|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,369.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3,056.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,840.26
|
| 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
|
OP
|
$3,801.00
|
|
|
Service Code
|
CPT 31623
|
| Hospital Charge Code |
900803501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$355.27 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$760.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,518.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,289.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| 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 |
$3,433.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,518.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,289.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,660.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,777.26
|
| Rate for Payer: EPIC Health Plan Senior |
$2,518.18
|
| 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/Senior |
$3,754.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$355.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,289.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,413.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$401.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,204.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$912.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,884.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,067.59
|
| Rate for Payer: Multiplan Commercial |
$3,040.80
|
| 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 |
$1,900.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,289.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,518.18
|
| Rate for Payer: Vantage Medical Group Senior |
$2,289.25
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,660.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,413.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,242.59
|
| 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 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 |
$3,717.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,782.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$5,245.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,873.99
|
| 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
|
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 |
$3,717.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,782.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$5,245.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,873.99
|
| 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
|
OP
|
$8,261.00
|
|
|
Service Code
|
CPT 31525
|
| Hospital Charge Code |
900803512
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$320.44 |
| Max. Negotiated Rate |
$7,021.85 |
| Rate for Payer: Adventist Health Commercial |
$1,652.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,518.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,289.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$3,717.45
|
| Rate for Payer: Cash Price |
$3,717.45
|
| Rate for Payer: Cash Price |
$3,717.45
|
| 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 |
$3,433.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,518.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,289.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,782.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,777.26
|
| Rate for Payer: EPIC Health Plan Senior |
$2,518.18
|
| 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/Senior |
$3,754.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,289.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,245.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$320.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,460.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,982.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,884.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,067.59
|
| Rate for Payer: Multiplan Commercial |
$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 |
$2,289.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,518.18
|
| Rate for Payer: Vantage Medical Group Senior |
$2,289.25
|
|
|
HC DIAGNOSTIC LARYNGOSCOPY
|
Facility
|
OP
|
$8,261.00
|
|
|
Service Code
|
CPT 31525
|
| Hospital Charge Code |
900803512
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$283.33 |
| Max. Negotiated Rate |
$7,021.85 |
| Rate for Payer: Adventist Health Commercial |
$1,652.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,019.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,518.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,289.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Cash Price |
$3,717.45
|
| Rate for Payer: Cash Price |
$3,717.45
|
| Rate for Payer: Cash Price |
$3,717.45
|
| Rate for Payer: Cash Price |
$3,717.45
|
| 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 |
$3,433.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,518.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,289.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,782.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,777.26
|
| Rate for Payer: EPIC Health Plan Senior |
$2,518.18
|
| 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/Senior |
$3,754.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$283.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,289.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,245.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$320.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,204.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,982.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,884.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,067.59
|
| Rate for Payer: Multiplan Commercial |
$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 |
$2,289.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,518.18
|
| Rate for Payer: Vantage Medical Group Senior |
$2,289.25
|
|
|
HC 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 |
$3,882.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,038.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$5,478.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,089.93
|
| 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
|
450
|
| Min. Negotiated Rate |
$262.43 |
| Max. Negotiated Rate |
$7,332.95 |
| Rate for Payer: Adventist Health Commercial |
$1,725.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,518.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,289.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$3,882.15
|
| Rate for Payer: Cash Price |
$3,882.15
|
| Rate for Payer: Cash Price |
$3,882.15
|
| 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 |
$3,433.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,518.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,289.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,038.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,777.26
|
| Rate for Payer: EPIC Health Plan Senior |
$2,518.18
|
| 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/Senior |
$3,754.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,289.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,478.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$262.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,460.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,070.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,884.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,067.59
