|
HC CHEMO PUSH INITIAL
|
Facility
|
OP
|
$952.00
|
|
|
Service Code
|
CPT 96409
|
| Hospital Charge Code |
901200110
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$34.12 |
| Max. Negotiated Rate |
$1,461.00 |
| Rate for Payer: Adventist Health Commercial |
$190.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$424.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$788.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$424.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,029.00
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Central Health Plan Commercial |
$761.60
|
| Rate for Payer: Cigna of CA HMO |
$609.28
|
| Rate for Payer: Cigna of CA PPO |
$704.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$637.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$467.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$424.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$666.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$700.97
|
| Rate for Payer: EPIC Health Plan Senior |
$467.31
|
| Rate for Payer: Galaxy Health WC |
$809.20
|
| Rate for Payer: Global Benefits Group Commercial |
$571.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$856.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$696.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$153.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$604.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$594.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$569.27
|
| Rate for Payer: Multiplan Commercial |
$714.00
|
| Rate for Payer: Networks By Design Commercial |
$618.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$424.83
|
| Rate for Payer: Prime Health Services Commercial |
$809.20
|
| Rate for Payer: Prime Health Services Medicare |
$450.32
|
| Rate for Payer: Riverside University Health System MISP |
$467.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$571.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$571.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,461.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,352.00
|
| Rate for Payer: United Healthcare HMO Rider |
$887.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$813.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$424.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Vantage Medical Group Senior |
$424.83
|
|
|
HC CHEMO PUSH INITIAL
|
Facility
|
OP
|
$952.00
|
|
|
Service Code
|
CPT 96409
|
| Hospital Charge Code |
910100130
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$34.12 |
| Max. Negotiated Rate |
$1,461.00 |
| Rate for Payer: Adventist Health Commercial |
$190.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$424.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$788.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$424.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,029.00
|
| Rate for Payer: Blue Shield of California Commercial |
$603.57
|
| Rate for Payer: Blue Shield of California EPN |
$379.85
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Central Health Plan Commercial |
$761.60
|
| Rate for Payer: Cigna of CA HMO |
$609.28
|
| Rate for Payer: Cigna of CA PPO |
$704.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$637.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$467.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$424.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$666.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$700.97
|
| Rate for Payer: EPIC Health Plan Senior |
$467.31
|
| Rate for Payer: Galaxy Health WC |
$809.20
|
| Rate for Payer: Global Benefits Group Commercial |
$571.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$856.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$696.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$153.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$604.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$594.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$569.27
|
| Rate for Payer: Multiplan Commercial |
$714.00
|
| Rate for Payer: Networks By Design Commercial |
$618.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$424.83
|
| Rate for Payer: Prime Health Services Commercial |
$809.20
|
| Rate for Payer: Prime Health Services Medicare |
$450.32
|
| Rate for Payer: Riverside University Health System MISP |
$467.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$571.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$571.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,461.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,352.00
|
| Rate for Payer: United Healthcare HMO Rider |
$887.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$813.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$424.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Vantage Medical Group Senior |
$424.83
|
|
|
HC CHEMO PUSH INITIAL
|
Facility
|
OP
|
$952.00
|
|
|
Service Code
|
CPT 96409
|
| Hospital Charge Code |
911800804
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$34.12 |
| Max. Negotiated Rate |
$1,461.00 |
| Rate for Payer: Adventist Health Commercial |
$190.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$424.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$788.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$424.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,029.00
|
| Rate for Payer: Blue Shield of California Commercial |
$603.57
|
| Rate for Payer: Blue Shield of California EPN |
$379.85
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Central Health Plan Commercial |
$761.60
|
| Rate for Payer: Cigna of CA HMO |
$609.28
|
| Rate for Payer: Cigna of CA PPO |
