|
HC THERAPEUTIC PROCEDURE 30MIN MCAL
|
Facility
|
OP
|
$169.00
|
|
| Hospital Charge Code |
900409030
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$40.56 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$69.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$143.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$92.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$126.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: Cigna of CA HMO |
$108.16
|
| Rate for Payer: Cigna of CA PPO |
$125.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$143.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$143.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$143.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.60
|
| Rate for Payer: EPIC Health Plan Senior |
$67.60
|
| Rate for Payer: Galaxy Health WC |
$143.65
|
| Rate for Payer: Global Benefits Group Commercial |
$101.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$104.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$118.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$118.30
|
| Rate for Payer: Multiplan Commercial |
$135.20
|
| Rate for Payer: Networks By Design Commercial |
$109.85
|
| Rate for Payer: Prime Health Services Commercial |
$143.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$101.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$101.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$143.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$143.65
|
| Rate for Payer: Vantage Medical Group Senior |
$143.65
|
|
|
HC THERAPEUTIC PROCEDURE ADDL 15MIN PT
|
Facility
|
OP
|
$101.00
|
|
| Hospital Charge Code |
900409031
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$24.24 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$41.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$66.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$85.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$45.45
|
| Rate for Payer: Cash Price |
$45.45
|
| Rate for Payer: Cash Price |
$45.45
|
| Rate for Payer: Cigna of CA HMO |
$64.64
|
| Rate for Payer: Cigna of CA PPO |
$74.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$85.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.40
|
| Rate for Payer: EPIC Health Plan Senior |
$40.40
|
| Rate for Payer: Galaxy Health WC |
$85.85
|
| Rate for Payer: Global Benefits Group Commercial |
$60.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$67.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$70.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$70.70
|
| Rate for Payer: Multiplan Commercial |
$80.80
|
| Rate for Payer: Networks By Design Commercial |
$65.65
|
| Rate for Payer: Prime Health Services Commercial |
$85.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$85.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.85
|
| Rate for Payer: Vantage Medical Group Senior |
$85.85
|
|
|
HC THERAPEUTIC PROCEDURE ADDL 15MIN PT
|
Facility
|
IP
|
$101.00
|
|
| Hospital Charge Code |
900409031
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.20 |
| Max. Negotiated Rate |
$85.85 |
| Rate for Payer: Adventist Health Commercial |
$20.20
|
| Rate for Payer: Cash Price |
$45.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.40
|
| Rate for Payer: EPIC Health Plan Senior |
$40.40
|
| Rate for Payer: Galaxy Health WC |
$85.85
|
| Rate for Payer: Global Benefits Group Commercial |
$60.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$67.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.24
|
| Rate for Payer: Multiplan Commercial |
$80.80
|
| Rate for Payer: Networks By Design Commercial |
$65.65
|
| Rate for Payer: Prime Health Services Commercial |
$85.85
|
|
|
HC THERAPEUTIC PROCEDURE GRP MCAL
|
Facility
|
IP
|
$647.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
901300059
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$129.40 |
| Max. Negotiated Rate |
$549.95 |
| Rate for Payer: Adventist Health Commercial |
$129.40
|
| Rate for Payer: Cash Price |
$291.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$258.80
|
| Rate for Payer: EPIC Health Plan Senior |
$258.80
|
| Rate for Payer: Galaxy Health WC |
$549.95
|
| Rate for Payer: Global Benefits Group Commercial |
$388.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$431.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$246.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$400.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.28
|
| Rate for Payer: Multiplan Commercial |
$517.60
|
| Rate for Payer: Networks By Design Commercial |
$420.55
|
| Rate for Payer: Prime Health Services Commercial |
$549.95
|
|
|
HC THERAPEUTIC PROCEDURE GRP MCAL
|
Facility
|
OP
|
$647.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
900400055
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.75 |
| Max. Negotiated Rate |
$549.95 |
| Rate for Payer: Adventist Health Commercial |
$265.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$424.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$549.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$355.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$485.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$291.15
|
| Rate for Payer: Cash Price |
$291.15
|
| Rate for Payer: Cash Price |
$291.15
|
| Rate for Payer: Cash Price |
$291.15
|
| Rate for Payer: Cigna of CA HMO |
$414.08
|
| Rate for Payer: Cigna of CA PPO |
$478.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$549.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$549.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$549.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$258.80
|
| Rate for Payer: EPIC Health Plan Senior |
$258.80
|
| Rate for Payer: Galaxy Health WC |
$549.95
|
| Rate for Payer: Global Benefits Group Commercial |
$388.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$431.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$400.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$452.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$452.90
|
| Rate for Payer: Multiplan Commercial |
$517.60
|
| Rate for Payer: Networks By Design Commercial |
$420.55
|
| Rate for Payer: Prime Health Services Commercial |
$549.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$388.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$388.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$549.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$549.95
|
| Rate for Payer: Vantage Medical Group Senior |
$549.95
|
|
|
HC THERAPEUTIC PROCEDURE GRP MCAL
|
Facility
|
OP
|
$647.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
901300059
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$22.75 |
| Max. Negotiated Rate |
$549.95 |
| Rate for Payer: Adventist Health Commercial |
$265.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$424.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$549.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$355.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$485.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$291.15
