|
HC DFIB STJ UNIFY A CD335740Q
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813748
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$21,250.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,750.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,750.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,480.00
|
| Rate for Payer: Blue Shield of California Commercial |
$18,450.00
|
| Rate for Payer: Blue Shield of California EPN |
$12,150.00
|
| Rate for Payer: Cash Price |
$11,250.00
|
| Rate for Payer: Cigna of CA HMO |
$17,500.00
|
| Rate for Payer: Cigna of CA PPO |
$17,500.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,250.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21,250.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,000.00
|
| Rate for Payer: Galaxy Health WC |
$21,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,675.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,475.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,000.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,500.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,500.00
|
| Rate for Payer: Multiplan Commercial |
$20,000.00
|
| Rate for Payer: Networks By Design Commercial |
$12,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,250.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,000.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,382.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9,132.50
|
| Rate for Payer: United Healthcare HMO Rider |
$8,935.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,187.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Senior |
$21,250.00
|
|
|
HC DFIB STJ UNIFY ASSURA CD325740
|
Facility
|
IP
|
$29,250.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813696
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,850.00 |
| Max. Negotiated Rate |
$24,862.50 |
| Rate for Payer: Adventist Health Commercial |
$5,850.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$13,162.50
|
| Rate for Payer: Cash Price |
$13,162.50
|
| Rate for Payer: Cigna of CA HMO |
$20,475.00
|
| Rate for Payer: Cigna of CA PPO |
$20,475.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,700.00
|
| Rate for Payer: EPIC Health Plan Senior |
$11,700.00
|
| Rate for Payer: Galaxy Health WC |
$24,862.50
|
| Rate for Payer: Global Benefits Group Commercial |
$17,550.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,509.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,144.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,105.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,020.00
|
| Rate for Payer: Multiplan Commercial |
$23,400.00
|
| Rate for Payer: Networks By Design Commercial |
$14,625.00
|
| Rate for Payer: Prime Health Services Commercial |
$24,862.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,977.52
|
| Rate for Payer: United Healthcare All Other HMO |
$10,685.02
|
| Rate for Payer: United Healthcare HMO Rider |
$10,453.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,579.38
|
|
|
HC DFIB STJ UNIFY ASSURA CD325740
|
Facility
|
OP
|
$29,250.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813696
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,850.00 |
| Max. Negotiated Rate |
$24,862.50 |
| Rate for Payer: Adventist Health Commercial |
$5,850.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24,862.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,087.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21,937.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,941.60
|
| Rate for Payer: Blue Shield of California Commercial |
$21,586.50
|
| Rate for Payer: Blue Shield of California EPN |
$14,215.50
|
| Rate for Payer: Cash Price |
$13,162.50
|
| Rate for Payer: Cigna of CA HMO |
$20,475.00
|
| Rate for Payer: Cigna of CA PPO |
$20,475.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24,862.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,862.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24,862.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,700.00
|
| Rate for Payer: EPIC Health Plan Senior |
$11,700.00
|
| Rate for Payer: Galaxy Health WC |
$24,862.50
|
| Rate for Payer: Global Benefits Group Commercial |
$17,550.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,509.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,105.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,020.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20,475.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20,475.00
|
| Rate for Payer: Multiplan Commercial |
$23,400.00
|
| Rate for Payer: Networks By Design Commercial |
$14,625.00
|
| Rate for Payer: Prime Health Services Commercial |
$24,862.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17,550.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17,550.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,977.52
|
| Rate for Payer: United Healthcare All Other HMO |
$10,685.02
|
| Rate for Payer: United Healthcare HMO Rider |
$10,453.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,579.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24,862.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,862.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24,862.50
|
|
|
HC DFIB ST J UNIFY CD3231-40Q
|
Facility
|
IP
|
$32,500.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813656
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,500.00 |
| Max. Negotiated Rate |
$27,625.00 |
| Rate for Payer: Adventist Health Commercial |
$6,500.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$14,625.00
|
| Rate for Payer: Cash Price |
$14,625.00
|
| Rate for Payer: Cigna of CA HMO |
$22,750.00
|
| Rate for Payer: Cigna of CA PPO |
$22,750.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$13,000.00
|
| Rate for Payer: Galaxy Health WC |
$27,625.00
|
| Rate for Payer: Global Benefits Group Commercial |
$19,500.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21,677.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,382.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20,117.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,800.00