$704.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$637.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$467.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$424.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$666.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$700.97
|
| Rate for Payer: EPIC Health Plan Senior |
$467.31
|
| Rate for Payer: Galaxy Health WC |
$809.20
|
| Rate for Payer: Global Benefits Group Commercial |
$571.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$856.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$696.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$153.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$604.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$594.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$569.27
|
| Rate for Payer: Multiplan Commercial |
$714.00
|
| Rate for Payer: Networks By Design Commercial |
$618.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$424.83
|
| Rate for Payer: Prime Health Services Commercial |
$809.20
|
| Rate for Payer: Prime Health Services Medicare |
$450.32
|
| Rate for Payer: Riverside University Health System MISP |
$467.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$571.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$571.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,461.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,352.00
|
| Rate for Payer: United Healthcare HMO Rider |
$887.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$813.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$424.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Vantage Medical Group Senior |
$424.83
|
|
|
HC CHEMO PUSH INITIAL
|
Facility
|
IP
|
$952.00
|
|
|
Service Code
|
CPT 96409
|
| Hospital Charge Code |
910100130
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$190.40 |
| Max. Negotiated Rate |
$856.80 |
| Rate for Payer: Adventist Health Commercial |
$190.40
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Central Health Plan Commercial |
$761.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$666.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$380.80
|
| Rate for Payer: EPIC Health Plan Senior |
$380.80
|
| Rate for Payer: Galaxy Health WC |
$809.20
|
| Rate for Payer: Global Benefits Group Commercial |
$571.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$856.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$604.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$561.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.40
|
| Rate for Payer: Multiplan Commercial |
$714.00
|
| Rate for Payer: Networks By Design Commercial |
$618.80
|
| Rate for Payer: Prime Health Services Commercial |
$809.20
|
|
|
HC CHEMO PUSH INITIAL
|
Facility
|
IP
|
$952.00
|
|
|
Service Code
|
CPT 96409
|
| Hospital Charge Code |
901200110
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$190.40 |
| Max. Negotiated Rate |
$856.80 |
| Rate for Payer: Adventist Health Commercial |
$190.40
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Central Health Plan Commercial |
$761.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$666.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$380.80
|
| Rate for Payer: EPIC Health Plan Senior |
$380.80
|
| Rate for Payer: Galaxy Health WC |
$809.20
|
| Rate for Payer: Global Benefits Group Commercial |
$571.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$856.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$604.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$561.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.40
|
| Rate for Payer: Multiplan Commercial |
$714.00
|
| Rate for Payer: Networks By Design Commercial |
$618.80
|
| Rate for Payer: Prime Health Services Commercial |
$809.20
|
|
|
HC CHEMO PUSH INITIAL
|
Facility
|
IP
|
$952.00
|
|
|
Service Code
|
CPT 96409
|
| Hospital Charge Code |
911800804
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$190.40 |
| Max. Negotiated Rate |
$856.80 |
| Rate for Payer: Adventist Health Commercial |
$190.40
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Central Health Plan Commercial |
$761.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$666.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$380.80
|
| Rate for Payer: EPIC Health Plan Senior |
$380.80
|
| Rate for Payer: Galaxy Health WC |
$809.20
|
| Rate for Payer: Global Benefits Group Commercial |
$571.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$856.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$604.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$561.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.40
|
| Rate for Payer: Multiplan Commercial |
$714.00
|
| Rate for Payer: Networks By Design Commercial |
$618.80
|
| Rate for Payer: Prime Health Services Commercial |
$809.20
|
|
|
HC CHEST 2 VIEWS
|
Facility
|
OP
|
$833.00
|
|
|
Service Code
|
CPT 71046
|
| Hospital Charge Code |
909001407
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$47.25 |
| Max. Negotiated Rate |
$749.70 |
| Rate for Payer: Adventist Health Commercial |
$166.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$120.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$169.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$235.93
|
| Rate for Payer: Blue Shield of California Commercial |
$524.79
|
| Rate for Payer: Blue Shield of California EPN |
$330.70
|
| Rate for Payer: Cash Price |
$374.85
|
| Rate for Payer: Cash Price |
$374.85
|
| Rate for Payer: Central Health Plan Commercial |
$666.40
|
| Rate for Payer: Cigna of CA HMO |
$533.12
|
| Rate for Payer: Cigna of CA PPO |
