|
HC DFIB ST J UNIFY CD3231-40Q
|
Facility
|
IP
|
$32,500.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813656
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,500.00 |
| Max. Negotiated Rate |
$29,250.00 |
| Rate for Payer: Adventist Health Commercial |
$6,500.00
|
| Rate for Payer: Blue Shield of California Commercial |
$25,122.50
|
| Rate for Payer: Blue Shield of California EPN |
$16,380.00
|
| Rate for Payer: Cash Price |
$17,875.00
|
| Rate for Payer: Central Health Plan Commercial |
$26,000.00
|
| Rate for Payer: Cigna of CA HMO |
$22,750.00
|
| Rate for Payer: Cigna of CA PPO |
$22,750.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$13,000.00
|
| Rate for Payer: Galaxy Health WC |
$27,625.00
|
| Rate for Payer: Global Benefits Group Commercial |
$19,500.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$29,250.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21,677.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,382.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20,117.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,500.00
|
| Rate for Payer: Multiplan Commercial |
$24,375.00
|
| Rate for Payer: Networks By Design Commercial |
$16,250.00
|
| Rate for Payer: Prime Health Services Commercial |
$27,625.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,197.25
|
| Rate for Payer: United Healthcare All Other HMO |
$11,872.25
|
| Rate for Payer: United Healthcare HMO Rider |
$11,615.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10,643.75
|
|
|
HC DHEA-S
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
CPT 82627
|
| Hospital Charge Code |
900912126
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$69.30 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Cash Price |
$42.35
|
| Rate for Payer: Central Health Plan Commercial |
$61.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.80
|
| Rate for Payer: EPIC Health Plan Senior |
$30.80
|
| Rate for Payer: Galaxy Health WC |
$65.45
|
| Rate for Payer: Global Benefits Group Commercial |
$46.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$69.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.40
|
| Rate for Payer: Multiplan Commercial |
$57.75
|
| Rate for Payer: Networks By Design Commercial |
$50.05
|
| Rate for Payer: Prime Health Services Commercial |
$65.45
|
|
|
HC DHEA-S
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
CPT 82627
|
| Hospital Charge Code |
900912126
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$161.72 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$22.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$46.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$161.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.82
|
| Rate for Payer: Blue Shield of California Commercial |
$46.74
|
| Rate for Payer: Blue Shield of California EPN |
$30.57
|
| Rate for Payer: Cash Price |
$42.35
|
| Rate for Payer: Cash Price |
$42.35
|
| Rate for Payer: Central Health Plan Commercial |
$61.60
|
| Rate for Payer: Cigna of CA HMO |
$49.28
|
| Rate for Payer: Cigna of CA PPO |
$56.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.01
|
| Rate for Payer: EPIC Health Plan Senior |
$22.23
|
| Rate for Payer: Galaxy Health WC |
$65.45
|
| Rate for Payer: Global Benefits Group Commercial |
$46.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$69.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$36.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$33.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.23
|
| Rate for Payer: InnovAge PACE Commercial |
$33.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.79
|
| Rate for Payer: Multiplan Commercial |
$57.75
|
| Rate for Payer: Networks By Design Commercial |
$50.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$22.23
|
| Rate for Payer: Prime Health Services Commercial |
$65.45
|
| Rate for Payer: Prime Health Services Medicare |
$23.56
|
| Rate for Payer: Riverside University Health System MISP |
$24.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.01
|
| Rate for Payer: United Healthcare All Other HMO |
$18.01
|
| Rate for Payer: United Healthcare HMO Rider |
$18.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$22.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.45
|
| Rate for Payer: Vantage Medical Group Senior |
$22.23
|
|
|
HC DIABETIC SHOE X DEPTH USE/DENS
|
Facility
|
IP
|
$222.00
|
|
|
Service Code
|
CPT A5500
|
| Hospital Charge Code |
915365500
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$44.40 |
| Max. Negotiated Rate |
$199.80 |
| Rate for Payer: Adventist Health Commercial |
$44.40
|
| Rate for Payer: Cash Price |
$122.10
|
| Rate for Payer: Central Health Plan Commercial |
$177.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.80
|
| Rate for Payer: EPIC Health Plan Senior |
$88.80
|
| Rate for Payer: Galaxy Health WC |
$188.70
|
| Rate for Payer: Global Benefits Group Commercial |
$133.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$199.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$148.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.40
|
| Rate for Payer: Multiplan Commercial |
$166.50
|
| Rate for Payer: Networks By Design Commercial |
$144.30
|
| Rate for Payer: Prime Health Services Commercial |
$188.70
|
|
|
HC DIABETIC SHOE X DEPTH USE/DENS
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
CPT A5500
|
| Hospital Charge Code |
905365500
