|
HC BREAST PXMSTCTMY BRA W/INTGRT BILAT
|
Facility
|
IP
|
$434.00
|
|
|
Service Code
|
CPT L8002
|
| Hospital Charge Code |
905358002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$86.80 |
| Max. Negotiated Rate |
$390.60 |
| Rate for Payer: Adventist Health Commercial |
$86.80
|
| Rate for Payer: Blue Shield of California Commercial |
$348.07
|
| Rate for Payer: Blue Shield of California EPN |
$218.74
|
| Rate for Payer: Cash Price |
$195.30
|
| Rate for Payer: Central Health Plan Commercial |
$347.20
|
| Rate for Payer: Cigna of CA HMO |
$303.80
|
| Rate for Payer: Cigna of CA PPO |
$303.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$303.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$173.60
|
| Rate for Payer: EPIC Health Plan Senior |
$173.60
|
| Rate for Payer: Galaxy Health WC |
$368.90
|
| Rate for Payer: Global Benefits Group Commercial |
$260.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$390.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$275.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$256.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.80
|
| Rate for Payer: Multiplan Commercial |
$325.50
|
| Rate for Payer: Networks By Design Commercial |
$282.10
|
| Rate for Payer: Prime Health Services Commercial |
$368.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$162.88
|
| Rate for Payer: United Healthcare All Other HMO |
$158.54
|
| Rate for Payer: United Healthcare HMO Rider |
$155.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$142.13
|
|
|
HC BREAST PX MSTCTMY BRA W/INTGRT UNI
|
Facility
|
OP
|
$368.00
|
|
|
Service Code
|
CPT L8001
|
| Hospital Charge Code |
915358001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$120.52 |
| Max. Negotiated Rate |
$331.20 |
| Rate for Payer: Adventist Health Commercial |
$150.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$312.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$202.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$276.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$214.07
|
| Rate for Payer: Blue Shield of California Commercial |
$295.14
|
| Rate for Payer: Blue Shield of California EPN |
$185.47
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Central Health Plan Commercial |
$294.40
|
| Rate for Payer: Cigna of CA HMO |
$257.60
|
| Rate for Payer: Cigna of CA PPO |
$257.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$312.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$312.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$312.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$257.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$147.20
|
| Rate for Payer: EPIC Health Plan Senior |
$147.20
|
| Rate for Payer: Galaxy Health WC |
$312.80
|
| Rate for Payer: Global Benefits Group Commercial |
$220.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$331.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$135.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$233.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$150.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$217.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$150.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$257.60
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: Networks By Design Commercial |
$184.00
|
| Rate for Payer: Prime Health Services Commercial |
$312.80
|
| Rate for Payer: Riverside University Health System MISP |
$147.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$220.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$220.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$138.11
|
| Rate for Payer: United Healthcare All Other HMO |
$134.43
|
| Rate for Payer: United Healthcare HMO Rider |
$131.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$120.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$312.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$312.80
|
| Rate for Payer: Vantage Medical Group Senior |
$312.80
|
|
|
HC BREAST PX MSTCTMY BRA W/INTGRT UNI
|
Facility
|
IP
|
$368.00
|
|
|
Service Code
|
CPT L8001
|
| Hospital Charge Code |
905358001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$73.60 |
| Max. Negotiated Rate |
$331.20 |
| Rate for Payer: Adventist Health Commercial |
$73.60
|
| Rate for Payer: Blue Shield of California Commercial |
$295.14
|
| Rate for Payer: Blue Shield of California EPN |
$185.47
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Central Health Plan Commercial |
$294.40
|
| Rate for Payer: Cigna of CA HMO |
$257.60
|
| Rate for Payer: Cigna of CA PPO |
$257.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$257.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$147.20
|
| Rate for Payer: EPIC Health Plan Senior |
$147.20
|
| Rate for Payer: Galaxy Health WC |
$312.80
|
| Rate for Payer: Global Benefits Group Commercial |
$220.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$331.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$233.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$217.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.60
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: Networks By Design Commercial |
$239.20
|
| Rate for Payer: Prime Health Services Commercial |
$312.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$138.11
|
| Rate for Payer: United Healthcare All Other HMO |
$134.43
|
| Rate for Payer: United Healthcare HMO Rider |
$131.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$120.52
|
|
|
HC BREAST PX MSTCTMY BRA W/INTGRT UNI
|
Facility
|
IP
|
$368.00
|
|
|
Service Code
|
CPT L8001
|
| Hospital Charge Code |
915358001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$73.60 |
| Max. Negotiated Rate |
$331.20 |
| Rate for Payer: Adventist Health Commercial |
$73.60
|
| Rate for Payer: Blue Shield of California Commercial |
$295.14
|
| Rate for Payer: Blue Shield of California EPN |
$185.47
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Central Health Plan Commercial |
$294.40
|
| Rate for Payer: Cigna of CA HMO |
$257.60
|
| Rate for Payer: Cigna of CA PPO |
$257.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$257.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$147.20
