|
HC PULMONARY ARTERIAL ANGIO
|
Facility
|
IP
|
$2,323.00
|
|
|
Service Code
|
CPT 93568
|
| Hospital Charge Code |
906820074
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$464.60 |
| Max. Negotiated Rate |
$2,090.70 |
| Rate for Payer: Adventist Health Commercial |
$464.60
|
| Rate for Payer: Cash Price |
$1,277.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,858.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.20
|
| Rate for Payer: EPIC Health Plan Senior |
$929.20
|
| Rate for Payer: Galaxy Health WC |
$1,974.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,393.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,090.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,549.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$885.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,437.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$464.60
|
| Rate for Payer: Multiplan Commercial |
$1,742.25
|
| Rate for Payer: Networks By Design Commercial |
$1,509.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,974.55
|
|
|
HC PULMONARY ARTERIAL ANGIO
|
Facility
|
IP
|
$1,975.00
|
|
|
Service Code
|
CPT 93568
|
| Hospital Charge Code |
906811417
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$395.00 |
| Max. Negotiated Rate |
$1,777.50 |
| Rate for Payer: Adventist Health Commercial |
$395.00
|
| Rate for Payer: Cash Price |
$1,086.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,580.00
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$1,317.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$752.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,222.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$395.00
|
| 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
|
|
|
HC PULMONARY EXERCISE THERAPY GRP
|
Facility
|
OP
|
$820.00
|
|
|
Service Code
|
CPT G0239
|
| Hospital Charge Code |
900201804
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$49.87 |
| Max. Negotiated Rate |
$738.00 |
| Rate for Payer: Adventist Health Commercial |
$164.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$49.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$497.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$451.00
|
| Rate for Payer: Cash Price |
$451.00
|
| Rate for Payer: Cash Price |
$451.00
|
| Rate for Payer: Cash Price |
$451.00
|
| 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 |
$74.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$49.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.32
|
| Rate for Payer: EPIC Health Plan Senior |
$49.87
|
| 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 |
$81.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$49.87
|
| Rate for Payer: InnovAge PACE Commercial |
$74.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$546.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$312.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$66.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$66.83
|
| 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 |
$49.87
|
| Rate for Payer: Prime Health Services Commercial |
$697.00
|
| Rate for Payer: Prime Health Services Medicare |
$52.86
|
| Rate for Payer: Riverside University Health System MISP |
$54.86
|
| 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 |
$49.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.86
|
| Rate for Payer: Vantage Medical Group Senior |
$49.87
|
|
|
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 |
$451.00
|
| Rate for Payer: Central Health Plan Commercial |
$656.00
|
| 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 Permanente of CA Commercial/Self Funded |
$546.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$312.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.58
|
| 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 |
$510.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,222.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$639.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,182.23
|
| Rate for Payer: Blue Shield of California Commercial |
$1,221.89
|
| Rate for Payer: Blue Shield of California EPN |
$799.16
|
| Rate for Payer: Cash Price |
$1,107.15
|
| Rate for Payer: Cash Price |
$1,107.15
|
| 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 |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$689.27
|
| Rate for Payer: EPIC Health Plan Senior |
$510.57
|
| Rate for Payer: Galaxy Health WC |
$1,711.05
|
| 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 |
$837.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$193.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: InnovAge PACE Commercial |
$765.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,342.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$213.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$510.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$402.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$684.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$684.16
|
| 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 |
$510.57
|
| Rate for Payer: Prime Health Services Commercial |
$1,711.05
|
| Rate for Payer: Prime Health Services Medicare |
$541.20
|
| Rate for Payer: Riverside University Health System MISP |
$561.63
|
| 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 |
$510.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC PULM 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 |
$1,107.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,610.40
|
| 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 Permanente of CA Commercial/Self Funded |
$1,342.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$766.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,246.05
|
| 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 |
$2,185.15
|
| Rate for Payer: Central Health Plan Commercial |
$3,178.40
|
| 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 Permanente of CA Commercial/Self Funded |
$2,649.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,513.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,459.29
|
| 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 |
$332.26 |
| Max. Negotiated Rate |
$3,575.70 |
| Rate for Payer: Adventist Health Commercial |
$794.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$683.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,412.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$683.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,637.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$332.26
|
| Rate for Payer: Blue Shield of California Commercial |
$2,411.61
|
| Rate for Payer: Blue Shield of California EPN |
$1,577.28
|
| Rate for Payer: Cash Price |
$2,185.15
|
| Rate for Payer: Cash Price |
$2,185.15
|
| 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 |
$1,025.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$752.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$683.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$923.31
|
| Rate for Payer: EPIC Health Plan Senior |
$683.93
|
| Rate for Payer: Galaxy Health WC |
$3,377.05
|
| 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 |
