|
HC TRACTION MECHANICAL
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 97012
|
| Hospital Charge Code |
900417012
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.67 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$69.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$67.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$144.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$93.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$127.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Central Health Plan Commercial |
$136.00
|
| Rate for Payer: Cigna of CA HMO |
$108.80
|
| Rate for Payer: Cigna of CA PPO |
$125.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$144.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$144.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$144.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$119.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Senior |
$68.00
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$107.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$100.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$119.00
|
| Rate for Payer: Multiplan Commercial |
$127.50
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
| Rate for Payer: Riverside University Health System MISP |
$68.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$144.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$144.50
|
| Rate for Payer: Vantage Medical Group Senior |
$144.50
|
|
|
HC TRACTION MECHANICAL
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 97012
|
| Hospital Charge Code |
905103103
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.67 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$69.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$67.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$144.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$93.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$127.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Central Health Plan Commercial |
$136.00
|
| Rate for Payer: Cigna of CA HMO |
$108.80
|
| Rate for Payer: Cigna of CA PPO |
$125.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$144.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$144.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$144.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$119.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Senior |
$68.00
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$107.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$100.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$119.00
|
| Rate for Payer: Multiplan Commercial |
$127.50
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
| Rate for Payer: Riverside University Health System MISP |
$68.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$144.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$144.50
|
| Rate for Payer: Vantage Medical Group Senior |
$144.50
|
|
|
HC TRACTION MECHANICAL
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 97012
|
| Hospital Charge Code |
905103103
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Central Health Plan Commercial |
$136.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$119.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Senior |
$68.00
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$107.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$100.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.00
|
| Rate for Payer: Multiplan Commercial |
$127.50
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
|
|
HC TRACTION MECHANICAL MCAL
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 97012
|
| Hospital Charge Code |
900400025
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Central Health Plan Commercial |
$136.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$119.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Senior |
$68.00
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$107.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$100.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.00
|
| Rate for Payer: Multiplan Commercial |
$127.50
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
|
|
HC TRACTION MECHANICAL MCAL
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 97012
|
| Hospital Charge Code |
900400025
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.67 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$69.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$67.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$144.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$93.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$127.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Central Health Plan Commercial |
$136.00
|
| Rate for Payer: Cigna of CA HMO |
$108.80
|
| Rate for Payer: Cigna of CA PPO |
$125.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$144.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$144.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$144.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$119.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Senior |
$68.00
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$107.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$100.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$119.00
|
| Rate for Payer: Multiplan Commercial |
$127.50
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
| Rate for Payer: Riverside University Health System MISP |
$68.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$144.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$144.50
|
| Rate for Payer: Vantage Medical Group Senior |
$144.50
|
|
|
HC TRACTION MECHANICAL MCARE COMM
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 97012
|
| Hospital Charge Code |
900407037
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Central Health Plan Commercial |
$136.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$119.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Senior |
$68.00
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$107.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$100.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.00
|
| Rate for Payer: Multiplan Commercial |
$127.50
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
|
|
HC TRACTION MECHANICAL MCARE COMM
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 97012
|
| Hospital Charge Code |
900407037
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.67 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$69.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$67.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$144.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$93.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$127.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Central Health Plan Commercial |
