|
HC TROPONIN - I
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 84484
|
| Hospital Charge Code |
900910994
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.10 |
| Max. Negotiated Rate |
$188.45 |
| Rate for Payer: Adventist Health Commercial |
$11.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$36.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$188.45
|
| Rate for Payer: Blue Shield of California Commercial |
$37.46
|
| Rate for Payer: Blue Shield of California EPN |
$24.75
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna of CA HMO |
$35.84
|
| Rate for Payer: Cigna of CA PPO |
$41.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.83
|
| Rate for Payer: EPIC Health Plan Senior |
$12.47
|
| Rate for Payer: Galaxy Health WC |
$47.60
|
| Rate for Payer: Global Benefits Group Commercial |
$33.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.71
|
| Rate for Payer: Multiplan Commercial |
$44.80
|
| Rate for Payer: Networks By Design Commercial |
$36.40
|
| Rate for Payer: Prime Health Services Commercial |
$47.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.10
|
| Rate for Payer: United Healthcare All Other HMO |
$10.10
|
| Rate for Payer: United Healthcare HMO Rider |
$10.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.72
|
| Rate for Payer: Vantage Medical Group Senior |
$12.47
|
|
|
HC TROPONIN - I
|
Facility
|
IP
|
$1,014.00
|
|
|
Service Code
|
CPT 84484
|
| Hospital Charge Code |
900910994
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$202.80 |
| Max. Negotiated Rate |
$861.90 |
| Rate for Payer: Adventist Health Commercial |
$202.80
|
| Rate for Payer: Cash Price |
$456.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$405.60
|
| Rate for Payer: EPIC Health Plan Senior |
$405.60
|
| Rate for Payer: Galaxy Health WC |
$861.90
|
| Rate for Payer: Global Benefits Group Commercial |
$608.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$676.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$386.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$627.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.36
|
| Rate for Payer: Multiplan Commercial |
$811.20
|
| Rate for Payer: Networks By Design Commercial |
$659.10
|
| Rate for Payer: Prime Health Services Commercial |
$861.90
|
|
|
HC TROPONIN-T
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
CPT 84484
|
| Hospital Charge Code |
900912119
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.10 |
| Max. Negotiated Rate |
$188.45 |
| Rate for Payer: Adventist Health Commercial |
$15.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$51.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$188.45
|
| Rate for Payer: Blue Shield of California Commercial |
$52.18
|
| Rate for Payer: Blue Shield of California EPN |
$34.48
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cigna of CA HMO |
$49.92
|
| Rate for Payer: Cigna of CA PPO |
$57.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.83
|
| Rate for Payer: EPIC Health Plan Senior |
$12.47
|
| Rate for Payer: Galaxy Health WC |
$66.30
|
| Rate for Payer: Global Benefits Group Commercial |
$46.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.71
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: Networks By Design Commercial |
$50.70
|
| Rate for Payer: Prime Health Services Commercial |
$66.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.10
|
| Rate for Payer: United Healthcare All Other HMO |
$10.10
|
| Rate for Payer: United Healthcare HMO Rider |
$10.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.72
|
| Rate for Payer: Vantage Medical Group Senior |
$12.47
|
|
|
HC TROPONIN-T
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
CPT 84484
|
| Hospital Charge Code |
900912119
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$267.75 |
| Rate for Payer: Adventist Health Commercial |
$63.00
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.00
|
| Rate for Payer: EPIC Health Plan Senior |
$126.00
|
| Rate for Payer: Galaxy Health WC |
$267.75
|
| Rate for Payer: Global Benefits Group Commercial |
$189.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$210.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$194.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.60
|
| Rate for Payer: Multiplan Commercial |
$252.00
|
| Rate for Payer: Networks By Design Commercial |
$204.75
|
| Rate for Payer: Prime Health Services Commercial |
$267.75
|
|
|
HC TRSNCATH INS/REPL LEADLESS PCR
|
Facility
|
IP
|
$55,402.00
|
|
|
Service Code
|
CPT 33274
|
| Hospital Charge Code |
906811498
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$11,080.40 |
| Max. Negotiated Rate |
$47,091.70 |
| Rate for Payer: Adventist Health Commercial |
$11,080.40
|
| Rate for Payer: Cash Price |
$24,930.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,160.80
|
| Rate for Payer: EPIC Health Plan Senior |
$22,160.80
|
| Rate for Payer: Galaxy Health WC |
$47,091.70
|
| Rate for Payer: Global Benefits Group Commercial |
$33,241.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36,953.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21,108.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34,293.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,296.48