$616.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$583.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$708.05
|
| Rate for Payer: Global Benefits Group Commercial |
$499.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$749.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$47.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$528.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$52.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$624.75
|
| Rate for Payer: Networks By Design Commercial |
$541.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.93
|
| Rate for Payer: Prime Health Services Commercial |
$708.05
|
| Rate for Payer: Prime Health Services Medicare |
$118.65
|
| Rate for Payer: Riverside University Health System MISP |
$123.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$499.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$499.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$159.01
|
| Rate for Payer: United Healthcare All Other HMO |
$159.01
|
| Rate for Payer: United Healthcare HMO Rider |
$159.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC CHEST 2 VIEWS
|
Facility
|
IP
|
$833.00
|
|
|
Service Code
|
CPT 71046
|
| Hospital Charge Code |
909001407
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$166.60 |
| Max. Negotiated Rate |
$749.70 |
| Rate for Payer: Adventist Health Commercial |
$166.60
|
| Rate for Payer: Cash Price |
$374.85
|
| Rate for Payer: Central Health Plan Commercial |
$666.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$583.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$333.20
|
| Rate for Payer: EPIC Health Plan Senior |
$333.20
|
| Rate for Payer: Galaxy Health WC |
$708.05
|
| Rate for Payer: Global Benefits Group Commercial |
$499.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$749.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$528.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$491.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.60
|
| Rate for Payer: Multiplan Commercial |
$624.75
|
| Rate for Payer: Networks By Design Commercial |
$541.45
|
| Rate for Payer: Prime Health Services Commercial |
$708.05
|
|
|
HC CHEST COMP 4 VIEWS
|
Facility
|
IP
|
$1,002.00
|
|
|
Service Code
|
CPT 71048
|
| Hospital Charge Code |
909001402
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$200.40 |
| Max. Negotiated Rate |
$901.80 |
| Rate for Payer: Adventist Health Commercial |
$200.40
|
| Rate for Payer: Cash Price |
$450.90
|
| Rate for Payer: Central Health Plan Commercial |
$801.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$701.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$400.80
|
| Rate for Payer: EPIC Health Plan Senior |
$400.80
|
| Rate for Payer: Galaxy Health WC |
$851.70
|
| Rate for Payer: Global Benefits Group Commercial |
$601.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$901.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$636.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$591.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.40
|
| Rate for Payer: Multiplan Commercial |
$751.50
|
| Rate for Payer: Networks By Design Commercial |
$651.30
|
| Rate for Payer: Prime Health Services Commercial |
$851.70
|
|
|
HC CHEST COMP 4 VIEWS
|
Facility
|
OP
|
$1,002.00
|
|
|
Service Code
|
CPT 71048
|
| Hospital Charge Code |
909001402
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$64.98 |
| Max. Negotiated Rate |
$901.80 |
| Rate for Payer: Adventist Health Commercial |
$200.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$158.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$222.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$309.40
|
| Rate for Payer: Blue Shield of California Commercial |
$631.26
|
| Rate for Payer: Blue Shield of California EPN |
$397.79
|
| Rate for Payer: Cash Price |
$450.90
|
| Rate for Payer: Cash Price |
$450.90
|
| Rate for Payer: Central Health Plan Commercial |
$801.60
|
| Rate for Payer: Cigna of CA HMO |
$641.28
|
| Rate for Payer: Cigna of CA PPO |
$741.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$701.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$851.70
|
| Rate for Payer: Global Benefits Group Commercial |
$601.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$901.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$64.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$636.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$71.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$751.50
|
| Rate for Payer: Networks By Design Commercial |
$651.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: Prime Health Services Commercial |
$851.70
|
| Rate for Payer: Prime Health Services Medicare |
$142.53
|
| Rate for Payer: Riverside University Health System MISP |
$147.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$601.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$601.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$303.97
|
| Rate for Payer: United Healthcare All Other HMO |
$303.97
|
| Rate for Payer: United Healthcare HMO Rider |
$303.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$303.97
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC CHEST FLUORO/PACEMKR
|
Facility
|
IP
|
$872.00
|
|
| Hospital Charge Code |
909001469
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$174.40 |
| Max. Negotiated Rate |
$784.80 |
| Rate for Payer: Adventist Health Commercial |
$174.40
|
| Rate for Payer: Cash Price |
$392.40
|
| Rate for Payer: Central Health Plan Commercial |
$697.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$610.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.80
|
| Rate for Payer: EPIC Health Plan Senior |
