|
HC PT INIT EVAL LOW
|
Facility
|
IP
|
$868.00
|
|
|
Service Code
|
CPT 97161
|
| Hospital Charge Code |
900497161
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$173.60 |
| Max. Negotiated Rate |
$737.80 |
| Rate for Payer: Adventist Health Commercial |
$173.60
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$347.20
|
| Rate for Payer: EPIC Health Plan Senior |
$347.20
|
| Rate for Payer: Galaxy Health WC |
$737.80
|
| Rate for Payer: Global Benefits Group Commercial |
$520.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$578.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$330.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$537.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.32
|
| Rate for Payer: Multiplan Commercial |
$694.40
|
| Rate for Payer: Networks By Design Commercial |
$564.20
|
| Rate for Payer: Prime Health Services Commercial |
$737.80
|
|
|
HC PT INIT EVAL LOW
|
Facility
|
IP
|
$868.00
|
|
|
Service Code
|
CPT 97161
|
| Hospital Charge Code |
908697161
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$173.60 |
| Max. Negotiated Rate |
$737.80 |
| Rate for Payer: Adventist Health Commercial |
$173.60
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$347.20
|
| Rate for Payer: EPIC Health Plan Senior |
$347.20
|
| Rate for Payer: Galaxy Health WC |
$737.80
|
| Rate for Payer: Global Benefits Group Commercial |
$520.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$578.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$330.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$537.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.32
|
| Rate for Payer: Multiplan Commercial |
$694.40
|
| Rate for Payer: Networks By Design Commercial |
$564.20
|
| Rate for Payer: Prime Health Services Commercial |
$737.80
|
|
|
HC PT INIT EVAL LOW
|
Facility
|
OP
|
$868.00
|
|
|
Service Code
|
CPT 97161
|
| Hospital Charge Code |
908697161
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$737.80 |
| Rate for Payer: Adventist Health Commercial |
$355.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$569.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$737.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$477.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$651.00
|
| 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 |
$390.60
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Cigna of CA HMO |
$555.52
|
| Rate for Payer: Cigna of CA PPO |
$642.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$737.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$737.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$737.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$347.20
|
| Rate for Payer: EPIC Health Plan Senior |
$347.20
|
| Rate for Payer: Galaxy Health WC |
$737.80
|
| Rate for Payer: Global Benefits Group Commercial |
$520.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$578.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$330.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$537.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$607.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$607.60
|
| Rate for Payer: Multiplan Commercial |
$694.40
|
| Rate for Payer: Networks By Design Commercial |
$564.20
|
| Rate for Payer: Prime Health Services Commercial |
$737.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$520.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$520.80
|
| 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 |
$737.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$737.80
|
| Rate for Payer: Vantage Medical Group Senior |
$737.80
|
|
|
HC PT INIT EVAL MODERATE
|
Facility
|
OP
|
$1,086.00
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
900497162
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$923.10 |
| Rate for Payer: Adventist Health Commercial |
$445.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$712.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$923.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$597.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$814.50
|
| 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 |
$488.70
|
| Rate for Payer: Cash Price |
$488.70
|
| Rate for Payer: Cash Price |
$488.70
|
| Rate for Payer: Cigna of CA HMO |
$695.04
|
| Rate for Payer: Cigna of CA PPO |
$803.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$923.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$923.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$923.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$434.40
|
| Rate for Payer: EPIC Health Plan Senior |
$434.40
|
| Rate for Payer: Galaxy Health WC |
$923.10
|
| Rate for Payer: Global Benefits Group Commercial |
$651.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$724.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$413.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$672.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$260.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$760.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$760.20
|
| Rate for Payer: Multiplan Commercial |
$868.80
|
| Rate for Payer: Networks By Design Commercial |
$705.90
|
| Rate for Payer: Prime Health Services Commercial |
$923.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$651.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$651.60
|
| 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 |
