|
HC PULM STRESS TEST SIMPLE
|
Facility
|
OP
|
$1,425.00
|
|
|
Service Code
|
CPT 94618
|
| Hospital Charge Code |
900801020
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$50.60 |
| Max. Negotiated Rate |
$1,211.25 |
| Rate for Payer: Adventist Health Commercial |
$285.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$934.66
|
| 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 |
$875.09
|
| Rate for Payer: Blue Shield of California Commercial |
$872.10
|
| Rate for Payer: Blue Shield of California EPN |
$575.70
|
| Rate for Payer: Cash Price |
$641.25
|
| Rate for Payer: Cash Price |
$641.25
|
| Rate for Payer: Cash Price |
$641.25
|
| Rate for Payer: Cigna of CA HMO |
$912.00
|
| Rate for Payer: Cigna of CA PPO |
$1,054.50
|
| 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 |
$1,211.25
|
| Rate for Payer: Global Benefits Group Commercial |
$855.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$50.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$950.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.00
|
| 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 |
$1,140.00
|
| Rate for Payer: Networks By Design Commercial |
$926.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,211.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$855.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$855.00
|
| 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 |
$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 PULM STRESS TEST SIMPLE
|
Facility
|
IP
|
$1,425.00
|
|
|
Service Code
|
CPT 94618
|
| Hospital Charge Code |
900801020
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$285.00 |
| Max. Negotiated Rate |
$1,211.25 |
| Rate for Payer: Adventist Health Commercial |
$285.00
|
| Rate for Payer: Cash Price |
$641.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$570.00
|
| Rate for Payer: EPIC Health Plan Senior |
$570.00
|
| Rate for Payer: Galaxy Health WC |
$1,211.25
|
| Rate for Payer: Global Benefits Group Commercial |
$855.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$950.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$542.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$882.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.00
|
| Rate for Payer: Multiplan Commercial |
$1,140.00
|
| Rate for Payer: Networks By Design Commercial |
$926.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,211.25
|
|
|
HC PULSE OXIMETRY-CONTINUOUS OVER
|
Facility
|
IP
|
$489.00
|
|
|
Service Code
|
CPT 94762
|
| Hospital Charge Code |
900800103
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$97.80 |
| Max. Negotiated Rate |
$415.65 |
| Rate for Payer: Adventist Health Commercial |
$97.80
|
| Rate for Payer: Cash Price |
$220.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.60
|
| Rate for Payer: EPIC Health Plan Senior |
$195.60
|
| Rate for Payer: Galaxy Health WC |
$415.65
|
| Rate for Payer: Global Benefits Group Commercial |
$293.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$326.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$186.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$302.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.36
|
| Rate for Payer: Multiplan Commercial |
$391.20
|
| Rate for Payer: Networks By Design Commercial |
$317.85
|
| Rate for Payer: Prime Health Services Commercial |
$415.65
|
|
|
HC PULSE OXIMETRY-CONTINUOUS OVER
|
Facility
|
OP
|
$489.00
|
|
|
Service Code
|
CPT 94762
|
| Hospital Charge Code |
900800103
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$97.80 |
| Max. Negotiated Rate |
$764.00 |
| Rate for Payer: Adventist Health Commercial |
$97.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$320.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$300.29
|
| Rate for Payer: Blue Shield of California Commercial |
$299.27
|
| Rate for Payer: Blue Shield of California EPN |
$197.56
|
| Rate for Payer: Cash Price |
$220.05
|
| Rate for Payer: Cash Price |
$220.05
|
| Rate for Payer: Cash Price |
$220.05
|
| Rate for Payer: Cigna of CA HMO |
$312.96
|
| Rate for Payer: Cigna of CA PPO |
$361.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.38
|
| Rate for Payer: EPIC Health Plan Senior |
$198.80
|
| Rate for Payer: Galaxy Health WC |
$415.65
|
| Rate for Payer: Global Benefits Group Commercial |
$293.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$326.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$186.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$250.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.39
|
| Rate for Payer: Multiplan Commercial |
$391.20
|
| Rate for Payer: Networks By Design Commercial |
$317.85
|
| Rate for Payer: Prime Health Services Commercial |
$415.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$293.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$293.40
|
| 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 |
$198.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC PULSE OXIMETRY MULT DETER
|
Facility
|
OP
|
$439.00
|
|
|
Service Code
|
CPT 94761
|
| Hospital Charge Code |
900800106
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$87.80 |
| Max. Negotiated Rate |
$764.00 |