|
| Rate for Payer: Multiplan Commercial |
$26,000.00
|
| Rate for Payer: Networks By Design Commercial |
$16,250.00
|
| Rate for Payer: Prime Health Services Commercial |
$27,625.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,197.25
|
| Rate for Payer: United Healthcare All Other HMO |
$11,872.25
|
| Rate for Payer: United Healthcare HMO Rider |
$11,615.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10,643.75
|
|
|
HC DFIB ST J UNIFY CD3231-40Q
|
Facility
|
OP
|
$32,500.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813656
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,500.00 |
| Max. Negotiated Rate |
$27,625.00 |
| Rate for Payer: Adventist Health Commercial |
$6,500.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27,625.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17,875.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24,375.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18,824.00
|
| Rate for Payer: Blue Shield of California Commercial |
$23,985.00
|
| Rate for Payer: Blue Shield of California EPN |
$15,795.00
|
| Rate for Payer: Cash Price |
$14,625.00
|
| Rate for Payer: Cigna of CA HMO |
$22,750.00
|
| Rate for Payer: Cigna of CA PPO |
$22,750.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27,625.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$27,625.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27,625.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$13,000.00
|
| Rate for Payer: Galaxy Health WC |
$27,625.00
|
| Rate for Payer: Global Benefits Group Commercial |
$19,500.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21,677.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20,117.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,800.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22,750.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22,750.00
|
| Rate for Payer: Multiplan Commercial |
$26,000.00
|
| Rate for Payer: Networks By Design Commercial |
$16,250.00
|
| Rate for Payer: Prime Health Services Commercial |
$27,625.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19,500.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19,500.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,197.25
|
| Rate for Payer: United Healthcare All Other HMO |
$11,872.25
|
| Rate for Payer: United Healthcare HMO Rider |
$11,615.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10,643.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27,625.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27,625.00
|
| Rate for Payer: Vantage Medical Group Senior |
$27,625.00
|
|
|
HC DHEA-S
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
CPT 82627
|
| Hospital Charge Code |
900912126
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$219.57 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$50.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$219.57
|
| Rate for Payer: Blue Shield of California Commercial |
$51.51
|
| Rate for Payer: Blue Shield of California EPN |
$34.03
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cigna of CA HMO |
$49.28
|
| Rate for Payer: Cigna of CA PPO |
$56.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.01
|
| Rate for Payer: EPIC Health Plan Senior |
$22.23
|
| Rate for Payer: Galaxy Health WC |
$65.45
|
| Rate for Payer: Global Benefits Group Commercial |
$46.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.36
|
| 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 |
$18.48
|
| 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 |
$61.60
|
| Rate for Payer: Networks By Design Commercial |
$50.05
|
| Rate for Payer: Prime Health Services Commercial |
$65.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.20
|
| 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: Upland Medical Group Pediatric |
$22.23
|
| 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 DHEA-S
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
CPT 82627
|
| Hospital Charge Code |
900912126
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.20 |
| Max. Negotiated Rate |
$102.85 |
| Rate for Payer: Adventist Health Commercial |
$24.20
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.40
|
| Rate for Payer: EPIC Health Plan Senior |
$48.40
|
| Rate for Payer: Galaxy Health WC |
$102.85
|
| Rate for Payer: Global Benefits Group Commercial |
$72.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.04
|
| Rate for Payer: Multiplan Commercial |
$96.80
|
| Rate for Payer: Networks By Design Commercial |
$78.65
|
| Rate for Payer: Prime Health Services Commercial |
$102.85
|
|
|
HC DIABETIC SHOE X DEPTH USE/DENS
|
Facility
|
IP
|
$222.00
|
|
|
Service Code
|
CPT A5500
|
| Hospital Charge Code |
915365500
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$44.40 |
| Max. Negotiated Rate |
$188.70 |
| Rate for Payer: Adventist Health Commercial |
$44.40
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.80
|
| Rate for Payer: EPIC Health Plan Senior |
$88.80
|
| Rate for Payer: Galaxy Health WC |
$188.70
|
| Rate for Payer: Global Benefits Group Commercial |
$133.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$148.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.28
|
| Rate for Payer: Multiplan Commercial |
$177.60
|
| Rate for Payer: Networks By Design Commercial |
$144.30
|
| Rate for Payer: Prime Health Services Commercial |
$188.70
|
|
|
HC DIABETIC SHOE X DEPTH USE/DENS
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
CPT A5500
|
| Hospital Charge Code |
905365500
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$165.75 |
| Rate for Payer: Adventist Health Commercial |
$39.00
|
| Rate for Payer: Cash Price |
$87.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.00
|
| Rate for Payer: EPIC Health Plan Senior |
$78.00
|
| Rate for Payer: Galaxy Health WC |
$165.75
|
| Rate for Payer: Global Benefits Group Commercial |
$117.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$120.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.80
|
| Rate for Payer: Multiplan Commercial |
$156.00
|
| Rate for Payer: Networks By Design Commercial |