$923.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$923.10
|
| Rate for Payer: Vantage Medical Group Senior |
$923.10
|
|
|
HC PT INIT EVAL MODERATE
|
Facility
|
IP
|
$1,086.00
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
908697162
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$217.20 |
| Max. Negotiated Rate |
$923.10 |
| Rate for Payer: Adventist Health Commercial |
$217.20
|
| Rate for Payer: Cash Price |
$488.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$434.40
|
| Rate for Payer: EPIC Health Plan Senior |
$434.40
|
| Rate for Payer: Galaxy Health WC |
$923.10
|
| Rate for Payer: Global Benefits Group Commercial |
$651.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$724.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$413.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$672.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$260.64
|
| Rate for Payer: Multiplan Commercial |
$868.80
|
| Rate for Payer: Networks By Design Commercial |
$705.90
|
| Rate for Payer: Prime Health Services Commercial |
$923.10
|
|
|
HC PT INIT EVAL MODERATE
|
Facility
|
OP
|
$1,086.00
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
908697162
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$923.10 |
| Rate for Payer: Adventist Health Commercial |
$445.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$712.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$923.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$597.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$814.50
|
| 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 |
$488.70
|
| Rate for Payer: Cash Price |
$488.70
|
| Rate for Payer: Cash Price |
$488.70
|
| Rate for Payer: Cigna of CA HMO |
$695.04
|
| Rate for Payer: Cigna of CA PPO |
$803.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$923.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$923.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$923.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$434.40
|
| Rate for Payer: EPIC Health Plan Senior |
$434.40
|
| Rate for Payer: Galaxy Health WC |
$923.10
|
| Rate for Payer: Global Benefits Group Commercial |
$651.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$724.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$413.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$672.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$260.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$760.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$760.20
|
| Rate for Payer: Multiplan Commercial |
$868.80
|
| Rate for Payer: Networks By Design Commercial |
$705.90
|
| Rate for Payer: Prime Health Services Commercial |
$923.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$651.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$651.60
|
| 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 |
$923.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$923.10
|
| Rate for Payer: Vantage Medical Group Senior |
$923.10
|
|
|
HC PT INIT EVAL MODERATE
|
Facility
|
IP
|
$1,086.00
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
900497162
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$217.20 |
| Max. Negotiated Rate |
$923.10 |
| Rate for Payer: Adventist Health Commercial |
$217.20
|
| Rate for Payer: Cash Price |
$488.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$434.40
|
| Rate for Payer: EPIC Health Plan Senior |
$434.40
|
| Rate for Payer: Galaxy Health WC |
$923.10
|
| Rate for Payer: Global Benefits Group Commercial |
$651.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$724.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$413.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$672.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$260.64
|
| Rate for Payer: Multiplan Commercial |
$868.80
|
| Rate for Payer: Networks By Design Commercial |
$705.90
|
| Rate for Payer: Prime Health Services Commercial |
$923.10
|
|
|
HC PT RE-EVALUATION
|
Facility
|
IP
|
$548.00
|
|
|
Service Code
|
CPT 97164
|
| Hospital Charge Code |
900409008
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$109.60 |
| Max. Negotiated Rate |
$465.80 |
| Rate for Payer: Adventist Health Commercial |
$109.60
|
| Rate for Payer: Cash Price |
$246.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$219.20
|
| Rate for Payer: EPIC Health Plan Senior |
$219.20
|
| Rate for Payer: Galaxy Health WC |
$465.80
|
| Rate for Payer: Global Benefits Group Commercial |
$328.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$365.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$208.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$339.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.52
|
| Rate for Payer: Multiplan Commercial |
$438.40
|
| Rate for Payer: Networks By Design Commercial |
$356.20
|
| Rate for Payer: Prime Health Services Commercial |
$465.80
|
|
|
HC PT RE-EVALUATION
|
Facility
|
OP
|
$548.00
|
|
|
Service Code
|
CPT 97164
|
| Hospital Charge Code |
900409008
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$131.52 |
| Max. Negotiated Rate |
$465.80 |
| Rate for Payer: Adventist Health Commercial |
$224.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$359.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$465.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$301.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$411.00
|
| 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 |
$246.60
|