|
| Rate for Payer: Multiplan Commercial |
$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 |
$2,289.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,518.18
|
| Rate for Payer: Vantage Medical Group Senior |
$2,289.25
|
|
|
HC 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 |
$3,882.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,038.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$5,478.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,089.93
|
| 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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,725.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,518.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,289.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Cash Price |
$3,882.15
|
| Rate for Payer: Cash Price |
$3,882.15
|
| Rate for Payer: Cash Price |
$3,882.15
|
| 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 |
$3,433.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,518.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,289.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,038.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,777.26
|
| Rate for Payer: EPIC Health Plan Senior |
$2,518.18
|
| 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/Senior |
$3,754.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$232.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,289.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,478.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$262.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,204.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,070.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,884.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,067.59
|
| Rate for Payer: Multiplan Commercial |
$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 |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,289.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,518.18
|
| Rate for Payer: Vantage Medical Group Senior |
$2,289.25
|
|
|
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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,667.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| 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 |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,508.41
|
| Rate for Payer: Blue Shield of California Commercial |
$3,638.65
|
| Rate for Payer: Cash Price |
$3,750.75
|
| Rate for Payer: Cash Price |
$3,750.75
|
| Rate for Payer: Cash Price |
$3,750.75
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,834.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$5,292.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,431.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,917.65
|
| 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 |
$4,167.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$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 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: Multiplan Commercial |
$6,668.00
|
| Rate for Payer: Adventist Health Commercial |
$1,667.00
|
| Rate for Payer: Cash Price |
$3,750.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,834.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$5,292.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,917.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,000.40
|
| Rate for Payer: Networks By Design Commercial |
$5,417.75
|
| Rate for Payer: Prime Health Services Commercial |
$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: Cash Price |
$225.90
|
| Rate for Payer: Adventist Health Commercial |
$100.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$351.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$318.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.18
|
| 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 |
$90.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,036.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: Cash Price |
$225.90
|
| 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 |
$90.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$66.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$351.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.38
|
| Rate for Payer: EPIC Health Plan Senior |
$66.25
|
| Rate for Payer: Galaxy Health WC |
$426.70
|
| Rate for Payer: Global Benefits Group Commercial |
$301.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$98.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$60.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$318.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$75.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$80.71
|
| 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 |
$60.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$90.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.25
|
| Rate for Payer: Vantage Medical Group Senior |
$60.23
|
|
|
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 |
$468.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$728.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$660.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$613.60
|
| 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/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 |
$885.51 |
| Rate for Payer: Adventist Health Commercial |
$208.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$543.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$805.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$590.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$536.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$667.37
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Cash Price |
$468.00
|
| 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 |
$805.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$590.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$536.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$728.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$885.51
|
| Rate for Payer: EPIC Health Plan Senior |
$590.34
|
| Rate for Payer: Galaxy Health WC |
$884.00
|
| Rate for Payer: Global Benefits Group Commercial |
$624.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$880.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$121.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$536.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$660.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$137.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$751.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$249.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$676.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$719.14
|
| 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 |
$536.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$805.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$590.34
|
| Rate for Payer: Vantage Medical Group Senior |
$536.67
|
|
|
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 |
$147.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$228.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$207.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$192.93
|
| 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 |
$813.55 |
| Rate for Payer: Adventist Health Commercial |
