|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$596.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$541.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$502.68
|
| 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 |
$179.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$315.76
|
| Rate for Payer: Blue Shield of California Commercial |
$358.69
|
| Rate for Payer: Blue Shield of California Commercial |
$543.58
|
| 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 |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$596.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$724.20
|
| Rate for Payer: Global Benefits Group Commercial |
$511.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$63.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$541.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$71.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| 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 |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
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 |
$4,230.69 |
| Rate for Payer: Adventist Health Commercial |
$427.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,230.69
|
| 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 |
$1,372.60
|
| Rate for Payer: Cash Price |
$962.55
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,497.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,358.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$776.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,262.01
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,497.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,358.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,262.01
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$494.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$448.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$416.54
|
| 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 |
$74.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.22
|
| Rate for Payer: Blue Shield of California Commercial |
$297.23
|
| Rate for Payer: Blue Shield of California Commercial |
$450.43
|
| 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 |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$494.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$600.10
|
| Rate for Payer: Global Benefits Group Commercial |
$423.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$448.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$141.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.99
|
| 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 |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$548.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$497.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$462.56
|
| 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 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 |
$174.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.86
|
| Rate for Payer: Blue Shield of California Commercial |
$330.06
|
| Rate for Payer: Blue Shield of California Commercial |
$500.19
|
| 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 |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$548.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$666.40
|
| Rate for Payer: Global Benefits Group Commercial |
$470.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$59.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$497.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$66.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$141.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.99
|
| 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 |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$687.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$623.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$579.38
|
| 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 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 |
$511.99
|
| Rate for Payer: Blue Shield of California Commercial |
$413.42
|
| Rate for Payer: Blue Shield of California Commercial |
$626.52
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$687.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$623.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$356.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$579.38
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$361.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$328.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$305.03
|
| 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
|
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: Cigna of CA PPO |
$382.58
|
| Rate for Payer: Adventist Health Commercial |
$103.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$164.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$331.76
|
| 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: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$361.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$439.45
|
| Rate for Payer: Global Benefits Group Commercial |
$310.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$33.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$328.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$215.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$229.30
|
| 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 |
$171.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
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: Cash Price |
$232.65
|
| Rate for Payer: Adventist Health Commercial |
$103.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$361.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$328.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$305.03
|
| 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
|
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 |
$164.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| 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 |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$361.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$439.45
|
| Rate for Payer: Global Benefits Group Commercial |
$310.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$33.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$328.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$215.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$229.30
|
| 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 |
$171.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
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 |
$282.35 |
| Rate for Payer: Adventist Health Commercial |
$64.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$159.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$205.99
|
| 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 |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$224.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$272.85
|
| Rate for Payer: Global Benefits Group Commercial |
$192.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$203.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$215.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$229.30
|
| 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 |
$171.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
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 |
$159.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| 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 |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$224.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$272.85
|
| Rate for Payer: Global Benefits Group Commercial |
$192.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$203.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$215.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$229.30
|
| 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 |
$171.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$224.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$203.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$189.39
|
| 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
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$224.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$203.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$189.39
|
| 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 CHICKEN FEATHERS IGE
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913634
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$56.10 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$46.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.40
|
| Rate for Payer: EPIC Health Plan Senior |
$26.40
|
| Rate for Payer: Galaxy Health WC |
$56.10
|
| Rate for Payer: Global Benefits Group Commercial |
$39.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$41.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.84
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: Prime Health Services Commercial |
$56.10
|
|
|
HC CHICKEN FEATHERS IGE
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913634
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$163.16 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$163.16
|
| Rate for Payer: Blue Shield of California Commercial |
$30.43
|
| Rate for Payer: Blue Shield of California Commercial |
$46.00
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cigna of CA HMO |
$42.24
|
| Rate for Payer: Cigna of CA PPO |
$48.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$46.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.61
|
| Rate for Payer: EPIC Health Plan Senior |
$5.74
|
| Rate for Payer: Galaxy Health WC |
$56.10
|
| Rate for Payer: Global Benefits Group Commercial |
$39.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$41.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: Prime Health Services Commercial |
$56.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Other HMO |
$4.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC CHILI PEPPER IGE
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913635
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$163.16 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$163.16
|
| Rate for Payer: Blue Shield of California Commercial |
$30.43
|
| Rate for Payer: Blue Shield of California Commercial |
$46.00
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cigna of CA HMO |
$42.24
|
| Rate for Payer: Cigna of CA PPO |
$48.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$46.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.61
|
| Rate for Payer: EPIC Health Plan Senior |
$5.74
|
| Rate for Payer: Galaxy Health WC |
$56.10
|
| Rate for Payer: Global Benefits Group Commercial |
$39.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$41.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: Prime Health Services Commercial |
$56.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Other HMO |
$4.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC CHILI PEPPER IGE
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913635
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$56.10 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$46.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.40
|
| Rate for Payer: EPIC Health Plan Senior |
$26.40
|
| Rate for Payer: Galaxy Health WC |
$56.10
|
| Rate for Payer: Global Benefits Group Commercial |
$39.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$41.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.84
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: Prime Health Services Commercial |
$56.10
|
|
|
HC CHI SERVICES EA ADD 30 MIN PER CLNDR MONTH
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G0022
|
| Hospital Charge Code |
908698201
|
|
Hospital Revenue Code
|
510
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
HC CHI SERVICES EA ADD 30 MIN PER CLNDR MONTH
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G0022
|
| Hospital Charge Code |
908698201
|
|
Hospital Revenue Code
|
510
|
| Max. Negotiated Rate |
$252.71 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$252.71
|
| 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 HMO/PPO |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: 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: 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 |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| 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 CHI SERVICES FIRST 60 MIN PER CLNDR MONTH
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G0019
|
| Hospital Charge Code |
908698200
|
|
Hospital Revenue Code
|
510
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