| Rate for Payer: Cash Price |
$246.60
|
| Rate for Payer: Cash Price |
$246.60
|
| Rate for Payer: Cash Price |
$246.60
|
| Rate for Payer: Cigna of CA HMO |
$350.72
|
| Rate for Payer: Cigna of CA PPO |
$405.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$465.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$465.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$465.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$219.20
|
| Rate for Payer: EPIC Health Plan Senior |
$219.20
|
| Rate for Payer: Galaxy Health WC |
$465.80
|
| Rate for Payer: Global Benefits Group Commercial |
$328.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$158.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$365.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$339.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$383.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$383.60
|
| Rate for Payer: Multiplan Commercial |
$438.40
|
| Rate for Payer: Networks By Design Commercial |
$356.20
|
| Rate for Payer: Prime Health Services Commercial |
$465.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$328.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$328.80
|
| 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 |
$465.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$465.80
|
| Rate for Payer: Vantage Medical Group Senior |
$465.80
|
|
|
HC PT SUBSTITUTION
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 85611
|
| Hospital Charge Code |
900910105
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.19 |
| Max. Negotiated Rate |
$38.90 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.90
|
| Rate for Payer: Blue Shield of California Commercial |
$28.10
|
| Rate for Payer: Blue Shield of California EPN |
$18.56
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cigna of CA HMO |
$26.88
|
| Rate for Payer: Cigna of CA PPO |
$31.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.32
|
| Rate for Payer: EPIC Health Plan Senior |
$3.94
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.28
|
| Rate for Payer: Multiplan Commercial |
$33.60
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.19
|
| Rate for Payer: United Healthcare All Other HMO |
$3.19
|
| Rate for Payer: United Healthcare HMO Rider |
$3.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.33
|
| Rate for Payer: Vantage Medical Group Senior |
$3.94
|
|
|
HC PT SUBSTITUTION
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
CPT 85611
|
| Hospital Charge Code |
900910105
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$35.40 |
| Max. Negotiated Rate |
$150.45 |
| Rate for Payer: Adventist Health Commercial |
$35.40
|
| Rate for Payer: Cash Price |
$79.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.80
|
| Rate for Payer: EPIC Health Plan Senior |
$70.80
|
| Rate for Payer: Galaxy Health WC |
$150.45
|
| Rate for Payer: Global Benefits Group Commercial |
$106.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$109.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.48
|
| Rate for Payer: Multiplan Commercial |
$141.60
|
| Rate for Payer: Networks By Design Commercial |
$115.05
|
| Rate for Payer: Prime Health Services Commercial |
$150.45
|
|
|
HC PTT
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
900910007
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$36.80 |
| Max. Negotiated Rate |
$156.40 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.60
|
| Rate for Payer: EPIC Health Plan Senior |
$73.60
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.16
|
| Rate for Payer: Multiplan Commercial |
$147.20
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
|
|
HC PTT
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
900910007
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.87 |
| Max. Negotiated Rate |
$59.32 |
| Rate for Payer: Adventist Health Commercial |
$12.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.32
|
| Rate for Payer: Blue Shield of California Commercial |
$41.48
|
| Rate for Payer: Blue Shield of California EPN |
$27.40
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna of CA HMO |
$39.68
|
| Rate for Payer: Cigna of CA PPO |
$45.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.11
|
| Rate for Payer: EPIC Health Plan Senior |
$6.01
|
| Rate for Payer: Galaxy Health WC |
$52.70
|
| Rate for Payer: Global Benefits Group Commercial |
$37.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$41.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.05
|
| Rate for Payer: Multiplan Commercial |
$49.60
|
| Rate for Payer: Networks By Design Commercial |
$40.30
|
| Rate for Payer: Prime Health Services Commercial |
$52.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.87
|
| Rate for Payer: United Healthcare All Other HMO |
$4.87
|
| Rate for Payer: United Healthcare HMO Rider |
$4.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.87
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.61
|
| Rate for Payer: Vantage Medical Group Senior |
$6.01
|
|
|
HC PTT SUBSTITUTION
|
Facility
|
OP
|
$58.00
|
|
|
Service Code
|
CPT 85732
|
| Hospital Charge Code |
900910106
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$63.90 |
| Rate for Payer: Adventist Health Commercial |
$11.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$38.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.90
|
| Rate for Payer: Blue Shield of California Commercial |
$38.80
|
| Rate for Payer: Blue Shield of California EPN |
