|
HC TRT DEVICES COMPLEX
|
Facility
|
IP
|
$4,043.00
|
|
|
Service Code
|
CPT 77334
|
| Hospital Charge Code |
904810506
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$970.32 |
| Max. Negotiated Rate |
$3,436.55 |
| Rate for Payer: Cash Price |
$1,819.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,617.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,617.20
|
| Rate for Payer: Galaxy Health WC |
$3,436.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,425.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,696.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,540.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$970.32
|
| Rate for Payer: Multiplan Commercial |
$3,234.40
|
| Rate for Payer: Networks By Design Commercial |
$2,627.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,436.55
|
|
|
HC TRT DEVICES COMPLEX
|
Facility
|
OP
|
$4,043.00
|
|
|
Service Code
|
CPT 77334
|
| Hospital Charge Code |
904810506
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$213.16 |
| Max. Negotiated Rate |
$3,436.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$583.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$692.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$507.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$461.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$847.77
|
| Rate for Payer: Blue Distinction Transplant |
$2,425.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,389.41
|
| Rate for Payer: Blue Shield of California EPN |
$1,896.17
|
| Rate for Payer: Cash Price |
$1,819.35
|
| Rate for Payer: Cash Price |
$1,819.35
|
| Rate for Payer: Cash Price |
$1,819.35
|
| Rate for Payer: Cigna of CA HMO |
$2,587.52
|
| Rate for Payer: Cigna of CA PPO |
$2,991.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$692.49
|
| Rate for Payer: Dignity Health Media |
$461.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$507.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$623.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$461.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$461.66
|
| Rate for Payer: Galaxy Health WC |
$3,436.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,425.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,032.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$757.12
|
| Rate for Payer: Heritage Provider Network Transplant |
$757.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$747.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$747.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$461.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,696.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$213.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$461.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$970.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$581.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$618.62
|
| Rate for Payer: Multiplan Commercial |
$3,234.40
|
| Rate for Payer: Networks By Design Commercial |
$2,627.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,436.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,425.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,269.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$692.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$507.83
|
| Rate for Payer: Vantage Medical Group Senior |
$461.66
|
|
|
HC TRT DEVICES INTER
|
Facility
|
OP
|
$1,298.00
|
|
|
Service Code
|
CPT 77333
|
| Hospital Charge Code |
909100210
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$86.89 |
| Max. Negotiated Rate |
$1,675.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$111.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$254.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$186.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$169.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$498.70
|
| Rate for Payer: Blue Distinction Transplant |
$778.80
|
| Rate for Payer: Blue Shield of California Commercial |
$767.12
|
| Rate for Payer: Blue Shield of California EPN |
$608.76
|
| Rate for Payer: Cash Price |
$584.10
|
| Rate for Payer: Cash Price |
$584.10
|
| Rate for Payer: Cash Price |
$584.10
|
| Rate for Payer: Cigna of CA HMO |
$830.72
|
| Rate for Payer: Cigna of CA PPO |
$960.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$254.30
|
| Rate for Payer: Dignity Health Media |
$169.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$186.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$228.87
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$169.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$169.53
|
| Rate for Payer: Galaxy Health WC |
$1,103.30
|
| Rate for Payer: Global Benefits Group Commercial |
$778.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$973.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$278.03
|
| Rate for Payer: Heritage Provider Network Transplant |
$278.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$274.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$274.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$169.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$865.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$169.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$311.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$213.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$227.17
|
| Rate for Payer: Multiplan Commercial |
$1,038.40
|
| Rate for Payer: Networks By Design Commercial |
$843.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,103.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$778.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,269.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$254.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$186.48
|