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$175.50 |
| Rate for Payer: Adventist Health Commercial |
$39.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$118.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$165.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$107.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$146.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$94.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.52
|
| Rate for Payer: Blue Shield of California Commercial |
$119.14
|
| Rate for Payer: Blue Shield of California EPN |
$77.81
|
| Rate for Payer: Cash Price |
$107.25
|
| Rate for Payer: Cash Price |
$107.25
|
| Rate for Payer: Central Health Plan Commercial |
$156.00
|
| Rate for Payer: Cigna of CA HMO |
$124.80
|
| Rate for Payer: Cigna of CA PPO |
$144.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$165.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$165.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.00
|
| Rate for Payer: EPIC Health Plan Senior |
$78.00
|
| Rate for Payer: Galaxy Health WC |
$165.75
|
| Rate for Payer: Global Benefits Group Commercial |
$117.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$175.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$81.68
|
| Rate for Payer: InnovAge PACE Commercial |
$97.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$120.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$136.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$136.50
|
| Rate for Payer: Multiplan Commercial |
$146.25
|
| Rate for Payer: Networks By Design Commercial |
$126.75
|
| Rate for Payer: Prime Health Services Commercial |
$165.75
|
| Rate for Payer: Riverside University Health System MISP |
$78.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$117.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$117.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$97.50
|
| Rate for Payer: United Healthcare All Other HMO |
$97.50
|
| Rate for Payer: United Healthcare HMO Rider |
$97.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$97.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$165.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$165.75
|
| Rate for Payer: Vantage Medical Group Senior |
$165.75
|
|
|
HC DIABETIC SHOE X DEPTH USE/DENS
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
CPT A5500
|
| Hospital Charge Code |
905365500
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$175.50 |
| Rate for Payer: Adventist Health Commercial |
$39.00
|
| Rate for Payer: Cash Price |
$107.25
|
| Rate for Payer: Central Health Plan Commercial |
$156.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.00
|
| Rate for Payer: EPIC Health Plan Senior |
$78.00
|
| Rate for Payer: Galaxy Health WC |
$165.75
|
| Rate for Payer: Global Benefits Group Commercial |
$117.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$175.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$120.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.00
|
| Rate for Payer: Multiplan Commercial |
$146.25
|
| Rate for Payer: Networks By Design Commercial |
$126.75
|
| Rate for Payer: Prime Health Services Commercial |
$165.75
|
|
|
HC DIABETIC SHOE X DEPTH USE/DENS
|
Facility
|
OP
|
$222.00
|
|
|
Service Code
|
CPT A5500
|
| Hospital Charge Code |
915365500
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$44.40 |
| Max. Negotiated Rate |
$199.80 |
| Rate for Payer: Adventist Health Commercial |
$44.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$134.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$188.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$122.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$166.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$107.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.38
|
| Rate for Payer: Blue Shield of California Commercial |
$135.64
|
| Rate for Payer: Blue Shield of California EPN |
$88.58
|
| Rate for Payer: Cash Price |
$122.10
|
| Rate for Payer: Cash Price |
$122.10
|
| Rate for Payer: Central Health Plan Commercial |
$177.60
|
| Rate for Payer: Cigna of CA HMO |
$142.08
|
| Rate for Payer: Cigna of CA PPO |
$164.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$188.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$188.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.80
|
| Rate for Payer: EPIC Health Plan Senior |
$88.80
|
| Rate for Payer: Galaxy Health WC |
$188.70
|
| Rate for Payer: Global Benefits Group Commercial |
$133.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$199.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$81.68
|
| Rate for Payer: InnovAge PACE Commercial |
$111.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$148.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$155.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$155.40
|
| Rate for Payer: Multiplan Commercial |
$166.50
|
| Rate for Payer: Networks By Design Commercial |
$144.30
|
| Rate for Payer: Prime Health Services Commercial |
$188.70
|
| Rate for Payer: Riverside University Health System MISP |
$88.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$133.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$133.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$111.00
|
| Rate for Payer: United Healthcare All Other HMO |
$111.00
|
| Rate for Payer: United Healthcare HMO Rider |