| Rate for Payer: Adventist Health Commercial |
$87.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$287.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$373.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$241.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$329.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$269.59
|
| Rate for Payer: Blue Shield of California Commercial |
$268.67
|
| Rate for Payer: Blue Shield of California EPN |
$177.36
|
| Rate for Payer: Cash Price |
$197.55
|
| Rate for Payer: Cash Price |
$197.55
|
| Rate for Payer: Cigna of CA HMO |
$280.96
|
| Rate for Payer: Cigna of CA PPO |
$324.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$373.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$373.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$373.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$175.60
|
| Rate for Payer: EPIC Health Plan Senior |
$175.60
|
| Rate for Payer: Galaxy Health WC |
$373.15
|
| Rate for Payer: Global Benefits Group Commercial |
$263.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$292.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$167.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$271.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$307.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$307.30
|
| Rate for Payer: Multiplan Commercial |
$351.20
|
| Rate for Payer: Networks By Design Commercial |
$285.35
|
| Rate for Payer: Prime Health Services Commercial |
$373.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$263.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$263.40
|
| 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: Vantage Medical Group Commercial/Exchange |
$373.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$373.15
|
| Rate for Payer: Vantage Medical Group Senior |
$373.15
|
|
|
HC PULSE OXIMETRY MULT DETER
|
Facility
|
IP
|
$439.00
|
|
|
Service Code
|
CPT 94761
|
| Hospital Charge Code |
900800106
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$87.80 |
| Max. Negotiated Rate |
$373.15 |
| Rate for Payer: Adventist Health Commercial |
$87.80
|
| Rate for Payer: Cash Price |
$197.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$175.60
|
| Rate for Payer: EPIC Health Plan Senior |
$175.60
|
| Rate for Payer: Galaxy Health WC |
$373.15
|
| Rate for Payer: Global Benefits Group Commercial |
$263.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$292.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$167.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$271.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.36
|
| Rate for Payer: Multiplan Commercial |
$351.20
|
| Rate for Payer: Networks By Design Commercial |
$285.35
|
| Rate for Payer: Prime Health Services Commercial |
$373.15
|
|
|
HC PULSE OXIMETRY SNGL DETER
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
CPT 94760
|
| Hospital Charge Code |
900800102
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$9.39 |
| Max. Negotiated Rate |
$764.00 |
| Rate for Payer: Adventist Health Commercial |
$39.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$129.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$108.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.98
|
| Rate for Payer: Blue Shield of California Commercial |
$120.56
|
| Rate for Payer: Blue Shield of California EPN |
$79.59
|
| Rate for Payer: Cash Price |
$88.65
|
| Rate for Payer: Cash Price |
$88.65
|
| Rate for Payer: Cash Price |
$88.65
|
| Rate for Payer: Cigna of CA HMO |
$126.08
|
| Rate for Payer: Cigna of CA PPO |
$145.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$167.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$167.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.80
|
| Rate for Payer: EPIC Health Plan Senior |
$78.80
|
| Rate for Payer: Galaxy Health WC |
$167.45
|
| Rate for Payer: Global Benefits Group Commercial |
$118.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$131.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$137.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$137.90
|
| Rate for Payer: Multiplan Commercial |
$157.60
|
| Rate for Payer: Networks By Design Commercial |
$128.05
|
| Rate for Payer: Prime Health Services Commercial |
$167.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$118.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$118.20
|
| 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: Vantage Medical Group Commercial/Exchange |
$167.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$167.45
|
| Rate for Payer: Vantage Medical Group Senior |
$167.45
|
|
|
HC PULSE OXIMETRY SNGL DETER
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
CPT 94760
|
| Hospital Charge Code |
900800102
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$10.62 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Adventist Health Commercial |
$39.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$108.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,489.00
|
| Rate for Payer: Cash Price |
$88.65
|
| Rate for Payer: Cash Price |
$88.65
|
| Rate for Payer: Cash Price |
$88.65
|
| Rate for Payer: Cigna of CA HMO |
$126.08
|
