|
LANTHANUM 1,000 MG CHEWABLE TABLET [43548]
|
Facility
|
OP
|
$12.95
|
|
|
Service Code
|
NDC 6699342475
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$11.01 |
| Rate for Payer: Adventist Health Commercial |
$2.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.31
|
| Rate for Payer: Cash Price |
$5.83
|
| Rate for Payer: Cigna of CA HMO |
$9.06
|
| Rate for Payer: Cigna of CA PPO |
$9.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.18
|
| Rate for Payer: EPIC Health Plan Senior |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$11.01
|
| Rate for Payer: Global Benefits Group Commercial |
$7.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.06
|
| Rate for Payer: Multiplan Commercial |
$10.36
|
| Rate for Payer: Networks By Design Commercial |
$6.47
|
| Rate for Payer: Prime Health Services Commercial |
$11.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.86
|
| Rate for Payer: United Healthcare All Other HMO |
$4.73
|
| Rate for Payer: United Healthcare HMO Rider |
$4.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.01
|
| Rate for Payer: Vantage Medical Group Senior |
$11.01
|
|
|
LANTHANUM 1,000 MG CHEWABLE TABLET [43548]
|
Facility
|
IP
|
$12.95
|
|
|
Service Code
|
NDC 6699342485
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$11.01 |
| Rate for Payer: Adventist Health Commercial |
$2.59
|
| Rate for Payer: Blue Shield of California Commercial |
$6.57
|
| Rate for Payer: Blue Shield of California Commercial |
$9.96
|
| Rate for Payer: Cash Price |
$5.83
|
| Rate for Payer: Cigna of CA HMO |
$9.06
|
| Rate for Payer: Cigna of CA PPO |
$9.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.18
|
| Rate for Payer: EPIC Health Plan Senior |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$11.01
|
| Rate for Payer: Global Benefits Group Commercial |
$7.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.11
|
| Rate for Payer: Multiplan Commercial |
$10.36
|
| Rate for Payer: Networks By Design Commercial |
$6.47
|
| Rate for Payer: Prime Health Services Commercial |
$11.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.86
|
| Rate for Payer: United Healthcare All Other HMO |
$4.73
|
| Rate for Payer: United Healthcare HMO Rider |
$4.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.24
|
|
|
LANTHANUM 1,000 MG CHEWABLE TABLET [43548]
|
Facility
|
IP
|
$6.67
|
|
|
Service Code
|
NDC 6818082110
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$5.67 |
| Rate for Payer: Adventist Health Commercial |
$1.33
|
| Rate for Payer: Blue Shield of California Commercial |
$3.38
|
| Rate for Payer: Blue Shield of California Commercial |
$5.13
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna of CA HMO |
$4.67
|
| Rate for Payer: Cigna of CA PPO |
$4.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.67
|
| Rate for Payer: EPIC Health Plan Senior |
$2.67
|
| Rate for Payer: Galaxy Health WC |
$5.67
|
| Rate for Payer: Global Benefits Group Commercial |
$4.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.60
|
| Rate for Payer: Multiplan Commercial |
$5.34
|
| Rate for Payer: Networks By Design Commercial |
$3.33
|
| Rate for Payer: Prime Health Services Commercial |
$5.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2.44
|
| Rate for Payer: United Healthcare HMO Rider |
$2.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.18
|
|
|
LANTHANUM 1,000 MG CHEWABLE TABLET [43548]
|
Facility
|
OP
|
$6.67
|
|
|
Service Code
|
NDC 6818082147
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$5.67 |
| Rate for Payer: Adventist Health Commercial |
$1.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.28
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna of CA HMO |
$4.67
|
| Rate for Payer: Cigna of CA PPO |
$4.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.67
|
| Rate for Payer: EPIC Health Plan Senior |
$2.67
|
| Rate for Payer: Galaxy Health WC |
$5.67
|
| Rate for Payer: Global Benefits Group Commercial |
$4.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.67
|
| Rate for Payer: Multiplan Commercial |
$5.34
|
| Rate for Payer: Networks By Design Commercial |
$3.33
|
| Rate for Payer: Prime Health Services Commercial |
$5.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2.44
|
| Rate for Payer: United Healthcare HMO Rider |
$2.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.67
|
| Rate for Payer: Vantage Medical Group Senior |
$5.67
|
|
|
LANTHANUM 1,000 MG CHEWABLE TABLET [43548]
|
Facility
|
OP
|
$6.67
|
|
|
Service Code
|
NDC 6818082110
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$5.67 |
| Rate for Payer: Adventist Health Commercial |
$1.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.28
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna of CA HMO |
$4.67
|
| Rate for Payer: Cigna of CA PPO |
$4.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.67
|
| Rate for Payer: EPIC Health Plan Senior |
$2.67
|
| Rate for Payer: Galaxy Health WC |
$5.67
|
| Rate for Payer: Global Benefits Group Commercial |
$4.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.67
|
| Rate for Payer: Multiplan Commercial |
$5.34
|
| Rate for Payer: Networks By Design Commercial |
$3.33
|
| Rate for Payer: Prime Health Services Commercial |
$5.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2.44
|
| Rate for Payer: United Healthcare HMO Rider |
$2.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.67
|
| Rate for Payer: Vantage Medical Group Senior |
$5.67
|
|
|
LANTHANUM 500 MG CHEWABLE TABLET [39975]
|
Facility
|
IP
|
$14.41
|
|
|
Service Code
|
NDC 5409225245
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$12.25 |
| Rate for Payer: Adventist Health Commercial |
$2.88
|
| Rate for Payer: Blue Shield of California Commercial |
$11.08
|
| Rate for Payer: Blue Shield of California Commercial |
$7.31
|
| Rate for Payer: Cash Price |
$6.48
|
| Rate for Payer: Cigna of CA HMO |
$10.09
|
| Rate for Payer: Cigna of CA PPO |
$10.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| Rate for Payer: EPIC Health Plan Senior |
$5.76
|
| Rate for Payer: Galaxy Health WC |
$12.25
|
| Rate for Payer: Global Benefits Group Commercial |
$8.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.46
|
| Rate for Payer: Multiplan Commercial |
$11.53
|
| Rate for Payer: Networks By Design Commercial |
$7.21
|
