|
HC PULMONARY ARTERIAL ANGIO
|
Facility
|
OP
|
$1,975.00
|
|
|
Service Code
|
CPT 93568
|
| Hospital Charge Code |
906811417
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$160.30 |
| Max. Negotiated Rate |
$8,136.21 |
| Rate for Payer: Adventist Health Commercial |
$395.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,678.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,086.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,481.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| 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 |
$888.75
|
| Rate for Payer: Cash Price |
$888.75
|
| Rate for Payer: Cash Price |
$888.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,580.00
|
| Rate for Payer: Cigna of CA HMO |
$1,283.75
|
| Rate for Payer: Cigna of CA PPO |
$1,461.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,678.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,678.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,678.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,382.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$790.00
|
| Rate for Payer: EPIC Health Plan Senior |
$790.00
|
| Rate for Payer: Galaxy Health WC |
$1,678.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,185.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,777.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$160.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,254.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$177.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,165.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$395.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,382.50
|
| Rate for Payer: Multiplan Commercial |
$1,481.25
|
| Rate for Payer: Networks By Design Commercial |
$1,283.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,678.75
|
| Rate for Payer: Riverside University Health System MISP |
$790.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,185.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,185.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$987.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,678.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,678.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,678.75
|
|
|
HC PULMONARY EXERCISE THERAPY GRP
|
Facility
|
OP
|
$820.00
|
|
|
Service Code
|
CPT G0239
|
| Hospital Charge Code |
900201804
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$48.04 |
| Max. Negotiated Rate |
$738.00 |
| Rate for Payer: Adventist Health Commercial |
$164.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$48.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$70.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| 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 |
$369.00
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Central Health Plan Commercial |
$656.00
|
| Rate for Payer: Cigna of CA HMO |
$524.80
|
| Rate for Payer: Cigna of CA PPO |
$606.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$574.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.27
|
| Rate for Payer: EPIC Health Plan Senior |
$52.84
|
| Rate for Payer: Galaxy Health WC |
$697.00
|
| Rate for Payer: Global Benefits Group Commercial |
$492.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$738.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$78.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$520.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$297.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$64.37
|
| Rate for Payer: Multiplan Commercial |
$615.00
|
| Rate for Payer: Networks By Design Commercial |
$533.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$48.04
|
| Rate for Payer: Prime Health Services Commercial |
$697.00
|
| Rate for Payer: Prime Health Services Medicare |
$50.92
|
| Rate for Payer: Riverside University Health System MISP |
$52.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$492.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$492.00
|
| 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 |
$48.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.84
|
| Rate for Payer: Vantage Medical Group Senior |
$48.04
|
|
|
HC PULMONARY EXERCISE THERAPY GRP
|
Facility
|
IP
|
$820.00
|
|
|
Service Code
|
CPT G0239
|
| Hospital Charge Code |
900201804
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$164.00 |
| Max. Negotiated Rate |
$738.00 |
| Rate for Payer: Adventist Health Commercial |
$164.00
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Central Health Plan Commercial |
$656.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$574.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$328.00
|
| Rate for Payer: EPIC Health Plan Senior |
$328.00
|
| Rate for Payer: Galaxy Health WC |
$697.00
|
| Rate for Payer: Global Benefits Group Commercial |
$492.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$738.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$520.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$483.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.00
|
| Rate for Payer: Multiplan Commercial |
$615.00
|
| Rate for Payer: Networks By Design Commercial |
$533.00
|
| Rate for Payer: Prime Health Services Commercial |
$697.00
|
|
|
HC PULM PERFUSION SCAN
|
Facility
|
OP
|
$2,013.00
|
|
|
Service Code
|
CPT 78580
|
| Hospital Charge Code |
909301400
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$193.50 |
| Max. Negotiated Rate |
$1,811.70 |
| Rate for Payer: Adventist Health Commercial |