$348.80
|
| Rate for Payer: Galaxy Health WC |
$741.20
|
| Rate for Payer: Global Benefits Group Commercial |
$523.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$784.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$553.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$514.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$174.40
|
| Rate for Payer: Multiplan Commercial |
$654.00
|
| Rate for Payer: Networks By Design Commercial |
$566.80
|
| Rate for Payer: Prime Health Services Commercial |
$741.20
|
|
|
HC CHEST FLUORO/PACEMKR
|
Facility
|
OP
|
$872.00
|
|
| Hospital Charge Code |
909001469
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$174.40 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$174.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$741.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$479.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$654.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$422.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$507.24
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$392.40
|
| Rate for Payer: Cash Price |
$392.40
|
| Rate for Payer: Central Health Plan Commercial |
$697.60
|
| Rate for Payer: Cigna of CA HMO |
$558.08
|
| Rate for Payer: Cigna of CA PPO |
$645.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$741.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$741.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$741.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$610.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.80
|
| Rate for Payer: EPIC Health Plan Senior |
$348.80
|
| Rate for Payer: Galaxy Health WC |
$741.20
|
| Rate for Payer: Global Benefits Group Commercial |
$523.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$784.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$553.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$316.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$514.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$174.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$610.40
|
| Rate for Payer: Multiplan Commercial |
$654.00
|
| Rate for Payer: Networks By Design Commercial |
$566.80
|
| Rate for Payer: Prime Health Services Commercial |
$741.20
|
| Rate for Payer: Riverside University Health System MISP |
$348.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$523.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$436.00
|
| Rate for Payer: United Healthcare All Other HMO |
$436.00
|
| Rate for Payer: United Healthcare HMO Rider |
$436.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$436.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$741.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$741.20
|
| Rate for Payer: Vantage Medical Group Senior |
$741.20
|
|
|
HC CHEST FOUR OR MORE VIEWS
|
Facility
|
OP
|
$1,002.00
|
|
|
Service Code
|
CPT 71048
|
| Hospital Charge Code |
909071048
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$64.98 |
| Max. Negotiated Rate |
$901.80 |
| Rate for Payer: Adventist Health Commercial |
$200.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$158.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$222.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$309.40
|
| Rate for Payer: Blue Shield of California Commercial |
$631.26
|
| Rate for Payer: Blue Shield of California EPN |
$397.79
|
| Rate for Payer: Cash Price |
$450.90
|
| Rate for Payer: Cash Price |
$450.90
|
| Rate for Payer: Central Health Plan Commercial |
$801.60
|
| Rate for Payer: Cigna of CA HMO |
$641.28
|
| Rate for Payer: Cigna of CA PPO |
$741.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$701.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$851.70
|
| Rate for Payer: Global Benefits Group Commercial |
$601.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$901.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$64.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$636.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$71.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$751.50
|
| Rate for Payer: Networks By Design Commercial |
$651.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: Prime Health Services Commercial |
$851.70
|
| Rate for Payer: Prime Health Services Medicare |
$142.53
|
| Rate for Payer: Riverside University Health System MISP |
$147.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$601.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$601.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$303.97
|
| Rate for Payer: United Healthcare All Other HMO |
$303.97
|
| Rate for Payer: United Healthcare HMO Rider |
$303.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$303.97
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC CHEST FOUR OR MORE VIEWS
|
Facility
|
IP
|
$1,002.00
|
|
|
Service Code
|
CPT 71048
|
| Hospital Charge Code |
909071048
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$200.40 |
| Max. Negotiated Rate |
$901.80 |
| Rate for Payer: Adventist Health Commercial |
$200.40
|
| Rate for Payer: Cash Price |
$450.90
|
| Rate for Payer: Central Health Plan Commercial |
$801.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$701.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$400.80
|
| Rate for Payer: EPIC Health Plan Senior |
$400.80
|
| Rate for Payer: Galaxy Health WC |
$851.70
|
| Rate for Payer: Global Benefits Group Commercial |
$601.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$901.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$636.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$591.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.40
