|
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 |
$2,894.65
|
| 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 |
$2,894.65
|
| Rate for Payer: Cash Price |
$2,894.65
|
| Rate for Payer: Cash Price |
$2,894.65
|
| 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
|
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 |
$2,894.65
|
| Rate for Payer: Cash Price |
$2,894.65
|
| Rate for Payer: Cash Price |
$2,894.65
|
| 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 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 |
$2,647.70
|
| Rate for Payer: Cash Price |
$2,647.70
|
| Rate for Payer: Cash Price |
$2,647.70
|
| 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 |
$2,647.70
|
| 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 |
$2,090.55
|
| 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 |
$2,090.55
|
| Rate for Payer: Cash Price |
$2,090.55
|
| Rate for Payer: Cash Price |
$2,090.55
|
| 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
|
|
|
HC DIAGNOSTIC LARYNGOSCOPY
|
Facility
|
OP
|
$8,261.00
|
|
|
Service Code
|
CPT 31525
|
| Hospital Charge Code |
900803512
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$320.44 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$1,652.20
|
| 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 |
$5,398.00
|
| Rate for Payer: Cash Price |
$4,543.55
|
| Rate for Payer: Cash Price |
$4,543.55
|
| Rate for Payer: Cash Price |
$4,543.55
|
| Rate for Payer: Cigna of CA HMO |
$5,287.04
|
| Rate for Payer: Cigna of CA PPO |
$6,113.14
|
| 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 |
$7,021.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,956.60
|
| 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 |
$5,510.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,191.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,982.64
|
| 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 |
$6,608.80
|
| Rate for Payer: Multiplan WC |
$3,491.15
|
| Rate for Payer: Networks By Design Commercial |
$5,369.65
|
| Rate for Payer: Prime Health Services Commercial |
$7,021.85
|
| Rate for Payer: Prime Health Services WC |
$3,455.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,956.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,130.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,130.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,130.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,130.50
|
| 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 LARYNGOSCOPY
|
Facility
|
OP
|
$8,261.00
|
|
|
Service Code
|
CPT 31525
|
| Hospital Charge Code |
900803512
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$279.00 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$1,652.20
|
| 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 |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$4,543.55
|
| Rate for Payer: Cash Price |
$4,543.55
|
| Rate for Payer: Cash Price |
$4,543.55
|
| Rate for Payer: Cigna of CA HMO |
$5,287.04
|
| Rate for Payer: Cigna of CA PPO |
$6,113.14
|
| 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 |
$7,021.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,956.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,593.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$283.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,191.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,510.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,191.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,982.64
|
| 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 |
$6,608.80
|
| Rate for Payer: Networks By Design Commercial |
$5,369.65
|
| Rate for Payer: Prime Health Services Commercial |
$7,021.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,956.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,956.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| 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 LARYNGOSCOPY
|
Facility
|
IP
|
$8,261.00
|
|
|
Service Code
|
CPT 31525
|
| Hospital Charge Code |
900803512
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,652.20 |
| Max. Negotiated Rate |
$7,021.85 |
| Rate for Payer: Adventist Health Commercial |
$1,652.20
|
| Rate for Payer: Cash Price |
$4,543.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,304.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,304.40
|
| Rate for Payer: Galaxy Health WC |
$7,021.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,956.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,510.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,147.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,113.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,982.64
|
| Rate for Payer: Multiplan Commercial |
$6,608.80
|
| Rate for Payer: Networks By Design Commercial |
$5,369.65
|
| Rate for Payer: Prime Health Services Commercial |
$7,021.85
|
|
|
HC DIAGNOSTIC LARYNGOSCOPY
|
Facility
|
IP
|
$8,261.00
|
|
|
Service Code
|
CPT 31525
|
| Hospital Charge Code |
900803512
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,652.20 |
| Max. Negotiated Rate |
$7,021.85 |
| Rate for Payer: Adventist Health Commercial |
$1,652.20
|
| Rate for Payer: Cash Price |
