|
HC BREAST PX MSTCTMY BRA W/INTGRT UNI
|
Facility
|
OP
|
$368.00
|
|
|
Service Code
|
CPT L8001
|
| Hospital Charge Code |
915358001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$88.32 |
| Max. Negotiated Rate |
$312.80 |
| Rate for Payer: Adventist Health Commercial |
$150.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$312.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$202.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$276.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$222.75
|
| Rate for Payer: Blue Shield of California Commercial |
$282.99
|
| Rate for Payer: Blue Shield of California Commercial |
$186.58
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cigna of CA HMO |
$257.60
|
| Rate for Payer: Cigna of CA PPO |
$257.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$312.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$312.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$312.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$257.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$147.20
|
| Rate for Payer: EPIC Health Plan Senior |
$147.20
|
| Rate for Payer: Galaxy Health WC |
$312.80
|
| Rate for Payer: Global Benefits Group Commercial |
$220.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$132.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$233.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$150.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$217.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$257.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$257.60
|
| Rate for Payer: Multiplan Commercial |
$294.40
|
| Rate for Payer: Networks By Design Commercial |
$184.00
|
| Rate for Payer: Prime Health Services Commercial |
$312.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$220.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$220.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$138.11
|
| Rate for Payer: United Healthcare All Other HMO |
$134.43
|
| Rate for Payer: United Healthcare HMO Rider |
$131.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$120.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$312.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$312.80
|
| Rate for Payer: Vantage Medical Group Senior |
$312.80
|
|
|
HC BREAST PX MSTCTMY BRA W/INTGRT UNI
|
Facility
|
OP
|
$368.00
|
|
|
Service Code
|
CPT L8001
|
| Hospital Charge Code |
905358001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$88.32 |
| Max. Negotiated Rate |
$312.80 |
| Rate for Payer: Adventist Health Commercial |
$150.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$312.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$202.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$276.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$222.75
|
| Rate for Payer: Blue Shield of California Commercial |
$282.99
|
| Rate for Payer: Blue Shield of California Commercial |
$186.58
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cigna of CA HMO |
$257.60
|
| Rate for Payer: Cigna of CA PPO |
$257.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$312.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$312.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$312.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$257.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$147.20
|
| Rate for Payer: EPIC Health Plan Senior |
$147.20
|
| Rate for Payer: Galaxy Health WC |
$312.80
|
| Rate for Payer: Global Benefits Group Commercial |
$220.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$132.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$233.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$150.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$217.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$257.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$257.60
|
| Rate for Payer: Multiplan Commercial |
$294.40
|
| Rate for Payer: Networks By Design Commercial |
$184.00
|
| Rate for Payer: Prime Health Services Commercial |
$312.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$220.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$220.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$138.11
|
| Rate for Payer: United Healthcare All Other HMO |
$134.43
|
| Rate for Payer: United Healthcare HMO Rider |
$131.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$120.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$312.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$312.80
|
| Rate for Payer: Vantage Medical Group Senior |
$312.80
|
|
|
HC BREAST PX MSTCTMY BRA W/INTGRT UNI
|
Facility
|
IP
|
$368.00
|
|
|
Service Code
|
CPT L8001
|
| Hospital Charge Code |
915358001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$73.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$73.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cigna of CA HMO |
$257.60
|
| Rate for Payer: Cigna of CA PPO |
$257.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$257.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$147.20
|
| Rate for Payer: EPIC Health Plan Senior |
$147.20
|
| Rate for Payer: Galaxy Health WC |
$312.80
|
| Rate for Payer: Global Benefits Group Commercial |
$220.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$233.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$217.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.32
|
| Rate for Payer: Multiplan Commercial |
$294.40
|
| Rate for Payer: Networks By Design Commercial |
$239.20
|
| Rate for Payer: Prime Health Services Commercial |
$312.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$138.11
|
| Rate for Payer: United Healthcare All Other HMO |
$134.43
|
| Rate for Payer: United Healthcare HMO Rider |
$131.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$120.52
|
|
|
HC BREAST PX MSTCTMY BRA W/INTGRT UNI
|
Facility
|
IP
|
$368.00
|
|
|
Service Code
|
CPT L8001
|
| Hospital Charge Code |
905358001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$73.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$73.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cigna of CA HMO |
$257.60
|
| Rate for Payer: Cigna of CA PPO |
$257.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$257.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$147.20
|
| Rate for Payer: EPIC Health Plan Senior |
$147.20
|
| Rate for Payer: Galaxy Health WC |
$312.80
|
| Rate for Payer: Global Benefits Group Commercial |
$220.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$233.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$217.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.32