$25.64
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna of CA HMO |
$37.12
|
| Rate for Payer: Cigna of CA PPO |
$42.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.73
|
| Rate for Payer: EPIC Health Plan Senior |
$6.47
|
| Rate for Payer: Galaxy Health WC |
$49.30
|
| Rate for Payer: Global Benefits Group Commercial |
$34.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.67
|
| Rate for Payer: Multiplan Commercial |
$46.40
|
| Rate for Payer: Networks By Design Commercial |
$37.70
|
| Rate for Payer: Prime Health Services Commercial |
$49.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.24
|
| Rate for Payer: United Healthcare All Other HMO |
$5.24
|
| Rate for Payer: United Healthcare HMO Rider |
$5.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
|
HC PTT SUBSTITUTION
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
CPT 85732
|
| Hospital Charge Code |
900910106
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$36.80 |
| Max. Negotiated Rate |
$156.40 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.60
|
| Rate for Payer: EPIC Health Plan Senior |
$73.60
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.16
|
| Rate for Payer: Multiplan Commercial |
$147.20
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
|
|
HC PULMONARY ARTERIAL ANGIO
|
Facility
|
IP
|
$2,323.00
|
|
|
Service Code
|
CPT 93568
|
| Hospital Charge Code |
906820074
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$464.60 |
| Max. Negotiated Rate |
$1,974.55 |
| Rate for Payer: Adventist Health Commercial |
$464.60
|
| Rate for Payer: Cash Price |
$1,045.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.20
|
| Rate for Payer: EPIC Health Plan Senior |
$929.20
|
| Rate for Payer: Galaxy Health WC |
$1,974.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,393.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,549.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$885.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,437.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$557.52
|
| Rate for Payer: Multiplan Commercial |
$1,858.40
|
| Rate for Payer: Networks By Design Commercial |
$1,509.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,974.55
|
|
|
HC PULMONARY ARTERIAL ANGIO
|
Facility
|
OP
|
$2,323.00
|
|
|
Service Code
|
CPT 93568
|
| Hospital Charge Code |
906820074
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$156.58 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$464.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,974.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,277.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,742.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| 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 |
$1,045.35
|
| Rate for Payer: Cash Price |
$1,045.35
|
| Rate for Payer: Cash Price |
$1,045.35
|
| Rate for Payer: Cigna of CA HMO |
$1,509.95
|
| Rate for Payer: Cigna of CA PPO |
$1,719.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,974.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,974.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,974.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.20
|
| Rate for Payer: EPIC Health Plan Senior |
$929.20
|
| Rate for Payer: Galaxy Health WC |
$1,974.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,393.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$156.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,549.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$177.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,437.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$557.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,626.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,626.10
|
| Rate for Payer: Multiplan Commercial |
$1,858.40
|
| Rate for Payer: Networks By Design Commercial |
$1,509.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,974.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,393.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,393.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,974.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,974.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,974.55
|
|
|
HC PULMONARY ARTERIAL ANGIO
|
Facility
|
IP
|
$2,389.00
|
|
|
Service Code
|
CPT 93568
|
| Hospital Charge Code |
906811417
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$477.80 |
| Max. Negotiated Rate |
$2,030.65 |
| Rate for Payer: Adventist Health Commercial |
$477.80
|
| Rate for Payer: Cash Price |
$1,075.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$955.60
|
| Rate for Payer: EPIC Health Plan Senior |
$955.60
|
| Rate for Payer: Galaxy Health WC |
$2,030.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,433.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,593.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$910.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,478.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$573.36
|
| Rate for Payer: Multiplan Commercial |
$1,911.20
|
| Rate for Payer: Networks By Design Commercial |
$1,552.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,030.65
|
|
|
HC PULMONARY ARTERIAL ANGIO
|
Facility
|
OP
|
$2,389.00
|
|
|
Service Code
|
CPT 93568
|
| Hospital Charge Code |
906811417