$136.00
|
| Rate for Payer: Cigna of CA HMO |
$108.80
|
| Rate for Payer: Cigna of CA PPO |
$125.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$144.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$144.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$144.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$119.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Senior |
$68.00
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$107.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$100.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$119.00
|
| Rate for Payer: Multiplan Commercial |
$127.50
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
| Rate for Payer: Riverside University Health System MISP |
$68.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$144.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$144.50
|
| Rate for Payer: Vantage Medical Group Senior |
$144.50
|
|
|
HC TRANSABD AMNIOINFUSION ADDL FETUS
|
Facility
|
IP
|
$1,025.00
|
|
|
Service Code
|
CPT 59070
|
| Hospital Charge Code |
902400112
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$205.00 |
| Max. Negotiated Rate |
$922.50 |
| Rate for Payer: Adventist Health Commercial |
$205.00
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Central Health Plan Commercial |
$820.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$717.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$410.00
|
| Rate for Payer: EPIC Health Plan Senior |
$410.00
|
| Rate for Payer: Galaxy Health WC |
$871.25
|
| Rate for Payer: Global Benefits Group Commercial |
$615.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$922.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$650.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$604.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.00
|
| Rate for Payer: Multiplan Commercial |
$768.75
|
| Rate for Payer: Networks By Design Commercial |
$666.25
|
| Rate for Payer: Prime Health Services Commercial |
$871.25
|
|
|
HC TRANSABD AMNIOINFUSION ADDL FETUS
|
Facility
|
OP
|
$1,025.00
|
|
|
Service Code
|
CPT 59070
|
| Hospital Charge Code |
902400112
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$205.00 |
| Max. Negotiated Rate |
$8,074.00 |
| Rate for Payer: Adventist Health Commercial |
$205.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$391.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,891.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$391.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Blue Shield of California Commercial |
$649.85
|
| Rate for Payer: Blue Shield of California EPN |
$408.98
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Central Health Plan Commercial |
$820.00
|
| Rate for Payer: Cigna of CA HMO |
$656.00
|
| Rate for Payer: Cigna of CA PPO |
$758.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$587.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$391.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$717.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$646.68
|
| Rate for Payer: EPIC Health Plan Senior |
$431.12
|
| Rate for Payer: Galaxy Health WC |
$871.25
|
| Rate for Payer: Global Benefits Group Commercial |
$615.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$922.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$642.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$569.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$391.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$650.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$629.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$548.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$525.19
|
| Rate for Payer: Multiplan Commercial |
$768.75
|
| Rate for Payer: Networks By Design Commercial |
$666.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$391.93
|
| Rate for Payer: Prime Health Services Commercial |
$871.25
|
| Rate for Payer: Prime Health Services Medicare |
$415.45
|
| Rate for Payer: Riverside University Health System MISP |
$431.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$615.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$615.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$391.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Vantage Medical Group Senior |
$391.93
|
|
|
HC TRANSABDOMINAL AMNIOINFUSION
|
Facility
|
IP
|
$1,025.00
|
|
|
Service Code
|
CPT 59070
|
| Hospital Charge Code |
910400088
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$205.00 |
| Max. Negotiated Rate |
$922.50 |
| Rate for Payer: Adventist Health Commercial |
$205.00
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Central Health Plan Commercial |
$820.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$717.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$410.00
|
| Rate for Payer: EPIC Health Plan Senior |
$410.00
|
| Rate for Payer: Galaxy Health WC |
$871.25
|
| Rate for Payer: Global Benefits Group Commercial |
$615.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$922.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$650.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$604.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.00
|
| Rate for Payer: Multiplan Commercial |
$768.75
|
| Rate for Payer: Networks By Design Commercial |
$666.25
|
| Rate for Payer: Prime Health Services Commercial |
$871.25
|
|
|
HC TRANSABDOMINAL AMNIOINFUSION
|
Facility
|
OP
|
$1,025.00
|
|
|
Service Code
|
CPT 59070
|
| Hospital Charge Code |
910400088
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$205.00 |
| Max. Negotiated Rate |
$8,074.00 |
| Rate for Payer: Adventist Health Commercial |
$205.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$391.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,891.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$391.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Blue Shield of California Commercial |
$649.85
|
| Rate for Payer: Blue Shield of California EPN |
$408.98
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Central Health Plan Commercial |
$820.00
|
| Rate for Payer: Cigna of CA HMO |
$656.00
|
| Rate for Payer: Cigna of CA PPO |
$758.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$587.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$391.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$717.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$646.68
|
| Rate for Payer: EPIC Health Plan Senior |
$431.12
|
| Rate for Payer: Galaxy Health WC |
$871.25
|
| Rate for Payer: Global Benefits Group Commercial |