|
| Rate for Payer: Multiplan Commercial |
$294.40
|
| Rate for Payer: Networks By Design Commercial |
$239.20
|
| Rate for Payer: Prime Health Services Commercial |
$312.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$138.11
|
| Rate for Payer: United Healthcare All Other HMO |
$134.43
|
| Rate for Payer: United Healthcare HMO Rider |
$131.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$120.52
|
|
|
HC BREAST TOMO
|
Facility
|
IP
|
$2,311.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909002014
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$462.20 |
| Max. Negotiated Rate |
$1,964.35 |
| Rate for Payer: Adventist Health Commercial |
$462.20
|
| Rate for Payer: Cash Price |
$1,039.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,617.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$924.40
|
| Rate for Payer: EPIC Health Plan Senior |
$924.40
|
| Rate for Payer: Galaxy Health WC |
$1,964.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,386.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,467.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,363.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$554.64
|
| Rate for Payer: Multiplan Commercial |
$1,848.80
|
| Rate for Payer: Networks By Design Commercial |
$1,502.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,964.35
|
|
|
HC BREAST TOMO
|
Facility
|
OP
|
$2,311.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909002014
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$462.20 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$462.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,964.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,271.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,733.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,482.97
|
| Rate for Payer: Blue Shield of California Commercial |
$1,474.42
|
| Rate for Payer: Blue Shield of California Commercial |
$972.93
|
| Rate for Payer: Cash Price |
$1,039.95
|
| Rate for Payer: Cash Price |
$1,039.95
|
| Rate for Payer: Cigna of CA HMO |
$1,479.04
|
| Rate for Payer: Cigna of CA PPO |
$1,710.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,964.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,964.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,964.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,617.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$924.40
|
| Rate for Payer: EPIC Health Plan Senior |
$924.40
|
| Rate for Payer: Galaxy Health WC |
$1,964.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,386.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,467.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$838.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,363.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$554.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,617.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,617.70
|
| Rate for Payer: Multiplan Commercial |
$1,848.80
|
| Rate for Payer: Networks By Design Commercial |
$1,502.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,964.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,386.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,386.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,155.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,155.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,155.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,155.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,964.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,964.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,964.35
|
|
|
HC BREAST TOMO COMBO
|
Facility
|
IP
|
$2,311.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909002017
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$462.20 |
| Max. Negotiated Rate |
$1,964.35 |
| Rate for Payer: Adventist Health Commercial |
$462.20
|
| Rate for Payer: Cash Price |
$1,039.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,617.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$924.40
|
| Rate for Payer: EPIC Health Plan Senior |
$924.40
|
| Rate for Payer: Galaxy Health WC |
$1,964.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,386.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,467.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,363.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$554.64
|
| Rate for Payer: Multiplan Commercial |
$1,848.80
|
| Rate for Payer: Networks By Design Commercial |
$1,502.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,964.35
|
|
|
HC BREAST TOMO COMBO
|
Facility
|
OP
|
$2,311.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909002017
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$462.20 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$462.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,964.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,271.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,733.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,482.97
|
| Rate for Payer: Blue Shield of California Commercial |
$1,474.42
|
| Rate for Payer: Blue Shield of California Commercial |
$972.93
|
| Rate for Payer: Cash Price |
$1,039.95
|
| Rate for Payer: Cash Price |
$1,039.95
|
| Rate for Payer: Cigna of CA HMO |
$1,479.04
|
| Rate for Payer: Cigna of CA PPO |
$1,710.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,964.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,964.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,964.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,617.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$924.40
|
| Rate for Payer: EPIC Health Plan Senior |
$924.40
|
| Rate for Payer: Galaxy Health WC |
$1,964.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,386.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,467.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$838.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,363.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$554.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,617.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,617.70
|
| Rate for Payer: Multiplan Commercial |
$1,848.80
|
| Rate for Payer: Networks By Design Commercial |
