|
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 |
$97.35
|
| 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 PT SUBSTITUTION
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
CPT 85611
|
| Hospital Charge Code |
900910105
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.19 |
| Max. Negotiated Rate |
$150.45 |
| Rate for Payer: Adventist Health Commercial |
$35.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$116.09
|
| 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 |
$118.41
|
| Rate for Payer: Blue Shield of California EPN |
$78.23
|
| Rate for Payer: Cash Price |
$97.35
|
| Rate for Payer: Cash Price |
$97.35
|
| Rate for Payer: Cigna of CA HMO |
$113.28
|
| Rate for Payer: Cigna of CA PPO |
$130.98
|
| 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 |
$150.45
|
| Rate for Payer: Global Benefits Group Commercial |
$106.20
|
| 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 |
$118.06
|
| 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 |
$42.48
|
| 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 |
$141.60
|
| Rate for Payer: Networks By Design Commercial |
$115.05
|
| Rate for Payer: Prime Health Services Commercial |
$150.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$106.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$106.20
|
| 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 PTT
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
900910007
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.87 |
| Max. Negotiated Rate |
$156.40 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$120.69
|
| 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 |
$123.10
|
| Rate for Payer: Blue Shield of California EPN |
$81.33
|
| Rate for Payer: Cash Price |
$101.20
|
| Rate for Payer: Cash Price |
$101.20
|
| Rate for Payer: Cigna of CA HMO |
$117.76
|
| Rate for Payer: Cigna of CA PPO |
$136.16
|
| 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 |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| 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 |
$122.73
|
| 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 |
$44.16
|
| 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 |
$147.20
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$110.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$110.40
|
| 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
|
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 |
$101.20
|
| 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 SUBSTITUTION
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
CPT 85732
|
| Hospital Charge Code |
900910106
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$156.40 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$120.69
|
| 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 |
$123.10
|
| Rate for Payer: Blue Shield of California EPN |
$81.33
|
| Rate for Payer: Cash Price |
$101.20
|
| Rate for Payer: Cash Price |
$101.20
|
| Rate for Payer: Cigna of CA HMO |
$117.76
|
| Rate for Payer: Cigna of CA PPO |
$136.16
|
| 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 |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| 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 |
$122.73
|
| 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 |
$44.16
|
| 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 |
$147.20
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$110.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$110.40
|
| 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 |
$101.20
|
| 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
|
$2,389.00
|
|
|
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 |
$1,313.95
|
| 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
|
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 |
$1,277.65
|
| 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
|
$2,389.00
|
|
|
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 |
$1,313.95
|
| Rate for Payer: Cash Price |
$1,313.95
|
| Rate for Payer: Cash Price |
$1,313.95
|
| 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 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 |
$1,277.65
|
| Rate for Payer: Cash Price |
$1,277.65
|
| Rate for Payer: Cash Price |
$1,277.65
|
| 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 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 |
$1,226.50
|
| 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 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 |
$1,226.50
|
| Rate for Payer: Cash Price |
$1,226.50
|
| 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 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 |
$2,421.10
|
| 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 |
$2,421.10
|
| Rate for Payer: Cash Price |
$2,421.10
|
| 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 |
$1,585.65
|
| 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 |
$1,585.65
|
| Rate for Payer: Cash Price |
$1,585.65
|
| Rate for Payer: Cash Price |
$1,585.65
|
| 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
|
|
|
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 |
$783.75
|
| 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 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 |
$783.75
|
| Rate for Payer: Cash Price |
$783.75
|
| Rate for Payer: Cash Price |
$783.75
|
| 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 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 |
$268.95
|
| 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 |
$268.95
|
| Rate for Payer: Cash Price |
$268.95
|
| Rate for Payer: Cash Price |
$268.95
|
| 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
|
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 |
$241.45
|
| 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 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 |
$241.45
|
| Rate for Payer: Cash Price |
$241.45
|
| 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 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 |
$108.35
|
| 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 |
$108.35
|
| 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
|
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 |
$108.35
|
| Rate for Payer: Cash Price |
$108.35
|
| Rate for Payer: Cash Price |
$108.35
|
| 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
|
|