$4,543.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,304.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,304.40
|
| Rate for Payer: Galaxy Health WC |
$7,021.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,956.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,510.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,147.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,113.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,982.64
|
| Rate for Payer: Multiplan Commercial |
$6,608.80
|
| Rate for Payer: Networks By Design Commercial |
$5,369.65
|
| Rate for Payer: Prime Health Services Commercial |
$7,021.85
|
|
|
HC DIAGNOSTIC LARYNGOSCOPY W/MICR
|
Facility
|
IP
|
$8,627.00
|
|
|
Service Code
|
CPT 31526
|
| Hospital Charge Code |
900501508
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,725.40 |
| Max. Negotiated Rate |
$7,332.95 |
| Rate for Payer: Adventist Health Commercial |
$1,725.40
|
| Rate for Payer: Cash Price |
$4,744.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,450.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,450.80
|
| Rate for Payer: Galaxy Health WC |
$7,332.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,176.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,754.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,286.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,340.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,070.48
|
| Rate for Payer: Multiplan Commercial |
$6,901.60
|
| Rate for Payer: Networks By Design Commercial |
$5,607.55
|
| Rate for Payer: Prime Health Services Commercial |
$7,332.95
|
|
|
HC DIAGNOSTIC LARYNGOSCOPY W/MICR
|
Facility
|
IP
|
$8,627.00
|
|
|
Service Code
|
CPT 31526
|
| Hospital Charge Code |
900501508
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,725.40 |
| Max. Negotiated Rate |
$7,332.95 |
| Rate for Payer: Adventist Health Commercial |
$1,725.40
|
| Rate for Payer: Cash Price |
$4,744.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,450.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,450.80
|
| Rate for Payer: Galaxy Health WC |
$7,332.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,176.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,754.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,286.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,340.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,070.48
|
| Rate for Payer: Multiplan Commercial |
$6,901.60
|
| Rate for Payer: Networks By Design Commercial |
$5,607.55
|
| Rate for Payer: Prime Health Services Commercial |
$7,332.95
|
|
|
HC DIAGNOSTIC LARYNGOSCOPY W/MICR
|
Facility
|
OP
|
$8,627.00
|
|
|
Service Code
|
CPT 31526
|
| Hospital Charge Code |
900501508
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$232.04 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$1,725.40
|
| 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 |
$4,744.85
|
| Rate for Payer: Cash Price |
$4,744.85
|
| Rate for Payer: Cash Price |
$4,744.85
|
| Rate for Payer: Cigna of CA HMO |
$5,521.28
|
| Rate for Payer: Cigna of CA PPO |
$6,383.98
|
| 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 |
$7,332.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,176.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,593.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$232.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,191.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,754.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$262.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,191.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,070.48
|
| 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 |
$6,901.60
|
| Rate for Payer: Multiplan WC |
$3,491.15
|
| Rate for Payer: Networks By Design Commercial |
$5,607.55
|
| Rate for Payer: Prime Health Services Commercial |
$7,332.95
|
| Rate for Payer: Prime Health Services WC |
$3,455.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,176.20
|
| 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 LARYNGOSCOPY W/MICR
|
Facility
|
OP
|
$8,627.00
|
|
|
Service Code
|
CPT 31526
|
| Hospital Charge Code |
900501508
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$262.43 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$1,725.40
|
| 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 |
$4,744.85
|
| Rate for Payer: Cash Price |
$4,744.85
|
| Rate for Payer: Cash Price |
$4,744.85
|
| Rate for Payer: Cigna of CA HMO |
$5,521.28
|
| Rate for Payer: Cigna of CA PPO |
$6,383.98
|
| 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 |
$7,332.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,176.20
|
| 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 |
$5,754.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$262.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,191.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,070.48
|
| 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 |
$6,901.60
|
| Rate for Payer: Multiplan WC |
$3,491.15
|
| Rate for Payer: Networks By Design Commercial |
$5,607.55
|
| Rate for Payer: Prime Health Services Commercial |
$7,332.95
|
| Rate for Payer: Prime Health Services WC |
