Price |
$383.40
|
| Rate for Payer: Cigna of CA HMO |
$545.28
|
| Rate for Payer: Cigna of CA PPO |
$630.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$724.20
|
| Rate for Payer: Global Benefits Group Commercial |
$511.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$63.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$568.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$681.60
|
| Rate for Payer: Networks By Design Commercial |
$553.80
|
| Rate for Payer: Prime Health Services Commercial |
$724.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$511.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$511.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$303.97
|
| Rate for Payer: United Healthcare All Other HMO |
$303.97
|
| Rate for Payer: United Healthcare HMO Rider |
$303.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$303.97
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC CHEST PORT
|
Facility
|
OP
|
$2,139.00
|
|
|
Service Code
|
CPT C1788
|
| Hospital Charge Code |
909081700
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$427.80 |
| Max. Negotiated Rate |
$1,818.15 |
| Rate for Payer: Adventist Health Commercial |
$427.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,402.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,818.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,176.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,604.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,313.56
|
| Rate for Payer: Cash Price |
$962.55
|
| Rate for Payer: Cigna of CA HMO |
$1,368.96
|
| Rate for Payer: Cigna of CA PPO |
$1,582.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,818.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,818.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,818.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$855.60
|
| Rate for Payer: EPIC Health Plan Senior |
$855.60
|
| Rate for Payer: Galaxy Health WC |
$1,818.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,283.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,426.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$814.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,324.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$513.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,497.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,497.30
|
| Rate for Payer: Multiplan Commercial |
$1,711.20
|
| Rate for Payer: Networks By Design Commercial |
$1,390.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,818.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,283.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,283.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,069.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,069.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,069.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,069.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,818.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,818.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,818.15
|
|
|
HC CHEST PORT
|
Facility
|
IP
|
$2,139.00
|
|
|
Service Code
|
CPT C1788
|
| Hospital Charge Code |
909081700
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$427.80 |
| Max. Negotiated Rate |
$1,818.15 |
| Rate for Payer: Adventist Health Commercial |
$427.80
|
| Rate for Payer: Cash Price |
$962.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$855.60
|
| Rate for Payer: EPIC Health Plan Senior |
$855.60
|
| Rate for Payer: Galaxy Health WC |
$1,818.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,283.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,426.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$814.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,324.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$513.36
|
| Rate for Payer: Multiplan Commercial |
$1,711.20
|
| Rate for Payer: Networks By Design Commercial |
$1,390.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,818.15
|
|
|
HC CHEST SINGLE VIEW
|
Facility
|
IP
|
$706.00
|
|
|
Service Code
|
CPT 71045
|
| Hospital Charge Code |
909001408
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$141.20 |
| Max. Negotiated Rate |
$600.10 |
| Rate for Payer: Adventist Health Commercial |
$141.20
|
| Rate for Payer: Cash Price |
$317.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.40
|
| Rate for Payer: EPIC Health Plan Senior |
$282.40
|
| Rate for Payer: Galaxy Health WC |
$600.10
|
| Rate for Payer: Global Benefits Group Commercial |
$423.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$470.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$268.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$437.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.44
|
| Rate for Payer: Multiplan Commercial |
$564.80
|
| Rate for Payer: Networks By Design Commercial |
$458.90
|
| Rate for Payer: Prime Health Services Commercial |
$600.10
|
|
|
HC CHEST SINGLE VIEW
|
Facility
|
OP
|
$706.00
|
|
|
Service Code
|
CPT 71045
|
| Hospital Charge Code |
909001408