|
| Rate for Payer: Cash Price |
$291.15
|
| Rate for Payer: Cash Price |
$291.15
|
| Rate for Payer: Cash Price |
$291.15
|
| Rate for Payer: Cigna of CA HMO |
$414.08
|
| Rate for Payer: Cigna of CA PPO |
$478.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$549.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$549.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$549.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$258.80
|
| Rate for Payer: EPIC Health Plan Senior |
$258.80
|
| Rate for Payer: Galaxy Health WC |
$549.95
|
| Rate for Payer: Global Benefits Group Commercial |
$388.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$431.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$400.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$452.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$452.90
|
| Rate for Payer: Multiplan Commercial |
$517.60
|
| Rate for Payer: Networks By Design Commercial |
$420.55
|
| Rate for Payer: Prime Health Services Commercial |
$549.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$388.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$388.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$549.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$549.95
|
| Rate for Payer: Vantage Medical Group Senior |
$549.95
|
|
|
HC THERAPEUTIC PROCEDURE GRP MCAL
|
Facility
|
IP
|
$647.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
900400055
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$129.40 |
| Max. Negotiated Rate |
$549.95 |
| Rate for Payer: Adventist Health Commercial |
$129.40
|
| Rate for Payer: Cash Price |
$291.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$258.80
|
| Rate for Payer: EPIC Health Plan Senior |
$258.80
|
| Rate for Payer: Galaxy Health WC |
$549.95
|
| Rate for Payer: Global Benefits Group Commercial |
$388.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$431.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$246.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$400.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.28
|
| Rate for Payer: Multiplan Commercial |
$517.60
|
| Rate for Payer: Networks By Design Commercial |
$420.55
|
| Rate for Payer: Prime Health Services Commercial |
$549.95
|
|
|
HC THERAPEUTIC RAD PORT IMAGE
|
Facility
|
OP
|
$703.00
|
|
|
Service Code
|
CPT 77417
|
| Hospital Charge Code |
909100309
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$1,759.00 |
| Rate for Payer: Adventist Health Commercial |
$140.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$461.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$597.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$386.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$527.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$163.58
|
| Rate for Payer: Blue Shield of California Commercial |
$430.24
|
| Rate for Payer: Blue Shield of California EPN |
$284.01
|
| Rate for Payer: Cash Price |
$316.35
|
| Rate for Payer: Cash Price |
$316.35
|
| Rate for Payer: Cash Price |
$316.35
|
| Rate for Payer: Cigna of CA HMO |
$449.92
|
| Rate for Payer: Cigna of CA PPO |
$520.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$597.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$597.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$597.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$281.20
|
| Rate for Payer: EPIC Health Plan Senior |
$281.20
|
| Rate for Payer: Galaxy Health WC |
$597.55
|
| Rate for Payer: Global Benefits Group Commercial |
$421.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$468.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$435.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$492.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$492.10
|
| Rate for Payer: Multiplan Commercial |
$562.40
|
| Rate for Payer: Networks By Design Commercial |
$456.95
|
| Rate for Payer: Prime Health Services Commercial |
$597.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$421.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,748.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,759.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,332.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,221.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$597.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$597.55
|
| Rate for Payer: Vantage Medical Group Senior |
$597.55
|
|
|
HC THERAPEUTIC RAD PORT IMAGE
|
Facility
|
IP
|
$703.00
|
|
|
Service Code
|
CPT 77417
|
| Hospital Charge Code |
909100309
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$140.60 |
| Max. Negotiated Rate |
$597.55 |
| Rate for Payer: Adventist Health Commercial |
$140.60
|
| Rate for Payer: Cash Price |
$316.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$281.20
|
| Rate for Payer: EPIC Health Plan Senior |
$281.20
|
| Rate for Payer: Galaxy Health WC |
$597.55
|
| Rate for Payer: Global Benefits Group Commercial |
$421.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$468.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$267.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$435.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.72
|
| Rate for Payer: Multiplan Commercial |
$562.40
|
| Rate for Payer: Networks By Design Commercial |
$456.95
|
| Rate for Payer: Prime Health Services Commercial |
$597.55
|
|
|
HC THERAPUTIC BRONCH SUB
|
Facility
|
IP
|
$3,516.00
|
|
|
Service Code
|
CPT 31646
|
| Hospital Charge Code |
900803511
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$703.20 |
| Max. Negotiated Rate |
$2,988.60 |
| Rate for Payer: Adventist Health Commercial |
$703.20
|
| Rate for Payer: Cash Price |
$1,582.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,406.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,406.40
|
| Rate for Payer: Galaxy Health WC |
$2,988.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,109.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,345.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,339.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,176.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$843.84
|
| Rate for Payer: Multiplan Commercial |
$2,812.80
|
| Rate for Payer: Networks By Design Commercial |
$2,285.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,988.60
|
|
|
HC THERAPUTIC BRONCH SUB
|
Facility
|
OP
|
$3,516.00
|
|
|
Service Code
|
CPT 31646
|
| Hospital Charge Code |
900803511
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$183.89 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$703.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$740.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$542.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$493.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$1,582.20
|
| Rate for Payer: Cash Price |
$1,582.20
|
| Rate for Payer: Cash Price |
$1,582.20
|