|
| Rate for Payer: Multiplan Commercial |
$44,321.60
|
| Rate for Payer: Networks By Design Commercial |
$36,011.30
|
| Rate for Payer: Prime Health Services Commercial |
$47,091.70
|
|
|
HC TRSNCATH INS/REPL LEADLESS PCR
|
Facility
|
OP
|
$55,402.00
|
|
|
Service Code
|
CPT 33274
|
| Hospital Charge Code |
906811498
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$701.77 |
| Max. Negotiated Rate |
$71,375.00 |
| Rate for Payer: Adventist Health Commercial |
$11,080.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26,655.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24,231.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$3,490.94
|
| Rate for Payer: Cash Price |
$24,930.90
|
| Rate for Payer: Cash Price |
$24,930.90
|
| Rate for Payer: Cash Price |
$24,930.90
|
| Rate for Payer: Cigna of CA HMO |
$35,457.28
|
| Rate for Payer: Cigna of CA PPO |
$40,997.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$26,655.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24,231.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$32,712.96
|
| Rate for Payer: EPIC Health Plan Senior |
$24,231.82
|
| Rate for Payer: Galaxy Health WC |
$47,091.70
|
| Rate for Payer: Global Benefits Group Commercial |
$33,241.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$39,740.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$701.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24,231.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36,953.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$793.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24,231.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,296.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,532.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32,470.64
|
| Rate for Payer: Multiplan Commercial |
$44,321.60
|
| Rate for Payer: Multiplan WC |
$38,609.08
|
| Rate for Payer: Networks By Design Commercial |
$36,011.30
|
| Rate for Payer: Prime Health Services Commercial |
$47,091.70
|
| Rate for Payer: Prime Health Services WC |
$38,215.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33,241.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$60,866.00
|
| Rate for Payer: United Healthcare All Other HMO |
$71,375.00
|
| Rate for Payer: United Healthcare HMO Rider |
$57,385.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52,575.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$24,231.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26,655.00
|
| Rate for Payer: Vantage Medical Group Senior |
$24,231.82
|
|
|
HC TRSNCATH INS/REPL LEADLESS PCR
|
Facility
|
OP
|
$53,844.00
|
|
|
Service Code
|
CPT 33274
|
| Hospital Charge Code |
906820022
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$701.77 |
| Max. Negotiated Rate |
$71,375.00 |
| Rate for Payer: Adventist Health Commercial |
$10,768.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26,655.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24,231.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$3,490.94
|
| Rate for Payer: Cash Price |
$24,229.80
|
| Rate for Payer: Cash Price |
$24,229.80
|
| Rate for Payer: Cash Price |
$24,229.80
|
| Rate for Payer: Cigna of CA HMO |
$34,460.16
|
| Rate for Payer: Cigna of CA PPO |
$39,844.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$26,655.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24,231.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$32,712.96
|
| Rate for Payer: EPIC Health Plan Senior |
$24,231.82
|
| Rate for Payer: Galaxy Health WC |
$45,767.40
|
| Rate for Payer: Global Benefits Group Commercial |
$32,306.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$39,740.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$701.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24,231.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35,913.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$793.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24,231.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,922.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,532.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32,470.64
|
| Rate for Payer: Multiplan Commercial |
$43,075.20
|
| Rate for Payer: Multiplan WC |
$38,609.08
|
| Rate for Payer: Networks By Design Commercial |
$34,998.60
|
| Rate for Payer: Prime Health Services Commercial |
$45,767.40
|
| Rate for Payer: Prime Health Services WC |
$38,215.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32,306.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$60,866.00
|
| Rate for Payer: United Healthcare All Other HMO |
$71,375.00
|
| Rate for Payer: United Healthcare HMO Rider |
$57,385.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52,575.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$24,231.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26,655.00
|
| Rate for Payer: Vantage Medical Group Senior |
$24,231.82
|
|
|
HC TRSNCATH INS/REPL LEADLESS PCR
|
Facility
|
IP
|
$53,844.00
|
|
|
Service Code
|
CPT 33274