|
| Rate for Payer: EPIC Health Plan Senior |
$147.20
|
| Rate for Payer: Galaxy Health WC |
$312.80
|
| Rate for Payer: Global Benefits Group Commercial |
$220.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$331.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$233.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$217.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.60
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: Networks By Design Commercial |
$239.20
|
| Rate for Payer: Prime Health Services Commercial |
$312.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$138.11
|
| Rate for Payer: United Healthcare All Other HMO |
$134.43
|
| Rate for Payer: United Healthcare HMO Rider |
$131.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$120.52
|
|
|
HC BREAST PX MSTCTMY BRA W/INTGRT UNI
|
Facility
|
OP
|
$368.00
|
|
|
Service Code
|
CPT L8001
|
| Hospital Charge Code |
905358001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$120.52 |
| Max. Negotiated Rate |
$331.20 |
| Rate for Payer: Adventist Health Commercial |
$150.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$312.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$202.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$276.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$214.07
|
| Rate for Payer: Blue Shield of California Commercial |
$295.14
|
| Rate for Payer: Blue Shield of California EPN |
$185.47
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Central Health Plan Commercial |
$294.40
|
| Rate for Payer: Cigna of CA HMO |
$257.60
|
| Rate for Payer: Cigna of CA PPO |
$257.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$312.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$312.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$312.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$257.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$147.20
|
| Rate for Payer: EPIC Health Plan Senior |
$147.20
|
| Rate for Payer: Galaxy Health WC |
$312.80
|
| Rate for Payer: Global Benefits Group Commercial |
$220.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$331.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$135.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$233.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$150.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$217.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$150.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$257.60
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: Networks By Design Commercial |
$184.00
|
| Rate for Payer: Prime Health Services Commercial |
$312.80
|
| Rate for Payer: Riverside University Health System MISP |
$147.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$220.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$220.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$138.11
|
| Rate for Payer: United Healthcare All Other HMO |
$134.43
|
| Rate for Payer: United Healthcare HMO Rider |
$131.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$120.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$312.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$312.80
|
| Rate for Payer: Vantage Medical Group Senior |
$312.80
|
|
|
HC BREAST TOMO
|
Facility
|
OP
|
$2,658.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909002014
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$531.60 |
| Max. Negotiated Rate |
$2,392.20 |
| Rate for Payer: Adventist Health Commercial |
$531.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,259.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,461.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,993.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$739.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,546.16
|
| Rate for Payer: Blue Shield of California Commercial |
$1,674.54
|
| Rate for Payer: Blue Shield of California EPN |
$1,055.23
|
| Rate for Payer: Cash Price |
$1,196.10
|
| Rate for Payer: Cash Price |
$1,196.10
|
| Rate for Payer: Cash Price |
$1,196.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,126.40
|
| Rate for Payer: Cigna of CA HMO |
$1,701.12
|
| Rate for Payer: Cigna of CA PPO |
$1,966.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,259.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,259.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,259.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,860.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,063.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,063.20
|
| Rate for Payer: Galaxy Health WC |
$2,259.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,594.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,392.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,687.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$964.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,568.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$531.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,860.60
|
| Rate for Payer: Multiplan Commercial |
$1,993.50
|
| Rate for Payer: Networks By Design Commercial |
$1,727.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,259.30
|
| Rate for Payer: Riverside University Health System MISP |
$1,063.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,594.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,594.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,329.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,329.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,329.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,329.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,259.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,259.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,259.30
|
|
|
HC BREAST TOMO
|
Facility
|
IP
|
$2,658.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909002014
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$531.60 |
| Max. Negotiated Rate |
$2,392.20 |
| Rate for Payer: Adventist Health Commercial |
$531.60
|
| Rate for Payer: Cash Price |