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$156.58 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$477.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,030.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,313.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,791.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| 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 |
$1,075.05
|
| Rate for Payer: Cash Price |
$1,075.05
|
| Rate for Payer: Cash Price |
$1,075.05
|
| Rate for Payer: Cigna of CA HMO |
$1,552.85
|
| Rate for Payer: Cigna of CA PPO |
$1,767.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,030.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,030.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,030.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$955.60
|
| Rate for Payer: EPIC Health Plan Senior |
$955.60
|
| Rate for Payer: Galaxy Health WC |
$2,030.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,433.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$156.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,593.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$177.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,478.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$573.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,672.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,672.30
|
| Rate for Payer: Multiplan Commercial |
$1,911.20
|
| Rate for Payer: Networks By Design Commercial |
$1,552.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,030.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,433.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,433.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,030.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,030.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,030.65
|
|
|
HC PULM PERFUSION SCAN
|
Facility
|
OP
|
$2,230.00
|
|
|
Service Code
|
CPT 78580
|
| Hospital Charge Code |
909301400
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$189.00 |
| Max. Negotiated Rate |
$1,895.50 |
| Rate for Payer: Adventist Health Commercial |
$446.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,462.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,369.44
|
| Rate for Payer: Blue Shield of California Commercial |
$1,364.76
|
| Rate for Payer: Blue Shield of California EPN |
$900.92
|
| Rate for Payer: Cash Price |
$1,003.50
|
| Rate for Payer: Cash Price |
$1,003.50
|
| Rate for Payer: Cigna of CA HMO |
$1,427.20
|
| Rate for Payer: Cigna of CA PPO |
$1,650.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$689.27
|
| Rate for Payer: EPIC Health Plan Senior |
$510.57
|
| Rate for Payer: Galaxy Health WC |
$1,895.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,338.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$837.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$189.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,487.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$213.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$510.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$535.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$684.16
|
| Rate for Payer: Multiplan Commercial |
$1,784.00
|
| Rate for Payer: Networks By Design Commercial |
$1,449.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,895.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,338.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,338.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$518.19
|
| Rate for Payer: United Healthcare All Other HMO |
$518.19
|
| Rate for Payer: United Healthcare HMO Rider |
$518.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$518.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$510.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC PULM PERFUSION SCAN
|
Facility
|
IP
|
$2,230.00
|
|
|
Service Code
|
CPT 78580
|
| Hospital Charge Code |
909301400
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$446.00 |
| Max. Negotiated Rate |
$1,895.50 |
| Rate for Payer: Adventist Health Commercial |
$446.00
|
| Rate for Payer: Cash Price |
$1,003.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$892.00
|
| Rate for Payer: EPIC Health Plan Senior |
$892.00
|
| Rate for Payer: Galaxy Health WC |
$1,895.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,338.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,487.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$849.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,380.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$535.20
|
| Rate for Payer: Multiplan Commercial |
$1,784.00
|
| Rate for Payer: Networks By Design Commercial |
$1,449.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,895.50
|
|
|
HC PULM PERF & VENT/VQ
|
Facility
|
IP
|
$4,402.00
|
|
|
Service Code
|
CPT 78582
|
| Hospital Charge Code |
909301403
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$880.40 |
| Max. Negotiated Rate |
$3,741.70 |
| Rate for Payer: Adventist Health Commercial |
$880.40
|
| Rate for Payer: Cash Price |
$1,980.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,760.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,760.80
|
| Rate for Payer: Galaxy Health WC |
$3,741.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,641.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,936.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,677.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,724.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,056.48
|
| Rate for Payer: Multiplan Commercial |
$3,521.60
|