|
| Hospital Charge Code |
906820022
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$10,768.80 |
| Max. Negotiated Rate |
$45,767.40 |
| Rate for Payer: Adventist Health Commercial |
$10,768.80
|
| Rate for Payer: Cash Price |
$24,229.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$21,537.60
|
| Rate for Payer: EPIC Health Plan Senior |
$21,537.60
|
| Rate for Payer: Galaxy Health WC |
$45,767.40
|
| Rate for Payer: Global Benefits Group Commercial |
$32,306.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35,913.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20,514.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33,329.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,922.56
|
| Rate for Payer: Multiplan Commercial |
$43,075.20
|
| Rate for Payer: Networks By Design Commercial |
$34,998.60
|
| Rate for Payer: Prime Health Services Commercial |
$45,767.40
|
|
|
HC TRT DEVICES COMPLEX
|
Facility
|
IP
|
$3,437.00
|
|
|
Service Code
|
CPT 77334
|
| Hospital Charge Code |
904810506
|
|
Hospital Revenue Code
|
333
|
| 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 TRT DEVICES COMPLEX
|
Facility
|
OP
|
$3,437.00
|
|
|
Service Code
|
CPT 77334
|
| Hospital Charge Code |
904810506
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$188.48 |
| Max. Negotiated Rate |
$2,921.45 |
| Rate for Payer: Adventist Health Commercial |
$687.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,254.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$697.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$511.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$465.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$917.79
|
| Rate for Payer: Blue Shield of California Commercial |
$2,103.44
|
| Rate for Payer: Blue Shield of California EPN |
$1,388.55
|
| Rate for Payer: Cash Price |
$1,546.65
|
| Rate for Payer: Cash Price |
$1,546.65
|
| Rate for Payer: Cash Price |
$1,546.65
|
| Rate for Payer: Cigna of CA HMO |
$2,199.68
|
| Rate for Payer: Cigna of CA PPO |
$2,543.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$697.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$511.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$465.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$627.93
|
| Rate for Payer: EPIC Health Plan Senior |
$465.13
|
| Rate for Payer: Galaxy Health WC |
$2,921.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,062.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$762.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$188.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$465.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,292.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$213.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$465.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$824.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$586.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$623.27
|
| 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: TriValley Medical Group Commercial/Senior |
$2,062.20
|
| 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: Upland Medical Group Pediatric |
$465.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$697.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$511.64
|
| Rate for Payer: Vantage Medical Group Senior |
$465.13
|
|
|
HC TRT DEVICES INTER
|
Facility
|
IP
|
$1,048.00
|
|
|
Service Code
|
CPT 77333
|
| Hospital Charge Code |
909100210
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$209.60 |
| Max. Negotiated Rate |
$890.80 |
| Rate for Payer: Adventist Health Commercial |
$209.60
|
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$419.20
|
| Rate for Payer: EPIC Health Plan Senior |
$419.20
|
| Rate for Payer: Galaxy Health WC |
$890.80
|
| Rate for Payer: Global Benefits Group Commercial |
$628.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$699.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$399.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$648.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$251.52
|
| Rate for Payer: Multiplan Commercial |
$838.40
|
| Rate for Payer: Networks By Design Commercial |
$681.20
|
| Rate for Payer: Prime Health Services Commercial |
$890.80
|
|
|
HC TRT DEVICES INTER
|
Facility
|
OP
|
$1,048.00
|
|
|
Service Code
|
CPT 77333
|
| Hospital Charge Code |
909100210
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$76.83 |
| Max. Negotiated Rate |
$1,759.00 |
| Rate for Payer: Adventist Health Commercial |
$209.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$687.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$253.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$185.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$168.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$539.89
|
| Rate for Payer: Blue Shield of California Commercial |
$641.38
|
| Rate for Payer: Blue Shield of California EPN |
$423.39
|
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Cigna of CA HMO |
$670.72
|
| Rate for Payer: Cigna of CA PPO |