$1,196.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,126.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,860.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,063.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,063.20
|
| Rate for Payer: Galaxy Health WC |
$2,259.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,594.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,392.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,687.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,568.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$531.60
|
| Rate for Payer: Multiplan Commercial |
$1,993.50
|
| Rate for Payer: Networks By Design Commercial |
$1,727.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,259.30
|
|
|
HC BREAST TOMO COMBO
|
Facility
|
IP
|
$2,658.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909002017
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$531.60 |
| Max. Negotiated Rate |
$2,392.20 |
| Rate for Payer: Adventist Health Commercial |
$531.60
|
| Rate for Payer: Cash Price |
$1,196.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,126.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,860.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,063.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,063.20
|
| Rate for Payer: Galaxy Health WC |
$2,259.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,594.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,392.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,687.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,568.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$531.60
|
| Rate for Payer: Multiplan Commercial |
$1,993.50
|
| Rate for Payer: Networks By Design Commercial |
$1,727.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,259.30
|
|
|
HC BREAST TOMO COMBO
|
Facility
|
OP
|
$2,658.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909002017
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$531.60 |
| Max. Negotiated Rate |
$2,392.20 |
| Rate for Payer: Adventist Health Commercial |
$531.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,259.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,461.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,993.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$739.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,546.16
|
| Rate for Payer: Blue Shield of California Commercial |
$1,674.54
|
| Rate for Payer: Blue Shield of California EPN |
$1,055.23
|
| Rate for Payer: Cash Price |
$1,196.10
|
| Rate for Payer: Cash Price |
$1,196.10
|
| Rate for Payer: Cash Price |
$1,196.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,126.40
|
| Rate for Payer: Cigna of CA HMO |
$1,701.12
|
| Rate for Payer: Cigna of CA PPO |
$1,966.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,259.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,259.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,259.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,860.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,063.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,063.20
|
| Rate for Payer: Galaxy Health WC |
$2,259.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,594.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,392.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,687.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$964.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,568.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$531.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,860.60
|
| Rate for Payer: Multiplan Commercial |
$1,993.50
|
| Rate for Payer: Networks By Design Commercial |
$1,727.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,259.30
|
| Rate for Payer: Riverside University Health System MISP |
$1,063.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,594.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,594.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,329.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,329.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,329.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,329.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,259.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,259.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,259.30
|
|
|
HC BREATHING RESPONSE TO HYPOXIA
|
Facility
|
OP
|
$561.00
|
|
|
Service Code
|
CPT 94450
|
| Hospital Charge Code |
900801450
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$41.62 |
| Max. Negotiated Rate |
$764.00 |
| Rate for Payer: Adventist Health Commercial |
$112.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$165.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$260.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$103.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$326.33
|
| Rate for Payer: Blue Shield of California Commercial |
$353.43
|
| Rate for Payer: Blue Shield of California EPN |
$222.72
|
| Rate for Payer: Cash Price |
$252.45
|
| Rate for Payer: Cash Price |
$252.45
|
| Rate for Payer: Cash Price |
$252.45
|
| Rate for Payer: Central Health Plan Commercial |
$448.80
|
| Rate for Payer: Cigna of CA HMO |
$359.04
|
| Rate for Payer: Cigna of CA PPO |
$415.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$392.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.06
|
| Rate for Payer: EPIC Health Plan Senior |
$182.04
|
| Rate for Payer: Galaxy Health WC |
$476.85
|
| Rate for Payer: Global Benefits Group Commercial |
$336.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$504.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$271.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$356.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$45.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$231.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$221.76
|
| Rate for Payer: Multiplan Commercial |
$420.75
|
| Rate for Payer: Networks By Design Commercial |
$364.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$165.49
|
| Rate for Payer: Prime Health Services Commercial |
$476.85
|
| Rate for Payer: Prime Health Services Medicare |
$175.42
|
| Rate for Payer: Riverside University Health System MISP |