|
| Rate for Payer: Multiplan Commercial |
$751.50
|
| Rate for Payer: Networks By Design Commercial |
$651.30
|
| Rate for Payer: Prime Health Services Commercial |
$851.70
|
|
|
HC CHEST PORT
|
Facility
|
IP
|
$2,139.00
|
|
|
Service Code
|
CPT C1788
|
| Hospital Charge Code |
909081700
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$427.80 |
| Max. Negotiated Rate |
$1,925.10 |
| Rate for Payer: Adventist Health Commercial |
$427.80
|
| Rate for Payer: Cash Price |
$962.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,711.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,497.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$855.60
|
| Rate for Payer: EPIC Health Plan Senior |
$855.60
|
| Rate for Payer: Galaxy Health WC |
$1,818.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,283.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,925.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,358.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,262.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$427.80
|
| Rate for Payer: Multiplan Commercial |
$1,604.25
|
| Rate for Payer: Networks By Design Commercial |
$1,390.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,818.15
|
|
|
HC CHEST PORT
|
Facility
|
OP
|
$2,139.00
|
|
|
Service Code
|
CPT C1788
|
| Hospital Charge Code |
909081700
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$427.80 |
| Max. Negotiated Rate |
$3,733.82 |
| Rate for Payer: Adventist Health Commercial |
$427.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,733.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,818.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,176.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,604.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,035.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,244.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1,356.13
|
| Rate for Payer: Blue Shield of California EPN |
$853.46
|
| Rate for Payer: Cash Price |
$962.55
|
| Rate for Payer: Cash Price |
$962.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,711.20
|
| Rate for Payer: Cigna of CA HMO |
$1,368.96
|
| Rate for Payer: Cigna of CA PPO |
$1,582.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,818.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,818.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,818.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,497.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$855.60
|
| Rate for Payer: EPIC Health Plan Senior |
$855.60
|
| Rate for Payer: Galaxy Health WC |
$1,818.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,283.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,925.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,358.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$776.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,262.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$427.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,497.30
|
| Rate for Payer: Multiplan Commercial |
$1,604.25
|
| Rate for Payer: Networks By Design Commercial |
$1,390.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,818.15
|
| Rate for Payer: Riverside University Health System MISP |
$855.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,283.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,283.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,069.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,069.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,069.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,069.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,818.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,818.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,818.15
|
|
|
HC CHEST SINGLE VIEW
|
Facility
|
OP
|
$830.00
|
|
|
Service Code
|
CPT 71045
|
| Hospital Charge Code |
909001408
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$30.36 |
| Max. Negotiated Rate |
$747.00 |
| Rate for Payer: Adventist Health Commercial |
$166.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$65.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$91.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.60
|
| Rate for Payer: Blue Shield of California Commercial |
$522.90
|
| Rate for Payer: Blue Shield of California EPN |
$329.51
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Central Health Plan Commercial |
$664.00
|
| Rate for Payer: Cigna of CA HMO |
$531.20
|
| Rate for Payer: Cigna of CA PPO |
$614.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$581.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$705.50
|
| Rate for Payer: Global Benefits Group Commercial |
$498.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$747.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$30.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$527.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$622.50
|
| Rate for Payer: Networks By Design Commercial |
$539.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.93
|
| Rate for Payer: Prime Health Services Commercial |
$705.50
|
| Rate for Payer: Prime Health Services Medicare |
$118.65
|
| Rate for Payer: Riverside University Health System MISP |
$123.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$498.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$498.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$159.01
|
| Rate for Payer: United Healthcare All Other HMO |
$159.01
|
| Rate for Payer: United Healthcare HMO Rider |
$159.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC CHEST SINGLE VIEW
|
Facility
|
IP
|
$830.00
|
|
|
Service Code
|
CPT 71045
