|
HC PT SINGLE PROC EA ADDL 15 MIN MCAL
|
Facility
|
OP
|
$98.00
|
|
| Hospital Charge Code |
900419021
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$34.30 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$59.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$83.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$58.80
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Central Health Plan Commercial |
$78.40
|
| Rate for Payer: Cigna of CA HMO |
$62.72
|
| Rate for Payer: Cigna of CA PPO |
$72.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$83.30
|
| Rate for Payer: Dignity Health Media |
$83.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$39.20
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$88.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$73.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$34.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.18
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
| Rate for Payer: Riverside University Health System MISP |
$39.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.30
|
| Rate for Payer: Vantage Medical Group Senior |
$83.30
|
|
|
HC PT SINGLE PROC EA ADDL 15 MIN MCAL
|
Facility
|
IP
|
$98.00
|
|
| Hospital Charge Code |
900419021
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Central Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.20
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$88.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.60
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
|
|
HC PT SINGLE PROC INITIAL 30 MIN
|
Facility
|
IP
|
$184.00
|
|
| Hospital Charge Code |
905103302
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$36.80 |
| Max. Negotiated Rate |
$165.60 |
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Central Health Plan Commercial |
$147.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.60
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$165.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.80
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
|
|
HC PT SINGLE PROC INITIAL 30 MIN
|
Facility
|
OP
|
$184.00
|
|
| Hospital Charge Code |
905103302
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$64.40 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$111.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$156.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$101.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$110.40
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Central Health Plan Commercial |
$147.20
|
| Rate for Payer: Cigna of CA HMO |
$117.76
|
| Rate for Payer: Cigna of CA PPO |
$136.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$156.40
|
| Rate for Payer: Dignity Health Media |
$156.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$156.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$73.60
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$165.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$138.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$64.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.44
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
| Rate for Payer: Riverside University Health System MISP |
$73.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$110.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$110.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$156.40
|
| Rate for Payer: Vantage Medical Group Senior |
$156.40
|
|
|
HC PT SINGLE PROC INITIAL 30 MIN MCAL
|
Facility
|
OP
|
$184.00
|
|
| Hospital Charge Code |
900419020
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$64.40 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$111.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$156.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$101.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$110.40
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Central Health Plan Commercial |
$147.20
|
| Rate for Payer: Cigna of CA HMO |
$117.76
|
| Rate for Payer: Cigna of CA PPO |
$136.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$156.40
|
| Rate for Payer: Dignity Health Media |
$156.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$156.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$73.60
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$165.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$138.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$64.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.44
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
| Rate for Payer: Riverside University Health System MISP |
$73.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$110.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$110.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$156.40
|
| Rate for Payer: Vantage Medical Group Senior |
$156.40
|
|
|
HC PT SINGLE PROC INITIAL 30 MIN MCAL
|
Facility
|
IP
|
$184.00
|
|
| Hospital Charge Code |
900419020
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$36.80 |
| Max. Negotiated Rate |
$165.60 |
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Central Health Plan Commercial |
$147.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.60
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$165.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.80
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
|
|
HC PT SUBSTITUTION
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 85611
|
| Hospital Charge Code |
900910105
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$167.40 |
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Central Health Plan Commercial |
$148.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.40
|
| Rate for Payer: Galaxy Health WC |
$158.10
|
| Rate for Payer: Global Benefits Group Commercial |
$111.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$167.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$124.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.20
|
| Rate for Payer: Multiplan Commercial |
$139.50
|
| Rate for Payer: Networks By Design Commercial |
$120.90
|
| Rate for Payer: Prime Health Services Commercial |
$158.10
|
|
|
HC PT SUBSTITUTION
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 85611
|
| Hospital Charge Code |
900910105
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$34.95 |
| Rate for Payer: Adventist Health Medi-Cal |
$3.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$28.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.95
|
| Rate for Payer: Blue Distinction Transplant |
$9.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9.27
|