| Rate for Payer: Cigna of CA PPO |
$145.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$167.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$167.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.80
|
| Rate for Payer: EPIC Health Plan Senior |
$78.80
|
| Rate for Payer: Galaxy Health WC |
$167.45
|
| Rate for Payer: Global Benefits Group Commercial |
$118.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$131.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$137.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$137.90
|
| Rate for Payer: Multiplan Commercial |
$157.60
|
| Rate for Payer: Networks By Design Commercial |
$128.05
|
| Rate for Payer: Prime Health Services Commercial |
$167.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$118.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$98.50
|
| Rate for Payer: United Healthcare All Other HMO |
$98.50
|
| Rate for Payer: United Healthcare HMO Rider |
$98.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$167.45
|
| Rate for Payer: Vantage Medical Group Senior |
$167.45
|
|
|
HC PULSE OXIMETRY SNGL DETER
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
CPT 94760
|
| Hospital Charge Code |
900800102
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$39.40 |
| Max. Negotiated Rate |
$167.45 |
| Rate for Payer: Adventist Health Commercial |
$39.40
|
| Rate for Payer: Cash Price |
$88.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.80
|
| Rate for Payer: EPIC Health Plan Senior |
$78.80
|
| Rate for Payer: Galaxy Health WC |
$167.45
|
| Rate for Payer: Global Benefits Group Commercial |
$118.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$131.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.28
|
| Rate for Payer: Multiplan Commercial |
$157.60
|
| Rate for Payer: Networks By Design Commercial |
$128.05
|
| Rate for Payer: Prime Health Services Commercial |
$167.45
|
|
|
HC PULSE OXIMETRY SNGL DETER
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
CPT 94760
|
| Hospital Charge Code |
900800102
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$39.40 |
| Max. Negotiated Rate |
$167.45 |
| Rate for Payer: Adventist Health Commercial |
$39.40
|
| Rate for Payer: Cash Price |
$88.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.80
|
| Rate for Payer: EPIC Health Plan Senior |
$78.80
|
| Rate for Payer: Galaxy Health WC |
$167.45
|
| Rate for Payer: Global Benefits Group Commercial |
$118.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$131.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.28
|
| Rate for Payer: Multiplan Commercial |
$157.60
|
| Rate for Payer: Networks By Design Commercial |
$128.05
|
| Rate for Payer: Prime Health Services Commercial |
$167.45
|
|
|
HC PUNCH BX SKIN EA SEP/ADD LSN
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
CPT 11105
|
| Hospital Charge Code |
900511105
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$64.00 |
| Max. Negotiated Rate |
$272.00 |
| Rate for Payer: Adventist Health Commercial |
$64.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.00
|
| Rate for Payer: EPIC Health Plan Senior |
$128.00
|
| Rate for Payer: Galaxy Health WC |
$272.00
|
| Rate for Payer: Global Benefits Group Commercial |
$192.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$213.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$121.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.80
|
| Rate for Payer: Multiplan Commercial |
$256.00
|
| Rate for Payer: Networks By Design Commercial |
$208.00
|
| Rate for Payer: Prime Health Services Commercial |
$272.00
|
|
|
HC PUNCH BX SKIN EA SEP/ADD LSN
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
CPT 11105
|
| Hospital Charge Code |
900511105
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$64.00 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$64.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$272.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$240.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| 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 |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna of CA HMO |
$204.80
|
| Rate for Payer: Cigna of CA PPO |
$236.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$272.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$272.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$272.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.00
|
| Rate for Payer: EPIC Health Plan Senior |
$128.00
|
| Rate for Payer: Galaxy Health WC |
$272.00
|
| Rate for Payer: Global Benefits Group Commercial |
$192.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$92.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$213.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$105.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$224.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$224.00
|
| Rate for Payer: Multiplan Commercial |
$256.00
|
| Rate for Payer: Networks By Design Commercial |
$208.00
|
| Rate for Payer: Prime Health Services Commercial |
$272.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$192.00
|
| 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 |