$111.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$111.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$188.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.70
|
| Rate for Payer: Vantage Medical Group Senior |
$188.70
|
|
|
HC DIAB OP SELF MGMT-GRP 30 MIN
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
CPT G0109
|
| Hospital Charge Code |
902501101
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$122.40 |
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Cash Price |
$74.80
|
| Rate for Payer: Central Health Plan Commercial |
$108.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.40
|
| Rate for Payer: EPIC Health Plan Senior |
$54.40
|
| Rate for Payer: Galaxy Health WC |
$115.60
|
| Rate for Payer: Global Benefits Group Commercial |
$81.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$122.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$84.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.20
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
| Rate for Payer: Networks By Design Commercial |
$88.40
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
|
|
HC DIAB OP SELF MGMT-GRP 30 MIN
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
CPT G0109
|
| Hospital Charge Code |
902501101
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$24.32 |
| Max. Negotiated Rate |
$824.00 |
| Rate for Payer: Adventist Health Commercial |
$55.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$82.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$115.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$102.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$65.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.87
|
| Rate for Payer: Blue Shield of California Commercial |
$83.10
|
| Rate for Payer: Blue Shield of California EPN |
$54.26
|
| Rate for Payer: Cash Price |
$74.80
|
| Rate for Payer: Cash Price |
$74.80
|
| Rate for Payer: Cash Price |
$74.80
|
| Rate for Payer: Central Health Plan Commercial |
$108.80
|
| Rate for Payer: Cigna of CA HMO |
$87.04
|
| Rate for Payer: Cigna of CA PPO |
$100.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$115.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$115.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$115.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.40
|
| Rate for Payer: EPIC Health Plan Senior |
$54.40
|
| Rate for Payer: Galaxy Health WC |
$115.60
|
| Rate for Payer: Global Benefits Group Commercial |
$81.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$122.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.32
|
| Rate for Payer: InnovAge PACE Commercial |
$68.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$84.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$95.20
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
| Rate for Payer: Networks By Design Commercial |
$88.40
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
| Rate for Payer: Riverside University Health System MISP |
$54.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$634.00
|
| Rate for Payer: United Healthcare All Other HMO |
$824.00
|
| Rate for Payer: United Healthcare HMO Rider |
$623.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$570.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$115.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$115.60
|
| Rate for Payer: Vantage Medical Group Senior |
$115.60
|
|
|
HC DIAB OP SELF MGMT-INDIV 30 MIN
|
Facility
|
OP
|
$311.00
|
|
|
Service Code
|
CPT G0108
|
| Hospital Charge Code |
902501100
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$62.20 |
| Max. Negotiated Rate |
$824.00 |
| Rate for Payer: Adventist Health Commercial |
$127.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$188.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$264.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$171.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$233.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$150.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$182.65
|
| Rate for Payer: Blue Shield of California Commercial |
$190.02
|
| Rate for Payer: Blue Shield of California EPN |
$124.09
|
| Rate for Payer: Cash Price |
$171.05
|
| Rate for Payer: Cash Price |
$171.05
|
| Rate for Payer: Cash Price |
$171.05
|
| Rate for Payer: Central Health Plan Commercial |
$248.80
|
| Rate for Payer: Cigna of CA HMO |
$199.04
|
| Rate for Payer: Cigna of CA PPO |
$230.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$264.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$264.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$264.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.40
|
| Rate for Payer: EPIC Health Plan Senior |
$124.40
|
| Rate for Payer: Galaxy Health WC |
$264.35
|
| Rate for Payer: Global Benefits Group Commercial |
$186.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$279.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$78.67
|
| Rate for Payer: InnovAge PACE Commercial |
$155.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$207.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$192.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$217.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$217.70
|
| Rate for Payer: Multiplan Commercial |
$233.25
|
| Rate for Payer: Networks By Design Commercial |
$202.15
|
| Rate for Payer: Prime Health Services Commercial |
$264.35
|
| Rate for Payer: Riverside University Health System MISP |