| Rate for Payer: Blue Shield of California EPN |
$7.29
|
| Rate for Payer: Caremore Medicare Advantage |
$3.94
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Central Health Plan Commercial |
$12.00
|
| Rate for Payer: Cigna of CA HMO |
$9.60
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.91
|
| Rate for Payer: Dignity Health Media |
$3.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.94
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.94
|
| Rate for Payer: InnovAge PACE Commercial |
$5.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.28
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Prime Health Services Medicare |
$4.18
|
| Rate for Payer: Riverside University Health System MISP |
$4.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.20
|
| Rate for Payer: United Healthcare All Other HMO |
$3.20
|
| Rate for Payer: United Healthcare HMO Rider |
$3.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.33
|
| Rate for Payer: Vantage Medical Group Senior |
$3.94
|
|
|
HC PTT
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
900910007
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$38.80 |
| Max. Negotiated Rate |
$174.60 |
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Central Health Plan Commercial |
$155.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.60
|
| Rate for Payer: Galaxy Health WC |
$164.90
|
| Rate for Payer: Global Benefits Group Commercial |
$116.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$174.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$129.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.80
|
| Rate for Payer: Multiplan Commercial |
$145.50
|
| Rate for Payer: Networks By Design Commercial |
$126.10
|
| Rate for Payer: Prime Health Services Commercial |
$164.90
|
|
|
HC PTT
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
900910007
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$53.29 |
| Rate for Payer: Adventist Health Medi-Cal |
$6.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$44.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$43.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.29
|
| Rate for Payer: Blue Distinction Transplant |
$12.60
|
| Rate for Payer: Blue Shield of California Commercial |
$12.98
|
| Rate for Payer: Blue Shield of California EPN |
$10.21
|
| Rate for Payer: Caremore Medicare Advantage |
$6.01
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: Central Health Plan Commercial |
$16.80
|
| Rate for Payer: Cigna of CA HMO |
$13.44
|
| Rate for Payer: Cigna of CA PPO |
$15.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.02
|
| Rate for Payer: Dignity Health Media |
$6.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.01
|
| Rate for Payer: Galaxy Health WC |
$17.85
|
| Rate for Payer: Global Benefits Group Commercial |
$12.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$15.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.01
|
| Rate for Payer: InnovAge PACE Commercial |
$9.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.05
|
| Rate for Payer: Multiplan Commercial |
$15.75
|
| Rate for Payer: Networks By Design Commercial |
$13.65
|
| Rate for Payer: Prime Health Services Commercial |
$17.85
|
| Rate for Payer: Prime Health Services Medicare |
$6.37
|
| Rate for Payer: Riverside University Health System MISP |
$6.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.87
|
| Rate for Payer: United Healthcare All Other HMO |
$4.87
|
| Rate for Payer: United Healthcare HMO Rider |
$4.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.61
|
| Rate for Payer: Vantage Medical Group Senior |
$6.01
|
|
|
HC PTT SUBSTITUTION
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
CPT 85732
|
| Hospital Charge Code |
900910106
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$38.80 |
| Max. Negotiated Rate |
$174.60 |
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Central Health Plan Commercial |
$155.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.60
|
| Rate for Payer: Galaxy Health WC |
$164.90
|
| Rate for Payer: Global Benefits Group Commercial |
$116.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$174.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$129.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.80
|
| Rate for Payer: Multiplan Commercial |
$145.50
|
| Rate for Payer: Networks By Design Commercial |
$126.10
|
| Rate for Payer: Prime Health Services Commercial |
$164.90
|
|
|
HC PTT SUBSTITUTION
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 85732
|
| Hospital Charge Code |
900910106
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$57.41 |
| Rate for Payer: Adventist Health Medi-Cal |
$6.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$47.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$47.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.41
|
| Rate for Payer: Blue Distinction Transplant |
$18.60
|
| Rate for Payer: Blue Shield of California Commercial |
$19.16
|
| Rate for Payer: Blue Shield of California EPN |
$15.07
|
| Rate for Payer: Caremore Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Central Health Plan Commercial |
$24.80
|
| Rate for Payer: Cigna of CA HMO |
$19.84
|
| Rate for Payer: Cigna of CA PPO |
$22.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.70
|
| Rate for Payer: Dignity Health Media |
$6.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.73
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.47
|
| Rate for Payer: Galaxy Health WC |
$26.35
|
| Rate for Payer: Global Benefits Group Commercial |
$18.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$23.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: InnovAge PACE Commercial |
$9.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.67
|
| Rate for Payer: Multiplan Commercial |
$23.25
|
| Rate for Payer: Networks By Design Commercial |
$20.15
|
| Rate for Payer: Prime Health Services Commercial |
$26.35
|
| Rate for Payer: Prime Health Services Medicare |
$6.86
|
| Rate for Payer: Riverside University Health System MISP |
$7.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.24
|
| Rate for Payer: United Healthcare All Other HMO |
$5.24
|
| Rate for Payer: United Healthcare HMO Rider |
$5.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
|
HC PULMONARY ARTERIAL ANGIO
|
Facility
|
IP
|
$2,445.00
|
|
|
Service Code
|
CPT 93568
|
| Hospital Charge Code |
906811417
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$489.00 |
| Max. Negotiated Rate |
$2,200.50 |
| Rate for Payer: Cash Price |