$402.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$514.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,119.34
|
| 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 Exchange |
$639.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,170.96
|
| Rate for Payer: Blue Shield of California Commercial |
$1,268.19
|
| Rate for Payer: Blue Shield of California EPN |
$799.16
|
| Rate for Payer: Cash Price |
$905.85
|
| Rate for Payer: Cash Price |
$905.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,610.40
|
| Rate for Payer: Cigna of CA HMO |
$1,288.32
|
| Rate for Payer: Cigna of CA PPO |
$1,489.62
|
| 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 |
$1,409.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$848.38
|
| Rate for Payer: EPIC Health Plan Senior |
$565.59
|
| Rate for Payer: Galaxy Health WC |
$1,711.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,207.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,811.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$843.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$193.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$514.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,278.26
|
| 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 |
$402.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$688.99
|
| Rate for Payer: Multiplan Commercial |
$1,509.75
|
| Rate for Payer: Networks By Design Commercial |
$1,308.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$514.17
|
| Rate for Payer: Prime Health Services Commercial |
$1,711.05
|
| Rate for Payer: Prime Health Services Medicare |
$545.02
|
| Rate for Payer: Riverside University Health System MISP |
$565.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,207.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,207.80
|
| 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 PERFUSION SCAN
|
Facility
|
IP
|
$2,013.00
|
|
|
Service Code
|
CPT 78580
|
| Hospital Charge Code |
909301400
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$402.60 |
| Max. Negotiated Rate |
$1,811.70 |
| Rate for Payer: Adventist Health Commercial |
$402.60
|
| Rate for Payer: Cash Price |
$905.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,610.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,409.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$805.20
|
| Rate for Payer: EPIC Health Plan Senior |
$805.20
|
| Rate for Payer: Galaxy Health WC |
$1,711.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,207.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,811.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,278.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,187.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$402.60
|
| Rate for Payer: Multiplan Commercial |
$1,509.75
|
| Rate for Payer: Networks By Design Commercial |
$1,308.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,711.05
|
|
|
HC PULM PERF & VENT/VQ
|
Facility
|
IP
|
$3,973.00
|
|
|
Service Code
|
CPT 78582
|
| Hospital Charge Code |
909301403
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$794.60 |
| Max. Negotiated Rate |
$3,575.70 |
| Rate for Payer: Adventist Health Commercial |
$794.60
|
| Rate for Payer: Cash Price |
$1,787.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,178.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,781.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,589.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,589.20
|
| Rate for Payer: Galaxy Health WC |
$3,377.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,383.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,575.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,522.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,344.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$794.60
|
| Rate for Payer: Multiplan Commercial |
$2,979.75
|
| Rate for Payer: Networks By Design Commercial |
$2,582.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,377.05
|
|
|
HC PULM PERF & VENT/VQ
|
Facility
|
OP
|
$3,973.00
|
|
|
Service Code
|
CPT 78582
|
| Hospital Charge Code |
909301403
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$500.40 |
| Max. Negotiated Rate |
$3,575.70 |
| Rate for Payer: Adventist Health Commercial |
$794.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$698.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,634.06
|
| 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 Exchange |
$1,637.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,276.04
|
| Rate for Payer: Blue Shield of California Commercial |
$2,502.99
|
| Rate for Payer: Blue Shield of California EPN |
$1,577.28
|
| Rate for Payer: Cash Price |
$1,787.85
|
| Rate for Payer: Cash Price |
$1,787.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,178.40
|
| Rate for Payer: Cigna of CA HMO |
$2,542.72
|
| Rate for Payer: Cigna of CA PPO |
$2,940.02
|
| 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 |
$2,781.10
|
| 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 |
$3,377.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,383.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,575.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,145.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$500.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$698.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,522.86
|
| 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 |
$794.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$935.79