$124.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$186.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$186.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$634.00
|
| Rate for Payer: United Healthcare All Other HMO |
$824.00
|
| Rate for Payer: United Healthcare HMO Rider |
$623.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$570.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$264.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$264.35
|
| Rate for Payer: Vantage Medical Group Senior |
$264.35
|
|
|
HC DIAB OP SELF MGMT-INDIV 30 MIN
|
Facility
|
IP
|
$311.00
|
|
|
Service Code
|
CPT G0108
|
| Hospital Charge Code |
902501100
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$62.20 |
| Max. Negotiated Rate |
$279.90 |
| Rate for Payer: Adventist Health Commercial |
$62.20
|
| Rate for Payer: Cash Price |
$171.05
|
| Rate for Payer: Central Health Plan Commercial |
$248.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.40
|
| Rate for Payer: EPIC Health Plan Senior |
$124.40
|
| Rate for Payer: Galaxy Health WC |
$264.35
|
| Rate for Payer: Global Benefits Group Commercial |
$186.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$279.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$207.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$192.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.20
|
| Rate for Payer: Multiplan Commercial |
$233.25
|
| Rate for Payer: Networks By Design Commercial |
$202.15
|
| Rate for Payer: Prime Health Services Commercial |
$264.35
|
|
|
HC DIAG GASTRO INTUB W ASP SPECS
|
Facility
|
IP
|
$629.00
|
|
|
Service Code
|
CPT 43755
|
| Hospital Charge Code |
906743755
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$125.80 |
| Max. Negotiated Rate |
$566.10 |
| Rate for Payer: Adventist Health Commercial |
$125.80
|
| Rate for Payer: Cash Price |
$345.95
|
| Rate for Payer: Central Health Plan Commercial |
$503.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$251.60
|
| Rate for Payer: EPIC Health Plan Senior |
$251.60
|
| Rate for Payer: Galaxy Health WC |
$534.65
|
| Rate for Payer: Global Benefits Group Commercial |
$377.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$566.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$419.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$239.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$389.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.80
|
| Rate for Payer: Multiplan Commercial |
$471.75
|
| Rate for Payer: Networks By Design Commercial |
$408.85
|
| Rate for Payer: Prime Health Services Commercial |
$534.65
|
|
|
HC DIAG GASTRO INTUB W ASP SPECS
|
Facility
|
OP
|
$629.00
|
|
|
Service Code
|
CPT 43755
|
| Hospital Charge Code |
906743755
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$85.17 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$125.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$198.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$304.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$369.41
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$345.95
|
| Rate for Payer: Cash Price |
$345.95
|
| Rate for Payer: Cash Price |
$345.95
|
| Rate for Payer: Central Health Plan Commercial |
$503.20
|
| Rate for Payer: Cigna of CA HMO |
$402.56
|
| Rate for Payer: Cigna of CA PPO |
$465.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.38
|
| Rate for Payer: EPIC Health Plan Senior |
$198.80
|
| Rate for Payer: Galaxy Health WC |
$534.65
|
| Rate for Payer: Global Benefits Group Commercial |
$377.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$566.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$85.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: InnovAge PACE Commercial |
$298.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$419.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$266.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.39
|
| Rate for Payer: Multiplan Commercial |
$471.75
|
| Rate for Payer: Networks By Design Commercial |
$408.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$198.80
|
| Rate for Payer: Prime Health Services Commercial |
$534.65
|
| Rate for Payer: Prime Health Services Medicare |
$210.73
|
| Rate for Payer: Riverside University Health System MISP |
$218.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$377.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$238.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| 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: Upland Medical Group Pediatric |
$198.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC DIAGNOSTIC BRONCH
|
Facility
|
IP
|
$8,386.00
|
|
|
Service Code
|
CPT 31622
|
| Hospital Charge Code |
900501418
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,677.20 |
| Max. Negotiated Rate |
$7,547.40 |
| Rate for Payer: Adventist Health Commercial |
$1,677.20
|
| Rate for Payer: Cash Price |
$4,612.30
|
| Rate for Payer: Central Health Plan Commercial |
$6,708.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,354.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,354.40
|
| Rate for Payer: Galaxy Health WC |
$7,128.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,031.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,547.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,593.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,195.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,190.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,677.20
