|
HC TRACHEOBRONCH VIA TRACHESOTOMY
|
Facility
|
OP
|
$3,313.00
|
|
|
Service Code
|
CPT 31615
|
| Hospital Charge Code |
900501297
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$322.56 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$687.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,987.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$1,490.85
|
| Rate for Payer: Cash Price |
$1,490.85
|
| Rate for Payer: Cigna of CA PPO |
$2,451.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Dignity Health Media |
$687.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$756.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$928.04
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$687.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$687.44
|
| Rate for Payer: Galaxy Health WC |
$2,816.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,987.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,484.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,127.40
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,127.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,113.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,113.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$687.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,209.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$322.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$687.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$795.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$866.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$921.17
|
| Rate for Payer: Multiplan Commercial |
$2,650.40
|
| Rate for Payer: Networks By Design Commercial |
$2,153.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,816.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,987.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Vantage Medical Group Senior |
$687.44
|
|
|
HC TRACHEOSTOMY CRICOTHYROID MEMB
|
Facility
|
IP
|
$2,772.00
|
|
|
Service Code
|
CPT 31605
|
| Hospital Charge Code |
900501344
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$665.28 |
| Max. Negotiated Rate |
$2,356.20 |
| Rate for Payer: Cash Price |
$1,247.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,108.80
|
| Rate for Payer: Galaxy Health WC |
$2,356.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,663.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,848.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,056.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$665.28
|
| Rate for Payer: Multiplan Commercial |
$2,217.60
|
| Rate for Payer: Networks By Design Commercial |
$1,801.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,356.20
|
|
|
HC TRACHEOSTOMY CRICOTHYROID MEMB
|
Facility
|
OP
|
$2,772.00
|
|
|
Service Code
|
CPT 31605
|
| Hospital Charge Code |
900501344
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$305.19 |
| Max. Negotiated Rate |
$5,938.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$305.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,663.20
|
| Rate for Payer: Cash Price |
$1,247.40
|
| Rate for Payer: Cash Price |
$1,247.40
|
| Rate for Payer: Cash Price |
$1,247.40
|
| Rate for Payer: Cigna of CA PPO |
$2,051.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.78
|
| Rate for Payer: Dignity Health Media |
$305.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.01
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$305.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$305.19
|
| Rate for Payer: Galaxy Health WC |
$2,356.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,663.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,079.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$500.51
|
| Rate for Payer: Heritage Provider Network Transplant |
$500.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$305.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,848.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$381.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$305.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$665.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.95
|
| Rate for Payer: Multiplan Commercial |
$2,217.60
|
| Rate for Payer: Networks By Design Commercial |
$1,801.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,356.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,663.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,386.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,386.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,386.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,386.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Vantage Medical Group Senior |
$305.19
|
|
|
HC TRACHEOSTOMY, EMERG
|
Facility
|
IP
|
$4,467.00
|
|
|
Service Code
|
CPT 31603
|
| Hospital Charge Code |
900501122
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,072.08 |
| Max. Negotiated Rate |
$3,796.95 |
| Rate for Payer: Cash Price |
$2,010.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,786.80
|
| Rate for Payer: Galaxy Health WC |
$3,796.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,680.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,979.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,701.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,072.08
|
| Rate for Payer: Multiplan Commercial |
$3,573.60
|
| Rate for Payer: Networks By Design Commercial |
$2,903.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,796.95
|
|
|
HC TRACHEOSTOMY, EMERG
|
Facility
|
OP
|
$4,467.00
|
|
|
Service Code
|
CPT 31603
|
| Hospital Charge Code |
900501122
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$202.31 |
| Max. Negotiated Rate |
$7,282.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,905.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,680.20
|
| Rate for Payer: Cash Price |
$2,010.15
|
| Rate for Payer: Cash Price |
$2,010.15
|
| Rate for Payer: Cash Price |