|
| Rate for Payer: Multiplan Commercial |
$2,979.75
|
| Rate for Payer: Networks By Design Commercial |
$2,582.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$698.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,377.05
|
| Rate for Payer: Prime Health Services Medicare |
$740.25
|
| Rate for Payer: Riverside University Health System MISP |
$768.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,383.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,383.80
|
| 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 STRESS TEST COMPLEX
|
Facility
|
OP
|
$3,901.00
|
|
|
Service Code
|
CPT 94621
|
| Hospital Charge Code |
900801021
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$171.33 |
| Max. Negotiated Rate |
$3,510.90 |
| Rate for Payer: Adventist Health Commercial |
$780.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$479.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$612.04
|
| 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 Exchange |
$342.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,269.21
|
| Rate for Payer: Blue Shield of California Commercial |
$2,457.63
|
| Rate for Payer: Blue Shield of California EPN |
$1,548.70
|
| Rate for Payer: Cash Price |
$1,755.45
|
| Rate for Payer: Cash Price |
$1,755.45
|
| Rate for Payer: Cash Price |
$1,755.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.80
|
| Rate for Payer: Cigna of CA HMO |
$2,496.64
|
| Rate for Payer: Cigna of CA PPO |
$2,886.74
|
| 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 |
$2,730.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$791.90
|
| Rate for Payer: EPIC Health Plan Senior |
$527.93
|
| Rate for Payer: Galaxy Health WC |
$3,315.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$787.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$171.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$479.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,477.14
|
| 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 |
$780.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$643.12
|
| Rate for Payer: Multiplan Commercial |
$2,925.75
|
| Rate for Payer: Networks By Design Commercial |
$2,535.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$479.94
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.85
|
| Rate for Payer: Prime Health Services Medicare |
$508.74
|
| Rate for Payer: Riverside University Health System MISP |
$527.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.60
|
| 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 COMPLEX
|
Facility
|
IP
|
$3,901.00
|
|
|
Service Code
|
CPT 94621
|
| Hospital Charge Code |
900801021
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$780.20 |
| Max. Negotiated Rate |
$3,510.90 |
| Rate for Payer: Adventist Health Commercial |
$780.20
|
| Rate for Payer: Cash Price |
$1,755.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,730.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.40
|
| Rate for Payer: Galaxy Health WC |
$3,315.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,477.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,301.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.20
|
| Rate for Payer: Multiplan Commercial |
$2,925.75
|
| Rate for Payer: Networks By Design Commercial |
$2,535.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.85
|
|
|
HC PULM STRESS TEST SIMPLE
|
Facility
|
IP
|
$1,929.00
|
|
|
Service Code
|
CPT 94618
|
| Hospital Charge Code |
900801020
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$385.80 |
| Max. Negotiated Rate |
$1,736.10 |
| Rate for Payer: Adventist Health Commercial |
$385.80
|
| Rate for Payer: Cash Price |
$868.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,543.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,350.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$771.60
|
| Rate for Payer: EPIC Health Plan Senior |
$771.60
|
| Rate for Payer: Galaxy Health WC |
$1,639.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,157.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,736.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,224.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,138.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.80
|
| Rate for Payer: Multiplan Commercial |
$1,446.75
|
| Rate for Payer: Networks By Design Commercial |
$1,253.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,639.65
|
|
|
HC PULM STRESS TEST SIMPLE
|
Facility
|
OP
|
$1,929.00
|
|
|
Service Code
|
CPT 94618
|
| Hospital Charge Code |
900801020
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$51.81 |
| Max. Negotiated Rate |
$1,736.10 |
| Rate for Payer: Adventist Health Commercial |
$385.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$171.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$71.42
|
| 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 |
$67.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,122.10
|
| Rate for Payer: Blue Shield of California Commercial |
$1,215.27
|
| Rate for Payer: Blue Shield of California EPN |
$765.81
|
| Rate for Payer: Cash Price |
$868.05
|
| Rate for Payer: Cash Price |
$868.05
|
| Rate for Payer: Cash Price |
$868.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,543.20
|
| Rate for Payer: Cigna of CA HMO |
$1,234.56
|
| Rate for Payer: Cigna of CA PPO |
$1,427.46
|
| 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 |