$3,455.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,176.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,313.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,313.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,313.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,313.50
|
| 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 DIALYSIS CRCT VASC EMBO OR OCC
|
Facility
|
IP
|
$8,335.00
|
|
|
Service Code
|
CPT 36909
|
| Hospital Charge Code |
909036909
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,667.00 |
| Max. Negotiated Rate |
$7,084.75 |
| Rate for Payer: Adventist Health Commercial |
$1,667.00
|
| Rate for Payer: Cash Price |
$4,584.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,334.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,334.00
|
| Rate for Payer: Galaxy Health WC |
$7,084.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,001.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,559.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,175.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,159.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,000.40
|
| Rate for Payer: Multiplan Commercial |
$6,668.00
|
| Rate for Payer: Networks By Design Commercial |
$5,417.75
|
| Rate for Payer: Prime Health Services Commercial |
$7,084.75
|
|
|
HC DIALYSIS CRCT VASC EMBO OR OCC
|
Facility
|
OP
|
$8,335.00
|
|
|
Service Code
|
CPT 36909
|
| Hospital Charge Code |
909036909
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,000.00 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$1,667.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,084.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,584.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,251.25
|
| 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 |
$3,490.94
|
| Rate for Payer: Cash Price |
$4,584.25
|
| Rate for Payer: Cash Price |
$4,584.25
|
| Rate for Payer: Cash Price |
$4,584.25
|
| Rate for Payer: Cigna of CA HMO |
$5,334.40
|
| Rate for Payer: Cigna of CA PPO |
$6,167.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,084.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,084.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,084.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,334.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,334.00
|
| Rate for Payer: Galaxy Health WC |
$7,084.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,001.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,034.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,559.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,431.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,159.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,000.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,834.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,834.50
|
| Rate for Payer: Multiplan Commercial |
$6,668.00
|
| Rate for Payer: Networks By Design Commercial |
$5,417.75
|
| Rate for Payer: Prime Health Services Commercial |
$7,084.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,001.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$7,084.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,084.75
|
| Rate for Payer: Vantage Medical Group Senior |
$7,084.75
|
|
|
HC DIALYSIS ONLY IV PUSH EA ADD NEW DRUG
|
Facility
|
IP
|
$502.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
946100112
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$100.40 |
| Max. Negotiated Rate |
$426.70 |
| Rate for Payer: Adventist Health Commercial |
$100.40
|
| Rate for Payer: Cash Price |
$276.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$200.80
|
| Rate for Payer: EPIC Health Plan Senior |
$200.80
|
| Rate for Payer: Galaxy Health WC |
$426.70
|
| Rate for Payer: Global Benefits Group Commercial |
$301.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$334.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$191.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$310.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.48
|
| Rate for Payer: Multiplan Commercial |
$401.60
|
| Rate for Payer: Networks By Design Commercial |
$326.30
|
| Rate for Payer: Prime Health Services Commercial |
$426.70
|
|
|
HC DIALYSIS ONLY IV PUSH EA ADD NEW DRUG
|
Facility
|
OP
|
$502.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
946100112
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$35.77 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$100.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$87.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$64.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$991.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$276.10
|
| Rate for Payer: Cash Price |
$276.10
|
| Rate for Payer: Cash Price |
$276.10
|
| Rate for Payer: Cigna of CA HMO |
$321.28
|
| Rate for Payer: Cigna of CA PPO |
$371.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$87.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$58.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.15
|
| Rate for Payer: EPIC Health Plan Senior |
$58.63
|
| Rate for Payer: Galaxy Health WC |
$426.70
|
| Rate for Payer: Global Benefits Group Commercial |