$272.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$272.00
|
| Rate for Payer: Vantage Medical Group Senior |
$272.00
|
|
|
HC PUNCH BX SKIN SINGLE LESION
|
Facility
|
OP
|
$638.00
|
|
|
Service Code
|
CPT 11104
|
| Hospital Charge Code |
900511104
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$127.60 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$127.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cigna of CA HMO |
$408.32
|
| Rate for Payer: Cigna of CA PPO |
$472.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.31
|
| Rate for Payer: EPIC Health Plan Senior |
$507.64
|
| Rate for Payer: Galaxy Health WC |
$542.30
|
| Rate for Payer: Global Benefits Group Commercial |
$382.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$832.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$188.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$425.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$212.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$639.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| Rate for Payer: Multiplan Commercial |
$510.40
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$414.70
|
| Rate for Payer: Prime Health Services Commercial |
$542.30
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$382.80
|
| 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: Upland Medical Group Pediatric |
$507.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC PUNCH BX SKIN SINGLE LESION
|
Facility
|
IP
|
$638.00
|
|
|
Service Code
|
CPT 11104
|
| Hospital Charge Code |
900511104
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$127.60 |
| Max. Negotiated Rate |
$542.30 |
| Rate for Payer: Adventist Health Commercial |
$127.60
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$255.20
|
| Rate for Payer: EPIC Health Plan Senior |
$255.20
|
| Rate for Payer: Galaxy Health WC |
$542.30
|
| Rate for Payer: Global Benefits Group Commercial |
$382.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$425.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$243.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$394.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.12
|
| Rate for Payer: Multiplan Commercial |
$510.40
|
| Rate for Payer: Networks By Design Commercial |
$414.70
|
| Rate for Payer: Prime Health Services Commercial |
$542.30
|
|
|
HC PUNCTURE ASPIR ABCESS/HEM/CYST
|
Facility
|
OP
|
$1,069.00
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
900501006
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$78.81 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$213.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$481.05
|
| Rate for Payer: Cash Price |
$481.05
|
| Rate for Payer: Cash Price |
$481.05
|
| Rate for Payer: Cigna of CA HMO |
$684.16
|
| Rate for Payer: Cigna of CA PPO |
$791.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.31
|
| Rate for Payer: EPIC Health Plan Senior |
$507.64
|
| Rate for Payer: Galaxy Health WC |
$908.65
|
| Rate for Payer: Global Benefits Group Commercial |
$641.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$832.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$78.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$713.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$639.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| Rate for Payer: Multiplan Commercial |
$855.20
|
| Rate for Payer: Networks By Design Commercial |
$694.85
|
| Rate for Payer: Prime Health Services Commercial |
$908.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$641.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$641.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$507.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC PUNCTURE ASPIR ABCESS/HEM/CYST
|
Facility
|
OP
|
$1,069.00
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
900501006
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$89.13 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$213.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$481.05
|
| Rate for Payer: Cash Price |
$481.05
|
| Rate for Payer: Cash Price |
$481.05
|
| Rate for Payer: Cigna of CA HMO |
$684.16
|
| Rate for Payer: Cigna of CA PPO |
$791.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.31
|
| Rate for Payer: EPIC Health Plan Senior |
$507.64
|
| Rate for Payer: Galaxy Health WC |
$908.65
|
| Rate for Payer: Global Benefits Group Commercial |
$641.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$832.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$713.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$639.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| Rate for Payer: Multiplan Commercial |
$855.20
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$694.85
|
| Rate for Payer: Prime Health Services Commercial |
$908.65
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$641.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$534.50
|
| Rate for Payer: United Healthcare All Other HMO |
$534.50
|
| Rate for Payer: United Healthcare HMO Rider |
$534.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$534.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$507.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC PUNCTURE ASPIR ABCESS/HEM/CYST