$1,350.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$1,639.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,157.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,736.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$51.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,224.91
|
| 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 |
$385.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$1,446.75
|
| Rate for Payer: Networks By Design Commercial |
$1,253.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,639.65
|
| 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 |
$1,157.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,157.40
|
| 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 |
$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 PULSE OXIMETRY-CONTINUOUS OVER
|
Facility
|
OP
|
$661.00
|
|
|
Service Code
|
CPT 94762
|
| Hospital Charge Code |
900800103
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$129.65 |
| Max. Negotiated Rate |
$764.00 |
| Rate for Payer: Adventist Health Commercial |
$132.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$165.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$129.65
|
| 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 Exchange |
$257.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$384.50
|
| Rate for Payer: Blue Shield of California Commercial |
$416.43
|
| Rate for Payer: Blue Shield of California EPN |
$262.42
|
| Rate for Payer: Cash Price |
$297.45
|
| Rate for Payer: Cash Price |
$297.45
|
| Rate for Payer: Cash Price |
$297.45
|
| Rate for Payer: Central Health Plan Commercial |
$528.80
|
| Rate for Payer: Cigna of CA HMO |
$423.04
|
| Rate for Payer: Cigna of CA PPO |
$489.14
|
| 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 |
$462.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.06
|
| Rate for Payer: EPIC Health Plan Senior |
$182.04
|
| Rate for Payer: Galaxy Health WC |
$561.85
|
| Rate for Payer: Global Benefits Group Commercial |
$396.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$594.90
|
| 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 |
$419.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$231.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$221.76
|
| Rate for Payer: Multiplan Commercial |
$495.75
|
| Rate for Payer: Networks By Design Commercial |
$429.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$165.49
|
| Rate for Payer: Prime Health Services Commercial |
$561.85
|
| Rate for Payer: Prime Health Services Medicare |
$175.42
|
| Rate for Payer: Riverside University Health System MISP |
$182.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$396.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$396.60
|
| 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
|
$661.00
|
|
|
Service Code
|
CPT 94762
|
| Hospital Charge Code |
900800103
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$132.20 |
| Max. Negotiated Rate |
$594.90 |
| Rate for Payer: Adventist Health Commercial |
$132.20
|
| Rate for Payer: Cash Price |
$297.45
|
| Rate for Payer: Central Health Plan Commercial |
$528.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$462.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.40
|
| Rate for Payer: EPIC Health Plan Senior |
$264.40
|
| Rate for Payer: Galaxy Health WC |
$561.85
|
| Rate for Payer: Global Benefits Group Commercial |
$396.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$594.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$419.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$389.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.20
|
| Rate for Payer: Multiplan Commercial |
$495.75
|
| Rate for Payer: Networks By Design Commercial |
$429.65
|
| Rate for Payer: Prime Health Services Commercial |
$561.85
|
|
|
HC PULSE OXIMETRY MULT DETER
|
Facility
|
OP
|
$593.00
|
|
|
Service Code
|
CPT 94761
|
| Hospital Charge Code |
900800106
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$27.86 |
| Max. Negotiated Rate |
$764.00 |
| Rate for Payer: Adventist Health Commercial |
$118.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$504.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$326.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$444.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$174.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$344.95
|
| Rate for Payer: Blue Shield of California Commercial |
$373.59
|
| Rate for Payer: Blue Shield of California EPN |
$235.42
|
| Rate for Payer: Cash Price |
$266.85
|
| Rate for Payer: Cash Price |
$266.85
|
| Rate for Payer: Cash Price |
$266.85
|
| Rate for Payer: Central Health Plan Commercial |
$474.40
|
| Rate for Payer: Cigna of CA HMO |
$379.52
|
| Rate for Payer: Cigna of CA PPO |
$438.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$504.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$504.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$504.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$415.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$237.20
|
| Rate for Payer: EPIC Health Plan Senior |
$237.20
|
| Rate for Payer: Galaxy Health WC |
$504.05
|
| Rate for Payer: Global Benefits Group Commercial |
$355.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$533.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$376.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$349.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$415.10
|
| Rate for Payer: Multiplan Commercial |
$444.75
|
| Rate for Payer: Networks By Design Commercial |
$385.45
|