$2,010.15
|
| Rate for Payer: Cigna of CA PPO |
$3,305.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Dignity Health Media |
$1,905.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,095.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,572.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,905.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,905.44
|
| Rate for Payer: Galaxy Health WC |
$3,796.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,680.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,350.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,124.92
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,124.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,905.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,979.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$202.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,905.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,072.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,400.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,553.29
|
| Rate for Payer: Multiplan Commercial |
$3,573.60
|
| Rate for Payer: Networks By Design Commercial |
$2,903.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,796.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,680.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,233.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,233.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,233.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,233.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Vantage Medical Group Senior |
$1,905.44
|
|
|
HC TRACH PLACEMENT ASSIST
|
Facility
|
OP
|
$6,361.00
|
|
|
Service Code
|
CPT 31600
|
| Hospital Charge Code |
900800522
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$293.00 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,022.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,816.60
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$2,862.45
|
| Rate for Payer: Cash Price |
$2,862.45
|
| Rate for Payer: Cash Price |
$2,862.45
|
| Rate for Payer: Cigna of CA HMO |
$4,071.04
|
| Rate for Payer: Cigna of CA PPO |
$4,707.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Dignity Health Media |
$4,022.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,424.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,430.63
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,022.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,022.69
|
| Rate for Payer: Galaxy Health WC |
$5,406.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,816.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,770.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,597.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,597.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,516.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6,516.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,022.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,242.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$381.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,022.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,526.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,068.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,390.40
|
| Rate for Payer: Multiplan Commercial |
$5,088.80
|
| Rate for Payer: Networks By Design Commercial |
$4,134.65
|
| Rate for Payer: Prime Health Services Commercial |
$5,406.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,816.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,816.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.00
|
| Rate for Payer: United Healthcare All Other HMO |
$478.00
|
| Rate for Payer: United Healthcare HMO Rider |
$428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$391.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Vantage Medical Group Senior |
$4,022.69
|
|
|
HC TRACH PLACEMENT ASSIST
|
Facility
|
IP
|
$6,361.00
|
|
|
Service Code
|
CPT 31600
|
| Hospital Charge Code |
900800522
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,526.64 |
| Max. Negotiated Rate |
$5,406.85 |
| Rate for Payer: Cash Price |
$2,862.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,544.40
|
| Rate for Payer: Galaxy Health WC |
$5,406.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,816.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,242.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,423.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,526.64
|
| Rate for Payer: Multiplan Commercial |
$5,088.80
|
| Rate for Payer: Networks By Design Commercial |
$4,134.65
|
| Rate for Payer: Prime Health Services Commercial |
$5,406.85
|
|
|
HC TRACH PUNCTURE/CLEAR WINDPIPE
|
Facility
|
OP
|
$9,154.00
|
|
|
Service Code
|
CPT 31612
|
| Hospital Charge Code |
900501421
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$141.47 |
| Max. Negotiated Rate |
$7,780.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,022.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,492.40
|
| Rate for Payer: Cash Price |
$4,119.30
|
| Rate for Payer: Cash Price |
$4,119.30
|
| Rate for Payer: Cash Price |
$4,119.30
|
| Rate for Payer: Cigna of CA PPO |
$6,773.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Dignity Health Media |
$4,022.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,424.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,430.63
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,022.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,022.69
|
| Rate for Payer: Galaxy Health WC |
$7,780.90
|
| Rate for Payer: Global Benefits Group Commercial |
