|
HC DESTROY INTERNAL HEMORRHOIDS
|
Facility
IP
|
$2,997.00
|
|
|
Service Code
|
CPT 46930
|
| Hospital Charge Code |
906746930
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$719.28 |
| Max. Negotiated Rate |
$2,547.45 |
| Rate for Payer: Cash Price |
$1,348.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,198.80
|
| Rate for Payer: Galaxy Health WC |
$2,547.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,798.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,999.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,141.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$719.28
|
| Rate for Payer: Multiplan Commercial |
$2,397.60
|
| Rate for Payer: Networks By Design Commercial |
$1,948.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,547.45
|
|
|
HC DETERMINATION/VENOUS PRESSURE
|
Facility
IP
|
$298.00
|
|
|
Service Code
|
CPT 93770
|
| Hospital Charge Code |
900501622
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$71.52 |
| Max. Negotiated Rate |
$253.30 |
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$119.20
|
| Rate for Payer: Galaxy Health WC |
$253.30
|
| Rate for Payer: Global Benefits Group Commercial |
$178.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$198.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.52
|
| Rate for Payer: Multiplan Commercial |
$238.40
|
| Rate for Payer: Networks By Design Commercial |
$193.70
|
| Rate for Payer: Prime Health Services Commercial |
$253.30
|
|
|
HC DETERMINATION/VENOUS PRESSURE
|
Facility
OP
|
$298.00
|
|
|
Service Code
|
CPT 93770
|
| Hospital Charge Code |
900501622
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$71.52 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$253.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$163.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$163.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,299.00
|
| Rate for Payer: BCBS Transplant Transplant |
$178.80
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna of CA PPO |
$220.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$253.30
|
| Rate for Payer: Dignity Health Media |
$253.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$253.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$119.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$119.20
|
| Rate for Payer: Galaxy Health WC |
$253.30
|
| Rate for Payer: Global Benefits Group Commercial |
$178.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$223.50
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$198.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.52
|
| Rate for Payer: Multiplan Commercial |
$238.40
|
| Rate for Payer: Networks By Design Commercial |
$193.70
|
| Rate for Payer: Prime Health Services Commercial |
$253.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$178.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$178.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$149.00
|
| Rate for Payer: United Healthcare All Other HMO |
$149.00
|
| Rate for Payer: United Healthcare HMO Rider |
$149.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$149.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$253.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$253.30
|
| Rate for Payer: Vantage Medical Group Senior |
$253.30
|
|
|
HC DEVELOP TESTING W/INTERP & RPT ST
|
Facility
IP
|
$1,130.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
905601810
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$271.20 |
| Max. Negotiated Rate |
$960.50 |
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$452.00
|
| Rate for Payer: Galaxy Health WC |
$960.50
|
| Rate for Payer: Global Benefits Group Commercial |
$678.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$753.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$430.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.20
|
| Rate for Payer: Multiplan Commercial |
$904.00
|
| Rate for Payer: Networks By Design Commercial |
$734.50
|
| Rate for Payer: Prime Health Services Commercial |
$960.50
|
|
|
HC DEVELOP TESTING W/INTERP & RPT ST
|
Facility
IP
|
$1,130.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
905601810
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$271.20 |
| Max. Negotiated Rate |
$960.50 |
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$452.00
|
| Rate for Payer: Galaxy Health WC |
$960.50
|
| Rate for Payer: Global Benefits Group Commercial |
$678.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$753.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$430.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.20
|
| Rate for Payer: Multiplan Commercial |
$904.00
|
| Rate for Payer: Networks By Design Commercial |
$734.50
|
| Rate for Payer: Prime Health Services Commercial |
$960.50
|
|
|
HC DEVELOP TESTING W/INTERP & RPT ST
|
Facility
OP
|
$1,130.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
905601810
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$12.10 |
| Max. Negotiated Rate |
$960.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$55.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$960.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$621.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$621.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$673.25
|
| Rate for Payer: BCBS Transplant Transplant |
$678.00
|
| Rate for Payer: Blue Shield of California Commercial |
$832.81
|
| Rate for Payer: Blue Shield of California EPN |
$659.92
|
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: Cigna of CA HMO |
$723.20
|
| Rate for Payer: Cigna of CA PPO |
$836.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$960.50
|
| Rate for Payer: Dignity Health Media |
$960.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$960.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$452.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$452.00