| Rate for Payer: Prime Health Services Commercial |
$504.05
|
| Rate for Payer: Riverside University Health System MISP |
$237.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$355.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$355.80
|
| 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: Vantage Medical Group Commercial/Exchange |
$504.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$504.05
|
| Rate for Payer: Vantage Medical Group Senior |
$504.05
|
|
|
HC PULSE OXIMETRY MULT DETER
|
Facility
|
IP
|
$593.00
|
|
|
Service Code
|
CPT 94761
|
| Hospital Charge Code |
900800106
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$118.60 |
| Max. Negotiated Rate |
$533.70 |
| Rate for Payer: Adventist Health Commercial |
$118.60
|
| Rate for Payer: Cash Price |
$266.85
|
| Rate for Payer: Central Health Plan Commercial |
$474.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$415.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$237.20
|
| Rate for Payer: EPIC Health Plan Senior |
$237.20
|
| Rate for Payer: Galaxy Health WC |
$504.05
|
| Rate for Payer: Global Benefits Group Commercial |
$355.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$533.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$376.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$349.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.60
|
| Rate for Payer: Multiplan Commercial |
$444.75
|
| Rate for Payer: Networks By Design Commercial |
$385.45
|
| Rate for Payer: Prime Health Services Commercial |
$504.05
|
|
|
HC PULSE OXIMETRY SNGL DETER
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
CPT 94760
|
| Hospital Charge Code |
900800102
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$10.62 |
| Max. Negotiated Rate |
$1,833.00 |
| Rate for Payer: Adventist Health Commercial |
$109.47
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$226.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$146.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$200.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.31
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Central Health Plan Commercial |
$213.60
|
| Rate for Payer: Cigna of CA HMO |
$170.88
|
| Rate for Payer: Cigna of CA PPO |
$197.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$226.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$226.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$186.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.80
|
| Rate for Payer: EPIC Health Plan Senior |
$106.80
|
| Rate for Payer: Galaxy Health WC |
$226.95
|
| Rate for Payer: Global Benefits Group Commercial |
$160.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$240.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$169.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$157.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$186.90
|
| Rate for Payer: Multiplan Commercial |
$200.25
|
| Rate for Payer: Networks By Design Commercial |
$173.55
|
| Rate for Payer: Prime Health Services Commercial |
$226.95
|
| Rate for Payer: Riverside University Health System MISP |
$106.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$160.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$160.20
|
| 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 |
$226.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$226.95
|
| Rate for Payer: Vantage Medical Group Senior |
$226.95
|
|
|
HC PULSE OXIMETRY SNGL DETER
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
CPT 94760
|
| Hospital Charge Code |
900800102
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$53.40 |
| Max. Negotiated Rate |
$240.30 |
| Rate for Payer: Adventist Health Commercial |
$53.40
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Central Health Plan Commercial |
$213.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$186.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.80
|
| Rate for Payer: EPIC Health Plan Senior |
$106.80
|
| Rate for Payer: Galaxy Health WC |
$226.95
|
| Rate for Payer: Global Benefits Group Commercial |
$160.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$240.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$169.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$157.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.40
|
| Rate for Payer: Multiplan Commercial |
$200.25
|
| Rate for Payer: Networks By Design Commercial |
$173.55
|
| Rate for Payer: Prime Health Services Commercial |
$226.95
|
|
|
HC PULSE OXIMETRY SNGL DETER
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
CPT 94760
|
| Hospital Charge Code |
900800102
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$10.62 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Commercial |
$53.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$226.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$146.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$200.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,685.00
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Central Health Plan Commercial |
$213.60
|
| Rate for Payer: Cigna of CA HMO |
$170.88
|
| Rate for Payer: Cigna of CA PPO |
$197.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$226.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$226.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$186.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.80
|
| Rate for Payer: EPIC Health Plan Senior |
$106.80
|
| Rate for Payer: Galaxy Health WC |
$226.95
|