| Rate for Payer: Cigna of CA HMO |
$2,250.24
|
| Rate for Payer: Cigna of CA PPO |
$2,601.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$740.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$542.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$666.08
|
| Rate for Payer: EPIC Health Plan Senior |
$493.39
|
| Rate for Payer: Galaxy Health WC |
$2,988.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,109.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$809.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$183.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$493.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,345.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$207.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$493.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$843.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$621.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$661.14
|
| Rate for Payer: Multiplan Commercial |
$2,812.80
|
| Rate for Payer: Networks By Design Commercial |
$2,285.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,988.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,109.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,109.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,758.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,758.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,758.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,758.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$493.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$740.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$542.73
|
| Rate for Payer: Vantage Medical Group Senior |
$493.39
|
|
|
HC THERMODILUTION CONGENITAL
|
Facility
|
IP
|
$4,018.00
|
|
|
Service Code
|
CPT 93561
|
| Hospital Charge Code |
906811494
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$803.60 |
| Max. Negotiated Rate |
$3,415.30 |
| Rate for Payer: Adventist Health Commercial |
$803.60
|
| Rate for Payer: Cash Price |
$1,808.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,607.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,607.20
|
| Rate for Payer: Galaxy Health WC |
$3,415.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,410.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,680.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,530.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,487.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$964.32
|
| Rate for Payer: Multiplan Commercial |
$3,214.40
|
| Rate for Payer: Networks By Design Commercial |
$2,611.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,415.30
|
|
|
HC THERMODILUTION CONGENITAL
|
Facility
|
OP
|
$4,018.00
|
|
|
Service Code
|
CPT 93561
|
| Hospital Charge Code |
906811494
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$803.60 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$803.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,415.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,209.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,013.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,467.45
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$1,808.10
|
| Rate for Payer: Cash Price |
$1,808.10
|
| Rate for Payer: Cigna of CA HMO |
$2,611.70
|
| Rate for Payer: Cigna of CA PPO |
$2,973.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,415.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,415.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,415.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,607.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,607.20
|
| Rate for Payer: Galaxy Health WC |
$3,415.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,410.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,680.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,530.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,487.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$964.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,812.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,812.60
|
| Rate for Payer: Multiplan Commercial |
$3,214.40
|
| Rate for Payer: Networks By Design Commercial |
$2,611.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,415.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,410.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,410.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,009.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,009.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,009.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,009.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,415.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,415.30
|
| Rate for Payer: Vantage Medical Group Senior |
$3,415.30
|
|
|
HC THERMODILUTION CONGENITAL ADDL
|
Facility
|
IP
|
$2,009.00
|
|
|
Service Code
|
CPT 93562
|
| Hospital Charge Code |
906811495
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$401.80 |
| Max. Negotiated Rate |
$1,707.65 |
| Rate for Payer: Adventist Health Commercial |
$401.80
|
| Rate for Payer: Cash Price |
$904.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$803.60
|
| Rate for Payer: EPIC Health Plan Senior |
$803.60
|
| Rate for Payer: Galaxy Health WC |
$1,707.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,205.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,340.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$765.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,243.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$482.16
|
| Rate for Payer: Multiplan Commercial |
$1,607.20
|
| Rate for Payer: Networks By Design Commercial |
$1,305.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,707.65
|
|
|
HC THERMODILUTION CONGENITAL ADDL
|
Facility
|
OP
|
$2,009.00
|
|
|
Service Code
|
CPT 93562
|
| Hospital Charge Code |
906811495
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$401.80 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$401.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,707.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,104.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,506.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,233.73
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$904.05
|
| Rate for Payer: Cash Price |
$904.05
|
| Rate for Payer: Cigna of CA HMO |
$1,305.85
|
| Rate for Payer: Cigna of CA PPO |
$1,486.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,707.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,707.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,707.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$803.60
|
| Rate for Payer: EPIC Health Plan Senior |
$803.60
|
| Rate for Payer: Galaxy Health WC |
$1,707.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,205.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,340.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$765.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,243.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$482.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,406.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,406.30
