|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,672.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,517.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,409.51
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,561.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,416.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,315.70
|
| 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 |
$1,268.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$514.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,430.99
|
| Rate for Payer: Blue Shield of California Commercial |
$938.83
|
| Rate for Payer: Blue Shield of California Commercial |
$1,422.74
|
| 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 |
$771.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,561.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$848.38
|
| Rate for Payer: EPIC Health Plan Senior |
$565.59
|
| 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/Senior |
$843.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$189.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$514.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,416.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$213.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$719.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$535.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$647.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$688.99
|
| 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 |
$514.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Vantage Medical Group Senior |
$514.17
|
|
|
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 |
$1,851.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$698.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,322.81
|
| Rate for Payer: Blue Shield of California Commercial |
$1,853.24
|
| Rate for Payer: Blue Shield of California Commercial |
$2,808.48
|
| 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 |
$1,047.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$768.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$698.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,081.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,152.28
|
| Rate for Payer: EPIC Health Plan Senior |
$768.18
|
| 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/Senior |
$1,145.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$488.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$698.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,795.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$552.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$977.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,056.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$879.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$935.79
|
| 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 |
$698.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Vantage Medical Group Senior |
$698.35
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,081.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,795.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,597.18
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,018.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,830.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,700.97
|
| 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 |
$693.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$719.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$527.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$479.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,850.02
|
| Rate for Payer: Blue Shield of California Commercial |
$1,213.74
|
| Rate for Payer: Blue Shield of California Commercial |
$1,839.35
|
| 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 |
$719.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$527.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$479.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,018.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$791.90
|
| Rate for Payer: EPIC Health Plan Senior |
$527.93
|
| 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/Senior |
$787.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$167.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$479.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,830.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$189.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$671.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$691.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$604.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.12
|
| 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 |
$479.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$719.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$527.93
|
| Rate for Payer: Vantage Medical Group Senior |
$479.94
|
|
|
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 |
$80.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$914.42
|
| Rate for Payer: Blue Shield of California Commercial |
$599.92
|
| Rate for Payer: Blue Shield of California Commercial |
$909.15
|
| 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 |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$997.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| 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/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$50.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$904.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$215.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$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 |
$171.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
HC 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$997.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$904.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$840.75
|
| 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
|
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 |
$146.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$313.79
|
| Rate for Payer: Blue Shield of California Commercial |
$205.87
|
| Rate for Payer: Blue Shield of California Commercial |
$311.98
|
| 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 |
$248.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$342.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.06
|
| Rate for Payer: EPIC Health Plan Senior |
$182.04
|
| Rate for Payer: Galaxy Health WC |
$415.65
|
| Rate for Payer: Global Benefits Group Commercial |
$293.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$271.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$310.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$231.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$208.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$221.76
|
| 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 |
$165.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Vantage Medical Group Senior |
$165.49
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$342.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$310.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$288.51
|
| 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 MULT DETER
|
Facility
|
OP
|
$439.00
|
|
|
Service Code
|
CPT 94761
|
| Hospital Charge Code |
900800106
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$31.56 |
| Max. Negotiated Rate |
$764.00 |
| Rate for Payer: Adventist Health Commercial |
$87.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.56
|
| 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 |
$281.71
|
| Rate for Payer: Blue Shield of California Commercial |
$280.08
|
| Rate for Payer: Blue Shield of California Commercial |
$184.82
|
| Rate for Payer: Cash Price |
$197.55
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$307.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$278.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$259.01
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$307.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$278.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$259.01
|
| 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
|
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 |
$2,601.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$137.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$125.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$116.23
|
| 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
|
456
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$137.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$125.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$116.23
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$137.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$125.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$116.23
|
| 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
|
510
|
| Min. Negotiated Rate |
$9.39 |
| Max. Negotiated Rate |
$167.45 |
| Rate for Payer: Vantage Medical Group Senior |
$167.45
|
| Rate for Payer: Adventist Health Commercial |
$39.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.05
|
| 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 |
$126.41
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$137.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$125.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$116.23
|
| 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 |
$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
|
|
|
HC PULSE OXIMETRY SNGL DETER
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
CPT 94760
|
| Hospital Charge Code |
900800102
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$10.62 |
| Max. Negotiated Rate |
$2,601.00 |
| Rate for Payer: Adventist Health Commercial |
$80.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.05
|
| 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 |
$2,601.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$137.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$125.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$116.23
|
| 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 |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| 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
|
IP
|
$197.00
|
|
|
Service Code
|
CPT 94760
|
| Hospital Charge Code |
900800102
|
|
Hospital Revenue Code
|
510
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$137.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$125.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$116.23
|
| 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
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$137.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$125.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$116.23
|
| 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: 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: Cash Price |
$88.65
|
| Rate for Payer: Adventist Health Commercial |
$39.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.05
|
| 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 |
$126.41
|
| Rate for Payer: Blue Shield of California Commercial |
$82.94
|
| Rate for Payer: Blue Shield of California Commercial |
$125.69
|
| Rate for Payer: Cash Price |
$88.65
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$137.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$125.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$116.23
|
| 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 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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$64.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| 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 |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$224.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$203.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$105.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.80
|
| 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 |
$160.00
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$224.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$203.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.80
|
| 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 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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$127.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| 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 |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$446.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$542.30
|
| Rate for Payer: Global Benefits Group Commercial |
$382.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$857.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$188.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$405.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$212.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$731.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$658.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$700.62
|
| 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 |
$319.00
|
| 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 |
$522.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$446.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$405.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$376.42
|
| 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
|
|