|
Facility
|
IP
|
$1,069.00
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
900501006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$213.80 |
| Max. Negotiated Rate |
$908.65 |
| Rate for Payer: Adventist Health Commercial |
$213.80
|
| Rate for Payer: Cash Price |
$481.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$427.60
|
| Rate for Payer: EPIC Health Plan Senior |
$427.60
|
| Rate for Payer: Galaxy Health WC |
$908.65
|
| Rate for Payer: Global Benefits Group Commercial |
$641.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$713.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$407.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$661.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.56
|
| Rate for Payer: Multiplan Commercial |
$855.20
|
| Rate for Payer: Networks By Design Commercial |
$694.85
|
| Rate for Payer: Prime Health Services Commercial |
$908.65
|
|
|
HC PUNCTURE ASPIR ABCESS/HEM/CYST
|
Facility
|
IP
|
$1,069.00
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
900501006
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$213.80 |
| Max. Negotiated Rate |
$908.65 |
| Rate for Payer: Adventist Health Commercial |
$213.80
|
| Rate for Payer: Cash Price |
$481.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$427.60
|
| Rate for Payer: EPIC Health Plan Senior |
$427.60
|
| Rate for Payer: Galaxy Health WC |
$908.65
|
| Rate for Payer: Global Benefits Group Commercial |
$641.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$713.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$407.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$661.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.56
|
| Rate for Payer: Multiplan Commercial |
$855.20
|
| Rate for Payer: Networks By Design Commercial |
$694.85
|
| Rate for Payer: Prime Health Services Commercial |
$908.65
|
|
|
HC PUNCTURE ASPIR ABCESS/HEM/CYST
|
Facility
|
IP
|
$1,258.00
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
906820028
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$251.60 |
| Max. Negotiated Rate |
$1,069.30 |
| Rate for Payer: Adventist Health Commercial |
$251.60
|
| Rate for Payer: Cash Price |
$566.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$503.20
|
| Rate for Payer: EPIC Health Plan Senior |
$503.20
|
| Rate for Payer: Galaxy Health WC |
$1,069.30
|
| Rate for Payer: Global Benefits Group Commercial |
$754.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$839.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$479.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$778.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$301.92
|
| Rate for Payer: Multiplan Commercial |
$1,006.40
|
| Rate for Payer: Networks By Design Commercial |
$817.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,069.30
|
|
|
HC PUNCTURE ASPIR ABCESS/HEM/CYST
|
Facility
|
IP
|
$1,069.00
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
900501006
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$213.80 |
| Max. Negotiated Rate |
$908.65 |
| Rate for Payer: Adventist Health Commercial |
$213.80
|
| Rate for Payer: Cash Price |
$481.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$427.60
|
| Rate for Payer: EPIC Health Plan Senior |
$427.60
|
| Rate for Payer: Galaxy Health WC |
$908.65
|
| Rate for Payer: Global Benefits Group Commercial |
$641.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$713.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$407.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$661.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.56
|
| Rate for Payer: Multiplan Commercial |
$855.20
|
| Rate for Payer: Networks By Design Commercial |
$694.85
|
| Rate for Payer: Prime Health Services Commercial |
$908.65
|
|
|
HC PUNCTURE ASPIR ABCESS/HEM/CYST
|
Facility
|
OP
|
$1,069.00
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
900501006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$78.81 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$213.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$481.05
|
| Rate for Payer: Cash Price |
$481.05
|
| Rate for Payer: Cash Price |
$481.05
|
| Rate for Payer: Cigna of CA HMO |
$684.16
|
| Rate for Payer: Cigna of CA PPO |
$791.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.31
|
| Rate for Payer: EPIC Health Plan Senior |
$507.64
|
| Rate for Payer: Galaxy Health WC |
$908.65
|
| Rate for Payer: Global Benefits Group Commercial |
$641.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$832.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$78.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$713.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$639.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| Rate for Payer: Multiplan Commercial |
$855.20
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$694.85
|
| Rate for Payer: Prime Health Services Commercial |
$908.65
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$641.40
|
| 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: Upland Medical Group Pediatric |
$507.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC PUNCTURE ASPIR ABCESS/HEM/CYST