$1,100.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,956.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$978.00
|
| Rate for Payer: Galaxy Health WC |
$2,078.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,467.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,200.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,630.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$931.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$489.00
|
| Rate for Payer: Multiplan Commercial |
$1,833.75
|
| Rate for Payer: Networks By Design Commercial |
$1,589.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,078.25
|
|
|
HC PULMONARY ARTERIAL ANGIO
|
Facility
|
OP
|
$2,445.00
|
|
|
Service Code
|
CPT 93568
|
| Hospital Charge Code |
906820074
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$177.08 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,559.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,078.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,344.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,344.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,467.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$1,100.25
|
| Rate for Payer: Cash Price |
$1,100.25
|
| Rate for Payer: Cash Price |
$1,100.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,956.00
|
| Rate for Payer: Cigna of CA PPO |
$1,809.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,078.25
|
| Rate for Payer: Dignity Health Media |
$2,078.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,078.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$978.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$978.00
|
| Rate for Payer: Galaxy Health WC |
$2,078.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,467.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,200.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,833.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$855.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,630.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$177.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$489.00
|
| Rate for Payer: Multiplan Commercial |
$1,833.75
|
| Rate for Payer: Networks By Design Commercial |
$1,589.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,078.25
|
| Rate for Payer: Riverside University Health System MISP |
$978.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,467.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,467.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,078.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,078.25
|
|
|
HC PULMONARY ARTERIAL ANGIO
|
Facility
|
IP
|
$2,445.00
|
|
|
Service Code
|
CPT 93568
|
| Hospital Charge Code |
906820074
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$489.00 |
| Max. Negotiated Rate |
$2,200.50 |
| Rate for Payer: Cash Price |
$1,100.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,956.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$978.00
|
| Rate for Payer: Galaxy Health WC |
$2,078.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,467.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,200.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,630.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$931.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$489.00
|
| Rate for Payer: Multiplan Commercial |
$1,833.75
|
| Rate for Payer: Networks By Design Commercial |
$1,589.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,078.25
|
|
|
HC PULMONARY ARTERIAL ANGIO
|
Facility
|
OP
|
$2,445.00
|
|
|
Service Code
|
CPT 93568
|
| Hospital Charge Code |
906811417
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$177.08 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,559.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,078.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,344.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,344.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,467.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$1,100.25
|
| Rate for Payer: Cash Price |
$1,100.25
|
| Rate for Payer: Cash Price |
$1,100.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,956.00
|
| Rate for Payer: Cigna of CA PPO |
$1,809.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,078.25
|
| Rate for Payer: Dignity Health Media |
$2,078.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,078.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$978.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$978.00
|
| Rate for Payer: Galaxy Health WC |
$2,078.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,467.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,200.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,833.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$855.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,630.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$177.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$489.00
|
| Rate for Payer: Multiplan Commercial |
$1,833.75
|
| Rate for Payer: Networks By Design Commercial |
$1,589.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,078.25
|
| Rate for Payer: Riverside University Health System MISP |
$978.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,467.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,467.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,078.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,078.25
|
|
|
HC PULMONARY COMPLIANCE STUDY
|
Facility
|
OP
|
$471.00
|
|
|
Service Code
|
CPT 94750
|
| Hospital Charge Code |
900801031
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$94.20 |
| Max. Negotiated Rate |
$725.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$286.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$400.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$259.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$259.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$127.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$278.27
|
| Rate for Payer: Blue Distinction Transplant |
$282.60
|
| Rate for Payer: Blue Shield of California Commercial |
$291.08
|
| Rate for Payer: Blue Shield of California EPN |
$228.91
|
| Rate for Payer: Cash Price |
$211.95
|
| Rate for Payer: Cash Price |
$211.95
|
| Rate for Payer: Cash Price |
$211.95
|
| Rate for Payer: Central Health Plan Commercial |
$376.80
|
| Rate for Payer: Cigna of CA HMO |
$301.44
|
| Rate for Payer: Cigna of CA PPO |
$348.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$400.35
|
| Rate for Payer: Dignity Health Media |
$400.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$400.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$188.40