$775.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$253.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$185.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$168.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.75
|
| Rate for Payer: EPIC Health Plan Senior |
$168.70
|
| Rate for Payer: Galaxy Health WC |
$890.80
|
| Rate for Payer: Global Benefits Group Commercial |
$628.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$276.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$76.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$168.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$699.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$168.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$251.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$212.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$226.06
|
| Rate for Payer: Multiplan Commercial |
$838.40
|
| Rate for Payer: Networks By Design Commercial |
$681.20
|
| Rate for Payer: Prime Health Services Commercial |
$890.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$628.80
|
| 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: Upland Medical Group Pediatric |
$168.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$253.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$185.57
|
| Rate for Payer: Vantage Medical Group Senior |
$168.70
|
|
|
HC TRT DEVICES SIMPLE
|
Facility
|
OP
|
$984.00
|
|
|
Service Code
|
CPT 77332
|
| Hospital Charge Code |
909100209
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$57.69 |
| Max. Negotiated Rate |
$1,759.00 |
| Rate for Payer: Adventist Health Commercial |
$196.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$645.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$253.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$185.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$168.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$379.56
|
| Rate for Payer: Blue Shield of California Commercial |
$602.21
|
| Rate for Payer: Blue Shield of California EPN |
$397.54
|
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Cigna of CA HMO |
$629.76
|
| Rate for Payer: Cigna of CA PPO |
$728.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$253.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$185.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$168.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.75
|
| Rate for Payer: EPIC Health Plan Senior |
$168.70
|
| Rate for Payer: Galaxy Health WC |
$836.40
|
| Rate for Payer: Global Benefits Group Commercial |
$590.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$276.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$57.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$168.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$656.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$168.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$236.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$212.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$226.06
|
| Rate for Payer: Multiplan Commercial |
$787.20
|
| Rate for Payer: Networks By Design Commercial |
$639.60
|
| Rate for Payer: Prime Health Services Commercial |
$836.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$590.40
|
| 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: Upland Medical Group Pediatric |
$168.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$253.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$185.57
|
| Rate for Payer: Vantage Medical Group Senior |
$168.70
|
|
|
HC TRT DEVICES SIMPLE
|
Facility
|
IP
|
$984.00
|
|
|
Service Code
|
CPT 77332
|
| Hospital Charge Code |
909100209
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$196.80 |
| Max. Negotiated Rate |
$836.40 |
| Rate for Payer: Adventist Health Commercial |
$196.80
|
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$393.60
|
| Rate for Payer: EPIC Health Plan Senior |
$393.60
|
| Rate for Payer: Galaxy Health WC |
$836.40
|
| Rate for Payer: Global Benefits Group Commercial |
$590.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$656.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$374.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$609.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$236.16
|
| Rate for Payer: Multiplan Commercial |
$787.20
|
| Rate for Payer: Networks By Design Commercial |
$639.60
|
| Rate for Payer: Prime Health Services Commercial |
$836.40
|
|
|
HC TRT SPEECH/LANG/VOICE INDIV
|
Facility
|
OP
|
$642.00
|
|
|
Service Code
|
CPT 92507
|
| Hospital Charge Code |
907001401
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$49.93 |
| Max. Negotiated Rate |
$545.70 |
| Rate for Payer: Adventist Health Commercial |
$263.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$421.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$545.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$481.50
|
| 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 |
$288.90
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: Cigna of CA HMO |
$410.88
|
| Rate for Payer: Cigna of CA PPO |