|
| Rate for Payer: Galaxy Health WC |
$960.50
|
| Rate for Payer: Global Benefits Group Commercial |
$678.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$847.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$753.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.20
|
| Rate for Payer: Multiplan Commercial |
$904.00
|
| Rate for Payer: Networks By Design Commercial |
$734.50
|
| Rate for Payer: Prime Health Services Commercial |
$960.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$678.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$678.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$678.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$565.00
|
| Rate for Payer: United Healthcare All Other HMO |
$565.00
|
| Rate for Payer: United Healthcare HMO Rider |
$565.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$565.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$960.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$960.50
|
| Rate for Payer: Vantage Medical Group Senior |
$960.50
|
|
|
HC DEVELOP TESTING W/INTERP & RPT ST
|
Facility
OP
|
$1,130.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
905601810
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$12.10 |
| Max. Negotiated Rate |
$960.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$55.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$960.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$621.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$621.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: BCBS Transplant Transplant |
$678.00
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: Cigna of CA HMO |
$723.20
|
| Rate for Payer: Cigna of CA PPO |
$836.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$960.50
|
| Rate for Payer: Dignity Health Media |
$960.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$960.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$452.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$452.00
|
| Rate for Payer: Galaxy Health WC |
$960.50
|
| Rate for Payer: Global Benefits Group Commercial |
$678.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$847.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$753.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.20
|
| Rate for Payer: Multiplan Commercial |
$904.00
|
| Rate for Payer: Networks By Design Commercial |
$734.50
|
| Rate for Payer: Prime Health Services Commercial |
$960.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$678.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$678.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$678.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$960.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$960.50
|
| Rate for Payer: Vantage Medical Group Senior |
$960.50
|
|
|
HC DEVELOP TESTING W/INTERP & RPT ST MCAL
|
Facility
IP
|
$1,130.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
907000009
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$271.20 |
| Max. Negotiated Rate |
$960.50 |
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$452.00
|
| Rate for Payer: Galaxy Health WC |
$960.50
|
| Rate for Payer: Global Benefits Group Commercial |
$678.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$753.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$430.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.20
|
| Rate for Payer: Multiplan Commercial |
$904.00
|
| Rate for Payer: Networks By Design Commercial |
$734.50
|
| Rate for Payer: Prime Health Services Commercial |
$960.50
|
|
|
HC DEVELOP TESTING W/INTERP & RPT ST MCAL
|
Facility
OP
|
$1,130.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
907000009
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$12.10 |
| Max. Negotiated Rate |
$960.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$55.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$960.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$621.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$621.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: BCBS Transplant Transplant |
$678.00
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: Cigna of CA HMO |
$723.20
|
| Rate for Payer: Cigna of CA PPO |
$836.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$960.50
|
| Rate for Payer: Dignity Health Media |
$960.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$960.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$452.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$452.00
|
| Rate for Payer: Galaxy Health WC |
$960.50
|
| Rate for Payer: Global Benefits Group Commercial |
$678.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$847.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$753.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.20
|
| Rate for Payer: Multiplan Commercial |
$904.00
|
| Rate for Payer: Networks By Design Commercial |
$734.50
|
| Rate for Payer: Prime Health Services Commercial |
$960.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$678.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$678.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$678.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$960.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$960.50
|
| Rate for Payer: Vantage Medical Group Senior |
$960.50
|
|
|
HC DEVELOP TEST W INTERP & RPT MCAL
|
Facility
IP
|
$1,130.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
901300035
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$271.20 |
| Max. Negotiated Rate |
$960.50 |
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$452.00
|
| Rate for Payer: Galaxy Health WC |
$960.50
|
| Rate for Payer: Global Benefits Group Commercial |