|
| Rate for Payer: Multiplan Commercial |
$6,289.50
|
| Rate for Payer: Networks By Design Commercial |
$5,450.90
|
| Rate for Payer: Prime Health Services Commercial |
$7,128.10
|
|
|
HC DIAGNOSTIC BRONCH
|
Facility
|
OP
|
$8,386.00
|
|
|
Service Code
|
CPT 31622
|
| Hospital Charge Code |
900501418
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$283.68 |
| Max. Negotiated Rate |
$7,547.40 |
| Rate for Payer: Adventist Health Commercial |
$1,677.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,191.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,286.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,410.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,191.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,491.15
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$4,612.30
|
| Rate for Payer: Cash Price |
$4,612.30
|
| Rate for Payer: Cash Price |
$4,612.30
|
| Rate for Payer: Central Health Plan Commercial |
$6,708.80
|
| Rate for Payer: Cigna of CA HMO |
$5,367.04
|
| Rate for Payer: Cigna of CA PPO |
$6,205.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,286.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,410.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,191.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,958.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,191.11
|
| Rate for Payer: Galaxy Health WC |
$7,128.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,031.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,547.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,593.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$283.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,191.11
|
| Rate for Payer: InnovAge PACE Commercial |
$3,286.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,593.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$313.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,191.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,677.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,936.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,936.09
|
| Rate for Payer: Multiplan Commercial |
$6,289.50
|
| Rate for Payer: Multiplan WC |
$3,491.15
|
| Rate for Payer: Networks By Design Commercial |
$5,450.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,191.11
|
| Rate for Payer: Preferred Health Network WC |
$3,562.40
|
| Rate for Payer: Prime Health Services Commercial |
$7,128.10
|
| Rate for Payer: Prime Health Services Medicare |
$2,322.58
|
| Rate for Payer: Prime Health Services WC |
$3,455.53
|
| Rate for Payer: Riverside University Health System MISP |
$2,410.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,031.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,191.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,286.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,410.22
|
| Rate for Payer: Vantage Medical Group Senior |
$2,191.11
|
|
|
HC DIAGNOSTIC BRONCH
|
Facility
|
IP
|
$8,386.00
|
|
|
Service Code
|
CPT 31622
|
| Hospital Charge Code |
900501418
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,677.20 |
| Max. Negotiated Rate |
$7,547.40 |
| Rate for Payer: Adventist Health Commercial |
$1,677.20
|
| Rate for Payer: Cash Price |
$4,612.30
|
| Rate for Payer: Central Health Plan Commercial |
$6,708.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,354.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,354.40
|
| Rate for Payer: Galaxy Health WC |
$7,128.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,031.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,547.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,593.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,195.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,190.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,677.20
|
| Rate for Payer: Multiplan Commercial |
$6,289.50
|
| Rate for Payer: Networks By Design Commercial |
$5,450.90
|
| Rate for Payer: Prime Health Services Commercial |
$7,128.10
|
|
|
HC DIAGNOSTIC BRONCH
|
Facility
|
OP
|
$8,386.00
|
|
|
Service Code
|
CPT 31622
|
| Hospital Charge Code |
900501418
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.37 |
| Max. Negotiated Rate |
$7,547.40 |
| Rate for Payer: Adventist Health Commercial |
$1,677.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,286.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,410.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,191.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,491.15
|
| Rate for Payer: Cash Price |
$4,612.30
|
| Rate for Payer: Cash Price |
$4,612.30
|
| Rate for Payer: Cash Price |
$4,612.30
|
| Rate for Payer: Cash Price |
$4,612.30
|
| Rate for Payer: Central Health Plan Commercial |
$6,708.80
|
| Rate for Payer: Cigna of CA HMO |
$5,367.04
|
| Rate for Payer: Cigna of CA PPO |
$6,205.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,286.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,410.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,191.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,958.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,191.11
|
| Rate for Payer: Galaxy Health WC |
$7,128.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,031.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,547.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,593.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,191.11