$1,502.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,964.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,386.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,386.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,155.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,155.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,155.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,155.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,964.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,964.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,964.35
|
|
|
HC BREATHING RESPONSE TO HYPOXIA
|
Facility
|
OP
|
$415.00
|
|
|
Service Code
|
CPT 94450
|
| Hospital Charge Code |
900801450
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$40.66 |
| Max. Negotiated Rate |
$764.00 |
| Rate for Payer: Adventist Health Commercial |
$83.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$294.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$266.31
|
| Rate for Payer: Blue Shield of California Commercial |
$174.72
|
| Rate for Payer: Blue Shield of California Commercial |
$264.77
|
| Rate for Payer: Cash Price |
$186.75
|
| Rate for Payer: Cash Price |
$186.75
|
| Rate for Payer: Cash Price |
$186.75
|
| Rate for Payer: Cigna of CA HMO |
$265.60
|
| Rate for Payer: Cigna of CA PPO |
$307.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$290.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.06
|
| Rate for Payer: EPIC Health Plan Senior |
$182.04
|
| Rate for Payer: Galaxy Health WC |
$352.75
|
| Rate for Payer: Global Benefits Group Commercial |
$249.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$271.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$40.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$263.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$45.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$231.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$208.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$221.76
|
| Rate for Payer: Multiplan Commercial |
$332.00
|
| Rate for Payer: Networks By Design Commercial |
$269.75
|
| Rate for Payer: Prime Health Services Commercial |
$352.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$249.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$249.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$165.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Vantage Medical Group Senior |
$165.49
|
|
|
HC BREATHING RESPONSE TO HYPOXIA
|
Facility
|
IP
|
$415.00
|
|
|
Service Code
|
CPT 94450
|
| Hospital Charge Code |
900801450
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$83.00 |
| Max. Negotiated Rate |
$352.75 |
| Rate for Payer: Adventist Health Commercial |
$83.00
|
| Rate for Payer: Cash Price |
$186.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$290.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$166.00
|
| Rate for Payer: EPIC Health Plan Senior |
$166.00
|
| Rate for Payer: Galaxy Health WC |
$352.75
|
| Rate for Payer: Global Benefits Group Commercial |
$249.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$263.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$244.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.60
|
| Rate for Payer: Multiplan Commercial |
$332.00
|
| Rate for Payer: Networks By Design Commercial |
$269.75
|
| Rate for Payer: Prime Health Services Commercial |
$352.75
|
|
|
HC BRISK PROFILE
|
Facility
|
IP
|
$445.00
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
900912001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$89.00 |
| Max. Negotiated Rate |
$378.25 |
| Rate for Payer: Adventist Health Commercial |
$89.00
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$311.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.00
|
| Rate for Payer: EPIC Health Plan Senior |
$178.00
|
| Rate for Payer: Galaxy Health WC |
$378.25
|
| Rate for Payer: Global Benefits Group Commercial |
$267.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$282.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$262.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.80
|
| Rate for Payer: Multiplan Commercial |
$356.00
|
| Rate for Payer: Networks By Design Commercial |
$289.25
|
| Rate for Payer: Prime Health Services Commercial |
$378.25
|
|
|
HC BRISK PROFILE
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
900912001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$19.99 |
| Max. Negotiated Rate |
$188.38 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Adventist Health Commercial |
$89.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$178.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$178.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$188.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$188.38
|
| Rate for Payer: Blue Shield of California Commercial |
$205.15
|
| Rate for Payer: Blue Shield of California Commercial |
$108.73
|
| Rate for Payer: Blue Shield of California Commercial |
$310.17
|
| Rate for Payer: Blue Shield of California Commercial |
$71.92
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna of CA HMO |
$284.80
|
| Rate for Payer: Cigna of CA HMO |
$99.84
|
| Rate for Payer: Cigna of CA PPO |
$115.44
|
| Rate for Payer: Cigna of CA PPO |
$329.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$109.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$311.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.10
|
| Rate for Payer: EPIC Health Plan Senior |
$27.40
|
| Rate for Payer: EPIC Health Plan Senior |
$27.40
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Galaxy Health WC |
$378.25
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Global Benefits Group Commercial |
$267.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$40.85
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$40.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$99.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$282.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.38
|
| Rate for Payer: Multiplan Commercial |
$356.00
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: Networks By Design Commercial |
$289.25
|
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
| Rate for Payer: Prime Health Services Commercial |
$378.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$93.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$267.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$93.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$267.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.18
|
| Rate for Payer: United Healthcare All Other HMO |
$20.18
|
| Rate for Payer: United Healthcare All Other HMO |
$20.18
|
| Rate for Payer: United Healthcare HMO Rider |
$20.18
|
| Rate for Payer: United Healthcare HMO Rider |
$20.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.18