$678.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$753.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$430.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.20
|
| Rate for Payer: Multiplan Commercial |
$904.00
|
| Rate for Payer: Networks By Design Commercial |
$734.50
|
| Rate for Payer: Prime Health Services Commercial |
$960.50
|
|
|
HC DEVELOP TEST W INTERP & RPT MCAL
|
Facility
OP
|
$1,130.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
901300035
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$12.10 |
| Max. Negotiated Rate |
$960.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$55.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$960.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$621.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$621.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: BCBS Transplant Transplant |
$678.00
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: Cigna of CA HMO |
$723.20
|
| Rate for Payer: Cigna of CA PPO |
$836.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$960.50
|
| Rate for Payer: Dignity Health Media |
$960.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$960.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$452.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$452.00
|
| Rate for Payer: Galaxy Health WC |
$960.50
|
| Rate for Payer: Global Benefits Group Commercial |
$678.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$847.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$753.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.20
|
| Rate for Payer: Multiplan Commercial |
$904.00
|
| Rate for Payer: Networks By Design Commercial |
$734.50
|
| Rate for Payer: Prime Health Services Commercial |
$960.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$678.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$678.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$678.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$960.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$960.50
|
| Rate for Payer: Vantage Medical Group Senior |
$960.50
|
|
|
HC DHEA-S
|
Facility
OP
|
$67.00
|
|
|
Service Code
|
CPT 82627
|
| Hospital Charge Code |
900912126
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.08 |
| Max. Negotiated Rate |
$202.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$184.93
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$33.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$202.82
|
| Rate for Payer: BCBS Transplant Transplant |
$40.20
|
| Rate for Payer: Blue Shield of California Commercial |
$43.28
|
| Rate for Payer: Blue Shield of California EPN |
$34.30
|
| Rate for Payer: Cash Price |
$30.15
|
| Rate for Payer: Cash Price |
$30.15
|
| Rate for Payer: Cigna of CA HMO |
$42.88
|
| Rate for Payer: Cigna of CA PPO |
$49.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.34
|
| Rate for Payer: Dignity Health Media |
$22.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.01
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$22.23
|
| Rate for Payer: EPIC Health Plan Transplant |
$22.23
|
| Rate for Payer: Galaxy Health WC |
$56.95
|
| Rate for Payer: Global Benefits Group Commercial |
$40.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$50.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.46
|
| Rate for Payer: Heritage Provider Network Transplant |
$36.46
|
| Rate for Payer: IEHP Medi-Cal |
$36.01
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$36.01
|
| Rate for Payer: IEHP Medicare Advantage |
$22.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.79
|
| Rate for Payer: Multiplan Commercial |
$53.60
|
| Rate for Payer: Networks By Design Commercial |
$43.55
|
| Rate for Payer: Prime Health Services Commercial |
$56.95
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$40.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$40.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$40.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.01
|
| Rate for Payer: United Healthcare All Other HMO |
$18.01
|
| Rate for Payer: United Healthcare HMO Rider |
$18.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.45
|
| Rate for Payer: Vantage Medical Group Senior |
$22.23
|
|
|
HC DIAB OP SELF MGMT-GRP 30 MIN
|
Facility
IP
|
$136.00
|
|
|
Service Code
|
CPT G0109
|
| Hospital Charge Code |
902501101
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$32.64 |
| Max. Negotiated Rate |
$115.60 |
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.40
|
| Rate for Payer: Galaxy Health WC |
$115.60
|
| Rate for Payer: Global Benefits Group Commercial |
$81.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.64
|
| Rate for Payer: Multiplan Commercial |
$108.80
|
| Rate for Payer: Networks By Design Commercial |
$88.40
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
|
|
HC DIAB OP SELF MGMT-GRP 30 MIN
|
Facility
OP
|
$136.00
|
|
|
Service Code
|
CPT G0109
|
| Hospital Charge Code |
902501101
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$26.87 |
| Max. Negotiated Rate |
$785.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$110.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$115.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$74.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$74.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$81.03
|
| Rate for Payer: BCBS Transplant Transplant |
$81.60
|
| Rate for Payer: Blue Shield of California Commercial |
$100.23
|
| Rate for Payer: Blue Shield of California EPN |
$79.42
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna of CA HMO |
$87.04
|
| Rate for Payer: Cigna of CA PPO |
$100.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$115.60
|
| Rate for Payer: Dignity Health Media |
$115.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$115.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$54.40
|
| Rate for Payer: Galaxy Health WC |