$5,492.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,865.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,597.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,597.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,022.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,105.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$141.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,022.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,196.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,068.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,390.40
|
| Rate for Payer: Multiplan Commercial |
$7,323.20
|
| Rate for Payer: Networks By Design Commercial |
$5,950.10
|
| Rate for Payer: Prime Health Services Commercial |
$7,780.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,492.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,577.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,577.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,577.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,577.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Vantage Medical Group Senior |
$4,022.69
|
|
|
HC TRACH PUNCTURE/CLEAR WINDPIPE
|
Facility
|
IP
|
$9,154.00
|
|
|
Service Code
|
CPT 31612
|
| Hospital Charge Code |
900501421
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,196.96 |
| Max. Negotiated Rate |
$7,780.90 |
| Rate for Payer: Cash Price |
$4,119.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,661.60
|
| Rate for Payer: Galaxy Health WC |
$7,780.90
|
| Rate for Payer: Global Benefits Group Commercial |
$5,492.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,105.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,487.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,196.96
|
| Rate for Payer: Multiplan Commercial |
$7,323.20
|
| Rate for Payer: Networks By Design Commercial |
$5,950.10
|
| Rate for Payer: Prime Health Services Commercial |
$7,780.90
|
|
|
HC TRACH SHILEY 7MM MURPHY CUFFED
|
Facility
|
OP
|
$96.90
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
901698811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.26 |
| Max. Negotiated Rate |
$140.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$140.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$82.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.73
|
| Rate for Payer: Blue Distinction Transplant |
$58.14
|
| Rate for Payer: Blue Shield of California Commercial |
$71.42
|
| Rate for Payer: Blue Shield of California EPN |
$56.59
|
| Rate for Payer: Cash Price |
$43.61
|
| Rate for Payer: Cash Price |
$43.61
|
| Rate for Payer: Cigna of CA HMO |
$62.02
|
| Rate for Payer: Cigna of CA PPO |
$71.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$82.36
|
| Rate for Payer: Dignity Health Media |
$82.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$82.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$38.76
|
| Rate for Payer: Galaxy Health WC |
$82.36
|
| Rate for Payer: Global Benefits Group Commercial |
$58.14
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$72.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.26
|
| Rate for Payer: Multiplan Commercial |
$77.52
|
| Rate for Payer: Networks By Design Commercial |
$62.98
|
| Rate for Payer: Prime Health Services Commercial |
$82.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.45
|
| Rate for Payer: United Healthcare All Other HMO |
$48.45
|
| Rate for Payer: United Healthcare HMO Rider |
$48.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$82.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$82.36
|
| Rate for Payer: Vantage Medical Group Senior |
$82.36
|
|
|
HC TRACH SHILEY 7MM MURPHY CUFFED
|
Facility
|
IP
|
$96.90
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
901698811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.26 |
| Max. Negotiated Rate |
$82.36 |
| Rate for Payer: Cash Price |
$43.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.76
|
| Rate for Payer: Galaxy Health WC |
$82.36
|
| Rate for Payer: Global Benefits Group Commercial |
$58.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.26
|
| Rate for Payer: Multiplan Commercial |
$77.52
|
| Rate for Payer: Networks By Design Commercial |
$62.98
|
| Rate for Payer: Prime Health Services Commercial |
$82.36
|
|
|
HC TRACH TUBE CHANGE
|
Facility
|
OP
|
$1,511.00
|
|
|
Service Code
|
CPT 31502
|
| Hospital Charge Code |
900800523
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$113.18 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$305.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$906.60
|
| Rate for Payer: Cash Price |
$679.95
|
| Rate for Payer: Cash Price |
$679.95
|
| Rate for Payer: Cash Price |
$679.95
|
| Rate for Payer: Cigna of CA PPO |
$1,118.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.78
|
| Rate for Payer: Dignity Health Media |
$305.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.01
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$305.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$305.19
|
| Rate for Payer: Galaxy Health WC |
$1,284.35
|
| Rate for Payer: Global Benefits Group Commercial |
$906.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,133.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$500.51
|
| Rate for Payer: Heritage Provider Network Transplant |
$500.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$305.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,007.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$305.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$362.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.95
|
| Rate for Payer: Multiplan Commercial |
$1,208.80
|
| Rate for Payer: Networks By Design Commercial |
$982.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,284.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$906.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$755.50
|
| Rate for Payer: United Healthcare All Other HMO |
$755.50
|
| Rate for Payer: United Healthcare HMO Rider |
$755.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$755.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Vantage Medical Group Senior |
$305.19