$301.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$96.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$58.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$334.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$58.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$73.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78.56
|
| Rate for Payer: Multiplan Commercial |
$401.60
|
| Rate for Payer: Multiplan WC |
$93.40
|
| Rate for Payer: Networks By Design Commercial |
$326.30
|
| Rate for Payer: Prime Health Services Commercial |
$426.70
|
| Rate for Payer: Prime Health Services WC |
$92.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$301.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$251.00
|
| Rate for Payer: United Healthcare All Other HMO |
$251.00
|
| Rate for Payer: United Healthcare HMO Rider |
$251.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$251.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$58.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$87.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.49
|
| Rate for Payer: Vantage Medical Group Senior |
$58.63
|
|
|
HC DIALYSIS PERITONEAL/CCPD
|
Facility
|
OP
|
$1,040.00
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
944000100
|
|
Hospital Revenue Code
|
804
|
| Min. Negotiated Rate |
$121.23 |
| Max. Negotiated Rate |
$887.32 |
| Rate for Payer: Adventist Health Commercial |
$208.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$682.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$811.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$595.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$541.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$638.66
|
| Rate for Payer: Cash Price |
$572.00
|
| Rate for Payer: Cash Price |
$572.00
|
| Rate for Payer: Cigna of CA HMO |
$665.60
|
| Rate for Payer: Cigna of CA PPO |
$769.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$811.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$595.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$541.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$730.42
|
| Rate for Payer: EPIC Health Plan Senior |
$541.05
|
| Rate for Payer: Galaxy Health WC |
$884.00
|
| Rate for Payer: Global Benefits Group Commercial |
$624.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$887.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$121.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$541.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$693.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$541.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$249.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$681.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$725.01
|
| Rate for Payer: Multiplan Commercial |
$832.00
|
| Rate for Payer: Networks By Design Commercial |
$676.00
|
| Rate for Payer: Prime Health Services Commercial |
$884.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$624.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$624.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$520.00
|
| Rate for Payer: United Healthcare All Other HMO |
$520.00
|
| Rate for Payer: United Healthcare HMO Rider |
$520.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$520.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$541.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$811.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$595.15
|
| Rate for Payer: Vantage Medical Group Senior |
$541.05
|
|
|
HC DIALYSIS PERITONEAL/CCPD
|
Facility
|
IP
|
$1,040.00
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
944000100
|
|
Hospital Revenue Code
|
804
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$884.00 |
| Rate for Payer: Adventist Health Commercial |
$208.00
|
| Rate for Payer: Cash Price |
$572.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$416.00
|
| Rate for Payer: EPIC Health Plan Senior |
$416.00
|
| Rate for Payer: Galaxy Health WC |
$884.00
|
| Rate for Payer: Global Benefits Group Commercial |
$624.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$693.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$396.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$643.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$249.60
|
| Rate for Payer: Multiplan Commercial |
$832.00
|
| Rate for Payer: Networks By Design Commercial |
$676.00
|
| Rate for Payer: Prime Health Services Commercial |
$884.00
|
|
|
HC DIALYSIS PERITONEAL REPEAT
|
Facility
|
IP
|
$327.00
|
|
|
Service Code
|
CPT 90947
|
| Hospital Charge Code |
988190947
|
|
Hospital Revenue Code
|
804
|
| Min. Negotiated Rate |
$65.40 |
| Max. Negotiated Rate |
$277.95 |
| Rate for Payer: Adventist Health Commercial |
$65.40
|
| Rate for Payer: Cash Price |
$179.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.80
|
| Rate for Payer: EPIC Health Plan Senior |
$130.80
|
| Rate for Payer: Galaxy Health WC |
$277.95
|
| Rate for Payer: Global Benefits Group Commercial |
$196.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$218.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$202.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.48
|
| Rate for Payer: Multiplan Commercial |
$261.60
|
| Rate for Payer: Networks By Design Commercial |
$212.55
|