| Rate for Payer: Prime Health Services Commercial |
$12.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.41
|
| Rate for Payer: United Healthcare All Other HMO |
$5.26
|
| Rate for Payer: United Healthcare HMO Rider |
$5.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.72
|
|
|
LANTHANUM 500 MG CHEWABLE TABLET [39975]
|
Facility
|
OP
|
$14.41
|
|
|
Service Code
|
NDC 5409225245
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$12.25 |
| Rate for Payer: Adventist Health Commercial |
$2.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.25
|
| Rate for Payer: Cash Price |
$6.48
|
| Rate for Payer: Cigna of CA HMO |
$10.09
|
| Rate for Payer: Cigna of CA PPO |
$10.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| Rate for Payer: EPIC Health Plan Senior |
$5.76
|
| Rate for Payer: Galaxy Health WC |
$12.25
|
| Rate for Payer: Global Benefits Group Commercial |
$8.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.09
|
| Rate for Payer: Multiplan Commercial |
$11.53
|
| Rate for Payer: Networks By Design Commercial |
$7.21
|
| Rate for Payer: Prime Health Services Commercial |
$12.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.41
|
| Rate for Payer: United Healthcare All Other HMO |
$5.26
|
| Rate for Payer: United Healthcare HMO Rider |
$5.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.25
|
| Rate for Payer: Vantage Medical Group Senior |
$12.25
|
|
|
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC
|
Facility
|
IP
|
$109,266.76
|
|
|
Service Code
|
MSDRG 418
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$109,266.76 |
| Rate for Payer: Aetna of CA HMO/PPO |
$51,282.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$109,266.76
|
| Rate for Payer: EPIC Health Plan Senior |
$72,844.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$66,222.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$92,711.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$88,737.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC
|
Facility
|
IP
|
$121,595.89
|
|
|
Service Code
|
MSDRG 417
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$121,595.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$72,346.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$121,595.89
|
| Rate for Payer: EPIC Health Plan Senior |
$81,063.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$73,694.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$103,172.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$98,750.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC
|
Facility
|
IP
|
$103,485.49
|
|
|
Service Code
|
MSDRG 419
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$103,485.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$41,405.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$103,485.49
|
| Rate for Payer: EPIC Health Plan Senior |
$68,990.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62,718.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87,805.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$84,042.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
LAPAROSCOPY, ABDOMEN, PERITONEUM, AND OMENTUM, DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 49320
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$78.81 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,663.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,553.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,775.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,454.70
|
| Rate for Payer: Blue Shield of California Commercial |
$2,942.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,663.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,553.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,775.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,829.67
|
| Rate for Payer: EPIC Health Plan Senior |
$8,553.12
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,751.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$78.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,775.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$89.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,885.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,797.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,419.25
|
| Rate for Payer: Multiplan WC |
$11,811.52
|
| Rate for Payer: Prime Health Services WC |
$11,690.99
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,775.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,663.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,553.12
|
| Rate for Payer: Vantage Medical Group Senior |
$7,775.56
|
|
|
LAPAROSCOPY, SURGICAL, APPENDECTOMY
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 44970
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$91.95 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,663.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,553.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,775.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,663.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,553.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,775.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,829.67
|
| Rate for Payer: EPIC Health Plan Senior |
$8,553.12
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,751.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$91.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,775.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$103.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,885.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,797.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,419.25
|
| Rate for Payer: Multiplan WC |
$11,811.52
|
| Rate for Payer: Prime Health Services WC |
$11,690.99
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,775.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,663.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,553.12
|
| Rate for Payer: Vantage Medical Group Senior |
$7,775.56
|
|
|
LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 47562
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$783.08 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,663.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,553.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,775.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,261.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,695.24