|
| Rate for Payer: Galaxy Health WC |
$400.35
|
| Rate for Payer: Global Benefits Group Commercial |
$282.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$423.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$353.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$164.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$314.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$179.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.20
|
| Rate for Payer: Multiplan Commercial |
$353.25
|
| Rate for Payer: Networks By Design Commercial |
$306.15
|
| Rate for Payer: Prime Health Services Commercial |
$400.35
|
| Rate for Payer: Riverside University Health System MISP |
$188.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$282.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$282.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$725.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$696.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$636.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$400.35
|
| Rate for Payer: Vantage Medical Group Senior |
$400.35
|
|
|
HC PULMONARY COMPLIANCE STUDY
|
Facility
|
IP
|
$471.00
|
|
|
Service Code
|
CPT 94750
|
| Hospital Charge Code |
900801031
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$94.20 |
| Max. Negotiated Rate |
$423.90 |
| Rate for Payer: Cash Price |
$211.95
|
| Rate for Payer: Central Health Plan Commercial |
$376.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.40
|
| Rate for Payer: Galaxy Health WC |
$400.35
|
| Rate for Payer: Global Benefits Group Commercial |
$282.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$423.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$314.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$179.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.20
|
| Rate for Payer: Multiplan Commercial |
$353.25
|
| Rate for Payer: Networks By Design Commercial |
$306.15
|
| Rate for Payer: Prime Health Services Commercial |
$400.35
|
|
|
HC PULMONARY EXERCISE THERAPY GRP
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
CPT G0239
|
| Hospital Charge Code |
900201804
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Central Health Plan Commercial |
$600.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$300.00
|
| Rate for Payer: Galaxy Health WC |
$637.50
|
| Rate for Payer: Global Benefits Group Commercial |
$450.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$675.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$500.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$285.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$150.00
|
| Rate for Payer: Multiplan Commercial |
$562.50
|
| Rate for Payer: Networks By Design Commercial |
$487.50
|
| Rate for Payer: Prime Health Services Commercial |
$637.50
|
|
|
HC PULMONARY EXERCISE THERAPY GRP
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
CPT G0239
|
| Hospital Charge Code |
900201804
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$50.11 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$50.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$63.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$75.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$50.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$450.00
|
| Rate for Payer: Blue Shield of California Commercial |
$471.75
|
| Rate for Payer: Blue Shield of California EPN |
$366.75
|
| Rate for Payer: Caremore Medicare Advantage |
$50.11
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Central Health Plan Commercial |
$600.00
|
| Rate for Payer: Cigna of CA HMO |
$480.00
|
| Rate for Payer: Cigna of CA PPO |
$555.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$75.16
|
| Rate for Payer: Dignity Health Media |
$50.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$55.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.65
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$50.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$50.11
|
| Rate for Payer: Galaxy Health WC |
$637.50
|
| Rate for Payer: Global Benefits Group Commercial |
$450.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$675.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$562.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$82.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$82.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$50.11
|
| Rate for Payer: InnovAge PACE Commercial |
$75.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$500.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$285.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$150.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$67.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$67.15
|
| Rate for Payer: Multiplan Commercial |
$562.50
|
| Rate for Payer: Networks By Design Commercial |
$487.50
|
| Rate for Payer: Prime Health Services Commercial |
$637.50
|
| Rate for Payer: Prime Health Services Medicare |
$53.12
|
| Rate for Payer: Riverside University Health System MISP |
$55.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$450.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$450.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.00
|
| Rate for Payer: United Healthcare All Other HMO |
$478.00
|
| Rate for Payer: United Healthcare HMO Rider |
$428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$391.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$75.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.12
|
| Rate for Payer: Vantage Medical Group Senior |
$50.11
|
|
|
HC PULM PERFUSION SCAN
|
Facility
|
IP
|
$2,493.00
|
|
|
Service Code
|
CPT 78580
|
| Hospital Charge Code |
909301400
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$498.60 |
| Max. Negotiated Rate |
$2,243.70 |
| Rate for Payer: Cash Price |
$1,121.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,994.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$997.20
|
| Rate for Payer: Galaxy Health WC |
$2,119.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,495.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,243.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,662.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$949.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$498.60
|
| Rate for Payer: Multiplan Commercial |
$1,869.75
|
| Rate for Payer: Networks By Design Commercial |
$1,620.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,119.05
|
|
|
HC PULM PERFUSION SCAN
|
Facility
|
OP
|
$2,493.00
|
|
|
Service Code
|
CPT 78580
|
| Hospital Charge Code |
909301400