| Rate for Payer: Vantage Medical Group Senior |
$169.53
|
|
|
HC TRT DEVICES INTER
|
Facility
|
IP
|
$1,298.00
|
|
|
Service Code
|
CPT 77333
|
| Hospital Charge Code |
909100210
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$311.52 |
| Max. Negotiated Rate |
$1,103.30 |
| Rate for Payer: Cash Price |
$584.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$519.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$519.20
|
| Rate for Payer: Galaxy Health WC |
$1,103.30
|
| Rate for Payer: Global Benefits Group Commercial |
$778.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$865.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$494.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$311.52
|
| Rate for Payer: Multiplan Commercial |
$1,038.40
|
| Rate for Payer: Networks By Design Commercial |
$843.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,103.30
|
|
|
HC TRT DEVICES SIMPLE
|
Facility
|
IP
|
$1,158.00
|
|
|
Service Code
|
CPT 77332
|
| Hospital Charge Code |
909100209
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$277.92 |
| Max. Negotiated Rate |
$984.30 |
| Rate for Payer: Cash Price |
$521.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$463.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$463.20
|
| Rate for Payer: Galaxy Health WC |
$984.30
|
| Rate for Payer: Global Benefits Group Commercial |
$694.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$772.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$441.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$277.92
|
| Rate for Payer: Multiplan Commercial |
$926.40
|
| Rate for Payer: Networks By Design Commercial |
$752.70
|
| Rate for Payer: Prime Health Services Commercial |
$984.30
|
|
|
HC TRT DEVICES SIMPLE
|
Facility
|
OP
|
$1,158.00
|
|
|
Service Code
|
CPT 77332
|
| Hospital Charge Code |
909100209
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$65.25 |
| Max. Negotiated Rate |
$1,675.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$327.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$254.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$186.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$169.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$350.61
|
| Rate for Payer: Blue Distinction Transplant |
$694.80
|
| Rate for Payer: Blue Shield of California Commercial |
$684.38
|
| Rate for Payer: Blue Shield of California EPN |
$543.10
|
| Rate for Payer: Cash Price |
$521.10
|
| Rate for Payer: Cash Price |
$521.10
|
| Rate for Payer: Cash Price |
$521.10
|
| Rate for Payer: Cigna of CA HMO |
$741.12
|
| Rate for Payer: Cigna of CA PPO |
$856.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$254.30
|
| Rate for Payer: Dignity Health Media |
$169.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$186.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$228.87
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$169.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$169.53
|
| Rate for Payer: Galaxy Health WC |
$984.30
|
| Rate for Payer: Global Benefits Group Commercial |
$694.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$868.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$278.03
|
| Rate for Payer: Heritage Provider Network Transplant |
$278.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$274.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$274.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$169.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$772.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$169.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$277.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$213.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$227.17
|
| Rate for Payer: Multiplan Commercial |
$926.40
|
| Rate for Payer: Networks By Design Commercial |
$752.70
|
| Rate for Payer: Prime Health Services Commercial |
$984.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$694.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,269.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$254.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$186.48
|
| Rate for Payer: Vantage Medical Group Senior |
$169.53
|
|
|
HC TRT SPEECH/LANG/VOICE INDIV
|
Facility
|
OP
|
$795.00
|
|
|
Service Code
|
CPT 92507
|
| Hospital Charge Code |
907001401
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$56.47 |
| Max. Negotiated Rate |
$675.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$458.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$675.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$437.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$437.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$477.00
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cigna of CA HMO |
$508.80
|
| Rate for Payer: Cigna of CA PPO |
$588.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$675.75
|
| Rate for Payer: Dignity Health Media |
$675.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$675.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$318.00
|
| Rate for Payer: Galaxy Health WC |
$675.75
|
| Rate for Payer: Global Benefits Group Commercial |
$477.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$596.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.80
|
| Rate for Payer: Multiplan Commercial |
$636.00
|
| Rate for Payer: Networks By Design Commercial |
$516.75
|
| Rate for Payer: Prime Health Services Commercial |
$675.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$477.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$477.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$675.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$675.75
|
| Rate for Payer: Vantage Medical Group Senior |
$675.75
|
|
|
HC TRT SPEECH/LANG/VOICE INDIV
|
Facility
|
IP
|