$126.75
|
| Rate for Payer: Prime Health Services Commercial |
$165.75
|
|
|
HC DIABETIC SHOE X DEPTH USE/DENS
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
CPT A5500
|
| Hospital Charge Code |
905365500
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$165.75 |
| Rate for Payer: Adventist Health Commercial |
$39.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$127.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$165.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$107.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$146.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.75
|
| Rate for Payer: Cash Price |
$87.75
|
| Rate for Payer: Cash Price |
$87.75
|
| Rate for Payer: Cigna of CA HMO |
$124.80
|
| Rate for Payer: Cigna of CA PPO |
$144.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$165.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$165.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.00
|
| Rate for Payer: EPIC Health Plan Senior |
$78.00
|
| Rate for Payer: Galaxy Health WC |
$165.75
|
| Rate for Payer: Global Benefits Group Commercial |
$117.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$79.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$120.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$136.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$136.50
|
| Rate for Payer: Multiplan Commercial |
$156.00
|
| Rate for Payer: Networks By Design Commercial |
$126.75
|
| Rate for Payer: Prime Health Services Commercial |
$165.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$117.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$117.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$97.50
|
| Rate for Payer: United Healthcare All Other HMO |
$97.50
|
| Rate for Payer: United Healthcare HMO Rider |
$97.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$97.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$165.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$165.75
|
| Rate for Payer: Vantage Medical Group Senior |
$165.75
|
|
|
HC DIABETIC SHOE X DEPTH USE/DENS
|
Facility
|
OP
|
$222.00
|
|
|
Service Code
|
CPT A5500
|
| Hospital Charge Code |
915365500
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$44.40 |
| Max. Negotiated Rate |
$188.70 |
| Rate for Payer: Adventist Health Commercial |
$44.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$145.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$188.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$122.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$166.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.33
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna of CA HMO |
$142.08
|
| Rate for Payer: Cigna of CA PPO |
$164.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$188.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$188.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.80
|
| Rate for Payer: EPIC Health Plan Senior |
$88.80
|
| Rate for Payer: Galaxy Health WC |
$188.70
|
| Rate for Payer: Global Benefits Group Commercial |
$133.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$79.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$148.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$155.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$155.40
|
| Rate for Payer: Multiplan Commercial |
$177.60
|
| Rate for Payer: Networks By Design Commercial |
$144.30
|
| Rate for Payer: Prime Health Services Commercial |
$188.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$133.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$133.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$111.00
|
| Rate for Payer: United Healthcare All Other HMO |
$111.00
|
| Rate for Payer: United Healthcare HMO Rider |
$111.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$111.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$188.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.70
|
| Rate for Payer: Vantage Medical Group Senior |
$188.70
|
|
|
HC DIAB OP SELF MGMT-GRP 30 MIN
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
CPT G0109
|
| Hospital Charge Code |
902501101
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$23.76 |
| Max. Negotiated Rate |
$824.00 |
| Rate for Payer: Adventist Health Commercial |
$60.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$96.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$124.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$80.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$110.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.27
|
| Rate for Payer: Cash Price |
$66.15
|
| Rate for Payer: Cash Price |
$66.15
|
| Rate for Payer: Cash Price |
$66.15
|
| Rate for Payer: Cigna of CA HMO |
$94.08
|
| Rate for Payer: Cigna of CA PPO |
$108.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$124.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$124.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.80
|
| Rate for Payer: EPIC Health Plan Senior |
$58.80
|
| Rate for Payer: Galaxy Health WC |
$124.95
|
| Rate for Payer: Global Benefits Group Commercial |
$88.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$102.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.90
|
| Rate for Payer: Multiplan Commercial |
$117.60
|
| Rate for Payer: Networks By Design Commercial |
$95.55
|
| Rate for Payer: Prime Health Services Commercial |
$124.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$88.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$88.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$634.00
|
| Rate for Payer: United Healthcare All Other HMO |
$824.00
|
| Rate for Payer: United Healthcare HMO Rider |
$623.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$570.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$124.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.95
|
| Rate for Payer: Vantage Medical Group Senior |
$124.95
|
|
|
HC DIAB OP SELF MGMT-GRP 30 MIN
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
CPT G0109
|
| Hospital Charge Code |
902501101
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$124.95 |