$1,121.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$500.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$683.93
|
| Rate for Payer: InnovAge PACE Commercial |
$1,025.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,649.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$552.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$683.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$794.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$916.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$916.47
|
| 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 |
$683.93
|
| Rate for Payer: Prime Health Services Commercial |
$3,377.05
|
| Rate for Payer: Prime Health Services Medicare |
$724.97
|
| Rate for Payer: Riverside University Health System MISP |
$752.32
|
| 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 |
$683.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Vantage Medical Group Senior |
$683.93
|
|
|
HC PULM STRESS TEST COMPLEX
|
Facility
|
IP
|
$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 |
$2,145.55
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.80
|
| 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 Permanente of CA Commercial/Self Funded |
$2,601.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,486.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.72
|
| 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 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 |
$395.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,369.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$395.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$342.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,291.06
|
| Rate for Payer: Blue Shield of California Commercial |
$2,367.91
|
| Rate for Payer: Blue Shield of California EPN |
$1,548.70
|
| Rate for Payer: Cash Price |
$2,145.55
|
| Rate for Payer: Cash Price |
$2,145.55
|
| Rate for Payer: Cash Price |
$2,145.55
|
| 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 |
$593.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$435.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$395.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$534.14
|
| Rate for Payer: EPIC Health Plan Senior |
$395.66
|
| Rate for Payer: Galaxy Health WC |
$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 |
$648.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$171.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$395.66
|
| Rate for Payer: InnovAge PACE Commercial |
$593.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$189.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$395.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$530.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$530.18
|
| 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 |
$395.66
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.85
|
| Rate for Payer: Prime Health Services Medicare |
$419.40
|
| Rate for Payer: Riverside University Health System MISP |
$435.23
|
| 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 |
$395.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Vantage Medical Group Senior |
$395.66
|
|
|
HC PULM STRESS TEST SIMPLE
|
Facility
|
IP
|
$1,929.00
|
|
|
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 |
$1,060.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,543.20
|
| 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 Permanente of CA Commercial/Self Funded |
$1,286.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$734.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,194.05
|
| 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 |
$163.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,171.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$67.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,132.90
|
| Rate for Payer: Blue Shield of California Commercial |
$1,170.90
|
| Rate for Payer: Blue Shield of California EPN |
$765.81
|
| Rate for Payer: Cash Price |
$1,060.95
|
| Rate for Payer: Cash Price |
$1,060.95
|
| Rate for Payer: Cash Price |
$1,060.95
|
| 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 |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$1,639.65
|
| 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 |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$51.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: InnovAge PACE Commercial |
$245.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,286.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$219.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| 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 |
$163.78
|
| Rate for Payer: Prime Health Services Commercial |
$1,639.65
|
| Rate for Payer: Prime Health Services Medicare |
$173.61
|
| Rate for Payer: Riverside University Health System MISP |
$180.16
|
| 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 |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC PULSE OXIMETRY-CONTINUOUS OVER
|
Facility
|
IP
|
$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 |
$363.55
|
| Rate for Payer: Central Health Plan Commercial |
$528.80
|
| 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 Permanente of CA Commercial/Self Funded |
$440.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$251.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$409.16
|
| 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-CONTINUOUS OVER
|
Facility
|
OP
|
$661.00
|
|
|
Service Code
|
CPT 94762
|
| Hospital Charge Code |
900800103
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$132.20 |
| Max. Negotiated Rate |
$764.00 |
| Rate for Payer: Adventist Health Commercial |
$132.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$198.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$401.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$257.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$388.21
|
| Rate for Payer: Blue Shield of California Commercial |
$401.23
|
| Rate for Payer: Blue Shield of California EPN |
$262.42
|
| Rate for Payer: Cash Price |
$363.55
|
| Rate for Payer: Cash Price |
$363.55
|
| Rate for Payer: Cash Price |
$363.55
|
| 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 |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.38
|
| Rate for Payer: EPIC Health Plan Senior |
$198.80
|
| Rate for Payer: Galaxy Health WC |
$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 |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: InnovAge PACE Commercial |
$298.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$440.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$251.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$266.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.39
|
| 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 |
$198.80
|
| Rate for Payer: Prime Health Services Commercial |
$561.85
|
| Rate for Payer: Prime Health Services Medicare |
$210.73
|
| Rate for Payer: Riverside University Health System MISP |
$218.68
|
| 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 |
$198.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC PULSE OXIMETRY MULT DETER
|
Facility
|
OP
|
$593.00
|
|
|
Service Code
|
CPT 94761
|
| Hospital Charge Code |
900800106