|
| Rate for Payer: InnovAge PACE Commercial |
$3,286.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,593.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$313.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,191.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,677.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,936.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,936.09
|
| Rate for Payer: Multiplan Commercial |
$6,289.50
|
| Rate for Payer: Multiplan WC |
$3,491.15
|
| Rate for Payer: Networks By Design Commercial |
$5,450.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,191.11
|
| Rate for Payer: Preferred Health Network WC |
$3,562.40
|
| Rate for Payer: Prime Health Services Commercial |
$7,128.10
|
| Rate for Payer: Prime Health Services Medicare |
$2,322.58
|
| Rate for Payer: Prime Health Services WC |
$3,455.53
|
| Rate for Payer: Riverside University Health System MISP |
$2,410.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,031.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,193.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,193.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,193.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,193.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,191.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,286.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,410.22
|
| Rate for Payer: Vantage Medical Group Senior |
$2,191.11
|
|
|
HC DIAGNOSTIC BRONCH W BIOPSY
|
Facility
|
IP
|
$8,074.00
|
|
|
Service Code
|
CPT 31625
|
| Hospital Charge Code |
900803503
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,614.80 |
| Max. Negotiated Rate |
$7,266.60 |
| Rate for Payer: Adventist Health Commercial |
$1,614.80
|
| Rate for Payer: Cash Price |
$4,440.70
|
| Rate for Payer: Central Health Plan Commercial |
$6,459.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,229.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,229.60
|
| Rate for Payer: Galaxy Health WC |
$6,862.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,844.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,266.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,385.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,076.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,997.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,614.80
|
| Rate for Payer: Multiplan Commercial |
$6,055.50
|
| Rate for Payer: Networks By Design Commercial |
$5,248.10
|
| Rate for Payer: Prime Health Services Commercial |
$6,862.90
|
|
|
HC DIAGNOSTIC BRONCH W BIOPSY
|
Facility
|
OP
|
$8,074.00
|
|
|
Service Code
|
CPT 31625
|
| Hospital Charge Code |
900803503
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$346.43 |
| Max. Negotiated Rate |
$7,266.60 |
| Rate for Payer: Adventist Health Commercial |
$1,614.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,191.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,286.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,410.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,191.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,933.21
|
| Rate for Payer: Blue Shield of California EPN |
$3,221.53
|
| Rate for Payer: Cash Price |
$4,440.70
|
| Rate for Payer: Cash Price |
$4,440.70
|
| Rate for Payer: Cash Price |
$4,440.70
|
| Rate for Payer: Central Health Plan Commercial |
$6,459.20
|
| Rate for Payer: Cigna of CA HMO |
$5,167.36
|
| Rate for Payer: Cigna of CA PPO |
$5,974.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,286.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,410.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,191.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,958.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,191.11
|
| Rate for Payer: Galaxy Health WC |
$6,862.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,844.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,266.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,593.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$346.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,191.11
|
| Rate for Payer: InnovAge PACE Commercial |
$3,286.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,385.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$382.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,191.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,614.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,936.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,936.09
|
| Rate for Payer: Multiplan Commercial |
$6,055.50
|
| Rate for Payer: Networks By Design Commercial |
$5,248.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,191.11
|
| Rate for Payer: Prime Health Services Commercial |
$6,862.90
|
| Rate for Payer: Prime Health Services Medicare |
$2,322.58
|
| Rate for Payer: Riverside University Health System MISP |
$2,410.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,844.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,844.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,037.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,037.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,037.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,037.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,191.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,286.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,410.22