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.91
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.40
|
| Rate for Payer: Vantage Medical Group Senior |
$24.91
|
| Rate for Payer: Vantage Medical Group Senior |
$24.91
|
|
|
HC BRONCH COMTR AIDED NAVIGATION
|
Facility
|
IP
|
$1,338.00
|
|
|
Service Code
|
CPT 31627
|
| Hospital Charge Code |
900531627
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$267.60 |
| Max. Negotiated Rate |
$1,137.30 |
| Rate for Payer: Adventist Health Commercial |
$267.60
|
| Rate for Payer: Cash Price |
$602.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$936.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$535.20
|
| Rate for Payer: EPIC Health Plan Senior |
$535.20
|
| Rate for Payer: Galaxy Health WC |
$1,137.30
|
| Rate for Payer: Global Benefits Group Commercial |
$802.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$849.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$789.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.12
|
| Rate for Payer: Multiplan Commercial |
$1,070.40
|
| Rate for Payer: Networks By Design Commercial |
$869.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,137.30
|
|
|
HC BRONCH COMTR AIDED NAVIGATION
|
Facility
|
OP
|
$1,338.00
|
|
|
Service Code
|
CPT 31627
|
| Hospital Charge Code |
900531627
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$267.60 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$267.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,137.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$735.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,003.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$602.10
|
| Rate for Payer: Cash Price |
$602.10
|
| Rate for Payer: Cash Price |
$602.10
|
| Rate for Payer: Cigna of CA HMO |
$856.32
|
| Rate for Payer: Cigna of CA PPO |
$990.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,137.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,137.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,137.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$936.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$535.20
|
| Rate for Payer: EPIC Health Plan Senior |
$535.20
|
| Rate for Payer: Galaxy Health WC |
$1,137.30
|
| Rate for Payer: Global Benefits Group Commercial |
$802.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,816.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$849.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,054.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$789.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$936.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$936.60
|
| Rate for Payer: Multiplan Commercial |
$1,070.40
|
| Rate for Payer: Networks By Design Commercial |
$869.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,137.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$802.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$669.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,137.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,137.30
|
| Rate for Payer: Vantage Medical Group Senior |
$1,137.30
|
|
|
HC BRONCH EBUS PERIPHERAL LESION
|
Facility
|
OP
|
$3,281.00
|
|
|
Service Code
|
CPT 31654
|
| Hospital Charge Code |
900831654
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$216.42 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$656.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,788.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,804.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,460.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Cash Price |
$1,476.45
|
| Rate for Payer: Cash Price |
$1,476.45
|
| Rate for Payer: Cash Price |
$1,476.45
|
| Rate for Payer: Cigna of CA HMO |
$2,099.84
|
| Rate for Payer: Cigna of CA PPO |
$2,427.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,788.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,788.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,788.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,296.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,312.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,312.40
|
| Rate for Payer: Galaxy Health WC |
$2,788.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,968.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$216.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,083.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$244.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,935.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$787.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,296.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,296.70
|
| Rate for Payer: Multiplan Commercial |
$2,624.80
|
| Rate for Payer: Networks By Design Commercial |
$2,132.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,788.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,968.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,640.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,788.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,788.85
|
| Rate for Payer: Vantage Medical Group Senior |
$2,788.85
|
|
|
HC BRONCH EBUS PERIPHERAL LESION
|
Facility
|
IP
|
$3,281.00
|
|
|
Service Code
|
CPT 31654
|
| Hospital Charge Code |
900831654
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$656.20 |
| Max. Negotiated Rate |
$2,788.85 |
| Rate for Payer: Adventist Health Commercial |
$656.20
|
| Rate for Payer: Cash Price |
$1,476.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,296.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,312.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,312.40
|
| Rate for Payer: Galaxy Health WC |
$2,788.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,968.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,083.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,935.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$787.44
|
| Rate for Payer: Multiplan Commercial |
$2,624.80
|
| Rate for Payer: Networks By Design Commercial |
$2,132.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,788.85
|
|
|
HC BRONCH EBUS SAMP 1-2 NODES
|
Facility
|
IP
|
$5,322.00
|
|
|
Service Code
|
CPT 31652
|
| Hospital Charge Code |
900831652
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,064.40 |
| Max. Negotiated Rate |
$4,523.70 |
| Rate for Payer: Adventist Health Commercial |
$1,064.40
|
| Rate for Payer: Cash Price |
$2,394.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,725.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,128.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,128.80