|
| Rate for Payer: Blue Shield of California Commercial |
$5,743.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,663.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,553.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,775.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,829.67
|
| Rate for Payer: EPIC Health Plan Senior |
$8,553.12
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,751.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$783.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,775.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$885.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,885.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,797.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,419.25
|
| Rate for Payer: Multiplan WC |
$11,811.52
|
| Rate for Payer: Prime Health Services WC |
$11,690.99
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,775.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,663.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,553.12
|
| Rate for Payer: Vantage Medical Group Senior |
$7,775.56
|
|
|
LAPAROSCOPY, SURGICAL; REPAIR INITIAL INGUINAL HERNIA
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 49650
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$444.71 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,663.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,553.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,775.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,104.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,638.65
|
| Rate for Payer: Blue Shield of California Commercial |
$5,508.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,663.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,553.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,775.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,829.67
|
| Rate for Payer: EPIC Health Plan Senior |
$8,553.12
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,751.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$444.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,775.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$502.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,885.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,797.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,419.25
|
| Rate for Payer: Multiplan WC |
$11,811.52
|
| Rate for Payer: Prime Health Services WC |
$11,690.99
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,775.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,663.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,553.12
|
| Rate for Payer: Vantage Medical Group Senior |
$7,775.56
|
|
|
LAPAROSCOPY, SURGICAL; WITH ASPIRATION OF CAVITY OR CYST (EG, OVARIAN CYST) (SINGLE OR MULTIPLE)
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 49322
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$86.94 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,663.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,553.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,775.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,924.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,508.41
|
| Rate for Payer: Blue Shield of California Commercial |
$3,638.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,663.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,553.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,775.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,829.67
|
| Rate for Payer: EPIC Health Plan Senior |
$8,553.12
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,751.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$86.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,775.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$98.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,885.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,797.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,419.25
|
| Rate for Payer: Multiplan WC |
$11,811.52
|
| Rate for Payer: Prime Health Services WC |
$11,690.99
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,775.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,663.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,553.12
|
| Rate for Payer: Vantage Medical Group Senior |
$7,775.56
|
|
|
LAPAROSCOPY, SURGICAL; WITH FULGURATION OR EXCISION OF LESIONS OF THE OVARY, PELVIC VISCERA, OR PERITONEAL SURFACE BY ANY METHOD
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 58662
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$513.51 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,663.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,553.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,775.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,323.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,136.63
|
| Rate for Payer: Blue Shield of California Commercial |
$6,262.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,663.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,553.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,775.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,829.67
|
| Rate for Payer: EPIC Health Plan Senior |
$8,553.12
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,751.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$513.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,775.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$580.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,885.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,797.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,419.25
|
| Rate for Payer: Multiplan WC |
$11,811.52
|
| Rate for Payer: Prime Health Services WC |
$11,690.99
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,775.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,663.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,553.12
|
| Rate for Payer: Vantage Medical Group Senior |
$7,775.56
|
|
|
LAPAROSCOPY, SURGICAL; WITH REMOVAL OF ADNEXAL STRUCTURES (PARTIAL OR TOTAL OOPHORECTOMY AND/OR SALPINGECTOMY)
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 58661