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$29.65 |
| Max. Negotiated Rate |
$600.10 |
| Rate for Payer: Adventist Health Commercial |
$141.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$463.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.62
|
| Rate for Payer: Blue Shield of California Commercial |
$432.07
|
| Rate for Payer: Blue Shield of California EPN |
$285.22
|
| Rate for Payer: Cash Price |
$317.70
|
| Rate for Payer: Cash Price |
$317.70
|
| Rate for Payer: Cigna of CA HMO |
$451.84
|
| Rate for Payer: Cigna of CA PPO |
$522.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$600.10
|
| Rate for Payer: Global Benefits Group Commercial |
$423.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$470.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$564.80
|
| Rate for Payer: Networks By Design Commercial |
$458.90
|
| Rate for Payer: Prime Health Services Commercial |
$600.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$423.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$423.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$159.01
|
| Rate for Payer: United Healthcare All Other HMO |
$159.01
|
| Rate for Payer: United Healthcare HMO Rider |
$159.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC CHEST THREE VIEWS
|
Facility
|
OP
|
$784.00
|
|
|
Service Code
|
CPT 71047
|
| Hospital Charge Code |
909071047
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$59.24 |
| Max. Negotiated Rate |
$666.40 |
| Rate for Payer: Adventist Health Commercial |
$156.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$514.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$293.65
|
| Rate for Payer: Blue Shield of California Commercial |
$479.81
|
| Rate for Payer: Blue Shield of California EPN |
$316.74
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cigna of CA HMO |
$501.76
|
| Rate for Payer: Cigna of CA PPO |
$580.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$666.40
|
| Rate for Payer: Global Benefits Group Commercial |
$470.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$59.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$522.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$627.20
|
| Rate for Payer: Networks By Design Commercial |
$509.60
|
| Rate for Payer: Prime Health Services Commercial |
$666.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$470.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$470.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$159.01
|
| Rate for Payer: United Healthcare All Other HMO |
$159.01
|
| Rate for Payer: United Healthcare HMO Rider |
$159.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC CHEST THREE VIEWS
|
Facility
|
IP
|
$784.00
|
|
|
Service Code
|
CPT 71047
|
| Hospital Charge Code |
909071047
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$156.80 |
| Max. Negotiated Rate |
$666.40 |
| Rate for Payer: Adventist Health Commercial |
$156.80
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$313.60
|
| Rate for Payer: EPIC Health Plan Senior |
$313.60
|
| Rate for Payer: Galaxy Health WC |
$666.40
|
| Rate for Payer: Global Benefits Group Commercial |
$470.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$522.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$298.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$485.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.16
|
| Rate for Payer: Multiplan Commercial |
$627.20
|
| Rate for Payer: Networks By Design Commercial |
$509.60
|
| Rate for Payer: Prime Health Services Commercial |
$666.40
|
|
|
HC CHEST TOMO FULL LUNG
|
Facility
|
OP
|
$982.00
|
|
|
Service Code
|
CPT 76102
|
| Hospital Charge Code |
909001465
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$196.40 |
| Max. Negotiated Rate |
$834.70 |
| Rate for Payer: Adventist Health Commercial |
$196.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$644.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$834.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$540.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$736.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$489.95
|
| Rate for Payer: Blue Shield of California Commercial |
$600.98
|
| Rate for Payer: Blue Shield of California EPN |
$396.73
|
| Rate for Payer: Cash Price |
$441.90
|
| Rate for Payer: Cash Price |
$441.90
|
| Rate for Payer: Cigna of CA HMO |
$628.48
|
| Rate for Payer: Cigna of CA PPO |
$726.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$834.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$834.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$834.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$392.80
|
| Rate for Payer: EPIC Health Plan Senior |
$392.80
|
| Rate for Payer: Galaxy Health WC |
$834.70
|
| Rate for Payer: Global Benefits Group Commercial |
$589.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$654.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$374.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$607.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$687.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$687.40