|
| Rate for Payer: Galaxy Health WC |
$4,523.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,193.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,379.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,139.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,277.28
|
| Rate for Payer: Multiplan Commercial |
$4,257.60
|
| Rate for Payer: Networks By Design Commercial |
$3,459.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,523.70
|
|
|
HC BRONCH EBUS SAMP 1-2 NODES
|
Facility
|
OP
|
$5,322.00
|
|
|
Service Code
|
CPT 31652
|
| Hospital Charge Code |
900831652
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,064.40 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,064.40
|
| 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 |
$5,641.00
|
| 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: Cash Price |
$2,394.90
|
| Rate for Payer: Cash Price |
$2,394.90
|
| Rate for Payer: Cash Price |
$2,394.90
|
| Rate for Payer: Cigna of CA HMO |
$3,406.08
|
| Rate for Payer: Cigna of CA PPO |
$3,938.28
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,725.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,912.21
|
| Rate for Payer: EPIC Health Plan Senior |
$5,274.81
|
| Rate for Payer: Galaxy Health WC |
$4,523.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,193.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,864.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,389.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,795.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,379.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,571.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,713.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,277.28
|
| 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 Commercial |
$4,257.60
|
| Rate for Payer: Multiplan WC |
$7,464.14
|
| Rate for Payer: Networks By Design Commercial |
$3,459.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,523.70
|
| Rate for Payer: Prime Health Services WC |
$7,387.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,193.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,661.00
|
| 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
|
|
|
HC BRONCH EBUS SAMP 3 GT NODES
|
Facility
|
IP
|
$5,322.00
|
|
|
Service Code
|
CPT 31653
|
| Hospital Charge Code |
900831653
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,064.40 |
| Max. Negotiated Rate |
$4,523.70 |
| Rate for Payer: Networks By Design Commercial |
$3,459.30
|
| Rate for Payer: Adventist Health Commercial |
$1,064.40
|
| Rate for Payer: Cash Price |
$2,394.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,725.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,128.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,128.80
|
| Rate for Payer: Galaxy Health WC |
$4,523.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,193.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,379.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,139.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,277.28
|
| Rate for Payer: Multiplan Commercial |
$4,257.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,523.70
|
|
|
HC BRONCH EBUS SAMP 3 GT NODES
|
Facility
|
OP
|
$5,322.00
|
|
|
Service Code
|
CPT 31653
|
| Hospital Charge Code |
900831653
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,064.40 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,064.40
|
| 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 |
$5,641.00
|
| 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: Cash Price |
$2,394.90
|
| Rate for Payer: Cash Price |
$2,394.90
|
| Rate for Payer: Cash Price |
$2,394.90
|
| Rate for Payer: Cigna of CA HMO |
$3,406.08
|
| Rate for Payer: Cigna of CA PPO |
$3,938.28
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,725.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,912.21
|
| Rate for Payer: EPIC Health Plan Senior |
$5,274.81
|
| Rate for Payer: Galaxy Health WC |
$4,523.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,193.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,864.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,475.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,795.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,379.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,668.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,713.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,277.28
|
| 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 Commercial |
$4,257.60
|
| Rate for Payer: Multiplan WC |
$7,464.14
|
| Rate for Payer: Networks By Design Commercial |
$3,459.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,523.70
|
| Rate for Payer: Prime Health Services WC |
$7,387.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,193.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,661.00
|
| 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
|
|
|
HC BRONCH FOREIGN BODY REMOVAL
|
Facility
|
OP
|
$4,482.00
|
|
|
Service Code
|
CPT 31635
|
| Hospital Charge Code |
900803505
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$350.26 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: EPIC Health Plan Senior |
$2,518.18
|
| Rate for Payer: Galaxy Health WC |
$3,809.70
|
| Rate for Payer: Adventist Health Commercial |
$896.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,173.53
|
| 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: Cash Price |
$2,016.90
|
| Rate for Payer: Cash Price |
$2,016.90
|
| Rate for Payer: Cash Price |
$2,016.90
|
| Rate for Payer: Cigna of CA HMO |
$2,868.48
|
| Rate for Payer: Cigna of CA PPO |
$3,316.68
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,137.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,777.26
|
| Rate for Payer: Global Benefits Group Commercial |
$2,689.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,754.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$350.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,289.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,846.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$396.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,204.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,075.68
|
| 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 Commercial |
$3,585.60
|
| Rate for Payer: Networks By Design Commercial |