$182.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$336.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$336.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$165.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Vantage Medical Group Senior |
$165.49
|
|
|
HC BREATHING RESPONSE TO HYPOXIA
|
Facility
|
IP
|
$561.00
|
|
|
Service Code
|
CPT 94450
|
| Hospital Charge Code |
900801450
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$112.20 |
| Max. Negotiated Rate |
$504.90 |
| Rate for Payer: Adventist Health Commercial |
$112.20
|
| Rate for Payer: Cash Price |
$252.45
|
| Rate for Payer: Central Health Plan Commercial |
$448.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$392.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.40
|
| Rate for Payer: EPIC Health Plan Senior |
$224.40
|
| Rate for Payer: Galaxy Health WC |
$476.85
|
| Rate for Payer: Global Benefits Group Commercial |
$336.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$504.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$356.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$330.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.20
|
| Rate for Payer: Multiplan Commercial |
$420.75
|
| Rate for Payer: Networks By Design Commercial |
$364.65
|
| Rate for Payer: Prime Health Services Commercial |
$476.85
|
|
|
HC BRISK PROFILE
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
900912001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$20.18 |
| Max. Negotiated Rate |
$184.59 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Adventist Health Commercial |
$89.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$24.91
|
| Rate for Payer: Adventist Health Medi-Cal |
$24.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$157.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$157.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$132.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$132.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.59
|
| Rate for Payer: Blue Shield of California Commercial |
$280.35
|
| Rate for Payer: Blue Shield of California Commercial |
$98.28
|
| Rate for Payer: Blue Shield of California EPN |
$176.66
|
| Rate for Payer: Blue Shield of California EPN |
$61.93
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Central Health Plan Commercial |
$124.80
|
| Rate for Payer: Central Health Plan Commercial |
$356.00
|
| Rate for Payer: Cigna of CA HMO |
$284.80
|
| Rate for Payer: Cigna of CA HMO |
$99.84
|
| Rate for Payer: Cigna of CA PPO |
$329.30
|
| Rate for Payer: Cigna of CA PPO |
$115.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$109.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$311.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.10
|
| Rate for Payer: EPIC Health Plan Senior |
$27.40
|
| Rate for Payer: EPIC Health Plan Senior |
$27.40
|
| Rate for Payer: Galaxy Health WC |
$378.25
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Global Benefits Group Commercial |
$267.00
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$400.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$140.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$40.85
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$40.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$99.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$282.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$33.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$33.38
|
| Rate for Payer: Multiplan Commercial |
$333.75
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: Networks By Design Commercial |
$289.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$24.91
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$24.91
|
| Rate for Payer: Prime Health Services Commercial |
$378.25
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
| Rate for Payer: Prime Health Services Medicare |
$26.40
|
| Rate for Payer: Prime Health Services Medicare |
$26.40
|
| Rate for Payer: Riverside University Health System MISP |
$27.40
|
| Rate for Payer: Riverside University Health System MISP |
$27.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$93.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$267.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$267.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$93.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.18
|
| Rate for Payer: United Healthcare All Other HMO |
$20.18
|
| Rate for Payer: United Healthcare All Other HMO |
$20.18
|
| Rate for Payer: United Healthcare HMO Rider |
$20.18
|
| Rate for Payer: United Healthcare HMO Rider |
$20.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.18
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.91
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.40
|
| Rate for Payer: Vantage Medical Group Senior |
$24.91
|
| Rate for Payer: Vantage Medical Group Senior |
$24.91
|
|
|
HC BRISK PROFILE
|
Facility
|
IP
|
$445.00
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
900912001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$89.00 |
| Max. Negotiated Rate |
$400.50 |
| Rate for Payer: Adventist Health Commercial |
$89.00
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Central Health Plan Commercial |
$356.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$311.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.00
|
| Rate for Payer: EPIC Health Plan Senior |
$178.00
|
| Rate for Payer: Galaxy Health WC |
$378.25
|
| Rate for Payer: Global Benefits Group Commercial |
$267.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$400.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$282.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$262.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.00
|
| Rate for Payer: Multiplan Commercial |
$333.75
|
| Rate for Payer: Networks By Design Commercial |
$289.25
|
| Rate for Payer: Prime Health Services Commercial |
$378.25
|
|
|
HC BRNCHSC RF DSTRCTN PULM NRV BI
|
Facility
|
IP
|
$8,379.00
|
|
|
Service Code
|
CPT 0781T
|
| Hospital Charge Code |
909010781
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,675.80 |
| Max. Negotiated Rate |
$7,541.10 |
| Rate for Payer: Adventist Health Commercial |