|
| Rate for Payer: Multiplan Commercial |
$785.60
|
| Rate for Payer: Networks By Design Commercial |
$638.30
|
| Rate for Payer: Prime Health Services Commercial |
$834.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$589.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$589.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$491.00
|
| Rate for Payer: United Healthcare All Other HMO |
$491.00
|
| Rate for Payer: United Healthcare HMO Rider |
$491.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$491.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$834.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$834.70
|
| Rate for Payer: Vantage Medical Group Senior |
$834.70
|
|
|
HC CHEST TOMO FULL LUNG
|
Facility
|
IP
|
$982.00
|
|
|
Service Code
|
CPT 76102
|
| Hospital Charge Code |
909001465
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$196.40 |
| Max. Negotiated Rate |
$834.70 |
| Rate for Payer: Adventist Health Commercial |
$196.40
|
| Rate for Payer: Cash Price |
$441.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$392.80
|
| Rate for Payer: EPIC Health Plan Senior |
$392.80
|
| Rate for Payer: Galaxy Health WC |
$834.70
|
| Rate for Payer: Global Benefits Group Commercial |
$589.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$654.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$374.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$607.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.68
|
| Rate for Payer: Multiplan Commercial |
$785.60
|
| Rate for Payer: Networks By Design Commercial |
$638.30
|
| Rate for Payer: Prime Health Services Commercial |
$834.70
|
|
|
HC CHEST WALL MANIPULATION INIT
|
Facility
|
OP
|
$517.00
|
|
|
Service Code
|
CPT 94667
|
| Hospital Charge Code |
900800390
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$33.43 |
| Max. Negotiated Rate |
$536.00 |
| Rate for Payer: Adventist Health Commercial |
$103.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$339.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$232.65
|
| Rate for Payer: Cash Price |
$232.65
|
| Rate for Payer: Cash Price |
$232.65
|
| Rate for Payer: Cash Price |
$232.65
|
| Rate for Payer: Cigna of CA HMO |
$330.88
|
| Rate for Payer: Cigna of CA PPO |
$382.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$439.45
|
| Rate for Payer: Global Benefits Group Commercial |
$310.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$33.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$344.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$413.60
|
| Rate for Payer: Networks By Design Commercial |
$336.05
|
| Rate for Payer: Prime Health Services Commercial |
$439.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$310.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$310.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC CHEST WALL MANIPULATION INIT
|
Facility
|
OP
|
$517.00
|
|
|
Service Code
|
CPT 94667
|
| Hospital Charge Code |
900800390
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$33.43 |
| Max. Negotiated Rate |
$439.45 |
| Rate for Payer: Adventist Health Commercial |
$103.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$339.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$317.49
|
| Rate for Payer: Cash Price |
$232.65
|
| Rate for Payer: Cash Price |
$232.65
|
| Rate for Payer: Cigna of CA HMO |
$330.88
|
| Rate for Payer: Cigna of CA PPO |
$382.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$439.45
|
| Rate for Payer: Global Benefits Group Commercial |
$310.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$33.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$344.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$413.60
|
| Rate for Payer: Networks By Design Commercial |
$336.05
|
| Rate for Payer: Prime Health Services Commercial |
$439.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$310.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$310.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$258.50
|
| Rate for Payer: United Healthcare All Other HMO |
$258.50
|
| Rate for Payer: United Healthcare HMO Rider |
$258.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$258.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC CHEST WALL MANIPULATION INIT
|
Facility
|
IP
|
$517.00
|
|
|
Service Code
|
CPT 94667
|
| Hospital Charge Code |
900800390
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$103.40 |
| Max. Negotiated Rate |
$439.45 |
| Rate for Payer: Adventist Health Commercial |
$103.40
|
| Rate for Payer: Cash Price |
$232.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$206.80
|
| Rate for Payer: EPIC Health Plan Senior |
$206.80
|
| Rate for Payer: Galaxy Health WC |
$439.45
|
| Rate for Payer: Global Benefits Group Commercial |
$310.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$344.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$320.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.08
|
| Rate for Payer: Multiplan Commercial |
$413.60
|