| Rate for Payer: Adventist Health Commercial |
$29.40
|
| Rate for Payer: Cash Price |
$66.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.80
|
| Rate for Payer: EPIC Health Plan Senior |
$58.80
|
| Rate for Payer: Galaxy Health WC |
$124.95
|
| Rate for Payer: Global Benefits Group Commercial |
$88.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.28
|
| Rate for Payer: Multiplan Commercial |
$117.60
|
| Rate for Payer: Networks By Design Commercial |
$95.55
|
| Rate for Payer: Prime Health Services Commercial |
$124.95
|
|
|
HC DIAB OP SELF MGMT-INDIV 30 MIN
|
Facility
|
OP
|
$336.00
|
|
|
Service Code
|
CPT G0108
|
| Hospital Charge Code |
902501100
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$76.84 |
| Max. Negotiated Rate |
$824.00 |
| Rate for Payer: Adventist Health Commercial |
$137.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$220.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$285.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$184.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.34
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cigna of CA HMO |
$215.04
|
| Rate for Payer: Cigna of CA PPO |
$248.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$285.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$285.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$285.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.40
|
| Rate for Payer: EPIC Health Plan Senior |
$134.40
|
| Rate for Payer: Galaxy Health WC |
$285.60
|
| Rate for Payer: Global Benefits Group Commercial |
$201.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$76.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$224.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$207.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$235.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$235.20
|
| Rate for Payer: Multiplan Commercial |
$268.80
|
| Rate for Payer: Networks By Design Commercial |
$218.40
|
| Rate for Payer: Prime Health Services Commercial |
$285.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$201.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$201.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$634.00
|
| Rate for Payer: United Healthcare All Other HMO |
$824.00
|
| Rate for Payer: United Healthcare HMO Rider |
$623.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$570.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$285.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$285.60
|
| Rate for Payer: Vantage Medical Group Senior |
$285.60
|
|
|
HC DIAB OP SELF MGMT-INDIV 30 MIN
|
Facility
|
IP
|
$336.00
|
|
|
Service Code
|
CPT G0108
|
| Hospital Charge Code |
902501100
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$285.60 |
| Rate for Payer: Adventist Health Commercial |
$67.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.40
|
| Rate for Payer: EPIC Health Plan Senior |
$134.40
|
| Rate for Payer: Galaxy Health WC |
$285.60
|
| Rate for Payer: Global Benefits Group Commercial |
$201.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$224.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$207.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.64
|
| Rate for Payer: Multiplan Commercial |
$268.80
|
| Rate for Payer: Networks By Design Commercial |
$218.40
|
| Rate for Payer: Prime Health Services Commercial |
$285.60
|
|
|
HC DIAG GASTRO INTUB W ASP SPECS
|
Facility
|
OP
|
$465.00
|
|
|
Service Code
|
CPT 43755
|
| Hospital Charge Code |
906743755
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$83.19 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$93.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$209.25
|
| Rate for Payer: Cash Price |
$209.25
|
| Rate for Payer: Cash Price |
$209.25
|
| Rate for Payer: Cigna of CA HMO |
$297.60
|
| Rate for Payer: Cigna of CA PPO |
$344.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.38
|
| Rate for Payer: EPIC Health Plan Senior |
$198.80
|
| Rate for Payer: Galaxy Health WC |
$395.25
|
| Rate for Payer: Global Benefits Group Commercial |
$279.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$83.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$310.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$250.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.39
|
| Rate for Payer: Multiplan Commercial |
$372.00
|
| Rate for Payer: Networks By Design Commercial |
$302.25
|
| Rate for Payer: Prime Health Services Commercial |
$395.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$279.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$238.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$198.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC DIAG GASTRO INTUB W ASP SPECS
|
Facility
|
IP
|
$465.00
|
|
|
Service Code
|
CPT 43755
|
| Hospital Charge Code |
906743755
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$93.00 |
| Max. Negotiated Rate |
$395.25 |
| Rate for Payer: Adventist Health Commercial |
$93.00
|
| Rate for Payer: Cash Price |
$209.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$186.00
|
| Rate for Payer: EPIC Health Plan Senior |
$186.00
|
| Rate for Payer: Galaxy Health WC |
$395.25
|
| Rate for Payer: Global Benefits Group Commercial |
$279.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$310.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$177.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$287.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.60
|
| Rate for Payer: Multiplan Commercial |
$372.00
|
| Rate for Payer: Networks By Design Commercial |
$302.25
|
| Rate for Payer: Prime Health Services Commercial |
$395.25
|
|
|
HC DIAGNOSTIC BRONCH
|
Facility
|
IP
|
$5,263.00
|
|
|
Service Code
|
CPT 31622
|
| Hospital Charge Code |
900501418
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,052.60 |
| Max. Negotiated Rate |
$4,473.55 |
| Rate for Payer: Adventist Health Commercial |
$1,052.60
|
| Rate for Payer: Cash Price |
$2,368.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,105.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,105.20
|
| Rate for Payer: Galaxy Health WC |