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$213.75 |
| Max. Negotiated Rate |
$2,243.70 |
| Rate for Payer: Adventist Health Medi-Cal |
$515.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$988.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$639.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,472.86
|
| Rate for Payer: Blue Distinction Transplant |
$1,495.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,540.67
|
| Rate for Payer: Blue Shield of California EPN |
$1,211.60
|
| Rate for Payer: Caremore Medicare Advantage |
$515.32
|
| Rate for Payer: Cash Price |
$1,121.85
|
| Rate for Payer: Cash Price |
$1,121.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,994.40
|
| Rate for Payer: Cigna of CA HMO |
$1,595.52
|
| Rate for Payer: Cigna of CA PPO |
$1,844.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Media |
$515.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$695.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$515.32
|
| Rate for Payer: Galaxy Health WC |
$2,119.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,495.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,243.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,869.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$845.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$850.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$515.32
|
| Rate for Payer: InnovAge PACE Commercial |
$772.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,662.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$213.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$498.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$690.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$690.53
|
| Rate for Payer: Multiplan Commercial |
$1,869.75
|
| Rate for Payer: Networks By Design Commercial |
$1,620.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,119.05
|
| Rate for Payer: Prime Health Services Medicare |
$546.24
|
| Rate for Payer: Riverside University Health System MISP |
$566.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,495.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,495.80
|
| 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: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC PULM PERF & VENT/VQ
|
Facility
|
IP
|
$4,920.00
|
|
|
Service Code
|
CPT 78582
|
| Hospital Charge Code |
909301403
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$984.00 |
| Max. Negotiated Rate |
$4,428.00 |
| Rate for Payer: Cash Price |
$2,214.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,936.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,968.00
|
| Rate for Payer: Galaxy Health WC |
$4,182.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,952.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,428.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,281.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,874.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$984.00
|
| Rate for Payer: Multiplan Commercial |
$3,690.00
|
| Rate for Payer: Networks By Design Commercial |
$3,198.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,182.00
|
|
|
HC PULM PERF & VENT/VQ
|
Facility
|
OP
|
$4,920.00
|
|
|
Service Code
|
CPT 78582
|
| Hospital Charge Code |
909301403
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$552.75 |
| Max. Negotiated Rate |
$4,428.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$675.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,536.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$675.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,637.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,996.93
|
| Rate for Payer: Blue Distinction Transplant |
$2,952.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,040.56
|
| Rate for Payer: Blue Shield of California EPN |
$2,391.12
|
| Rate for Payer: Caremore Medicare Advantage |
$675.33
|
| Rate for Payer: Cash Price |
$2,214.00
|
| Rate for Payer: Cash Price |
$2,214.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,936.00
|
| Rate for Payer: Cigna of CA HMO |
$3,148.80
|
| Rate for Payer: Cigna of CA PPO |
$3,640.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Dignity Health Media |
$675.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$742.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$911.70
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$675.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$675.33
|
| Rate for Payer: Galaxy Health WC |
$4,182.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,952.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,428.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,690.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,107.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,114.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$675.33
|
| Rate for Payer: InnovAge PACE Commercial |
$1,013.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,281.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$552.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$675.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$984.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$904.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$904.94
|
| Rate for Payer: Multiplan Commercial |
$3,690.00
|
| Rate for Payer: Networks By Design Commercial |
$3,198.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,182.00
|
| Rate for Payer: Prime Health Services Medicare |
$715.85
|
| Rate for Payer: Riverside University Health System MISP |
$742.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,952.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,952.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: Vantage Medical Group Senior |
$675.33
|
|
|
HC PULM REHAB W/EXER/MONT PER HR
|
Facility
|
IP
|
$289.00
|
|
|
Service Code
|
CPT 94626
|
| Hospital Charge Code |
900201805
|
|
Hospital Revenue Code
|
948
|
| Min. Negotiated Rate |
$57.80 |
| Max. Negotiated Rate |
$260.10 |
| Rate for Payer: Cash Price |
$130.05
|
| Rate for Payer: Central Health Plan Commercial |
$231.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.60
|
| Rate for Payer: Galaxy Health WC |
$245.65
|
| Rate for Payer: Global Benefits Group Commercial |
$173.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$260.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$192.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.80
|
| Rate for Payer: Multiplan Commercial |
$216.75
|
| Rate for Payer: Networks By Design Commercial |
$187.85
|
| Rate for Payer: Prime Health Services Commercial |
$245.65
|
|