$615.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$922.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$642.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$569.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$391.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$650.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$629.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$548.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$525.19
|
| Rate for Payer: Multiplan Commercial |
$768.75
|
| Rate for Payer: Networks By Design Commercial |
$666.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$391.93
|
| Rate for Payer: Prime Health Services Commercial |
$871.25
|
| Rate for Payer: Prime Health Services Medicare |
$415.45
|
| Rate for Payer: Riverside University Health System MISP |
$431.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$615.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$615.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$391.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Vantage Medical Group Senior |
$391.93
|
|
|
HC TRANSBRONCHIAL LUNG BIOPSY
|
Facility
|
IP
|
$7,758.00
|
|
|
Service Code
|
CPT 31628
|
| Hospital Charge Code |
900803504
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,551.60 |
| Max. Negotiated Rate |
$6,982.20 |
| Rate for Payer: Adventist Health Commercial |
$1,551.60
|
| Rate for Payer: Cash Price |
$3,491.10
|
| Rate for Payer: Central Health Plan Commercial |
$6,206.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,430.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,103.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,103.20
|
| Rate for Payer: Galaxy Health WC |
$6,594.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,654.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,982.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,926.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,577.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,551.60
|
| Rate for Payer: Multiplan Commercial |
$5,818.50
|
| Rate for Payer: Networks By Design Commercial |
$5,042.70
|
| Rate for Payer: Prime Health Services Commercial |
$6,594.30
|
|
|
HC TRANSBRONCHIAL LUNG BIOPSY
|
Facility
|
OP
|
$7,758.00
|
|
|
Service Code
|
CPT 31628
|
| Hospital Charge Code |
900803504
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$362.44 |
| Max. Negotiated Rate |
$7,912.21 |
| Rate for Payer: Adventist Health Commercial |
$1,551.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,795.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,037.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,274.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,795.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,918.57
|
| Rate for Payer: Blue Shield of California EPN |
$3,095.44
|
| Rate for Payer: Cash Price |
$3,491.10
|
| Rate for Payer: Cash Price |
$3,491.10
|
| Rate for Payer: Cash Price |
$3,491.10
|
| Rate for Payer: Central Health Plan Commercial |
$6,206.40
|
| Rate for Payer: Cigna of CA HMO |
$4,965.12
|
| Rate for Payer: Cigna of CA PPO |
$5,740.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,274.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,795.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,430.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,912.21
|
| Rate for Payer: EPIC Health Plan Senior |
$5,274.81
|
| Rate for Payer: Galaxy Health WC |
$6,594.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,654.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,982.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,864.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$362.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,795.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,926.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$400.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,713.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,551.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,425.68
|
| Rate for Payer: Multiplan Commercial |
$5,818.50
|
| Rate for Payer: Networks By Design Commercial |
$5,042.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,795.28
|
| Rate for Payer: Prime Health Services Commercial |
$6,594.30
|
| Rate for Payer: Prime Health Services Medicare |
$5,083.00
|
| Rate for Payer: Riverside University Health System MISP |
$5,274.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,654.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,654.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,879.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,879.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,879.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,879.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,795.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,274.81
|
| Rate for Payer: Vantage Medical Group Senior |
$4,795.28
|
|
|
HC TRANSBRONCHIAL LUNG BX, ADD'L
|
Facility
|
IP
|
$6,644.00
|
|
|
Service Code
|
CPT 31632
|
| Hospital Charge Code |
900803507
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,328.80 |
| Max. Negotiated Rate |
$5,979.60 |
| Rate for Payer: Adventist Health Commercial |
$1,328.80
|
| Rate for Payer: Cash Price |
$2,989.80
|
| Rate for Payer: Central Health Plan Commercial |
$5,315.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,650.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,657.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,657.60
|
| Rate for Payer: Galaxy Health WC |
$5,647.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,986.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,979.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,218.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,919.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,328.80
|
| Rate for Payer: Multiplan Commercial |
$4,983.00
|
| Rate for Payer: Networks By Design Commercial |
$4,318.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,647.40
|
|
|
HC TRANSBRONCHIAL LUNG BX, ADD'L
|
Facility
|
OP
|
$6,644.00
|
|
|
Service Code
|
CPT 31632
|
| Hospital Charge Code |
900803507
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.82 |
| Max. Negotiated Rate |
$5,979.60 |
| Rate for Payer: Adventist Health Commercial |
$1,328.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$267.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,647.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,654.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,983.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,212.30
|
| Rate for Payer: Blue Shield of California EPN |
$2,650.96
|
| Rate for Payer: Cash Price |
$2,989.80
|
| Rate for Payer: Cash Price |
$2,989.80
|
| Rate for Payer: Cash Price |