$795.00
|
|
|
Service Code
|
CPT 92507
|
| Hospital Charge Code |
907001401
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$190.80 |
| Max. Negotiated Rate |
$675.75 |
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.00
|
| Rate for Payer: Galaxy Health WC |
$675.75
|
| Rate for Payer: Global Benefits Group Commercial |
$477.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$302.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.80
|
| Rate for Payer: Multiplan Commercial |
$636.00
|
| Rate for Payer: Networks By Design Commercial |
$516.75
|
| Rate for Payer: Prime Health Services Commercial |
$675.75
|
|
|
HC TRT SPEECH/LANG/VOICE INDIV
|
Facility
|
OP
|
$795.00
|
|
|
Service Code
|
CPT 92507
|
| Hospital Charge Code |
905601401
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$56.47 |
| Max. Negotiated Rate |
$675.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$458.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$675.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$437.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$437.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$477.00
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cigna of CA HMO |
$508.80
|
| Rate for Payer: Cigna of CA PPO |
$588.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$675.75
|
| Rate for Payer: Dignity Health Media |
$675.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$675.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$318.00
|
| Rate for Payer: Galaxy Health WC |
$675.75
|
| Rate for Payer: Global Benefits Group Commercial |
$477.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$596.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.80
|
| Rate for Payer: Multiplan Commercial |
$636.00
|
| Rate for Payer: Networks By Design Commercial |
$516.75
|
| Rate for Payer: Prime Health Services Commercial |
$675.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$477.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$477.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$675.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$675.75
|
| Rate for Payer: Vantage Medical Group Senior |
$675.75
|
|
|
HC TRT SPEECH/LANG/VOICE INDIV
|
Facility
|
IP
|
$795.00
|
|
|
Service Code
|
CPT 92507
|
| Hospital Charge Code |
905601401
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$190.80 |
| Max. Negotiated Rate |
$675.75 |
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.00
|
| Rate for Payer: Galaxy Health WC |
$675.75
|
| Rate for Payer: Global Benefits Group Commercial |
$477.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$302.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.80
|
| Rate for Payer: Multiplan Commercial |
$636.00
|
| Rate for Payer: Networks By Design Commercial |
$516.75
|
| Rate for Payer: Prime Health Services Commercial |
$675.75
|
|
|
HC TRT SWALLOW/ORAL FUNC FEEDING
|
Facility
|
OP
|
$686.00
|
|
|
Service Code
|
CPT 92526
|
| Hospital Charge Code |
905601801
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$64.26 |
| Max. Negotiated Rate |
$622.78 |
| Rate for Payer: Aetna of CA HMO/PPO |
$622.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$583.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$377.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$377.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$411.60
|
| 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 |
$308.70
|
| Rate for Payer: Cash Price |
$308.70
|
| Rate for Payer: Cash Price |
$308.70
|
| Rate for Payer: Cash Price |
$308.70
|
| Rate for Payer: Cigna of CA HMO |
$439.04
|
| Rate for Payer: Cigna of CA PPO |
$507.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$583.10
|
| Rate for Payer: Dignity Health Media |
$583.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$583.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$274.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$274.40
|
| Rate for Payer: Galaxy Health WC |
$583.10
|
| Rate for Payer: Global Benefits Group Commercial |
$411.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$514.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$457.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.64
|
| Rate for Payer: Multiplan Commercial |
$548.80
|
| Rate for Payer: Networks By Design Commercial |
$445.90
|
| Rate for Payer: Prime Health Services Commercial |
$583.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$411.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$411.60
|
| 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 |
$583.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$583.10
|
| Rate for Payer: Vantage Medical Group Senior |
$583.10
|
|
|
HC TRT SWALLOW/ORAL FUNC FEEDING
|
Facility
|
IP
|
$686.00
|
|
|
Service Code
|
CPT 92526
|
| Hospital Charge Code |
905601801
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$164.64 |
| Max. Negotiated Rate |
$583.10 |
| Rate for Payer: Cash Price |
$308.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$274.40
|
| Rate for Payer: Galaxy Health WC |
$583.10
|
| Rate for Payer: Global Benefits Group Commercial |
$411.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$457.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$261.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.64
|
| Rate for Payer: Multiplan Commercial |
$548.80
|
| Rate for Payer: Networks By Design Commercial |
$445.90
|
| Rate for Payer: Prime Health Services Commercial |
$583.10
|
|
|
HC TRT SWALLOW/ORAL FUNC FEEDING MCAL
|
Facility
|
OP
|
$686.00
|
|
|
Service Code
|
CPT 92526
|
| Hospital Charge Code |
907000039
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$64.26 |
| Max. Negotiated Rate |
$622.78 |
| Rate for Payer: Aetna of CA HMO/PPO |