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$164.29 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,663.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,553.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,775.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,759.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,262.29
|
| Rate for Payer: Blue Shield of California Commercial |
$4,136.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,663.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,553.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,775.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,829.67
|
| Rate for Payer: EPIC Health Plan Senior |
$8,553.12
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,751.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$164.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,775.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$185.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,885.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,797.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,419.25
|
| Rate for Payer: Multiplan WC |
$11,811.52
|
| Rate for Payer: Prime Health Services WC |
$11,690.99
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,775.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,663.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,553.12
|
| Rate for Payer: Vantage Medical Group Senior |
$7,775.56
|
|
|
LARONIDASE 2.9 MG/5 ML INTRAVENOUS SOLUTION [35779]
|
Facility
|
IP
|
$277.90
|
|
|
Service Code
|
HCPCS J1931
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.58 |
| Max. Negotiated Rate |
$236.22 |
| Rate for Payer: Adventist Health Commercial |
$55.58
|
| Rate for Payer: Blue Shield of California Commercial |
$140.90
|
| Rate for Payer: Blue Shield of California Commercial |
$213.71
|
| Rate for Payer: Cash Price |
$125.06
|
| Rate for Payer: Cigna of CA HMO |
$194.53
|
| Rate for Payer: Cigna of CA PPO |
$194.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$194.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.16
|
| Rate for Payer: EPIC Health Plan Senior |
$111.16
|
| Rate for Payer: Galaxy Health WC |
$236.22
|
| Rate for Payer: Global Benefits Group Commercial |
$166.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$176.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$163.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.70
|
| Rate for Payer: Multiplan Commercial |
$222.32
|
| Rate for Payer: Networks By Design Commercial |
$138.95
|
| Rate for Payer: Prime Health Services Commercial |
$236.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$104.30
|
| Rate for Payer: United Healthcare All Other HMO |
$101.52
|
| Rate for Payer: United Healthcare HMO Rider |
$99.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$91.01
|
|
|
LARONIDASE 2.9 MG/5 ML INTRAVENOUS SOLUTION [35779]
|
Facility
|
OP
|
$277.90
|
|
|
Service Code
|
HCPCS J1931
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.49 |
| Max. Negotiated Rate |
$242.80 |
| Rate for Payer: Adventist Health Commercial |
$55.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$242.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.13
|
| Rate for Payer: Blue Shield of California Commercial |
$44.30
|
| Rate for Payer: Cash Price |
$125.06
|
| Rate for Payer: Cash Price |
$125.06
|
| Rate for Payer: Cigna of CA HMO |
$194.53
|
| Rate for Payer: Cigna of CA PPO |
$194.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$45.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$194.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.46
|
| Rate for Payer: EPIC Health Plan Senior |
$45.64
|
| Rate for Payer: Galaxy Health WC |
$236.22
|
| Rate for Payer: Global Benefits Group Commercial |
$166.74
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$68.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$41.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$41.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$176.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$75.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$58.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$52.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$55.60
|
| Rate for Payer: Multiplan Commercial |
$222.32
|
| Rate for Payer: Networks By Design Commercial |
$138.95
|
| Rate for Payer: Prime Health Services Commercial |
$236.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$166.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$166.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$104.30
|
| Rate for Payer: United Healthcare All Other HMO |
$101.52
|
| Rate for Payer: United Healthcare HMO Rider |
$99.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$91.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$41.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.64
|
| Rate for Payer: Vantage Medical Group Senior |
$45.64
|
|
|
LARYNGOSCOPY, DIRECT, OPERATIVE, WITH EXCISION OF TUMOR AND/OR STRIPPING OF VOCAL CORDS OR EPIGLOTTIS; WITH OPERATING MICROSCOPE OR TELESCOPE
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 31541
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$450.34 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,274.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,795.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,638.65
|
| Rate for Payer: Blue Shield of California Commercial |
$5,508.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,274.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,795.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,912.21
|
| Rate for Payer: EPIC Health Plan Senior |
$5,274.81
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,864.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$450.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,795.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$509.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,713.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,042.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,425.68
|
| Rate for Payer: Multiplan WC |
$7,464.14
|
| Rate for Payer: Prime Health Services WC |
$7,387.98
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,795.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,274.81
|
| Rate for Payer: Vantage Medical Group Senior |
$4,795.28
|
|
|
LARYNGOSCOPY, DIRECT, OPERATIVE, WITH FOREIGN BODY REMOVAL;
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 31530