$475.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$545.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$545.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$545.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$256.80
|
| Rate for Payer: EPIC Health Plan Senior |
$256.80
|
| Rate for Payer: Galaxy Health WC |
$545.70
|
| Rate for Payer: Global Benefits Group Commercial |
$385.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$49.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$428.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$397.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$449.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$449.40
|
| Rate for Payer: Multiplan Commercial |
$513.60
|
| Rate for Payer: Networks By Design Commercial |
$417.30
|
| Rate for Payer: Prime Health Services Commercial |
$545.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$385.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$385.20
|
| 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 |
$545.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$545.70
|
| Rate for Payer: Vantage Medical Group Senior |
$545.70
|
|
|
HC TRT SPEECH/LANG/VOICE INDIV
|
Facility
|
IP
|
$642.00
|
|
|
Service Code
|
CPT 92507
|
| Hospital Charge Code |
905601401
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$128.40 |
| Max. Negotiated Rate |
$545.70 |
| Rate for Payer: Adventist Health Commercial |
$128.40
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$256.80
|
| Rate for Payer: EPIC Health Plan Senior |
$256.80
|
| Rate for Payer: Galaxy Health WC |
$545.70
|
| Rate for Payer: Global Benefits Group Commercial |
$385.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$428.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$244.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$397.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.08
|
| Rate for Payer: Multiplan Commercial |
$513.60
|
| Rate for Payer: Networks By Design Commercial |
$417.30
|
| Rate for Payer: Prime Health Services Commercial |
$545.70
|
|
|
HC TRT SPEECH/LANG/VOICE INDIV
|
Facility
|
OP
|
$642.00
|
|
|
Service Code
|
CPT 92507
|
| Hospital Charge Code |
905601401
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$49.93 |
| Max. Negotiated Rate |
$545.70 |
| Rate for Payer: Adventist Health Commercial |
$263.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$421.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$545.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$481.50
|
| 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 |
$288.90
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: Cigna of CA HMO |
$410.88
|
| Rate for Payer: Cigna of CA PPO |
$475.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$545.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$545.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$545.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$256.80
|
| Rate for Payer: EPIC Health Plan Senior |
$256.80
|
| Rate for Payer: Galaxy Health WC |
$545.70
|
| Rate for Payer: Global Benefits Group Commercial |
$385.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$49.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$428.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$397.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$449.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$449.40
|
| Rate for Payer: Multiplan Commercial |
$513.60
|
| Rate for Payer: Networks By Design Commercial |
$417.30
|
| Rate for Payer: Prime Health Services Commercial |
$545.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$385.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$385.20
|
| 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 |
$545.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$545.70
|
| Rate for Payer: Vantage Medical Group Senior |
$545.70
|
|
|
HC TRT SPEECH/LANG/VOICE INDIV
|
Facility
|
IP
|
$642.00
|
|
|
Service Code
|
CPT 92507
|
| Hospital Charge Code |
907001401
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$128.40 |
| Max. Negotiated Rate |
$545.70 |
| Rate for Payer: Adventist Health Commercial |
$128.40
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$256.80
|
| Rate for Payer: EPIC Health Plan Senior |
$256.80
|
| Rate for Payer: Galaxy Health WC |
$545.70
|
| Rate for Payer: Global Benefits Group Commercial |
$385.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$428.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$244.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$397.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.08
|
| Rate for Payer: Multiplan Commercial |
$513.60
|
| Rate for Payer: Networks By Design Commercial |
$417.30
|
| Rate for Payer: Prime Health Services Commercial |
$545.70
|
|
|
HC TRT SWALLOW/ORAL FUNC FEEDING
|
Facility
|
OP
|
$553.00
|
|
|
Service Code
|
CPT 92526
|
| Hospital Charge Code |
905601801
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$56.82 |
| Max. Negotiated Rate |
$470.05 |
| Rate for Payer: Adventist Health Commercial |
$226.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$362.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$470.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$304.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$414.75