|
| Rate for Payer: Vantage Medical Group Senior |
$2,191.11
|
|
|
HC DIAGNOSTIC BRONCH W/BRUSHING
|
Facility
|
IP
|
$6,376.00
|
|
|
Service Code
|
CPT 31623
|
| Hospital Charge Code |
900803501
|
|
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 |
$3,506.80
|
| Rate for Payer: Central Health Plan Commercial |
$5,100.80
|
| 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 Permanente of CA Commercial/Self Funded |
$4,252.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,429.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,946.74
|
| 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 DIAGNOSTIC BRONCH W/BRUSHING
|
Facility
|
OP
|
$6,376.00
|
|
|
Service Code
|
CPT 31623
|
| Hospital Charge Code |
900803501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$363.73 |
| Max. Negotiated Rate |
$7,378.00 |
| Rate for Payer: Adventist Health Commercial |
$1,275.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,191.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,286.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,410.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,191.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,491.15
|
| Rate for Payer: Blue Shield of California Commercial |
$4,245.30
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$3,506.80
|
| Rate for Payer: Cash Price |
$3,506.80
|
| Rate for Payer: Cash Price |
$3,506.80
|
| 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 |
$3,286.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,410.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,191.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,958.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,191.11
|
| 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 |
$3,593.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$363.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,191.11
|
| Rate for Payer: InnovAge PACE Commercial |
$3,286.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,252.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$401.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,191.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,275.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,936.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,936.09
|
| Rate for Payer: Multiplan Commercial |
$4,782.00
|
| Rate for Payer: Multiplan WC |
$3,491.15
|
| Rate for Payer: Networks By Design Commercial |
$4,144.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,191.11
|
| Rate for Payer: Preferred Health Network WC |
$3,562.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,419.60
|
| Rate for Payer: Prime Health Services Medicare |
$2,322.58
|
| Rate for Payer: Prime Health Services WC |
$3,455.53
|
| Rate for Payer: Riverside University Health System MISP |
$2,410.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,825.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,191.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,286.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,410.22
|
| Rate for Payer: Vantage Medical Group Senior |
$2,191.11
|
|
|
HC DIAGNOSTIC LARYNGOSCOPY
|
Facility
|
IP
|
$13,857.00
|
|
|
Service Code
|
CPT 31525
|
| Hospital Charge Code |
900803512
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$2,771.40 |
| Max. Negotiated Rate |
$12,471.30 |
| Rate for Payer: Adventist Health Commercial |
$2,771.40
|
| Rate for Payer: Cash Price |
$7,621.35
|
| Rate for Payer: Central Health Plan Commercial |
$11,085.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,542.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5,542.80
|
| Rate for Payer: Galaxy Health WC |
$11,778.45
|
| Rate for Payer: Global Benefits Group Commercial |
$8,314.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,471.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,242.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,279.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,577.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,771.40
|
| Rate for Payer: Multiplan Commercial |
$10,392.75
|
| Rate for Payer: Networks By Design Commercial |
$9,007.05
|
| Rate for Payer: Prime Health Services Commercial |
$11,778.45
|
|
|
HC DIAGNOSTIC LARYNGOSCOPY
|
Facility
|
OP
|
$13,857.00
|
|
|
Service Code
|
CPT 31525
|
| Hospital Charge Code |
900803512
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$268.00 |
| Max. Negotiated Rate |
$12,471.30 |
| Rate for Payer: Adventist Health Commercial |
$2,771.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,191.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,286.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,410.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,191.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$7,621.35
|
| Rate for Payer: Cash Price |
$7,621.35
|
| Rate for Payer: Cash Price |
$7,621.35
|
| Rate for Payer: Cash Price |
$7,621.35
|
| Rate for Payer: Central Health Plan Commercial |
$11,085.60
|
| Rate for Payer: Cigna of CA HMO |
$8,868.48
|
| Rate for Payer: Cigna of CA PPO |
$10,254.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,286.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,410.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,191.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,958.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,191.11