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$375.28 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,518.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,289.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,518.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,289.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,777.26
|
| Rate for Payer: EPIC Health Plan Senior |
$2,518.18
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,754.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$375.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,289.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$424.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,204.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,884.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,067.59
|
| Rate for Payer: Multiplan WC |
$3,491.15
|
| Rate for Payer: Prime Health Services WC |
$3,455.53
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,289.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,518.18
|
| Rate for Payer: Vantage Medical Group Senior |
$2,289.25
|
|
|
LARYNGOSCOPY, DIRECT, WITH INJECTION INTO VOCAL CORD(S), THERAPEUTIC; WITH OPERATING MICROSCOPE OR TELESCOPE
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 31571
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$74.42 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,274.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,795.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,274.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,795.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,912.21
|
| Rate for Payer: EPIC Health Plan Senior |
$5,274.81
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,864.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$74.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,795.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$84.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,713.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,042.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,425.68
|
| Rate for Payer: Multiplan WC |
$7,464.14
|
| Rate for Payer: Prime Health Services WC |
$7,387.98
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,795.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,274.81
|
| Rate for Payer: Vantage Medical Group Senior |
$4,795.28
|
|
|
LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; DIAGNOSTIC, WITH OPERATING MICROSCOPE OR TELESCOPE
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 31526
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$232.04 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,518.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,289.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,518.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,289.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,777.26
|
| Rate for Payer: EPIC Health Plan Senior |
$2,518.18
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,754.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$232.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,289.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$262.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,204.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,884.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,067.59
|
| Rate for Payer: Multiplan WC |
$3,491.15
|
| Rate for Payer: Prime Health Services WC |
$3,455.53
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,289.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,518.18
|
| Rate for Payer: Vantage Medical Group Senior |
$2,289.25
|
|
|
LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; FOR ASPIRATION
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 31515
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$118.20 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$754.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$553.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$503.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$754.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$553.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$503.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$830.02
|
| Rate for Payer: EPIC Health Plan Senior |
$553.34
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$824.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$118.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$503.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$133.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$704.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$633.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$674.07
|
| Rate for Payer: Multiplan WC |
$786.13
|
| Rate for Payer: Prime Health Services WC |
$778.10
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$503.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$754.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$553.34
|
| Rate for Payer: Vantage Medical Group Senior |
$503.04
|
|
|
LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; WITH DILATION, INITIAL
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 31528
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$375.28 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,274.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,795.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,274.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,795.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,912.21
|
| Rate for Payer: EPIC Health Plan Senior |
$5,274.81
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,864.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$375.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,795.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$424.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,713.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,042.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,425.68
|
| Rate for Payer: Multiplan WC |
$7,464.14
|
| Rate for Payer: Prime Health Services WC |
$7,387.98
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,795.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,274.81
|
| Rate for Payer: Vantage Medical Group Senior |
$4,795.28
|
|