$1,675.80
|
| Rate for Payer: Cash Price |
$3,770.55
|
| Rate for Payer: Central Health Plan Commercial |
$6,703.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,865.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,351.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,351.60
|
| Rate for Payer: Galaxy Health WC |
$7,122.15
|
| Rate for Payer: Global Benefits Group Commercial |
$5,027.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,541.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,320.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,943.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,675.80
|
| Rate for Payer: Multiplan Commercial |
$6,284.25
|
| Rate for Payer: Networks By Design Commercial |
$5,446.35
|
| Rate for Payer: Prime Health Services Commercial |
$7,122.15
|
|
|
HC BRNCHSC RF DSTRCTN PULM NRV BI
|
Facility
|
OP
|
$8,379.00
|
|
|
Service Code
|
CPT 0781T
|
| Hospital Charge Code |
909010781
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$639.21 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,675.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,122.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,608.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,284.25
|
| 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 |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$3,770.55
|
| Rate for Payer: Cash Price |
$3,770.55
|
| Rate for Payer: Central Health Plan Commercial |
$6,703.20
|
| Rate for Payer: Cigna of CA HMO |
$5,362.56
|
| Rate for Payer: Cigna of CA PPO |
$6,200.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,122.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,122.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,122.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,865.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,351.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,351.60
|
| Rate for Payer: Galaxy Health WC |
$7,122.15
|
| Rate for Payer: Global Benefits Group Commercial |
$5,027.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,541.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,320.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,041.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,943.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,675.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,865.30
|
| Rate for Payer: Multiplan Commercial |
$6,284.25
|
| Rate for Payer: Networks By Design Commercial |
$5,446.35
|
| Rate for Payer: Prime Health Services Commercial |
$7,122.15
|
| Rate for Payer: Riverside University Health System MISP |
$3,351.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,027.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,189.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,122.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,122.15
|
| Rate for Payer: Vantage Medical Group Senior |
$7,122.15
|
|
|
HC BRNCHSC RF DSTRCTN PULM NRV UNI
|
Facility
|
OP
|
$4,190.00
|
|
|
Service Code
|
CPT 0782T
|
| Hospital Charge Code |
909010782
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$639.21 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$838.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,561.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,304.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,142.50
|
| 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 |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$1,885.50
|
| Rate for Payer: Cash Price |
$1,885.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,352.00
|
| Rate for Payer: Cigna of CA HMO |
$2,681.60
|
| Rate for Payer: Cigna of CA PPO |
$3,100.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,561.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,561.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,561.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,933.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,676.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,676.00
|
| Rate for Payer: Galaxy Health WC |
$3,561.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,514.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,771.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,660.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,520.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,472.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$838.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,933.00
|
| Rate for Payer: Multiplan Commercial |
$3,142.50
|
| Rate for Payer: Networks By Design Commercial |
$2,723.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,561.50
|
| Rate for Payer: Riverside University Health System MISP |
$1,676.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,514.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,095.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,561.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,561.50
|
| Rate for Payer: Vantage Medical Group Senior |
$3,561.50
|
|
|
HC BRNCHSC RF DSTRCTN PULM NRV UNI
|
Facility
|
IP
|
$4,190.00
|
|
|
Service Code
|
CPT 0782T
|
| Hospital Charge Code |
909010782
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$838.00 |
| Max. Negotiated Rate |
$3,771.00 |
| Rate for Payer: Adventist Health Commercial |
$838.00
|
| Rate for Payer: Cash Price |
$1,885.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,352.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,933.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,676.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,676.00
|
| Rate for Payer: Galaxy Health WC |
$3,561.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,514.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,771.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,660.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,472.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$838.00
|
| Rate for Payer: Multiplan Commercial |
$3,142.50
|
| Rate for Payer: Networks By Design Commercial |
$2,723.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,561.50
|
|
|
HC BRONCH COMTR AIDED NAVIGATION
|
Facility
|
OP
|
$2,245.00
|
|
|
Service Code