| Rate for Payer: Prime Health Services Commercial |
$277.95
|
|
|
HC DIALYSIS PERITONEAL REPEAT
|
Facility
|
OP
|
$327.00
|
|
|
Service Code
|
CPT 90947
|
| Hospital Charge Code |
988190947
|
|
Hospital Revenue Code
|
804
|
| Min. Negotiated Rate |
$65.40 |
| Max. Negotiated Rate |
$277.95 |
| Rate for Payer: Adventist Health Commercial |
$65.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$214.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$277.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$179.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$245.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$200.81
|
| Rate for Payer: Cash Price |
$179.85
|
| Rate for Payer: Cash Price |
$179.85
|
| Rate for Payer: Cigna of CA HMO |
$209.28
|
| Rate for Payer: Cigna of CA PPO |
$241.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$277.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$277.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.80
|
| Rate for Payer: EPIC Health Plan Senior |
$130.80
|
| Rate for Payer: Galaxy Health WC |
$277.95
|
| Rate for Payer: Global Benefits Group Commercial |
$196.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$181.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$218.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$202.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$228.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$228.90
|
| Rate for Payer: Multiplan Commercial |
$261.60
|
| Rate for Payer: Networks By Design Commercial |
$212.55
|
| Rate for Payer: Prime Health Services Commercial |
$277.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$196.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$196.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$163.50
|
| Rate for Payer: United Healthcare All Other HMO |
$163.50
|
| Rate for Payer: United Healthcare HMO Rider |
$163.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$163.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$277.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.95
|
| Rate for Payer: Vantage Medical Group Senior |
$277.95
|
|
|
HC DIALYSIS VESSEL MAPPING
|
Facility
|
IP
|
$971.00
|
|
| Hospital Charge Code |
906601319
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$194.20 |
| Max. Negotiated Rate |
$825.35 |
| Rate for Payer: Adventist Health Commercial |
$194.20
|
| Rate for Payer: Cash Price |
$534.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$388.40
|
| Rate for Payer: EPIC Health Plan Senior |
$388.40
|
| Rate for Payer: Galaxy Health WC |
$825.35
|
| Rate for Payer: Global Benefits Group Commercial |
$582.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$647.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$369.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$601.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.04
|
| Rate for Payer: Multiplan Commercial |
$776.80
|
| Rate for Payer: Networks By Design Commercial |
$631.15
|
| Rate for Payer: Prime Health Services Commercial |
$825.35
|
|
|
HC DIALYSIS VESSEL MAPPING
|
Facility
|
OP
|
$971.00
|
|
| Hospital Charge Code |
906601319
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$194.20 |
| Max. Negotiated Rate |
$825.35 |
| Rate for Payer: Adventist Health Commercial |
$194.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$636.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$825.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$534.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$728.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$596.29
|
| Rate for Payer: Blue Shield of California Commercial |
$594.25
|
| Rate for Payer: Blue Shield of California EPN |
$392.28
|
| Rate for Payer: Cash Price |
$534.05
|
| Rate for Payer: Cigna of CA HMO |
$621.44
|
| Rate for Payer: Cigna of CA PPO |
$718.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$825.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$825.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$825.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$388.40
|
| Rate for Payer: EPIC Health Plan Senior |
$388.40
|
| Rate for Payer: Galaxy Health WC |
$825.35
|
| Rate for Payer: Global Benefits Group Commercial |
$582.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$647.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$369.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$601.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$679.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$679.70
|
| Rate for Payer: Multiplan Commercial |
$776.80
|
| Rate for Payer: Networks By Design Commercial |
$631.15
|
| Rate for Payer: Prime Health Services Commercial |
$825.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$582.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$582.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$485.50
|
| Rate for Payer: United Healthcare All Other HMO |
$485.50
|
| Rate for Payer: United Healthcare HMO Rider |
$485.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$485.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$825.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$825.35
|
| Rate for Payer: Vantage Medical Group Senior |
$825.35
|
|