| Rate for Payer: Networks By Design Commercial |
$336.05
|
| Rate for Payer: Prime Health Services Commercial |
$439.45
|
|
|
HC CHEST WALL MANIPULATION INIT
|
Facility
|
IP
|
$517.00
|
|
|
Service Code
|
CPT 94667
|
| Hospital Charge Code |
900800390
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$103.40 |
| Max. Negotiated Rate |
$439.45 |
| Rate for Payer: Adventist Health Commercial |
$103.40
|
| Rate for Payer: Cash Price |
$232.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$206.80
|
| Rate for Payer: EPIC Health Plan Senior |
$206.80
|
| Rate for Payer: Galaxy Health WC |
$439.45
|
| Rate for Payer: Global Benefits Group Commercial |
$310.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$344.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$320.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.08
|
| Rate for Payer: Multiplan Commercial |
$413.60
|
| Rate for Payer: Networks By Design Commercial |
$336.05
|
| Rate for Payer: Prime Health Services Commercial |
$439.45
|
|
|
HC CHEST WALL MANIPULATION SUB
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
CPT 94668
|
| Hospital Charge Code |
900800391
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$19.66 |
| Max. Negotiated Rate |
$536.00 |
| Rate for Payer: Adventist Health Commercial |
$64.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$210.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$144.45
|
| Rate for Payer: Cash Price |
$144.45
|
| Rate for Payer: Cash Price |
$144.45
|
| Rate for Payer: Cash Price |
$144.45
|
| Rate for Payer: Cigna of CA HMO |
$205.44
|
| Rate for Payer: Cigna of CA PPO |
$237.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$272.85
|
| Rate for Payer: Global Benefits Group Commercial |
$192.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$214.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: Networks By Design Commercial |
$208.65
|
| Rate for Payer: Prime Health Services Commercial |
$272.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$192.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$192.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC CHEST WALL MANIPULATION SUB
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
CPT 94668
|
| Hospital Charge Code |
900800391
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$64.20 |
| Max. Negotiated Rate |
$272.85 |
| Rate for Payer: Adventist Health Commercial |
$64.20
|
| Rate for Payer: Cash Price |
$144.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.40
|
| Rate for Payer: EPIC Health Plan Senior |
$128.40
|
| Rate for Payer: Galaxy Health WC |
$272.85
|
| Rate for Payer: Global Benefits Group Commercial |
$192.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$214.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.04
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: Networks By Design Commercial |
$208.65
|
| Rate for Payer: Prime Health Services Commercial |
$272.85
|
|
|
HC CHEST WALL MANIPULATION SUB
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
CPT 94668
|
| Hospital Charge Code |
900800391
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.20 |
| Max. Negotiated Rate |
$272.85 |
| Rate for Payer: Adventist Health Commercial |
$64.20
|
| Rate for Payer: Cash Price |
$144.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.40
|
| Rate for Payer: EPIC Health Plan Senior |
$128.40
|
| Rate for Payer: Galaxy Health WC |
$272.85
|
| Rate for Payer: Global Benefits Group Commercial |
$192.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$214.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.04
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: Networks By Design Commercial |
$208.65
|
| Rate for Payer: Prime Health Services Commercial |
$272.85
|
|
|
HC CHEST WALL MANIPULATION SUB
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
CPT 94668
|
| Hospital Charge Code |
900800391
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$19.66 |
| Max. Negotiated Rate |
$272.85 |
| Rate for Payer: Adventist Health Commercial |
$64.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$210.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$197.13
|
| Rate for Payer: Cash Price |
$144.45
|
| Rate for Payer: Cash Price |
$144.45
|
| Rate for Payer: Cigna of CA HMO |
$205.44
|
| Rate for Payer: Cigna of CA PPO |
$237.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$272.85
|
| Rate for Payer: Global Benefits Group Commercial |
$192.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$214.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: Networks By Design Commercial |
$208.65
|
| Rate for Payer: Prime Health Services Commercial |
$272.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$192.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$192.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$160.50
|
| Rate for Payer: United Healthcare All Other HMO |
$160.50
|
| Rate for Payer: United Healthcare HMO Rider |
$160.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$160.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