| Rate for Payer: Global Benefits Group Commercial |
$160.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$240.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$169.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$157.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$186.90
|
| Rate for Payer: Multiplan Commercial |
$200.25
|
| Rate for Payer: Networks By Design Commercial |
$173.55
|
| Rate for Payer: Prime Health Services Commercial |
$226.95
|
| Rate for Payer: Riverside University Health System MISP |
$106.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$160.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$133.50
|
| Rate for Payer: United Healthcare All Other HMO |
$133.50
|
| Rate for Payer: United Healthcare HMO Rider |
$133.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$133.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$226.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$226.95
|
| Rate for Payer: Vantage Medical Group Senior |
$226.95
|
|
|
HC PULSE OXIMETRY SNGL DETER
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
CPT 94760
|
| Hospital Charge Code |
900800102
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$53.40 |
| Max. Negotiated Rate |
$240.30 |
| Rate for Payer: Adventist Health Commercial |
$53.40
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Central Health Plan Commercial |
$213.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$186.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.80
|
| Rate for Payer: EPIC Health Plan Senior |
$106.80
|
| Rate for Payer: Galaxy Health WC |
$226.95
|
| Rate for Payer: Global Benefits Group Commercial |
$160.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$240.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$169.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$157.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.40
|
| Rate for Payer: Multiplan Commercial |
$200.25
|
| Rate for Payer: Networks By Design Commercial |
$173.55
|
| Rate for Payer: Prime Health Services Commercial |
$226.95
|
|
|
HC PULSE OXIMETRY SNGL DETER
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
CPT 94760
|
| Hospital Charge Code |
900800102
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$764.00 |
| Rate for Payer: Adventist Health Commercial |
$53.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$226.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$146.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$200.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$67.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.31
|
| Rate for Payer: Blue Shield of California Commercial |
$168.21
|
| Rate for Payer: Blue Shield of California EPN |
$106.00
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Central Health Plan Commercial |
$213.60
|
| Rate for Payer: Cigna of CA HMO |
$170.88
|
| Rate for Payer: Cigna of CA PPO |
$197.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$226.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$226.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$186.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.80
|
| Rate for Payer: EPIC Health Plan Senior |
$106.80
|
| Rate for Payer: Galaxy Health WC |
$226.95
|
| Rate for Payer: Global Benefits Group Commercial |
$160.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$240.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$169.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$157.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$186.90
|
| Rate for Payer: Multiplan Commercial |
$200.25
|
| Rate for Payer: Networks By Design Commercial |
$173.55
|
| Rate for Payer: Prime Health Services Commercial |
$226.95
|
| Rate for Payer: Riverside University Health System MISP |
$106.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$160.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$160.20
|
| 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 |
$226.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$226.95
|
| Rate for Payer: Vantage Medical Group Senior |
$226.95
|
|
|
HC PULSE OXIMETRY SNGL DETER
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
CPT 94760
|
| Hospital Charge Code |
900800102
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$53.40 |
| Max. Negotiated Rate |
$240.30 |
| Rate for Payer: Adventist Health Commercial |
$53.40
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Central Health Plan Commercial |
$213.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$186.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.80
|
| Rate for Payer: EPIC Health Plan Senior |
$106.80
|
| Rate for Payer: Galaxy Health WC |
$226.95
|
| Rate for Payer: Global Benefits Group Commercial |
$160.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$240.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$169.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$157.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.40
|
| Rate for Payer: Multiplan Commercial |
$200.25
|
| Rate for Payer: Networks By Design Commercial |
$173.55
|
| Rate for Payer: Prime Health Services Commercial |
$226.95
|
|
|
HC PUNCH BX SKIN EA SEP/ADD LSN
|
Facility
|
OP
|
$310.00
|
|
|
Service Code
|
CPT 11105
|
| Hospital Charge Code |
900511105
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$62.00 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$62.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$263.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$170.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$232.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| 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 |