$4,473.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,157.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,510.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,005.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,257.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,263.12
|
| Rate for Payer: Multiplan Commercial |
$4,210.40
|
| Rate for Payer: Networks By Design Commercial |
$3,420.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,473.55
|
|
|
HC DIAGNOSTIC BRONCH
|
Facility
|
OP
|
$5,263.00
|
|
|
Service Code
|
CPT 31622
|
| Hospital Charge Code |
900501418
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$277.08 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$1,052.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,286.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,410.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,191.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$2,368.35
|
| Rate for Payer: Cash Price |
$2,368.35
|
| Rate for Payer: Cash Price |
$2,368.35
|
| Rate for Payer: Cigna of CA HMO |
$3,368.32
|
| Rate for Payer: Cigna of CA PPO |
$3,894.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,286.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,410.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,191.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,958.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,191.11
|
| Rate for Payer: Galaxy Health WC |
$4,473.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,157.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,593.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$277.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,191.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,510.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$313.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,191.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,263.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,760.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,936.09
|
| Rate for Payer: Multiplan Commercial |
$4,210.40
|
| Rate for Payer: Multiplan WC |
$3,491.15
|
| Rate for Payer: Networks By Design Commercial |
$3,420.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,473.55
|
| Rate for Payer: Prime Health Services WC |
$3,455.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,157.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,191.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,286.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,410.22
|
| Rate for Payer: Vantage Medical Group Senior |
$2,191.11
|
|
|
HC DIAGNOSTIC BRONCH
|
Facility
|
IP
|
$5,263.00
|
|
|
Service Code
|
CPT 31622
|
| Hospital Charge Code |
900501418
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,052.60 |
| Max. Negotiated Rate |
$4,473.55 |
| Rate for Payer: Adventist Health Commercial |
$1,052.60
|
| Rate for Payer: Cash Price |
$2,368.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,105.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,105.20
|
| Rate for Payer: Galaxy Health WC |
$4,473.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,157.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,510.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,005.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,257.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,263.12
|
| Rate for Payer: Multiplan Commercial |
$4,210.40
|
| Rate for Payer: Networks By Design Commercial |
$3,420.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,473.55
|
|
|
HC DIAGNOSTIC BRONCH
|
Facility
|
OP
|
$5,263.00
|
|
|
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: Adventist Health Commercial |
$1,052.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,286.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,410.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,191.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$2,368.35
|
| Rate for Payer: Cash Price |
$2,368.35
|
| Rate for Payer: Cash Price |
$2,368.35
|
| Rate for Payer: Cigna of CA HMO |
$3,368.32
|
| Rate for Payer: Cigna of CA PPO |
$3,894.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,286.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,410.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,191.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,958.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,191.11
|
| Rate for Payer: Galaxy Health WC |
$4,473.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,157.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,593.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,191.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,510.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$313.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,191.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,263.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,760.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,936.09
|
| Rate for Payer: Multiplan Commercial |
$4,210.40
|
| Rate for Payer: Multiplan WC |
$3,491.15
|
| Rate for Payer: Networks By Design Commercial |
$3,420.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,473.55
|
| Rate for Payer: Prime Health Services WC |
$3,455.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,157.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,631.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,631.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,631.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,631.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,191.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,286.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,410.22
|
| Rate for Payer: Vantage Medical Group Senior |
$2,191.11
|
|
|
HC DIAGNOSTIC BRONCH W BIOPSY
|
Facility
|
OP
|
$4,814.00
|
|
|
Service Code
|
CPT 31625
|
| Hospital Charge Code |
900803503