$65.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$813.55
|
| 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 |
$209.84
|
| Rate for Payer: Cash Price |
$147.15
|
| Rate for Payer: Cash Price |
$147.15
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$228.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$207.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$205.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$192.93
|
| 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
|
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 |
$623.09
|
| Rate for Payer: Blue Shield of California Commercial |
$408.79
|
| Rate for Payer: Blue Shield of California Commercial |
$619.50
|
| Rate for Payer: Cash Price |
$436.95
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$679.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$616.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$352.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$572.89
|
| 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
|
|
|
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 |
$436.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$679.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$616.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$572.89
|
| 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 DIAPHRAGM/CAP FITTING
|
Facility
|
OP
|
$474.00
|
|
|
Service Code
|
CPT 57170
|
| Hospital Charge Code |
910400024
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$63.84 |
| Max. Negotiated Rate |
$429.05 |
| Rate for Payer: Adventist Health Commercial |
$94.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$331.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$390.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$286.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$260.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$304.17
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Cigna of CA HMO |
$303.36
|
| Rate for Payer: Cigna of CA PPO |
$350.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$390.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$286.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$260.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$331.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$429.05
|
| Rate for Payer: EPIC Health Plan Senior |
$286.03
|
| Rate for Payer: Galaxy Health WC |
$402.90
|
| Rate for Payer: Global Benefits Group Commercial |
$284.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$426.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$63.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$260.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$300.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$364.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$327.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$348.44
|
| Rate for Payer: Multiplan Commercial |
$379.20
|
| Rate for Payer: Networks By Design Commercial |
$308.10
|
| Rate for Payer: Prime Health Services Commercial |
$402.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$284.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$284.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$237.00
|
| Rate for Payer: United Healthcare All Other HMO |
$237.00
|
| Rate for Payer: United Healthcare HMO Rider |
$237.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$237.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$260.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$390.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$286.03
|
| Rate for Payer: Vantage Medical Group Senior |
$260.03
|
|
|
HC DIAPHRAGM/CAP FITTING
|
Facility
|
IP
|
$474.00
|
|
|
Service Code
|
CPT 57170
|
| Hospital Charge Code |
910400024
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$94.80 |
| Max. Negotiated Rate |
$402.90 |
| Rate for Payer: Adventist Health Commercial |
$94.80
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$331.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$189.60
|
| Rate for Payer: EPIC Health Plan Senior |
$189.60
|
| Rate for Payer: Galaxy Health WC |
$402.90
|
| Rate for Payer: Global Benefits Group Commercial |
$284.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$300.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$279.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.76
|
| Rate for Payer: Multiplan Commercial |
$379.20
|
| Rate for Payer: Networks By Design Commercial |
$308.10
|
| Rate for Payer: Prime Health Services Commercial |
$402.90
|
|
|
HC DIETICIAN CASE CONF COORD
|
Facility
|
OP
|
$246.00
|
|
| Hospital Charge Code |
908600157
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.20 |
| Max. Negotiated Rate |
$209.10 |
| Rate for Payer: Adventist Health Commercial |
$49.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$161.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$209.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$135.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$184.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.86
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cigna of CA HMO |
$157.44
|
| Rate for Payer: Cigna of CA PPO |
$182.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$209.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$209.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$209.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$172.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.40
|
| Rate for Payer: EPIC Health Plan Senior |
$98.40
|
| Rate for Payer: Galaxy Health WC |
$209.10
|
| Rate for Payer: Global Benefits Group Commercial |
$147.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$156.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$89.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$145.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$172.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$172.20
|
| Rate for Payer: Multiplan Commercial |
$196.80
|
| Rate for Payer: Networks By Design Commercial |
$159.90
|
| Rate for Payer: Prime Health Services Commercial |
$209.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$147.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$147.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.00
|
| Rate for Payer: United Healthcare All Other HMO |
$123.00
|
| Rate for Payer: United Healthcare HMO Rider |
$123.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$209.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$209.10
|
| Rate for Payer: Vantage Medical Group Senior |
$209.10
|
|
|
HC DIETICIAN CASE CONF COORD
|
Facility
|
IP
|
$246.00
|
|
| Hospital Charge Code |
908600157
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.20 |
| Max. Negotiated Rate |
$209.10 |
| Rate for Payer: Adventist Health Commercial |
$49.20
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$172.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.40
|
| Rate for Payer: EPIC Health Plan Senior |
$98.40
|
| Rate for Payer: Galaxy Health WC |
$209.10
|
| Rate for Payer: Global Benefits Group Commercial |
$147.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$156.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$145.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.04
|
| Rate for Payer: Multiplan Commercial |
$196.80
|
| Rate for Payer: Networks By Design Commercial |
$159.90
|
| Rate for Payer: Prime Health Services Commercial |
$209.10
|
|