|
| Rate for Payer: Multiplan Commercial |
$1,607.20
|
| Rate for Payer: Networks By Design Commercial |
$1,305.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,707.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,205.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,205.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,004.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,004.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,004.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,004.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,707.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,707.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1,707.65
|
|
|
HC THERMODILUTION CONG EVAL DEFECTS
|
Facility
|
IP
|
$3,341.00
|
|
|
Service Code
|
CPT 93598
|
| Hospital Charge Code |
906820098
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$668.20 |
| Max. Negotiated Rate |
$2,839.85 |
| Rate for Payer: Adventist Health Commercial |
$668.20
|
| Rate for Payer: Cash Price |
$1,503.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,336.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,336.40
|
| Rate for Payer: Galaxy Health WC |
$2,839.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,004.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,228.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,272.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,068.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$801.84
|
| Rate for Payer: Multiplan Commercial |
$2,672.80
|
| Rate for Payer: Networks By Design Commercial |
$2,171.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,839.85
|
|
|
HC THERMODILUTION CONG EVAL DEFECTS
|
Facility
|
OP
|
$3,437.00
|
|
|
Service Code
|
CPT 93598
|
| Hospital Charge Code |
906811598
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$687.40 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$687.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,921.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,890.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,577.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,110.66
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$1,546.65
|
| Rate for Payer: Cash Price |
$1,546.65
|
| Rate for Payer: Cigna of CA HMO |
$2,234.05
|
| Rate for Payer: Cigna of CA PPO |
$2,543.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,921.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,921.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,921.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,374.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,374.80
|
| Rate for Payer: Galaxy Health WC |
$2,921.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,062.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,292.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,127.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$824.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,405.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,405.90
|
| Rate for Payer: Multiplan Commercial |
$2,749.60
|
| Rate for Payer: Networks By Design Commercial |
$2,234.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,921.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,062.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,062.20
|
| 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 |
$2,921.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,921.45
|
| Rate for Payer: Vantage Medical Group Senior |
$2,921.45
|
|
|
HC THERMODILUTION CONG EVAL DEFECTS
|
Facility
|
OP
|
$3,341.00
|
|
|
Service Code
|
CPT 93598
|
| Hospital Charge Code |
906820098
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$668.20 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$668.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,839.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,837.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,505.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,051.71
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$1,503.45
|
| Rate for Payer: Cash Price |
$1,503.45
|
| Rate for Payer: Cigna of CA HMO |
$2,171.65
|
| Rate for Payer: Cigna of CA PPO |
$2,472.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,839.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,839.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,839.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,336.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,336.40
|
| Rate for Payer: Galaxy Health WC |
$2,839.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,004.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,228.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,068.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$801.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,338.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,338.70
|
| Rate for Payer: Multiplan Commercial |
$2,672.80
|
| Rate for Payer: Networks By Design Commercial |
$2,171.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,839.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,004.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,004.60
|
| 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 |
$2,839.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,839.85
|
| Rate for Payer: Vantage Medical Group Senior |
$2,839.85
|
|
|
HC THERMODILUTION CONG EVAL DEFECTS
|
Facility
|
IP
|
$3,437.00
|
|
|
Service Code
|
CPT 93598
|
| Hospital Charge Code |
906811598
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$687.40 |
| Max. Negotiated Rate |
$2,921.45 |
| Rate for Payer: Adventist Health Commercial |
$687.40
|
| Rate for Payer: Cash Price |
$1,546.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,374.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,374.80
|
| Rate for Payer: Galaxy Health WC |
$2,921.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,062.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,292.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,309.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,127.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$824.88
|
| Rate for Payer: Multiplan Commercial |
$2,749.60
|
| Rate for Payer: Networks By Design Commercial |
$2,234.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,921.45
|
|
|
HC THIOCYANATE SERUM
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
CPT 84430
|
| Hospital Charge Code |
900910463
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$101.80 |
| Max. Negotiated Rate |
$432.65 |
| Rate for Payer: Adventist Health Commercial |
$101.80
|
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$203.60
|
| Rate for Payer: EPIC Health Plan Senior |
$203.60
|
| Rate for Payer: Galaxy Health WC |
$432.65
|