$115.60
|
| Rate for Payer: Global Benefits Group Commercial |
$81.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$102.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.64
|
| Rate for Payer: Multiplan Commercial |
$108.80
|
| Rate for Payer: Networks By Design Commercial |
$88.40
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$81.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$602.00
|
| Rate for Payer: United Healthcare All Other HMO |
$785.00
|
| Rate for Payer: United Healthcare HMO Rider |
$593.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$115.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$115.60
|
| Rate for Payer: Vantage Medical Group Senior |
$115.60
|
|
|
HC DIAB OP SELF MGMT-INDIV 30 MIN
|
Facility
OP
|
$311.00
|
|
|
Service Code
|
CPT G0108
|
| Hospital Charge Code |
902501100
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$74.64 |
| Max. Negotiated Rate |
$785.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$320.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$264.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$171.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$171.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$185.29
|
| Rate for Payer: BCBS Transplant Transplant |
$186.60
|
| Rate for Payer: Blue Shield of California Commercial |
$229.21
|
| Rate for Payer: Blue Shield of California EPN |
$181.62
|
| Rate for Payer: Cash Price |
$139.95
|
| Rate for Payer: Cash Price |
$139.95
|
| Rate for Payer: Cash Price |
$139.95
|
| Rate for Payer: Cigna of CA HMO |
$199.04
|
| Rate for Payer: Cigna of CA PPO |
$230.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$264.35
|
| Rate for Payer: Dignity Health Media |
$264.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$264.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$124.40
|
| Rate for Payer: Galaxy Health WC |
$264.35
|
| Rate for Payer: Global Benefits Group Commercial |
$186.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$233.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$207.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.64
|
| Rate for Payer: Multiplan Commercial |
$248.80
|
| Rate for Payer: Networks By Design Commercial |
$202.15
|
| Rate for Payer: Prime Health Services Commercial |
$264.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$186.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$186.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$186.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$602.00
|
| Rate for Payer: United Healthcare All Other HMO |
$785.00
|
| Rate for Payer: United Healthcare HMO Rider |
$593.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$264.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$264.35
|
| Rate for Payer: Vantage Medical Group Senior |
$264.35
|
|
|
HC DIAB OP SELF MGMT-INDIV 30 MIN
|
Facility
IP
|
$311.00
|
|
|
Service Code
|
CPT G0108
|
| Hospital Charge Code |
902501100
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$74.64 |
| Max. Negotiated Rate |
$264.35 |
| Rate for Payer: Cash Price |
$139.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.40
|
| Rate for Payer: Galaxy Health WC |
$264.35
|
| Rate for Payer: Global Benefits Group Commercial |
$186.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$207.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.64
|
| Rate for Payer: Multiplan Commercial |
$248.80
|
| Rate for Payer: Networks By Design Commercial |
$202.15
|
| Rate for Payer: Prime Health Services Commercial |
$264.35
|
|
|
HC DIAG GASTRO INTUB W ASP SPECS
|
Facility
OP
|
$476.00
|
|
|
Service Code
|
CPT 43755
|
| Hospital Charge Code |
906743755
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$93.99 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$285.60
|
| Rate for Payer: Blue Shield of California Commercial |
$833.61
|
| Rate for Payer: Blue Shield of California EPN |
$542.56
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna of CA PPO |
$352.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: Dignity Health Media |
$195.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.48
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$195.17
|
| Rate for Payer: Galaxy Health WC |
$404.60
|
| Rate for Payer: Global Benefits Group Commercial |
$285.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$357.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$320.08
|
| Rate for Payer: Heritage Provider Network Transplant |
$320.08
|
| Rate for Payer: IEHP Medi-Cal |
$316.18
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$316.18
|
| Rate for Payer: IEHP Medicare Advantage |
$195.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$317.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$261.53
|
| Rate for Payer: Multiplan Commercial |
$380.80
|
| Rate for Payer: Networks By Design Commercial |
$309.40
|
| Rate for Payer: Prime Health Services Commercial |
$404.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$214.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$285.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$234.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC DIAG GASTRO INTUB W ASP SPECS
|
Facility
IP
|
$476.00
|
|
|
Service Code
|
CPT 43755
|
| Hospital Charge Code |
906743755
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$114.24 |
| Max. Negotiated Rate |
$404.60 |
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$190.40
|
| Rate for Payer: Galaxy Health WC |
$404.60
|
| Rate for Payer: Global Benefits Group Commercial |
$285.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$317.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$181.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.24
|
| Rate for Payer: Multiplan Commercial |
$380.80
|
| Rate for Payer: Networks By Design Commercial |