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$118.60 |
| Max. Negotiated Rate |
$764.00 |
| Rate for Payer: Adventist Health Commercial |
$118.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$360.13
|
| 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 |
$348.27
|
| Rate for Payer: Blue Shield of California Commercial |
$359.95
|
| Rate for Payer: Blue Shield of California EPN |
$235.42
|
| Rate for Payer: Cash Price |
$326.15
|
| Rate for Payer: Cash Price |
$326.15
|
| Rate for Payer: Cash Price |
$326.15
|
| 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: 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: InnovAge PACE Commercial |
$296.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$395.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$225.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$367.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$415.10
|
| Rate for Payer: Molina Healthcare of CA 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 |
$326.15
|
| Rate for Payer: Central Health Plan Commercial |
$474.40
|
| 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 Permanente of CA Commercial/Self Funded |
$395.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$225.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$367.07
|
| 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
|
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 |
$2,582.00
|
| Rate for Payer: Cash Price |
$146.85
|
| Rate for Payer: Cash Price |
$146.85
|
| Rate for Payer: Cash Price |
$146.85
|
| Rate for Payer: Cash Price |
$146.85
|
| 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: 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: InnovAge PACE Commercial |
$133.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$165.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$186.90
|
| Rate for Payer: Molina Healthcare of CA 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
|
450
|
| Min. Negotiated Rate |
$53.40 |
| Max. Negotiated Rate |
$240.30 |
| Rate for Payer: Adventist Health Commercial |
$53.40
|
| Rate for Payer: Cash Price |
$146.85
|
| Rate for Payer: Central Health Plan Commercial |
$213.60
|
| 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 Permanente of CA Commercial/Self Funded |
$178.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$165.27
|
| 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
|
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 |
$146.85
|
| Rate for Payer: Central Health Plan Commercial |
$213.60
|
| 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 Permanente of CA Commercial/Self Funded |
$178.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$165.27
|
| 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
|
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 |
$146.85
|
| Rate for Payer: Central Health Plan Commercial |
$213.60
|
| 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 Permanente of CA Commercial/Self Funded |
$178.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$165.27
|
| 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
|
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 |
$162.15
|
| 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 |
$156.81
|
| Rate for Payer: Cash Price |
$146.85
|
| Rate for Payer: Cash Price |
$146.85
|
| Rate for Payer: Cash Price |
$146.85
|
| Rate for Payer: Cash Price |
$146.85
|
| 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: 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: InnovAge PACE Commercial |
$133.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$165.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$186.90
|
| Rate for Payer: Molina Healthcare of CA 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
|
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 |
$162.15
|
| 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 |
$156.81
|
| Rate for Payer: Blue Shield of California Commercial |
$162.07
|
| Rate for Payer: Blue Shield of California EPN |
$106.00
|
| Rate for Payer: Cash Price |
$146.85
|
| Rate for Payer: Cash Price |
$146.85
|
| Rate for Payer: Cash Price |
$146.85
|
| 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: 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: InnovAge PACE Commercial |
$133.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$165.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$186.90
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$170.50
|
| Rate for Payer: Central Health Plan Commercial |
$248.00
|
| 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 Permanente of CA Commercial/Self Funded |
$206.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$191.89
|
| 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 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 |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$62.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| 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 |
$150.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$182.06
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$170.50
|
| Rate for Payer: Cash Price |
$170.50
|
| Rate for Payer: Cash Price |
$170.50
|
| 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: 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: InnovAge PACE Commercial |
$155.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$206.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$105.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$191.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$217.00
|
| Rate for Payer: Molina Healthcare of CA 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 |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$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 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 |
$6,333.00 |
| Rate for Payer: Adventist Health Commercial |
$172.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$507.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$808.84
|
| Rate for Payer: Blue Shield of California Commercial |
$4,245.30
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cash Price |
$475.20
|
| 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 |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.31
|
| Rate for Payer: EPIC Health Plan Senior |
$507.64
|
| Rate for Payer: Galaxy Health WC |
$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 |
$832.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$192.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: InnovAge PACE Commercial |
$761.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$576.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$212.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$680.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| 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 |
$507.64
|
| 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 |
$538.10
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Riverside University Health System MISP |
$558.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$518.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$507.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