|
|
|
HC TRACH TUBE CHANGE
|
Facility
|
OP
|
$1,511.00
|
|
|
Service Code
|
CPT 31502
|
| Hospital Charge Code |
900800523
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$113.18 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$305.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$906.60
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$679.95
|
| Rate for Payer: Cash Price |
$679.95
|
| Rate for Payer: Cash Price |
$679.95
|
| Rate for Payer: Cigna of CA HMO |
$967.04
|
| Rate for Payer: Cigna of CA PPO |
$1,118.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.78
|
| Rate for Payer: Dignity Health Media |
$305.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.01
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$305.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$305.19
|
| Rate for Payer: Galaxy Health WC |
$1,284.35
|
| Rate for Payer: Global Benefits Group Commercial |
$906.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,133.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$500.51
|
| Rate for Payer: Heritage Provider Network Transplant |
$500.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$494.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$494.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$305.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,007.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$305.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$362.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.95
|
| Rate for Payer: Multiplan Commercial |
$1,208.80
|
| Rate for Payer: Networks By Design Commercial |
$982.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,284.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$906.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$906.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.00
|
| Rate for Payer: United Healthcare All Other HMO |
$478.00
|
| Rate for Payer: United Healthcare HMO Rider |
$428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$391.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Vantage Medical Group Senior |
$305.19
|
|
|
HC TRACH TUBE CHANGE
|
Facility
|
IP
|
$1,511.00
|
|
|
Service Code
|
CPT 31502
|
| Hospital Charge Code |
900800523
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$362.64 |
| Max. Negotiated Rate |
$1,284.35 |
| Rate for Payer: Cash Price |
$679.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$604.40
|
| Rate for Payer: Galaxy Health WC |
$1,284.35
|
| Rate for Payer: Global Benefits Group Commercial |
$906.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,007.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$575.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$362.64
|
| Rate for Payer: Multiplan Commercial |
$1,208.80
|
| Rate for Payer: Networks By Design Commercial |
$982.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,284.35
|
|
|
HC TRACH TUBE CHANGE
|
Facility
|
IP
|
$1,511.00
|
|
|
Service Code
|
CPT 31502
|
| Hospital Charge Code |
900800523
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$362.64 |
| Max. Negotiated Rate |
$1,284.35 |
| Rate for Payer: Cash Price |
$679.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$604.40
|
| Rate for Payer: Galaxy Health WC |
$1,284.35
|
| Rate for Payer: Global Benefits Group Commercial |
$906.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,007.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$575.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$362.64
|
| Rate for Payer: Multiplan Commercial |
$1,208.80
|
| Rate for Payer: Networks By Design Commercial |
$982.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,284.35
|
|
|
HC TRACTION MECHANICAL MCAL
|
Facility
|
IP
|
$221.00
|
|
|
Service Code
|
CPT 97012
|
| Hospital Charge Code |
900400025
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$53.04 |
| Max. Negotiated Rate |
$187.85 |
| Rate for Payer: Cash Price |
$99.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.40
|
| Rate for Payer: Galaxy Health WC |
$187.85
|
| Rate for Payer: Global Benefits Group Commercial |
$132.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$147.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.04
|
| Rate for Payer: Multiplan Commercial |
$176.80
|
| Rate for Payer: Networks By Design Commercial |
$143.65
|
| Rate for Payer: Prime Health Services Commercial |
$187.85
|
|
|
HC TRACTION MECHANICAL MCAL
|
Facility
|
OP
|
$221.00
|
|
|
Service Code
|
CPT 97012
|
| Hospital Charge Code |
900400025
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$25.04 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$71.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$187.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$121.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$121.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$132.60
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$99.45
|
| Rate for Payer: Cash Price |
$99.45
|
| Rate for Payer: Cash Price |
$99.45
|
| Rate for Payer: Cash Price |
$99.45
|
| Rate for Payer: Cigna of CA HMO |
$141.44
|
| Rate for Payer: Cigna of CA PPO |
$163.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$187.85
|
| Rate for Payer: Dignity Health Media |
$187.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$187.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$88.40
|
| Rate for Payer: Galaxy Health WC |
$187.85
|
| Rate for Payer: Global Benefits Group Commercial |
$132.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$165.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$147.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.04
|
| Rate for Payer: Multiplan Commercial |
$176.80
|
| Rate for Payer: Networks By Design Commercial |
$143.65
|
| Rate for Payer: Prime Health Services Commercial |