|
| Rate for Payer: Galaxy Health WC |
$11,778.45
|
| Rate for Payer: Global Benefits Group Commercial |
$8,314.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,471.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,593.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$290.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,191.11
|
| Rate for Payer: InnovAge PACE Commercial |
$3,286.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,242.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,191.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,771.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,936.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,936.09
|
| Rate for Payer: Multiplan Commercial |
$10,392.75
|
| Rate for Payer: Networks By Design Commercial |
$9,007.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,191.11
|
| Rate for Payer: Prime Health Services Commercial |
$11,778.45
|
| Rate for Payer: Prime Health Services Medicare |
$2,322.58
|
| Rate for Payer: Riverside University Health System MISP |
$2,410.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,314.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,314.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,191.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,286.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,410.22
|
| Rate for Payer: Vantage Medical Group Senior |
$2,191.11
|
|
|
HC DIAGNOSTIC LARYNGOSCOPY
|
Facility
|
OP
|
$13,857.00
|
|
|
Service Code
|
CPT 31525
|
| Hospital Charge Code |
900803512
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$320.44 |
| Max. Negotiated Rate |
$12,471.30 |
| Rate for Payer: Adventist Health Commercial |
$2,771.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,286.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,410.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,191.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,491.15
|
| Rate for Payer: Cash Price |
$7,621.35
|
| Rate for Payer: Cash Price |
$7,621.35
|
| Rate for Payer: Cash Price |
$7,621.35
|
| Rate for Payer: Cash Price |
$7,621.35
|
| Rate for Payer: Central Health Plan Commercial |
$11,085.60
|
| Rate for Payer: Cigna of CA HMO |
$8,868.48
|
| Rate for Payer: Cigna of CA PPO |
$10,254.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,286.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,410.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,191.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,958.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,191.11
|
| Rate for Payer: Galaxy Health WC |
$11,778.45
|
| Rate for Payer: Global Benefits Group Commercial |
$8,314.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,471.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,593.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,191.11
|
| Rate for Payer: InnovAge PACE Commercial |
$3,286.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,242.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,191.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,771.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,936.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,936.09
|
| Rate for Payer: Multiplan Commercial |
$10,392.75
|
| Rate for Payer: Multiplan WC |
$3,491.15
|
| Rate for Payer: Networks By Design Commercial |
$9,007.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,191.11
|
| Rate for Payer: Preferred Health Network WC |
$3,562.40
|
| Rate for Payer: Prime Health Services Commercial |
$11,778.45
|
| Rate for Payer: Prime Health Services Medicare |
$2,322.58
|
| Rate for Payer: Prime Health Services WC |
$3,455.53
|
| Rate for Payer: Riverside University Health System MISP |
$2,410.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,314.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,928.50
|
| Rate for Payer: United Healthcare All Other HMO |
$6,928.50
|
| Rate for Payer: United Healthcare HMO Rider |
$6,928.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,928.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,191.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,286.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,410.22
|
| Rate for Payer: Vantage Medical Group Senior |
$2,191.11
|
|
|
HC DIAGNOSTIC LARYNGOSCOPY
|
Facility
|
IP
|
$13,857.00
|
|
|
Service Code
|
CPT 31525
|
| Hospital Charge Code |
900803512
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,771.40 |
| Max. Negotiated Rate |
$12,471.30 |
| Rate for Payer: Adventist Health Commercial |
$2,771.40
|
| Rate for Payer: Cash Price |
$7,621.35
|
| Rate for Payer: Central Health Plan Commercial |
$11,085.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,542.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5,542.80
|
| Rate for Payer: Galaxy Health WC |
$11,778.45
|
| Rate for Payer: Global Benefits Group Commercial |
$8,314.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,471.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,242.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,279.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,577.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,771.40
|
| Rate for Payer: Multiplan Commercial |
$10,392.75
|
| Rate for Payer: Networks By Design Commercial |
$9,007.05
|
| Rate for Payer: Prime Health Services Commercial |
$11,778.45
|
|