$2,913.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,809.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,689.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,689.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,241.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,241.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,241.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,241.00
|
| 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
|
|
|
HC BRONCH FOREIGN BODY REMOVAL
|
Facility
|
IP
|
$4,482.00
|
|
|
Service Code
|
CPT 31635
|
| Hospital Charge Code |
900803505
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$896.40 |
| Max. Negotiated Rate |
$3,809.70 |
| Rate for Payer: Adventist Health Commercial |
$896.40
|
| Rate for Payer: Cash Price |
$2,016.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,137.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,792.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,792.80
|
| Rate for Payer: Galaxy Health WC |
$3,809.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,689.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,846.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,644.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,075.68
|
| Rate for Payer: Multiplan Commercial |
$3,585.60
|
| Rate for Payer: Networks By Design Commercial |
$2,913.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,809.70
|
|
|
HC BRONCHIAL THERMOPLASTY 1 LOBE
|
Facility
|
OP
|
$8,193.00
|
|
|
Service Code
|
CPT 31660
|
| Hospital Charge Code |
900831660
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$313.35 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,638.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,984.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,077.07
|
| 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: Cash Price |
$3,686.85
|
| Rate for Payer: Cash Price |
$3,686.85
|
| Rate for Payer: Cash Price |
$3,686.85
|
| Rate for Payer: Cigna of CA HMO |
$5,243.52
|
| Rate for Payer: Cigna of CA PPO |
$6,062.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,984.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,077.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,735.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,977.17
|
| Rate for Payer: EPIC Health Plan Senior |
$9,984.78
|
| Rate for Payer: Galaxy Health WC |
$6,964.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,915.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14,886.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$313.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,077.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,202.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$354.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,707.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,966.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,437.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,163.27
|
| Rate for Payer: Multiplan Commercial |
$6,554.40
|
| Rate for Payer: Multiplan WC |
$14,014.35
|
| Rate for Payer: Networks By Design Commercial |
$5,325.45
|
| Rate for Payer: Prime Health Services Commercial |
$6,964.05
|
| Rate for Payer: Prime Health Services WC |
$13,871.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,915.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,096.50
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,077.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,984.78
|
| Rate for Payer: Vantage Medical Group Senior |
$9,077.07
|
|
|
HC BRONCHIAL THERMOPLASTY 1 LOBE
|
Facility
|
IP
|
$8,193.00
|
|
|
Service Code
|
CPT 31660
|
| Hospital Charge Code |
900831660
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,638.60 |
| Max. Negotiated Rate |
$6,964.05 |
| Rate for Payer: Adventist Health Commercial |
$1,638.60
|
| Rate for Payer: Cash Price |
$3,686.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,735.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,277.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,277.20
|
| Rate for Payer: Galaxy Health WC |
$6,964.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,915.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,202.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,833.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,966.32
|
| Rate for Payer: Multiplan Commercial |
$6,554.40
|
| Rate for Payer: Networks By Design Commercial |
$5,325.45
|
| Rate for Payer: Prime Health Services Commercial |
$6,964.05
|
|
|
HC BRONCHIAL THERMOPLASTY 2+ LOBES
|
Facility
|
OP
|
$8,193.00
|
|
|
Service Code
|
CPT 31661
|
| Hospital Charge Code |
900831661
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$330.24 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,638.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,984.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,077.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,942.61
|
| Rate for Payer: Blue Shield of California Commercial |
$4,454.70
|
| Rate for Payer: Cash Price |
$3,686.85
|
| Rate for Payer: Cash Price |
$3,686.85
|
| Rate for Payer: Cash Price |
$3,686.85
|
| Rate for Payer: Cigna of CA HMO |
$5,243.52
|
| Rate for Payer: Cigna of CA PPO |
$6,062.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,984.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,077.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,735.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,977.17
|
| Rate for Payer: EPIC Health Plan Senior |
$9,984.78
|
| Rate for Payer: Galaxy Health WC |
$6,964.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,915.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14,886.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$330.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,077.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,202.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$373.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,707.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,966.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,437.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,163.27
|
| Rate for Payer: Multiplan Commercial |
$6,554.40
|
| Rate for Payer: Multiplan WC |
$14,014.35
|
| Rate for Payer: Networks By Design Commercial |
$5,325.45
|
| Rate for Payer: Prime Health Services Commercial |
$6,964.05
|
| Rate for Payer: Prime Health Services WC |
$13,871.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,915.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,096.50
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,077.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,984.78
|
| Rate for Payer: Vantage Medical Group Senior |
$9,077.07
|
|