$622.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$583.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$377.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$377.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$411.60
|
| 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 |
$308.70
|
| Rate for Payer: Cash Price |
$308.70
|
| Rate for Payer: Cash Price |
$308.70
|
| Rate for Payer: Cash Price |
$308.70
|
| Rate for Payer: Cigna of CA HMO |
$439.04
|
| Rate for Payer: Cigna of CA PPO |
$507.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$583.10
|
| Rate for Payer: Dignity Health Media |
$583.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$583.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$274.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$274.40
|
| Rate for Payer: Galaxy Health WC |
$583.10
|
| Rate for Payer: Global Benefits Group Commercial |
$411.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$514.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$457.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.64
|
| Rate for Payer: Multiplan Commercial |
$548.80
|
| Rate for Payer: Networks By Design Commercial |
$445.90
|
| Rate for Payer: Prime Health Services Commercial |
$583.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$411.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$411.60
|
| 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 |
$583.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$583.10
|
| Rate for Payer: Vantage Medical Group Senior |
$583.10
|
|
|
HC TRT SWALLOW/ORAL FUNC FEEDING MCAL
|
Facility
|
IP
|
$686.00
|
|
|
Service Code
|
CPT 92526
|
| Hospital Charge Code |
907000039
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$164.64 |
| Max. Negotiated Rate |
$583.10 |
| Rate for Payer: Cash Price |
$308.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$274.40
|
| Rate for Payer: Galaxy Health WC |
$583.10
|
| Rate for Payer: Global Benefits Group Commercial |
$411.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$457.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$261.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.64
|
| Rate for Payer: Multiplan Commercial |
$548.80
|
| Rate for Payer: Networks By Design Commercial |
$445.90
|
| Rate for Payer: Prime Health Services Commercial |
$583.10
|
|
|
HC TRT SWALLOW/ORAL FUNC FEEDING MCAL
|
Facility
|
IP
|
$686.00
|
|
|
Service Code
|
CPT 92526
|
| Hospital Charge Code |
901300021
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$164.64 |
| Max. Negotiated Rate |
$583.10 |
| Rate for Payer: Cash Price |
$308.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$274.40
|
| Rate for Payer: Galaxy Health WC |
$583.10
|
| Rate for Payer: Global Benefits Group Commercial |
$411.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$457.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$261.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.64
|
| Rate for Payer: Multiplan Commercial |
$548.80
|
| Rate for Payer: Networks By Design Commercial |
$445.90
|
| Rate for Payer: Prime Health Services Commercial |
$583.10
|
|
|
HC TRT SWALLOW/ORAL FUNC FEEDING MCAL
|
Facility
|
OP
|
$686.00
|
|
|
Service Code
|
CPT 92526
|
| Hospital Charge Code |
901300021
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$64.26 |
| Max. Negotiated Rate |
$622.78 |
| Rate for Payer: Aetna of CA HMO/PPO |
$622.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$583.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$377.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$377.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$411.60
|
| 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 |
$308.70
|
| Rate for Payer: Cash Price |
$308.70
|
| Rate for Payer: Cash Price |
$308.70
|
| Rate for Payer: Cash Price |
$308.70
|
| Rate for Payer: Cigna of CA HMO |
$439.04
|
| Rate for Payer: Cigna of CA PPO |
$507.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$583.10
|
| Rate for Payer: Dignity Health Media |
$583.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$583.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$274.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$274.40
|
| Rate for Payer: Galaxy Health WC |
$583.10
|
| Rate for Payer: Global Benefits Group Commercial |
$411.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$514.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$457.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.64
|
| Rate for Payer: Multiplan Commercial |
$548.80
|
| Rate for Payer: Networks By Design Commercial |
$445.90
|
| Rate for Payer: Prime Health Services Commercial |
$583.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$411.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$411.60
|
| 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 |
$583.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$583.10
|
| Rate for Payer: Vantage Medical Group Senior |
$583.10
|
|
|
HC TRT SWALLOW ORAL FUNC FEEDING MCARE COMM
|
Facility
|
IP
|
$686.00
|
|
|
Service Code
|
CPT 92526
|
| Hospital Charge Code |
901300802
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$164.64 |
| Max. Negotiated Rate |
$583.10 |
| Rate for Payer: Cash Price |
$308.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$274.40
|
| Rate for Payer: Galaxy Health WC |
$583.10
|
| Rate for Payer: Global Benefits Group Commercial |
$411.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$457.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$261.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.64
|
| Rate for Payer: Multiplan Commercial |
$548.80
|
| Rate for Payer: Networks By Design Commercial |
$445.90
|
| Rate for Payer: Prime Health Services Commercial |
$583.10
|
|
|
HC TRT SWALLOW ORAL FUNC FEEDING MCARE COMM
|
Facility
|
OP
|
$686.00
|
|
|
Service Code