$2,989.80
|
| Rate for Payer: Central Health Plan Commercial |
$5,315.20
|
| Rate for Payer: Cigna of CA HMO |
$4,252.16
|
| Rate for Payer: Cigna of CA PPO |
$4,916.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,647.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,647.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,647.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,650.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,657.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,657.60
|
| Rate for Payer: Galaxy Health WC |
$5,647.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,986.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,979.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$101.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,218.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$112.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,919.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,328.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,650.80
|
| Rate for Payer: Multiplan Commercial |
$4,983.00
|
| Rate for Payer: Networks By Design Commercial |
$4,318.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,647.40
|
| Rate for Payer: Riverside University Health System MISP |
$2,657.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,986.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,986.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,322.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,322.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,322.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,322.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,647.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,647.40
|
| Rate for Payer: Vantage Medical Group Senior |
$5,647.40
|
|
|
HC TRANSBRONCHIAL NEEDLE BX ADD'L
|
Facility
|
OP
|
$6,083.00
|
|
|
Service Code
|
CPT 31633
|
| Hospital Charge Code |
900803509
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.51 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$1,216.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$342.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,170.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,345.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,562.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,856.62
|
| Rate for Payer: Blue Shield of California EPN |
$2,427.12
|
| Rate for Payer: Cash Price |
$2,737.35
|
| Rate for Payer: Cash Price |
$2,737.35
|
| Rate for Payer: Cash Price |
$2,737.35
|
| Rate for Payer: Central Health Plan Commercial |
$4,866.40
|
| Rate for Payer: Cigna of CA HMO |
$3,893.12
|
| Rate for Payer: Cigna of CA PPO |
$4,501.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,170.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,170.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,170.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,258.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,433.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,433.20
|
| Rate for Payer: Galaxy Health WC |
$5,170.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,649.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,474.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$125.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,862.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$138.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,588.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,216.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,258.10
|
| Rate for Payer: Multiplan Commercial |
$4,562.25
|
| Rate for Payer: Networks By Design Commercial |
$3,953.95
|
| Rate for Payer: Prime Health Services Commercial |
$5,170.55
|
| Rate for Payer: Riverside University Health System MISP |
$2,433.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,649.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,649.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,041.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,041.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,041.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,041.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,170.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,170.55
|
| Rate for Payer: Vantage Medical Group Senior |
$5,170.55
|
|
|
HC TRANSBRONCHIAL NEEDLE BX ADD'L
|
Facility
|
IP
|
$6,083.00
|
|
|
Service Code
|
CPT 31633
|
| Hospital Charge Code |
900803509
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,216.60 |
| Max. Negotiated Rate |
$5,474.70 |
| Rate for Payer: Adventist Health Commercial |
$1,216.60
|
| Rate for Payer: Cash Price |
$2,737.35
|
| Rate for Payer: Central Health Plan Commercial |
$4,866.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,258.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,433.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,433.20
|
| Rate for Payer: Galaxy Health WC |
$5,170.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,649.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,474.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,862.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,588.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,216.60
|
| Rate for Payer: Multiplan Commercial |
$4,562.25
|
| Rate for Payer: Networks By Design Commercial |
$3,953.95
|
| Rate for Payer: Prime Health Services Commercial |
$5,170.55
|
|
|
HC TRANSBRONCHIAL W/NEEDLE BIOPSY
|
Facility
|
OP
|
$6,376.00
|
|
|
Service Code
|
CPT 31629
|
| Hospital Charge Code |
900803508
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$320.18 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,275.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,795.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,274.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,795.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$7,464.14
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$2,869.20
|
| Rate for Payer: Cash Price |
$2,869.20
|
| Rate for Payer: Cash Price |
$2,869.20
|
| Rate for Payer: Central Health Plan Commercial |
$5,100.80
|
| Rate for Payer: Cigna of CA HMO |
$4,080.64
|
| Rate for Payer: Cigna of CA PPO |
$4,718.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,274.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,795.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,463.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,912.21
|
| Rate for Payer: EPIC Health Plan Senior |
$5,274.81
|
| Rate for Payer: Galaxy Health WC |