| Rate for Payer: Networks By Design Commercial |
$2,861.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,741.70
|
|
|
HC PULM PERF & VENT/VQ
|
Facility
|
OP
|
$4,402.00
|
|
|
Service Code
|
CPT 78582
|
| Hospital Charge Code |
909301403
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$488.76 |
| Max. Negotiated Rate |
$3,741.70 |
| Rate for Payer: Adventist Health Commercial |
$880.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,887.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$683.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,222.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,694.02
|
| Rate for Payer: Blue Shield of California EPN |
$1,778.41
|
| Rate for Payer: Cash Price |
$1,980.90
|
| Rate for Payer: Cash Price |
$1,980.90
|
| Rate for Payer: Cigna of CA HMO |
$2,817.28
|
| Rate for Payer: Cigna of CA PPO |
$3,257.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$752.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$683.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$923.31
|
| Rate for Payer: EPIC Health Plan Senior |
$683.93
|
| Rate for Payer: Galaxy Health WC |
$3,741.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,641.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,121.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$488.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$683.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,936.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$552.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$683.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,056.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$861.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$916.47
|
| Rate for Payer: Multiplan Commercial |
$3,521.60
|
| Rate for Payer: Networks By Design Commercial |
$2,861.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,741.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,641.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,641.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$809.82
|
| Rate for Payer: United Healthcare All Other HMO |
$809.82
|
| Rate for Payer: United Healthcare HMO Rider |
$809.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$809.82
|
| Rate for Payer: Upland Medical Group Pediatric |
$683.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Vantage Medical Group Senior |
$683.93
|
|
|
HC PULM STRESS TEST COMPLEX
|
Facility
|
IP
|
$2,883.00
|
|
|
Service Code
|
CPT 94621
|
| Hospital Charge Code |
900801021
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$576.60 |
| Max. Negotiated Rate |
$2,450.55 |
| Rate for Payer: Adventist Health Commercial |
$576.60
|
| Rate for Payer: Cash Price |
$1,297.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,153.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,153.20
|
| Rate for Payer: Galaxy Health WC |
$2,450.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,729.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,922.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,098.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,784.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$691.92
|
| Rate for Payer: Multiplan Commercial |
$2,306.40
|
| Rate for Payer: Networks By Design Commercial |
$1,873.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,450.55
|
|
|
HC PULM STRESS TEST COMPLEX
|
Facility
|
OP
|
$2,883.00
|
|
|
Service Code
|
CPT 94621
|
| Hospital Charge Code |
900801021
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$167.34 |
| Max. Negotiated Rate |
$2,450.55 |
| Rate for Payer: Adventist Health Commercial |
$576.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,890.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$395.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,770.45
|
| Rate for Payer: Blue Shield of California Commercial |
$1,764.40
|
| Rate for Payer: Blue Shield of California EPN |
$1,164.73
|
| Rate for Payer: Cash Price |
$1,297.35
|
| Rate for Payer: Cash Price |
$1,297.35
|
| Rate for Payer: Cash Price |
$1,297.35
|
| Rate for Payer: Cigna of CA HMO |
$1,845.12
|
| Rate for Payer: Cigna of CA PPO |
$2,133.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$435.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$395.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$534.14
|
| Rate for Payer: EPIC Health Plan Senior |
$395.66
|
| Rate for Payer: Galaxy Health WC |
$2,450.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,729.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$648.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$167.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$395.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,922.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$189.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$395.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$691.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$498.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$530.18
|
| Rate for Payer: Multiplan Commercial |
$2,306.40
|
| Rate for Payer: Networks By Design Commercial |
$1,873.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,450.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,729.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,729.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$395.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Vantage Medical Group Senior |
$395.66
|
|