|
CPT 92526
|
| Hospital Charge Code |
901300802
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$64.26 |
| Max. Negotiated Rate |
$622.78 |
| Rate for Payer: Aetna of CA HMO/PPO |
$622.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$583.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$377.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$377.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$411.60
|
| 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 |
$308.70
|
| Rate for Payer: Cash Price |
$308.70
|
| Rate for Payer: Cash Price |
$308.70
|
| Rate for Payer: Cash Price |
$308.70
|
| Rate for Payer: Cigna of CA HMO |
$439.04
|
| Rate for Payer: Cigna of CA PPO |
$507.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$583.10
|
| Rate for Payer: Dignity Health Media |
$583.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$583.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$274.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$274.40
|
| Rate for Payer: Galaxy Health WC |
$583.10
|
| Rate for Payer: Global Benefits Group Commercial |
$411.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$514.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$457.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.64
|
| Rate for Payer: Multiplan Commercial |
$548.80
|
| Rate for Payer: Networks By Design Commercial |
$445.90
|
| Rate for Payer: Prime Health Services Commercial |
$583.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$411.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$411.60
|
| 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 |
$583.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$583.10
|
| Rate for Payer: Vantage Medical Group Senior |
$583.10
|
|
|
HC TRT TARS BONE FX;W/MANIPUL, EA
|
Facility
|
IP
|
$3,039.00
|
|
|
Service Code
|
CPT 28455
|
| Hospital Charge Code |
900501247
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$729.36 |
| Max. Negotiated Rate |
$2,583.15 |
| Rate for Payer: Cash Price |
$1,367.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,215.60
|
| Rate for Payer: Galaxy Health WC |
$2,583.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,823.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,027.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,157.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$729.36
|
| Rate for Payer: Multiplan Commercial |
$2,431.20
|
| Rate for Payer: Networks By Design Commercial |
$1,975.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,583.15
|
|
|
HC TRT TARS BONE FX;W/MANIPUL, EA
|
Facility
|
OP
|
$3,039.00
|
|
|
Service Code
|
CPT 28455
|
| Hospital Charge Code |
900501247
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$276.58 |
| 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 |
$3,012.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,008.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,823.40
|
| Rate for Payer: Cash Price |
$1,367.55
|
| Rate for Payer: Cash Price |
$1,367.55
|
| Rate for Payer: Cash Price |
$1,367.55
|
| Rate for Payer: Cigna of CA PPO |
$2,248.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Dignity Health Media |
$2,008.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,208.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,710.92
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,008.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,008.09
|
| Rate for Payer: Galaxy Health WC |
$2,583.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,823.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,279.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,293.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,293.27
|
| 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 |
$2,008.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,027.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$276.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,008.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$729.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,530.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,690.84
|
| Rate for Payer: Multiplan Commercial |
$2,431.20
|
| Rate for Payer: Networks By Design Commercial |
$1,975.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,583.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,823.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,519.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,519.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,519.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,519.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,008.09
|
|
|
HC TRYPSIN STOOL
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 84488
|
| Hospital Charge Code |
900910231
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.91 |
| Max. Negotiated Rate |
$66.58 |
| Rate for Payer: Aetna of CA HMO/PPO |
$60.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.58
|
| Rate for Payer: Blue Distinction Transplant |
$16.80
|
| Rate for Payer: Blue Shield of California Commercial |
$18.09
|
| Rate for Payer: Blue Shield of California EPN |
$14.34
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna of CA HMO |
$17.92
|
| Rate for Payer: Cigna of CA PPO |
$20.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.95
|
| Rate for Payer: Dignity Health Media |
$7.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.86
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.30
|
| Rate for Payer: Galaxy Health WC |
$23.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$21.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.97
|
| Rate for Payer: Heritage Provider Network Transplant |
$11.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$11.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.78