$187.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$132.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$132.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$187.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$187.85
|
| Rate for Payer: Vantage Medical Group Senior |
$187.85
|
|
|
HC TRACTION MECHANICAL MCARE COMM
|
Facility
|
OP
|
$221.00
|
|
|
Service Code
|
CPT 97012
|
| Hospital Charge Code |
900407037
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$25.04 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$71.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$187.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$121.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$121.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$132.60
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$99.45
|
| Rate for Payer: Cash Price |
$99.45
|
| Rate for Payer: Cash Price |
$99.45
|
| Rate for Payer: Cash Price |
$99.45
|
| Rate for Payer: Cigna of CA HMO |
$141.44
|
| Rate for Payer: Cigna of CA PPO |
$163.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$187.85
|
| Rate for Payer: Dignity Health Media |
$187.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$187.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$88.40
|
| Rate for Payer: Galaxy Health WC |
$187.85
|
| Rate for Payer: Global Benefits Group Commercial |
$132.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$165.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$147.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.04
|
| Rate for Payer: Multiplan Commercial |
$176.80
|
| Rate for Payer: Networks By Design Commercial |
$143.65
|
| Rate for Payer: Prime Health Services Commercial |
$187.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$132.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$132.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$187.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$187.85
|
| Rate for Payer: Vantage Medical Group Senior |
$187.85
|
|
|
HC TRACTION MECHANICAL MCARE COMM
|
Facility
|
IP
|
$221.00
|
|
|
Service Code
|
CPT 97012
|
| Hospital Charge Code |
900407037
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$53.04 |
| Max. Negotiated Rate |
$187.85 |
| Rate for Payer: Cash Price |
$99.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.40
|
| Rate for Payer: Galaxy Health WC |
$187.85
|
| Rate for Payer: Global Benefits Group Commercial |
$132.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$147.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.04
|
| Rate for Payer: Multiplan Commercial |
$176.80
|
| Rate for Payer: Networks By Design Commercial |
$143.65
|
| Rate for Payer: Prime Health Services Commercial |
$187.85
|
|
|
HC TRANSABD AMNIOINFUSION ADDL FETUS
|
Facility
|
IP
|
$640.00
|
|
|
Service Code
|
CPT 59070
|
| Hospital Charge Code |
902400112
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$153.60 |
| Max. Negotiated Rate |
$544.00 |
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$256.00
|
| Rate for Payer: Galaxy Health WC |
$544.00
|
| Rate for Payer: Global Benefits Group Commercial |
$384.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$426.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$243.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.60
|
| Rate for Payer: Multiplan Commercial |
$512.00
|
| Rate for Payer: Networks By Design Commercial |
$416.00
|
| Rate for Payer: Prime Health Services Commercial |
$544.00
|
|
|
HC TRANSABD AMNIOINFUSION ADDL FETUS
|
Facility
|
IP
|
$640.00
|
|
|
Service Code
|
CPT 59070
|
| Hospital Charge Code |
910400089
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$153.60 |
| Max. Negotiated Rate |
$544.00 |
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$256.00
|
| Rate for Payer: Galaxy Health WC |
$544.00
|
| Rate for Payer: Global Benefits Group Commercial |
$384.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$426.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$243.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.60
|
| Rate for Payer: Multiplan Commercial |
$512.00
|
| Rate for Payer: Networks By Design Commercial |
$416.00
|
| Rate for Payer: Prime Health Services Commercial |
$544.00
|
|
|
HC TRANSABD AMNIOINFUSION ADDL FETUS
|
Facility
|
OP
|
$640.00
|
|
|
Service Code
|
CPT 59070
|
| Hospital Charge Code |
902400112
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$153.60 |
| Max. Negotiated Rate |
$7,282.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$400.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$384.00
|
| Rate for Payer: Blue Shield of California Commercial |
$471.68
|
| Rate for Payer: Blue Shield of California EPN |
$373.76
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cigna of CA HMO |
$409.60
|
| Rate for Payer: Cigna of CA PPO |
$473.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$601.23
|
| Rate for Payer: Dignity Health Media |
$400.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$440.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$541.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$400.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$400.82
|
| Rate for Payer: Galaxy Health WC |
$544.00
|
| Rate for Payer: Global Benefits Group Commercial |
$384.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$480.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$657.34
|
| Rate for Payer: Heritage Provider Network Transplant |
$657.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$649.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$649.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$400.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$426.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$666.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$400.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$505.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$537.10
|
| Rate for Payer: Multiplan Commercial |
$512.00
|