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$338.37 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$962.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,286.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,410.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,191.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$2,166.30
|
| Rate for Payer: Cash Price |
$2,166.30
|
| Rate for Payer: Cash Price |
$2,166.30
|
| Rate for Payer: Cigna of CA HMO |
$3,080.96
|
| Rate for Payer: Cigna of CA PPO |
$3,562.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,286.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,410.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,191.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,958.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,191.11
|
| Rate for Payer: Galaxy Health WC |
$4,091.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,888.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,593.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$338.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,191.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,210.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$382.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,191.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,155.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,760.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,936.09
|
| Rate for Payer: Multiplan Commercial |
$3,851.20
|
| Rate for Payer: Networks By Design Commercial |
$3,129.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,091.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,888.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,888.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,407.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,407.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,407.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,407.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,191.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,286.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,410.22
|
| Rate for Payer: Vantage Medical Group Senior |
$2,191.11
|
|
|
HC DIAGNOSTIC BRONCH W BIOPSY
|
Facility
|
IP
|
$4,814.00
|
|
|
Service Code
|
CPT 31625
|
| Hospital Charge Code |
900803503
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$962.80 |
| Max. Negotiated Rate |
$4,091.90 |
| Rate for Payer: Adventist Health Commercial |
$962.80
|
| Rate for Payer: Cash Price |
$2,166.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,925.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,925.60
|
| Rate for Payer: Galaxy Health WC |
$4,091.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,888.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,210.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,834.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,979.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,155.36
|
| Rate for Payer: Multiplan Commercial |
$3,851.20
|
| Rate for Payer: Networks By Design Commercial |
$3,129.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,091.90
|
|
|
HC DIAGNOSTIC BRONCH W/BRUSHING
|
Facility
|
IP
|
$3,801.00
|
|
|
Service Code
|
CPT 31623
|
| Hospital Charge Code |
900803501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$760.20 |
| Max. Negotiated Rate |
$3,230.85 |
| Rate for Payer: Adventist Health Commercial |
$760.20
|
| Rate for Payer: Cash Price |
$1,710.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,520.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,520.40
|
| Rate for Payer: Galaxy Health WC |
$3,230.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,280.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,535.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,448.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,352.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$912.24
|
| Rate for Payer: Multiplan Commercial |
$3,040.80
|
| Rate for Payer: Networks By Design Commercial |
$2,470.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,230.85
|
|
|
HC DIAGNOSTIC BRONCH W/BRUSHING
|
Facility
|
OP
|
$3,801.00
|
|
|
Service Code
|
CPT 31623
|
| Hospital Charge Code |
900803501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$355.27 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$760.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,286.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,410.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,191.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$1,710.45
|
| Rate for Payer: Cash Price |
$1,710.45
|
| Rate for Payer: Cash Price |
$1,710.45
|
| Rate for Payer: Cigna of CA HMO |
$2,432.64
|
| Rate for Payer: Cigna of CA PPO |
$2,812.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,286.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,410.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,191.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,958.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,191.11
|
| Rate for Payer: Galaxy Health WC |
$3,230.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,280.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,593.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$355.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,191.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,535.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$401.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,191.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$912.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,760.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,936.09
|
| Rate for Payer: Multiplan Commercial |
$3,040.80
|
| Rate for Payer: Multiplan WC |
$3,491.15
|
| Rate for Payer: Networks By Design Commercial |
$2,470.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,230.85
|
| Rate for Payer: Prime Health Services WC |
$3,455.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,280.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,191.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,286.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,410.22
|
| Rate for Payer: Vantage Medical Group Senior |
$2,191.11
|
|