|
| Rate for Payer: Multiplan Commercial |
$22.40
|
| Rate for Payer: Networks By Design Commercial |
$18.20
|
| Rate for Payer: Prime Health Services Commercial |
$23.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.91
|
| Rate for Payer: United Healthcare All Other HMO |
$5.91
|
| Rate for Payer: United Healthcare HMO Rider |
$5.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.03
|
| Rate for Payer: Vantage Medical Group Senior |
$7.30
|
|
|
HC TSH (THYROTROPIN)
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
900910829
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.72 |
| Max. Negotiated Rate |
$153.31 |
| Rate for Payer: Aetna of CA HMO/PPO |
$139.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.31
|
| Rate for Payer: Blue Distinction Transplant |
$16.80
|
| Rate for Payer: Blue Shield of California Commercial |
$18.09
|
| Rate for Payer: Blue Shield of California EPN |
$14.34
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna of CA HMO |
$17.92
|
| Rate for Payer: Cigna of CA PPO |
$20.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.20
|
| Rate for Payer: Dignity Health Media |
$16.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$16.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.80
|
| Rate for Payer: Galaxy Health WC |
$23.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$21.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.55
|
| Rate for Payer: Heritage Provider Network Transplant |
$27.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$27.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.51
|
| Rate for Payer: Multiplan Commercial |
$22.40
|
| Rate for Payer: Networks By Design Commercial |
$18.20
|
| Rate for Payer: Prime Health Services Commercial |
$23.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.61
|
| Rate for Payer: United Healthcare All Other HMO |
$13.61
|
| Rate for Payer: United Healthcare HMO Rider |
$13.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.48
|
| Rate for Payer: Vantage Medical Group Senior |
$16.80
|
|
|
HC TTG IGA
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913669
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.34 |
| Max. Negotiated Rate |
$213.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$77.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$213.45
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$25.19
|
| Rate for Payer: Blue Shield of California EPN |
$19.97
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Media |
$11.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$11.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.53
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.91
|
| Rate for Payer: Heritage Provider Network Transplant |
$18.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$18.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$31.20
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC TTG IGG
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913670
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.34 |
| Max. Negotiated Rate |
$213.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$77.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$213.45
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$25.19
|
| Rate for Payer: Blue Shield of California EPN |
$19.97
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Media |
$11.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$11.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.53
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.91
|
| Rate for Payer: Heritage Provider Network Transplant |
$18.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$18.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$31.20
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC T-TUBE CHOLANGIOGRAM INJ
|
Facility
|
OP
|
$2,926.00
|
|
|
Service Code
|
CPT 47531
|
| Hospital Charge Code |
909000191
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$647.96 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,322.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,755.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,128.35
|
| Rate for Payer: Blue Shield of California EPN |
$2,686.96
|
| Rate for Payer: Cash Price |
$1,316.70
|
| Rate for Payer: Cash Price |
$1,316.70
|
| Rate for Payer: Cigna of CA PPO |
$2,165.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Dignity Health Media |
$4,322.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,754.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,835.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,322.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,322.62
|
| Rate for Payer: Galaxy Health WC |
$2,487.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,755.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,194.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,089.10
|
| Rate for Payer: Heritage Provider Network Transplant |
$7,089.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,002.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$7,002.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,322.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,951.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$647.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,322.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$702.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,446.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,792.31
|
| Rate for Payer: Multiplan Commercial |
$2,340.80
|
| Rate for Payer: Networks By Design Commercial |
$1,901.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,487.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,755.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: Vantage Medical Group Senior |
$4,322.62
|
|