|
| 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 |
$248.85
|
| Rate for Payer: Cash Price |
$248.85
|
| Rate for Payer: Cash Price |
$248.85
|
| Rate for Payer: Cash Price |
$248.85
|
| Rate for Payer: Cigna of CA HMO |
$353.92
|
| Rate for Payer: Cigna of CA PPO |
$409.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$470.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$470.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$470.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.20
|
| Rate for Payer: EPIC Health Plan Senior |
$221.20
|
| Rate for Payer: Galaxy Health WC |
$470.05
|
| Rate for Payer: Global Benefits Group Commercial |
$331.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$56.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$368.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$342.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$387.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$387.10
|
| Rate for Payer: Multiplan Commercial |
$442.40
|
| Rate for Payer: Networks By Design Commercial |
$359.45
|
| Rate for Payer: Prime Health Services Commercial |
$470.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$331.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$331.80
|
| 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 |
$470.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$470.05
|
| Rate for Payer: Vantage Medical Group Senior |
$470.05
|
|
|
HC TRT SWALLOW/ORAL FUNC FEEDING
|
Facility
|
IP
|
$553.00
|
|
|
Service Code
|
CPT 92526
|
| Hospital Charge Code |
905601801
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$110.60 |
| Max. Negotiated Rate |
$470.05 |
| Rate for Payer: Adventist Health Commercial |
$110.60
|
| Rate for Payer: Cash Price |
$248.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.20
|
| Rate for Payer: EPIC Health Plan Senior |
$221.20
|
| Rate for Payer: Galaxy Health WC |
$470.05
|
| Rate for Payer: Global Benefits Group Commercial |
$331.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$368.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$210.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$342.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.72
|
| Rate for Payer: Multiplan Commercial |
$442.40
|
| Rate for Payer: Networks By Design Commercial |
$359.45
|
| Rate for Payer: Prime Health Services Commercial |
$470.05
|
|
|
HC TRT SWALLOW/ORAL FUNC FEEDING MCAL
|
Facility
|
OP
|
$553.00
|
|
|
Service Code
|
CPT 92526
|
| Hospital Charge Code |
901300021
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$56.82 |
| Max. Negotiated Rate |
$470.05 |
| Rate for Payer: Adventist Health Commercial |
$226.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$362.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$470.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$304.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$414.75
|
| 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 |
$248.85
|
| Rate for Payer: Cash Price |
$248.85
|
| Rate for Payer: Cash Price |
$248.85
|
| Rate for Payer: Cash Price |
$248.85
|
| Rate for Payer: Cigna of CA HMO |
$353.92
|
| Rate for Payer: Cigna of CA PPO |
$409.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$470.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$470.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$470.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.20
|
| Rate for Payer: EPIC Health Plan Senior |
$221.20
|
| Rate for Payer: Galaxy Health WC |
$470.05
|
| Rate for Payer: Global Benefits Group Commercial |
$331.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$56.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$368.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$342.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$387.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$387.10
|
| Rate for Payer: Multiplan Commercial |
$442.40
|
| Rate for Payer: Networks By Design Commercial |
$359.45
|
| Rate for Payer: Prime Health Services Commercial |
$470.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$331.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$331.80
|
| 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 |
$470.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$470.05
|
| Rate for Payer: Vantage Medical Group Senior |
$470.05
|
|
|
HC TRT SWALLOW/ORAL FUNC FEEDING MCAL
|
Facility
|
OP
|
$553.00
|
|
|
Service Code
|
CPT 92526
|
| Hospital Charge Code |
907000039
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$56.82 |
| Max. Negotiated Rate |
$470.05 |
| Rate for Payer: Adventist Health Commercial |
$226.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$362.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$470.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$304.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$414.75
|
| 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 |
$248.85
|
| Rate for Payer: Cash Price |
$248.85
|
| Rate for Payer: Cash Price |
$248.85
|
| Rate for Payer: Cash Price |