$309.40
|
| Rate for Payer: Prime Health Services Commercial |
$404.60
|
|
|
HC DIAGNOSTIC BRONCH
|
Facility
IP
|
$6,192.00
|
|
|
Service Code
|
CPT 31622
|
| Hospital Charge Code |
900501418
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,486.08 |
| Max. Negotiated Rate |
$5,263.20 |
| Rate for Payer: Cash Price |
$2,786.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,476.80
|
| Rate for Payer: Galaxy Health WC |
$5,263.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,715.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,130.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,359.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,486.08
|
| Rate for Payer: Multiplan Commercial |
$4,953.60
|
| Rate for Payer: Networks By Design Commercial |
$4,024.80
|
| Rate for Payer: Prime Health Services Commercial |
$5,263.20
|
|
|
HC DIAGNOSTIC BRONCH
|
Facility
IP
|
$6,192.00
|
|
|
Service Code
|
CPT 31622
|
| Hospital Charge Code |
900501418
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,486.08 |
| Max. Negotiated Rate |
$5,263.20 |
| Rate for Payer: Cash Price |
$2,786.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,476.80
|
| Rate for Payer: Galaxy Health WC |
$5,263.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,715.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,130.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,359.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,486.08
|
| Rate for Payer: Multiplan Commercial |
$4,953.60
|
| Rate for Payer: Networks By Design Commercial |
$4,024.80
|
| Rate for Payer: Prime Health Services Commercial |
$5,263.20
|
|
|
HC DIAGNOSTIC BRONCH
|
Facility
OP
|
$6,192.00
|
|
|
Service Code
|
CPT 31622
|
| Hospital Charge Code |
900501418
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$313.37 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,180.93
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,332.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,120.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: BCBS Transplant Transplant |
$3,715.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$2,786.40
|
| Rate for Payer: Cash Price |
$2,786.40
|
| Rate for Payer: Cigna of CA PPO |
$4,582.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Dignity Health Media |
$2,120.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,332.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,862.84
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,120.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,120.62
|
| Rate for Payer: Galaxy Health WC |
$5,263.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,715.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,644.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,477.82
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,477.82
|
| Rate for Payer: IEHP Medi-Cal |
$3,435.40
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3,435.40
|
| Rate for Payer: IEHP Medicare Advantage |
$2,120.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,130.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$313.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,120.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,486.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,671.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,841.63
|
| Rate for Payer: Multiplan Commercial |
$4,953.60
|
| Rate for Payer: Networks By Design Commercial |
$4,024.80
|
| Rate for Payer: Prime Health Services Commercial |
$5,263.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3,715.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,715.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,332.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2,120.62
|
|
|
HC DIAGNOSTIC BRONCH
|
Facility
OP
|
$6,192.00
|
|
|
Service Code
|
CPT 31622
|
| Hospital Charge Code |
900501418
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.37 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,180.93
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,332.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,120.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: BCBS Transplant Transplant |
$3,715.20
|
| Rate for Payer: Cash Price |
$2,786.40
|
| Rate for Payer: Cash Price |
$2,786.40
|
| Rate for Payer: Cash Price |
$2,786.40
|
| Rate for Payer: Cigna of CA PPO |
$4,582.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Dignity Health Media |
$2,120.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,332.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,862.84
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,120.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,120.62
|
| Rate for Payer: Galaxy Health WC |
$5,263.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,715.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,644.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,477.82
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,477.82
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,120.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,130.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$313.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,120.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,486.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,671.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,841.63
|
| Rate for Payer: Multiplan Commercial |
$4,953.60
|
| Rate for Payer: Networks By Design Commercial |
$4,024.80
|
| Rate for Payer: Prime Health Services Commercial |
$5,263.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3,715.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,715.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,096.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,096.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,096.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,096.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,332.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2,120.62