| Rate for Payer: Global Benefits Group Commercial |
$305.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$339.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$193.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$315.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.16
|
| Rate for Payer: Multiplan Commercial |
$407.20
|
| Rate for Payer: Networks By Design Commercial |
$330.85
|
| Rate for Payer: Prime Health Services Commercial |
$432.65
|
|
|
HC THIOCYANATE SERUM
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 84430
|
| Hospital Charge Code |
900910463
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.42 |
| Max. Negotiated Rate |
$114.91 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.91
|
| Rate for Payer: Blue Shield of California Commercial |
$33.45
|
| Rate for Payer: Blue Shield of California EPN |
$22.10
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.70
|
| Rate for Payer: EPIC Health Plan Senior |
$11.63
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.58
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.42
|
| Rate for Payer: United Healthcare All Other HMO |
$9.42
|
| Rate for Payer: United Healthcare HMO Rider |
$9.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.79
|
| Rate for Payer: Vantage Medical Group Senior |
$11.63
|
|
|
HC THORACENTESIS ASPIRATN W GUID
|
Facility
|
OP
|
$4,259.00
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
900200007
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$155.11 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$851.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$785.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$1,916.55
|
| Rate for Payer: Cash Price |
$1,916.55
|
| Rate for Payer: Cash Price |
$1,916.55
|
| Rate for Payer: Cigna of CA HMO |
$2,725.76
|
| Rate for Payer: Cigna of CA PPO |
$3,151.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$864.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$785.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,060.51
|
| Rate for Payer: EPIC Health Plan Senior |
$785.56
|
| Rate for Payer: Galaxy Health WC |
$3,620.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,555.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,288.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$155.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$785.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,840.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$175.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$785.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,022.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$989.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,052.65
|
| Rate for Payer: Multiplan Commercial |
$3,407.20
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: Networks By Design Commercial |
$2,768.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,620.15
|
| Rate for Payer: Prime Health Services WC |
$1,238.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,555.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$785.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Vantage Medical Group Senior |
$785.56
|
|
|
HC THORACENTESIS ASPIRATN W GUID
|
Facility
|
IP
|
$4,259.00
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
909020158
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$851.80 |
| Max. Negotiated Rate |
$3,620.15 |
| Rate for Payer: Adventist Health Commercial |
$851.80
|
| Rate for Payer: Cash Price |
$1,916.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,703.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,703.60
|
| Rate for Payer: Galaxy Health WC |
$3,620.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,555.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,840.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,622.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,636.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,022.16
|
| Rate for Payer: Multiplan Commercial |
$3,407.20
|
| Rate for Payer: Networks By Design Commercial |
$2,768.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,620.15
|
|
|
HC THORACENTESIS ASPIRATN W GUID
|
Facility
|
IP
|
$4,259.00
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
900200007
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$851.80 |
| Max. Negotiated Rate |
$3,620.15 |
| Rate for Payer: Adventist Health Commercial |
$851.80
|
| Rate for Payer: Cash Price |
$1,916.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,703.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,703.60
|
| Rate for Payer: Galaxy Health WC |
$3,620.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,555.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,840.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,622.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,636.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,022.16
|
| Rate for Payer: Multiplan Commercial |
$3,407.20
|
| Rate for Payer: Networks By Design Commercial |
$2,768.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,620.15
|
|
|
HC THORACENTESIS ASPIRATN W GUID
|
Facility
|
OP
|
$4,259.00
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
909020158
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$155.11 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$851.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$785.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$1,916.55
|
| Rate for Payer: Cash Price |
$1,916.55
|
| Rate for Payer: Cash Price |
$1,916.55
|
| Rate for Payer: Cigna of CA HMO |
$2,725.76
|
| Rate for Payer: Cigna of CA PPO |
$3,151.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$864.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$785.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,060.51
|
| Rate for Payer: EPIC Health Plan Senior |
$785.56
|
| Rate for Payer: Galaxy Health WC |
$3,620.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,555.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,288.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$155.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$785.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,840.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$175.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$785.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,022.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$989.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,052.65
|
| Rate for Payer: Multiplan Commercial |
$3,407.20
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: Networks By Design Commercial |
$2,768.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,620.15
|
| Rate for Payer: Prime Health Services WC |
$1,238.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,555.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$785.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Vantage Medical Group Senior |
$785.56
|
|