| Rate for Payer: Networks By Design Commercial |
$416.00
|
| Rate for Payer: Prime Health Services Commercial |
$544.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$384.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$384.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,036.00
|
| Rate for Payer: United Healthcare All Other HMO |
$799.00
|
| Rate for Payer: United Healthcare HMO Rider |
$605.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$552.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Vantage Medical Group Senior |
$400.82
|
|
|
HC TRANSABD AMNIOINFUSION ADDL FETUS
|
Facility
|
OP
|
$640.00
|
|
|
Service Code
|
CPT 59070
|
| Hospital Charge Code |
910400089
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$153.60 |
| Max. Negotiated Rate |
$7,282.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$400.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$384.00
|
| Rate for Payer: Blue Shield of California Commercial |
$471.68
|
| Rate for Payer: Blue Shield of California EPN |
$373.76
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cigna of CA HMO |
$409.60
|
| Rate for Payer: Cigna of CA PPO |
$473.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$601.23
|
| Rate for Payer: Dignity Health Media |
$400.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$440.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$541.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$400.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$400.82
|
| Rate for Payer: Galaxy Health WC |
$544.00
|
| Rate for Payer: Global Benefits Group Commercial |
$384.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$480.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$657.34
|
| Rate for Payer: Heritage Provider Network Transplant |
$657.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$649.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$649.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$400.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$426.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$666.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$400.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$505.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$537.10
|
| Rate for Payer: Multiplan Commercial |
$512.00
|
| Rate for Payer: Networks By Design Commercial |
$416.00
|
| Rate for Payer: Prime Health Services Commercial |
$544.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$384.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$384.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$320.00
|
| Rate for Payer: United Healthcare All Other HMO |
$320.00
|
| Rate for Payer: United Healthcare HMO Rider |
$320.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$320.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Vantage Medical Group Senior |
$400.82
|
|
|
HC TRANSABDOMINAL AMNIOINFUSION
|
Facility
|
IP
|
$640.00
|
|
|
Service Code
|
CPT 59070
|
| Hospital Charge Code |
910400088
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$153.60 |
| Max. Negotiated Rate |
$544.00 |
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$256.00
|
| Rate for Payer: Galaxy Health WC |
$544.00
|
| Rate for Payer: Global Benefits Group Commercial |
$384.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$426.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$243.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.60
|
| Rate for Payer: Multiplan Commercial |
$512.00
|
| Rate for Payer: Networks By Design Commercial |
$416.00
|
| Rate for Payer: Prime Health Services Commercial |
$544.00
|
|
|
HC TRANSABDOMINAL AMNIOINFUSION
|
Facility
|
OP
|
$640.00
|
|
|
Service Code
|
CPT 59070
|
| Hospital Charge Code |
910400088
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$153.60 |
| Max. Negotiated Rate |
$7,282.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$400.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$384.00
|
| Rate for Payer: Blue Shield of California Commercial |
$471.68
|
| Rate for Payer: Blue Shield of California EPN |
$373.76
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cigna of CA HMO |
$409.60
|
| Rate for Payer: Cigna of CA PPO |
$473.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$601.23
|
| Rate for Payer: Dignity Health Media |
$400.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$440.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$541.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$400.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$400.82
|
| Rate for Payer: Galaxy Health WC |
$544.00
|
| Rate for Payer: Global Benefits Group Commercial |
$384.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$480.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$657.34
|
| Rate for Payer: Heritage Provider Network Transplant |
$657.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$649.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$649.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$400.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$426.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$666.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$400.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$505.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$537.10
|
| Rate for Payer: Multiplan Commercial |
$512.00
|
| Rate for Payer: Networks By Design Commercial |
$416.00
|
| Rate for Payer: Prime Health Services Commercial |
$544.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$384.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$384.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,036.00
|
| Rate for Payer: United Healthcare All Other HMO |
$799.00
|
| Rate for Payer: United Healthcare HMO Rider |
$605.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$552.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Vantage Medical Group Senior |
$400.82
|
|