$139.50
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Central Health Plan Commercial |
$248.00
|
| Rate for Payer: Cigna of CA HMO |
$198.40
|
| Rate for Payer: Cigna of CA PPO |
$229.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$263.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$263.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$263.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$217.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.00
|
| Rate for Payer: EPIC Health Plan Senior |
$124.00
|
| Rate for Payer: Galaxy Health WC |
$263.50
|
| Rate for Payer: Global Benefits Group Commercial |
$186.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$279.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$95.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$196.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$105.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$182.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$217.00
|
| Rate for Payer: Multiplan Commercial |
$232.50
|
| Rate for Payer: Networks By Design Commercial |
$201.50
|
| Rate for Payer: Prime Health Services Commercial |
$263.50
|
| Rate for Payer: Riverside University Health System MISP |
$124.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$186.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$155.00
|
| 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 |
$263.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$263.50
|
| Rate for Payer: Vantage Medical Group Senior |
$263.50
|
|
|
HC PUNCH BX SKIN EA SEP/ADD LSN
|
Facility
|
IP
|
$310.00
|
|
|
Service Code
|
CPT 11105
|
| Hospital Charge Code |
900511105
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$62.00 |
| Max. Negotiated Rate |
$279.00 |
| Rate for Payer: Adventist Health Commercial |
$62.00
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Central Health Plan Commercial |
$248.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$217.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.00
|
| Rate for Payer: EPIC Health Plan Senior |
$124.00
|
| Rate for Payer: Galaxy Health WC |
$263.50
|
| Rate for Payer: Global Benefits Group Commercial |
$186.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$279.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$196.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$182.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.00
|
| Rate for Payer: Multiplan Commercial |
$232.50
|
| Rate for Payer: Networks By Design Commercial |
$201.50
|
| Rate for Payer: Prime Health Services Commercial |
$263.50
|
|
|
HC PUNCH BX SKIN SINGLE LESION
|
Facility
|
IP
|
$864.00
|
|
|
Service Code
|
CPT 11104
|
| Hospital Charge Code |
900511104
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$172.80 |
| Max. Negotiated Rate |
$777.60 |
| Rate for Payer: Adventist Health Commercial |
$172.80
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Central Health Plan Commercial |
$691.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$604.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$345.60
|
| Rate for Payer: EPIC Health Plan Senior |
$345.60
|
| Rate for Payer: Galaxy Health WC |
$734.40
|
| Rate for Payer: Global Benefits Group Commercial |
$518.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$777.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$548.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$509.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.80
|
| Rate for Payer: Multiplan Commercial |
$648.00
|
| Rate for Payer: Networks By Design Commercial |
$561.60
|
| Rate for Payer: Prime Health Services Commercial |
$734.40
|
|
|
HC PUNCH BX SKIN SINGLE LESION
|
Facility
|
OP
|
$864.00
|
|
|
Service Code
|
CPT 11104
|
| Hospital Charge Code |
900511104
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$172.80 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$172.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$522.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$808.84
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Central Health Plan Commercial |
$691.20
|
| Rate for Payer: Cigna of CA HMO |
$552.96
|
| Rate for Payer: Cigna of CA PPO |
$639.36
|
| 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 |
$604.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$734.40
|
| Rate for Payer: Global Benefits Group Commercial |
$518.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$777.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$857.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$192.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$548.64
|
| 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 |
$172.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$648.00
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$561.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$522.85
|
| Rate for Payer: Preferred Health Network WC |
$825.35
|
| Rate for Payer: Prime Health Services Commercial |
$734.40
|
| Rate for Payer: Prime Health Services Medicare |
$554.22
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Riverside University Health System MISP |
$575.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$518.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$432.00
|
| 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
|
|