|
| Hospital Charge Code |
909001408
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$166.00 |
| Max. Negotiated Rate |
$747.00 |
| Rate for Payer: Adventist Health Commercial |
$166.00
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Central Health Plan Commercial |
$664.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$581.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$332.00
|
| Rate for Payer: EPIC Health Plan Senior |
$332.00
|
| Rate for Payer: Galaxy Health WC |
$705.50
|
| Rate for Payer: Global Benefits Group Commercial |
$498.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$747.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$527.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$489.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.00
|
| Rate for Payer: Multiplan Commercial |
$622.50
|
| Rate for Payer: Networks By Design Commercial |
$539.50
|
| Rate for Payer: Prime Health Services Commercial |
$705.50
|
|
|
HC CHEST THREE VIEWS
|
Facility
|
OP
|
$922.00
|
|
|
Service Code
|
CPT 71047
|
| Hospital Charge Code |
909071047
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$60.65 |
| Max. Negotiated Rate |
$829.80 |
| Rate for Payer: Adventist Health Commercial |
$184.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$153.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$216.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$300.69
|
| Rate for Payer: Blue Shield of California Commercial |
$580.86
|
| Rate for Payer: Blue Shield of California EPN |
$366.03
|
| Rate for Payer: Cash Price |
$414.90
|
| Rate for Payer: Cash Price |
$414.90
|
| Rate for Payer: Central Health Plan Commercial |
$737.60
|
| Rate for Payer: Cigna of CA HMO |
$590.08
|
| Rate for Payer: Cigna of CA PPO |
$682.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$645.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$783.70
|
| Rate for Payer: Global Benefits Group Commercial |
$553.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$829.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$60.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$585.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$66.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$691.50
|
| Rate for Payer: Networks By Design Commercial |
$599.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.93
|
| Rate for Payer: Prime Health Services Commercial |
$783.70
|
| Rate for Payer: Prime Health Services Medicare |
$118.65
|
| Rate for Payer: Riverside University Health System MISP |
$123.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$553.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$553.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$159.01
|
| Rate for Payer: United Healthcare All Other HMO |
$159.01
|
| Rate for Payer: United Healthcare HMO Rider |
$159.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC CHEST THREE VIEWS
|
Facility
|
IP
|
$922.00
|
|
|
Service Code
|
CPT 71047
|
| Hospital Charge Code |
909071047
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$184.40 |
| Max. Negotiated Rate |
$829.80 |
| Rate for Payer: Adventist Health Commercial |
$184.40
|
| Rate for Payer: Cash Price |
$414.90
|
| Rate for Payer: Central Health Plan Commercial |
$737.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$645.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$368.80
|
| Rate for Payer: EPIC Health Plan Senior |
$368.80
|
| Rate for Payer: Galaxy Health WC |
$783.70
|
| Rate for Payer: Global Benefits Group Commercial |
$553.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$829.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$585.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$543.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.40
|
| Rate for Payer: Multiplan Commercial |
$691.50
|
| Rate for Payer: Networks By Design Commercial |
$599.30
|
| Rate for Payer: Prime Health Services Commercial |
$783.70
|
|
|
HC CHEST TOMO FULL LUNG
|
Facility
|
OP
|
$892.00
|
|
|
Service Code
|
CPT 76102
|
| Hospital Charge Code |
909001465
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$178.40 |
| Max. Negotiated Rate |
$802.80 |
| Rate for Payer: Adventist Health Commercial |
$178.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$541.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$758.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$490.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$669.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$360.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$501.69
|
| Rate for Payer: Blue Shield of California Commercial |
$561.96
|
| Rate for Payer: Blue Shield of California EPN |
$354.12
|
| Rate for Payer: Cash Price |
$401.40
|
| Rate for Payer: Cash Price |
$401.40
|
| Rate for Payer: Central Health Plan Commercial |
$713.60
|
| Rate for Payer: Cigna of CA HMO |
$570.88
|
| Rate for Payer: Cigna of CA PPO |
$660.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$758.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$758.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$758.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$624.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$356.80
|
| Rate for Payer: EPIC Health Plan Senior |
$356.80
|
| Rate for Payer: Galaxy Health WC |
$758.20
|
| Rate for Payer: Global Benefits Group Commercial |
$535.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$802.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$566.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$323.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$526.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$624.40