|
CPT 31627
|
| Hospital Charge Code |
900531627
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$449.00 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$449.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,908.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,234.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,683.75
|
| 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 |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$1,010.25
|
| Rate for Payer: Cash Price |
$1,010.25
|
| Rate for Payer: Cash Price |
$1,010.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,796.00
|
| Rate for Payer: Cigna of CA HMO |
$1,436.80
|
| Rate for Payer: Cigna of CA PPO |
$1,661.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,908.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,908.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,908.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,571.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$898.00
|
| Rate for Payer: EPIC Health Plan Senior |
$898.00
|
| Rate for Payer: Galaxy Health WC |
$1,908.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,347.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,020.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,859.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,425.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,054.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,324.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$449.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,571.50
|
| Rate for Payer: Multiplan Commercial |
$1,683.75
|
| Rate for Payer: Networks By Design Commercial |
$1,459.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,908.25
|
| Rate for Payer: Riverside University Health System MISP |
$898.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,347.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,122.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,908.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,908.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,908.25
|
|
|
HC BRONCH COMTR AIDED NAVIGATION
|
Facility
|
IP
|
$2,245.00
|
|
|
Service Code
|
CPT 31627
|
| Hospital Charge Code |
900531627
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$449.00 |
| Max. Negotiated Rate |
$2,020.50 |
| Rate for Payer: Adventist Health Commercial |
$449.00
|
| Rate for Payer: Cash Price |
$1,010.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,796.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,571.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$898.00
|
| Rate for Payer: EPIC Health Plan Senior |
$898.00
|
| Rate for Payer: Galaxy Health WC |
$1,908.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,347.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,020.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,425.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,324.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$449.00
|
| Rate for Payer: Multiplan Commercial |
$1,683.75
|
| Rate for Payer: Networks By Design Commercial |
$1,459.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,908.25
|
|
|
HC BRONCH EBUS PERIPHERAL LESION
|
Facility
|
OP
|
$8,927.00
|
|
|
Service Code
|
CPT 31654
|
| Hospital Charge Code |
900831654
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$221.57 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,785.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,587.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,909.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,695.25
|
| 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 |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$4,017.15
|
| Rate for Payer: Cash Price |
$4,017.15
|
| Rate for Payer: Cash Price |
$4,017.15
|
| Rate for Payer: Central Health Plan Commercial |
$7,141.60
|
| Rate for Payer: Cigna of CA HMO |
$5,713.28
|
| Rate for Payer: Cigna of CA PPO |
$6,605.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,587.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,587.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,587.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,248.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,570.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,570.80
|
| Rate for Payer: Galaxy Health WC |
$7,587.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,356.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,034.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$221.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,668.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$244.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,266.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,785.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,248.90
|
| Rate for Payer: Multiplan Commercial |
$6,695.25
|
| Rate for Payer: Networks By Design Commercial |
$5,802.55
|
| Rate for Payer: Prime Health Services Commercial |
$7,587.95
|
| Rate for Payer: Riverside University Health System MISP |
$3,570.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,356.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,463.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,587.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,587.95
|
| Rate for Payer: Vantage Medical Group Senior |
$7,587.95
|
|
|
HC BRONCH EBUS PERIPHERAL LESION
|
Facility
|
IP
|
$8,927.00
|
|
|
Service Code
|
CPT 31654
|
| Hospital Charge Code |
900831654
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,785.40 |
| Max. Negotiated Rate |
$8,034.30 |
| Rate for Payer: Adventist Health Commercial |
$1,785.40
|
| Rate for Payer: Cash Price |
$4,017.15
|
| Rate for Payer: Central Health Plan Commercial |
$7,141.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,248.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,570.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,570.80
|
| Rate for Payer: Galaxy Health WC |
$7,587.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,356.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,034.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,668.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,266.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,785.40