$5,419.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,825.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,738.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,864.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$320.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,795.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,048.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$353.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,713.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,275.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,425.68
|
| Rate for Payer: Multiplan Commercial |
$4,782.00
|
| Rate for Payer: Multiplan WC |
$7,464.14
|
| Rate for Payer: Networks By Design Commercial |
$4,144.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,795.28
|
| Rate for Payer: Preferred Health Network WC |
$7,616.47
|
| Rate for Payer: Prime Health Services Commercial |
$5,419.60
|
| Rate for Payer: Prime Health Services Medicare |
$5,083.00
|
| Rate for Payer: Prime Health Services WC |
$7,387.98
|
| Rate for Payer: Riverside University Health System MISP |
$5,274.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,825.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,188.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,795.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,274.81
|
| Rate for Payer: Vantage Medical Group Senior |
$4,795.28
|
|
|
HC TRANSBRONCHIAL W/NEEDLE BIOPSY
|
Facility
|
IP
|
$6,376.00
|
|
|
Service Code
|
CPT 31629
|
| Hospital Charge Code |
900803508
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,275.20 |
| Max. Negotiated Rate |
$5,738.40 |
| Rate for Payer: Adventist Health Commercial |
$1,275.20
|
| Rate for Payer: Cash Price |
$2,869.20
|
| Rate for Payer: Central Health Plan Commercial |
$5,100.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,463.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,550.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,550.40
|
| Rate for Payer: Galaxy Health WC |
$5,419.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,825.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,738.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,048.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,761.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,275.20
|
| Rate for Payer: Multiplan Commercial |
$4,782.00
|
| Rate for Payer: Networks By Design Commercial |
$4,144.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,419.60
|
|
|
HC TRANS CATH CLOSURE/ASD
|
Facility
|
IP
|
$31,188.00
|
|
|
Service Code
|
CPT 93580
|
| Hospital Charge Code |
906812218
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,237.60 |
| Max. Negotiated Rate |
$28,069.20 |
| Rate for Payer: Adventist Health Commercial |
$6,237.60
|
| Rate for Payer: Cash Price |
$14,034.60
|
| Rate for Payer: Central Health Plan Commercial |
$24,950.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21,831.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,475.20
|
| Rate for Payer: EPIC Health Plan Senior |
$12,475.20
|
| Rate for Payer: Galaxy Health WC |
$26,509.80
|
| Rate for Payer: Global Benefits Group Commercial |
$18,712.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$28,069.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19,804.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18,400.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,237.60
|
| Rate for Payer: Multiplan Commercial |
$23,391.00
|
| Rate for Payer: Networks By Design Commercial |
$20,272.20
|
| Rate for Payer: Prime Health Services Commercial |
$26,509.80
|
|
|
HC TRANS CATH CLOSURE/ASD
|
Facility
|
OP
|
$31,188.00
|
|
|
Service Code
|
CPT 93580
|
| Hospital Charge Code |
906812218
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,038.74 |
| Max. Negotiated Rate |
$53,714.00 |
| Rate for Payer: Adventist Health Commercial |
$6,237.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$23,577.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,577.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,877.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,562.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$14,034.60
|
| Rate for Payer: Cash Price |
$14,034.60
|
| Rate for Payer: Cash Price |
$14,034.60
|
| Rate for Payer: Central Health Plan Commercial |
$24,950.40
|
| Rate for Payer: Cigna of CA HMO |
$20,272.20
|
| Rate for Payer: Cigna of CA PPO |
$23,079.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,935.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,577.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21,831.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,902.96
|
| Rate for Payer: EPIC Health Plan Senior |
$25,935.31
|
| Rate for Payer: Galaxy Health WC |
$26,509.80
|
| Rate for Payer: Global Benefits Group Commercial |
$18,712.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$28,069.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38,667.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,038.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19,804.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,147.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,008.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,237.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31,593.92
|
| Rate for Payer: Multiplan Commercial |
$23,391.00
|
| Rate for Payer: Networks By Design Commercial |
$20,272.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Prime Health Services Commercial |
$26,509.80
|
| Rate for Payer: Prime Health Services Medicare |
$24,992.20
|
| Rate for Payer: Riverside University Health System MISP |
$25,935.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18,712.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18,712.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,594.00
|
| Rate for Payer: United Healthcare All Other HMO |
$53,714.00
|
| Rate for Payer: United Healthcare HMO Rider |
$37,572.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34,424.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$23,577.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Vantage Medical Group Senior |
$23,577.55
|
|
|
HC TRANS CATH CLOSURE/VSD
|
Facility
|
OP
|
$22,574.00
|
|
|
Service Code
|
CPT 93581
|
| Hospital Charge Code |
906812219
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,308.44 |
| Max. Negotiated Rate |
$53,714.00 |
| Rate for Payer: Adventist Health Commercial |
$4,514.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$23,577.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,577.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,877.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,562.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$10,158.30
|
| Rate for Payer: Cash Price |
$10,158.30
|
| Rate for Payer: Cash Price |
$10,158.30
|
| Rate for Payer: Central Health Plan Commercial |