|
| Rate for Payer: Multiplan Commercial |
$669.00
|
| Rate for Payer: Networks By Design Commercial |
$579.80
|
| Rate for Payer: Prime Health Services Commercial |
$758.20
|
| Rate for Payer: Riverside University Health System MISP |
$356.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$535.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$535.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$446.00
|
| Rate for Payer: United Healthcare All Other HMO |
$446.00
|
| Rate for Payer: United Healthcare HMO Rider |
$446.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$446.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$758.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$758.20
|
| Rate for Payer: Vantage Medical Group Senior |
$758.20
|
|
|
HC CHEST TOMO FULL LUNG
|
Facility
|
IP
|
$892.00
|
|
|
Service Code
|
CPT 76102
|
| Hospital Charge Code |
909001465
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$178.40 |
| Max. Negotiated Rate |
$802.80 |
| Rate for Payer: Adventist Health Commercial |
$178.40
|
| Rate for Payer: Cash Price |
$401.40
|
| Rate for Payer: Central Health Plan Commercial |
$713.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$624.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$356.80
|
| Rate for Payer: EPIC Health Plan Senior |
$356.80
|
| Rate for Payer: Galaxy Health WC |
$758.20
|
| Rate for Payer: Global Benefits Group Commercial |
$535.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$802.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$566.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$526.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.40
|
| Rate for Payer: Multiplan Commercial |
$669.00
|
| Rate for Payer: Networks By Design Commercial |
$579.80
|
| Rate for Payer: Prime Health Services Commercial |
$758.20
|
|
|
HC CHEST WALL MANIPULATION INIT
|
Facility
|
IP
|
$699.00
|
|
|
Service Code
|
CPT 94667
|
| Hospital Charge Code |
900800390
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$139.80 |
| Max. Negotiated Rate |
$629.10 |
| Rate for Payer: Adventist Health Commercial |
$139.80
|
| Rate for Payer: Cash Price |
$314.55
|
| Rate for Payer: Central Health Plan Commercial |
$559.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$489.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$279.60
|
| Rate for Payer: EPIC Health Plan Senior |
$279.60
|
| Rate for Payer: Galaxy Health WC |
$594.15
|
| Rate for Payer: Global Benefits Group Commercial |
$419.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$629.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$443.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$412.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.80
|
| Rate for Payer: Multiplan Commercial |
$524.25
|
| Rate for Payer: Networks By Design Commercial |
$454.35
|
| Rate for Payer: Prime Health Services Commercial |
$594.15
|
|
|
HC CHEST WALL MANIPULATION INIT
|
Facility
|
OP
|
$699.00
|
|
|
Service Code
|
CPT 94667
|
| Hospital Charge Code |
900800390
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$34.23 |
| Max. Negotiated Rate |
$629.10 |
| Rate for Payer: Adventist Health Commercial |
$139.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$171.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$145.11
|
| 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 Exchange |
$149.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$314.55
|
| Rate for Payer: Cash Price |
$314.55
|
| Rate for Payer: Cash Price |
$314.55
|
| Rate for Payer: Central Health Plan Commercial |
$559.20
|
| Rate for Payer: Cigna of CA HMO |
$447.36
|
| Rate for Payer: Cigna of CA PPO |
$517.26
|
| 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 |
$489.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$594.15
|
| Rate for Payer: Global Benefits Group Commercial |
$419.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$629.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$34.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$443.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$524.25
|
| Rate for Payer: Networks By Design Commercial |
$454.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.12
|
| Rate for Payer: Prime Health Services Commercial |
$594.15
|
| Rate for Payer: Prime Health Services Medicare |
$181.39
|
| Rate for Payer: Riverside University Health System MISP |
$188.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$419.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$419.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
HC CHEST WALL MANIPULATION SUB
|
Facility
|
IP
|
$435.00
|
|
|
Service Code
|
CPT 94668
|
| Hospital Charge Code |
900800391
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$87.00 |
| Max. Negotiated Rate |
$391.50 |
| Rate for Payer: Adventist Health Commercial |
$87.00
|
| Rate for Payer: Cash Price |
$195.75
|
| Rate for Payer: Central Health Plan Commercial |
$348.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$304.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$174.00
|
| Rate for Payer: EPIC Health Plan Senior |
$174.00
|
| Rate for Payer: Galaxy Health WC |
$369.75
|
| Rate for Payer: Global Benefits Group Commercial |
$261.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$391.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$276.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$256.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.00
|
| Rate for Payer: Multiplan Commercial |
$326.25
|
| Rate for Payer: Networks By Design Commercial |
$282.75
|
| Rate for Payer: Prime Health Services Commercial |
$369.75
|
|