|
|
|
HC DIAGNOSTIC BRONCH W BIOPSY
|
Facility
OP
|
$5,962.00
|
|
|
Service Code
|
CPT 31625
|
| Hospital Charge Code |
900803503
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$382.68 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,180.93
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,332.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,120.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: BCBS Transplant Transplant |
$3,577.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,393.99
|
| Rate for Payer: Blue Shield of California EPN |
$3,481.81
|
| Rate for Payer: Cash Price |
$2,682.90
|
| Rate for Payer: Cash Price |
$2,682.90
|
| Rate for Payer: Cigna of CA HMO |
$3,815.68
|
| Rate for Payer: Cigna of CA PPO |
$4,411.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Dignity Health Media |
$2,120.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,332.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,862.84
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,120.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,120.62
|
| Rate for Payer: Galaxy Health WC |
$5,067.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,577.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,471.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,477.82
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,477.82
|
| Rate for Payer: IEHP Medi-Cal |
$3,435.40
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3,435.40
|
| Rate for Payer: IEHP Medicare Advantage |
$2,120.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,976.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$382.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,120.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,430.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,671.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,841.63
|
| Rate for Payer: Multiplan Commercial |
$4,769.60
|
| Rate for Payer: Networks By Design Commercial |
$3,875.30
|
| Rate for Payer: Prime Health Services Commercial |
$5,067.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3,577.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,577.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,577.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,981.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,981.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,981.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,981.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,332.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2,120.62
|
|
|
HC DIAGNOSTIC BRONCH W BIOPSY
|
Facility
IP
|
$5,962.00
|
|
|
Service Code
|
CPT 31625
|
| Hospital Charge Code |
900803503
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,430.88 |
| Max. Negotiated Rate |
$5,067.70 |
| Rate for Payer: Cash Price |
$2,682.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,384.80
|
| Rate for Payer: Galaxy Health WC |
$5,067.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,577.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,976.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,271.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,430.88
|
| Rate for Payer: Multiplan Commercial |
$4,769.60
|
| Rate for Payer: Networks By Design Commercial |
$3,875.30
|
| Rate for Payer: Prime Health Services Commercial |
$5,067.70
|
|
|
HC DIAGNOSTIC BRONCH W/BRUSHING
|
Facility
OP
|
$4,708.00
|
|
|
Service Code
|
CPT 31623
|
| Hospital Charge Code |
900803501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$401.79 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,180.93
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,332.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,120.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: BCBS Transplant Transplant |
$2,824.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,612.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,351.09
|
| Rate for Payer: Cash Price |
$2,118.60
|
| Rate for Payer: Cash Price |
$2,118.60
|
| Rate for Payer: Cigna of CA PPO |
$3,483.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Dignity Health Media |
$2,120.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,332.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,862.84
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,120.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,120.62
|
| Rate for Payer: Galaxy Health WC |
$4,001.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,824.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,531.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,477.82
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,477.82
|
| Rate for Payer: IEHP Medi-Cal |
$3,435.40
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3,435.40
|
| Rate for Payer: IEHP Medicare Advantage |
$2,120.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,140.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$401.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,120.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,129.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,671.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,841.63
|
| Rate for Payer: Multiplan Commercial |
$3,766.40
|
| Rate for Payer: Networks By Design Commercial |
$3,060.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,001.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,824.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,824.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,332.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2,120.62
|
|