$18,059.20
|
| Rate for Payer: Cigna of CA HMO |
$14,673.10
|
| Rate for Payer: Cigna of CA PPO |
$16,704.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,935.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,577.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15,801.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,902.96
|
| Rate for Payer: EPIC Health Plan Senior |
$25,935.31
|
| Rate for Payer: Galaxy Health WC |
$19,187.90
|
| Rate for Payer: Global Benefits Group Commercial |
$13,544.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$20,316.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38,667.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,308.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14,334.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,445.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,008.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,514.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31,593.92
|
| Rate for Payer: Multiplan Commercial |
$16,930.50
|
| Rate for Payer: Networks By Design Commercial |
$14,673.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Prime Health Services Commercial |
$19,187.90
|
| Rate for Payer: Prime Health Services Medicare |
$24,992.20
|
| Rate for Payer: Riverside University Health System MISP |
$25,935.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,544.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13,544.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,287.00
|
| Rate for Payer: United Healthcare All Other HMO |
$53,714.00
|
| Rate for Payer: United Healthcare HMO Rider |
$37,572.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34,424.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$23,577.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Vantage Medical Group Senior |
$23,577.55
|
|
|
HC TRANS CATH CLOSURE/VSD
|
Facility
|
IP
|
$22,574.00
|
|
|
Service Code
|
CPT 93581
|
| Hospital Charge Code |
906812219
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,514.80 |
| Max. Negotiated Rate |
$20,316.60 |
| Rate for Payer: Adventist Health Commercial |
$4,514.80
|
| Rate for Payer: Cash Price |
$10,158.30
|
| Rate for Payer: Central Health Plan Commercial |
$18,059.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15,801.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,029.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9,029.60
|
| Rate for Payer: Galaxy Health WC |
$19,187.90
|
| Rate for Payer: Global Benefits Group Commercial |
$13,544.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$20,316.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14,334.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,318.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,514.80
|
| Rate for Payer: Multiplan Commercial |
$16,930.50
|
| Rate for Payer: Networks By Design Commercial |
$14,673.10
|
| Rate for Payer: Prime Health Services Commercial |
$19,187.90
|
|
|
HC TRANSCATHETER BIOPSY
|
Facility
|
IP
|
$6,289.00
|
|
|
Service Code
|
CPT 75970
|
| Hospital Charge Code |
909081664
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,257.80 |
| Max. Negotiated Rate |
$5,660.10 |
| Rate for Payer: Adventist Health Commercial |
$1,257.80
|
| Rate for Payer: Cash Price |
$2,830.05
|
| Rate for Payer: Central Health Plan Commercial |
$5,031.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,402.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,515.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,515.60
|
| Rate for Payer: Galaxy Health WC |
$5,345.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,773.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,660.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,993.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,710.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,257.80
|
| Rate for Payer: Multiplan Commercial |
$4,716.75
|
| Rate for Payer: Networks By Design Commercial |
$4,087.85
|
| Rate for Payer: Prime Health Services Commercial |
$5,345.65
|
|
|
HC TRANSCATHETER BIOPSY
|
Facility
|
OP
|
$13,096.00
|
|
|
Service Code
|
CPT 37200
|
| Hospital Charge Code |
909081356
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$236.93 |
| Max. Negotiated Rate |
$11,808.82 |
| Rate for Payer: Adventist Health Commercial |
$2,619.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$7,156.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,345.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,156.86
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,250.48
|
| Rate for Payer: Blue Shield of California EPN |
$5,199.11
|
| Rate for Payer: Cash Price |
$5,893.20
|
| Rate for Payer: Cash Price |
$5,893.20
|
| Rate for Payer: Cash Price |
$5,893.20
|
| Rate for Payer: Central Health Plan Commercial |
$10,476.80
|
| Rate for Payer: Cigna of CA HMO |
$8,381.44
|
| Rate for Payer: Cigna of CA PPO |
$9,691.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,872.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,156.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,167.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,808.82
|
| Rate for Payer: EPIC Health Plan Senior |
$7,872.55
|
| Rate for Payer: Galaxy Health WC |
$11,131.60
|
| Rate for Payer: Global Benefits Group Commercial |
$7,857.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,786.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,737.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$236.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,156.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,315.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$261.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,019.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,619.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,590.19
|
| Rate for Payer: Multiplan Commercial |
$9,822.00
|
| Rate for Payer: Networks By Design Commercial |
$8,512.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,156.86
|
| Rate for Payer: Prime Health Services Commercial |
$11,131.60
|
| Rate for Payer: Prime Health Services Medicare |
$7,586.27
|
| Rate for Payer: Riverside University Health System MISP |
$7,872.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,857.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,857.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,548.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6,548.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,548.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,548.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,156.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Vantage Medical Group Senior |
$7,156.86
|
|