|
| Rate for Payer: Multiplan Commercial |
$6,695.25
|
| Rate for Payer: Networks By Design Commercial |
$5,802.55
|
| Rate for Payer: Prime Health Services Commercial |
$7,587.95
|
|
|
HC BRONCH EBUS SAMP 1-2 NODES
|
Facility
|
OP
|
$8,927.00
|
|
|
Service Code
|
CPT 31652
|
| Hospital Charge Code |
900831652
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,422.23 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,785.40
|
| 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 |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| 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 |
$4,017.15
|
| Rate for Payer: Cash Price |
$4,017.15
|
| Rate for Payer: Cash Price |
$4,017.15
|
| Rate for Payer: Central Health Plan Commercial |
$7,141.60
|
| Rate for Payer: Cigna of CA HMO |
$5,713.28
|
| Rate for Payer: Cigna of CA PPO |
$6,605.98
|
| 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 |
$6,248.90
|
| 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 |
$7,587.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,356.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,034.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,864.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,422.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,795.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,668.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,571.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,713.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,785.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,425.68
|
| Rate for Payer: Multiplan Commercial |
$6,695.25
|
| Rate for Payer: Multiplan WC |
$7,464.14
|
| Rate for Payer: Networks By Design Commercial |
$5,802.55
|
| 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 |
$7,587.95
|
| 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 |
$5,356.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,463.50
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| 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 BRONCH EBUS SAMP 1-2 NODES
|
Facility
|
IP
|
$8,927.00
|
|
|
Service Code
|
CPT 31652
|
| Hospital Charge Code |
900831652
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,785.40 |
| Max. Negotiated Rate |
$8,034.30 |
| Rate for Payer: Adventist Health Commercial |
$1,785.40
|
| Rate for Payer: Cash Price |
$4,017.15
|
| Rate for Payer: Central Health Plan Commercial |
$7,141.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,248.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,570.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,570.80
|
| Rate for Payer: Galaxy Health WC |
$7,587.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,356.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,034.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,668.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,266.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,785.40
|
| Rate for Payer: Multiplan Commercial |
$6,695.25
|
| Rate for Payer: Networks By Design Commercial |
$5,802.55
|
| Rate for Payer: Prime Health Services Commercial |
$7,587.95
|
|
|
HC BRONCH EBUS SAMP 3 GT NODES
|
Facility
|
IP
|
$8,927.00
|
|
|
Service Code
|
CPT 31653
|
| Hospital Charge Code |
900831653
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,785.40 |
| Max. Negotiated Rate |
$8,034.30 |
| Rate for Payer: Adventist Health Commercial |
$1,785.40
|
| Rate for Payer: Cash Price |
$4,017.15
|
| Rate for Payer: Central Health Plan Commercial |
$7,141.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,248.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,570.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,570.80
|
| Rate for Payer: Galaxy Health WC |
$7,587.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,356.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,034.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,668.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,266.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,785.40
|
| Rate for Payer: Multiplan Commercial |
$6,695.25
|
| Rate for Payer: Networks By Design Commercial |
$5,802.55
|
| Rate for Payer: Prime Health Services Commercial |
$7,587.95
|
|
|
HC BRONCH EBUS SAMP 3 GT NODES
|
Facility
|
OP
|
$8,927.00
|
|
|
Service Code
|
CPT 31653
|
| Hospital Charge Code |
900831653
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,510.61 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,785.40
|
| 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 |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| 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 |
$4,017.15
|
| Rate for Payer: Cash Price |
$4,017.15
|
| Rate for Payer: Cash Price |
$4,017.15
|
| Rate for Payer: Central Health Plan Commercial |
$7,141.60
|
| Rate for Payer: Cigna of CA HMO |
$5,713.28
|
| Rate for Payer: Cigna of CA PPO |
$6,605.98
|
| 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 |
$6,248.90
|
| 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 |
$7,587.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,356.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,034.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,864.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,510.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,795.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,668.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,668.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,713.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,785.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,425.68
|
| Rate for Payer: Multiplan Commercial |
$6,695.25
|
| Rate for Payer: Multiplan WC |
$7,464.14
|
| Rate for Payer: Networks By Design Commercial |
$5,802.55
|
| 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 |
$7,587.95
|
| 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 |
$5,356.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,463.50
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| 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
|
|