|
Facility
|
OP
|
$1,258.00
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
906820028
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$78.81 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$251.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$566.10
|
| Rate for Payer: Cash Price |
$566.10
|
| Rate for Payer: Cash Price |
$566.10
|
| Rate for Payer: Cigna of CA HMO |
$805.12
|
| Rate for Payer: Cigna of CA PPO |
$930.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.31
|
| Rate for Payer: EPIC Health Plan Senior |
$507.64
|
| Rate for Payer: Galaxy Health WC |
$1,069.30
|
| Rate for Payer: Global Benefits Group Commercial |
$754.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$832.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$78.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$839.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$301.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$639.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| Rate for Payer: Multiplan Commercial |
$1,006.40
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$817.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,069.30
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$754.80
|
| 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: Upland Medical Group Pediatric |
$507.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC PUNCTURE SHUNT TUBE
|
Facility
|
OP
|
$2,022.00
|
|
|
Service Code
|
CPT 61070
|
| Hospital Charge Code |
909000198
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$248.29 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$404.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$909.90
|
| Rate for Payer: Cash Price |
$909.90
|
| Rate for Payer: Cash Price |
$909.90
|
| Rate for Payer: Cigna of CA HMO |
$1,294.08
|
| Rate for Payer: Cigna of CA PPO |
$1,496.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$967.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$879.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,187.89
|
| Rate for Payer: EPIC Health Plan Senior |
$879.92
|
| Rate for Payer: Galaxy Health WC |
$1,718.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,213.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,443.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,348.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$248.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$485.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,108.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,179.09
|
| Rate for Payer: Multiplan Commercial |
$1,617.60
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: Networks By Design Commercial |
$1,314.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,718.70
|
| Rate for Payer: Prime Health Services WC |
$1,387.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,213.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,011.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,011.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,011.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,011.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$879.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Vantage Medical Group Senior |
$879.92
|
|
|
HC PUNCTURE SHUNT TUBE
|
Facility
|
IP
|
$2,022.00
|
|
|
Service Code
|
CPT 61070
|
| Hospital Charge Code |
909000198
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$404.40 |
| Max. Negotiated Rate |
$1,718.70 |
| Rate for Payer: Adventist Health Commercial |
$404.40
|
| Rate for Payer: Cash Price |
$909.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$808.80
|
| Rate for Payer: EPIC Health Plan Senior |
$808.80
|
| Rate for Payer: Galaxy Health WC |
$1,718.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,213.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,348.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$770.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,251.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$485.28
|
| Rate for Payer: Multiplan Commercial |
$1,617.60
|
| Rate for Payer: Networks By Design Commercial |
$1,314.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,718.70
|
|
|
HC PUNCTURE SHUNT TUBE
|
Facility
|
IP
|
$2,022.00
|
|
|
Service Code
|
CPT 61070
|
| Hospital Charge Code |
909000198
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$404.40 |
| Max. Negotiated Rate |
$1,718.70 |
| Rate for Payer: Adventist Health Commercial |
$404.40
|
| Rate for Payer: Cash Price |
$909.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$808.80
|
| Rate for Payer: EPIC Health Plan Senior |
$808.80
|
| Rate for Payer: Galaxy Health WC |
$1,718.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,213.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,348.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$770.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,251.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$485.28
|
| Rate for Payer: Multiplan Commercial |
$1,617.60
|
| Rate for Payer: Networks By Design Commercial |
$1,314.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,718.70
|
|