$248.85
|
| Rate for Payer: Cigna of CA HMO |
$353.92
|
| Rate for Payer: Cigna of CA PPO |
$409.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$470.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$470.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$470.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.20
|
| Rate for Payer: EPIC Health Plan Senior |
$221.20
|
| Rate for Payer: Galaxy Health WC |
$470.05
|
| Rate for Payer: Global Benefits Group Commercial |
$331.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$56.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$368.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$342.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$387.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$387.10
|
| Rate for Payer: Multiplan Commercial |
$442.40
|
| Rate for Payer: Networks By Design Commercial |
$359.45
|
| Rate for Payer: Prime Health Services Commercial |
$470.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$331.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$331.80
|
| 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 |
$470.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$470.05
|
| Rate for Payer: Vantage Medical Group Senior |
$470.05
|
|
|
HC TRT SWALLOW/ORAL FUNC FEEDING MCAL
|
Facility
|
IP
|
$553.00
|
|
|
Service Code
|
CPT 92526
|
| Hospital Charge Code |
901300021
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$110.60 |
| Max. Negotiated Rate |
$470.05 |
| Rate for Payer: Adventist Health Commercial |
$110.60
|
| Rate for Payer: Cash Price |
$248.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.20
|
| Rate for Payer: EPIC Health Plan Senior |
$221.20
|
| Rate for Payer: Galaxy Health WC |
$470.05
|
| Rate for Payer: Global Benefits Group Commercial |
$331.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$368.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$210.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$342.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.72
|
| Rate for Payer: Multiplan Commercial |
$442.40
|
| Rate for Payer: Networks By Design Commercial |
$359.45
|
| Rate for Payer: Prime Health Services Commercial |
$470.05
|
|
|
HC TRT SWALLOW/ORAL FUNC FEEDING MCAL
|
Facility
|
IP
|
$553.00
|
|
|
Service Code
|
CPT 92526
|
| Hospital Charge Code |
907000039
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$110.60 |
| Max. Negotiated Rate |
$470.05 |
| Rate for Payer: Adventist Health Commercial |
$110.60
|
| Rate for Payer: Cash Price |
$248.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.20
|
| Rate for Payer: EPIC Health Plan Senior |
$221.20
|
| Rate for Payer: Galaxy Health WC |
$470.05
|
| Rate for Payer: Global Benefits Group Commercial |
$331.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$368.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$210.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$342.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.72
|
| Rate for Payer: Multiplan Commercial |
$442.40
|
| Rate for Payer: Networks By Design Commercial |
$359.45
|
| Rate for Payer: Prime Health Services Commercial |
$470.05
|
|
|
HC TRT SWALLOW ORAL FUNC FEEDING MCARE COMM
|
Facility
|
OP
|
$553.00
|
|
|
Service Code
|
CPT 92526
|
| Hospital Charge Code |
901300802
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$56.82 |
| Max. Negotiated Rate |
$470.05 |
| Rate for Payer: Adventist Health Commercial |
$226.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$362.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$470.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$304.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$414.75
|
| 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 |
$248.85
|
| Rate for Payer: Cash Price |
$248.85
|
| Rate for Payer: Cash Price |
$248.85
|
| Rate for Payer: Cash Price |
$248.85
|
| Rate for Payer: Cigna of CA HMO |
$353.92
|
| Rate for Payer: Cigna of CA PPO |
$409.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$470.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$470.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$470.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.20
|
| Rate for Payer: EPIC Health Plan Senior |
$221.20
|
| Rate for Payer: Galaxy Health WC |
$470.05
|
| Rate for Payer: Global Benefits Group Commercial |
$331.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$56.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$368.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$342.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$387.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$387.10
|
| Rate for Payer: Multiplan Commercial |
$442.40
|
| Rate for Payer: Networks By Design Commercial |
$359.45
|
| Rate for Payer: Prime Health Services Commercial |
$470.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$331.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$331.80
|
| 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 |
$470.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$470.05
|
| Rate for Payer: Vantage Medical Group Senior |
$470.05
|
|
