|
HC DIAG GASTRO INTUB W ASP SPECS
|
Facility
|
IP
|
$612.00
|
|
|
Service Code
|
CPT 43755
|
| Hospital Charge Code |
906743755
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$110.77 |
| Max. Negotiated Rate |
$459.00 |
| Rate for Payer: Adventist Health Commercial |
$122.40
|
| Rate for Payer: Cash Price |
$336.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$414.32
|
| Rate for Payer: Heritage Provider Network Senior |
$414.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.00
|
| Rate for Payer: Multiplan Commercial |
$459.00
|
|
|
HC DIAG GASTRO INTUB W ASP SPECS
|
Facility
|
OP
|
$612.00
|
|
|
Service Code
|
CPT 43755
|
| Hospital Charge Code |
906743755
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$122.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$420.44
|
| 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 HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$336.60
|
| Rate for Payer: Cash Price |
$336.60
|
| Rate for Payer: Cash Price |
$336.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$397.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Senior |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$198.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$378.83
|
| Rate for Payer: Heritage Provider Network Senior |
$244.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$80.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$291.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$228.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$250.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$250.49
|
| Rate for Payer: Multiplan Commercial |
$459.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| 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
|
OP
|
$2,877.00
|
|
|
Service Code
|
CPT 31622
|
| Hospital Charge Code |
900501418
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$575.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,976.50
|
| 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 HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,582.35
|
| Rate for Payer: Cash Price |
$1,582.35
|
| Rate for Payer: Cash Price |
$1,582.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,870.05
|
| 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 Senior |
$2,191.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,191.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,780.86
|
| Rate for Payer: Heritage Provider Network Senior |
$2,695.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$267.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,191.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,163.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$520.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,519.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$719.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,760.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,760.80
|
| Rate for Payer: Multiplan Commercial |
$2,157.75
|
| Rate for Payer: Multiplan WC |
$3,491.15
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,410.22
|
| Rate for Payer: TriValley Medical Group Senior |
$2,410.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| 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
|
OP
|
$2,877.00
|
|
|
Service Code
|
CPT 31622
|
| Hospital Charge Code |
900501418
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$575.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,976.50
|
| 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 HMO/PPO |
$4,959.00
|
| Rate for Payer: Cash Price |
$1,582.35
|
| Rate for Payer: Cash Price |
$1,582.35
|
| Rate for Payer: Cash Price |
$1,582.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,870.05
|
| 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 Senior |
$2,191.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,191.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,947.73
|
| Rate for Payer: Heritage Provider Network Senior |
$1,947.73
|
| 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: Kaiser Permanente of CA Commercial |
$1,372.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$520.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,519.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$719.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,760.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,760.80
|
| Rate for Payer: Multiplan Commercial |
$2,157.75
|
| Rate for Payer: Multiplan WC |
$3,491.15
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,035.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$952.57
|
| 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
|
$2,877.00
|
|
|
Service Code
|
CPT 31622
|
| Hospital Charge Code |
900501418
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$520.74 |
| Max. Negotiated Rate |
$2,157.75 |
| Rate for Payer: Adventist Health Commercial |
$575.40
|
| Rate for Payer: Cash Price |
$1,582.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,947.73
|
| Rate for Payer: Heritage Provider Network Senior |
$1,947.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$520.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$719.25
|
| Rate for Payer: Multiplan Commercial |
$2,157.75
|
|
|
HC DIAGNOSTIC BRONCH
|
Facility
|
IP
|
$2,877.00
|
|
|
Service Code
|
CPT 31622
|
| Hospital Charge Code |
900501418
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$520.74 |
| Max. Negotiated Rate |
$2,157.75 |
| Rate for Payer: Adventist Health Commercial |
$575.40
|
| Rate for Payer: Cash Price |
$1,582.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,947.73
|
| Rate for Payer: Heritage Provider Network Senior |
$1,947.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$520.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$719.25
|
| Rate for Payer: Multiplan Commercial |
$2,157.75
|
|
|
HC DIAGNOSTIC BRONCH W BIOPSY
|
Facility
|
OP
|
$3,330.00
|
|
|
Service Code
|
CPT 31625
|
| Hospital Charge Code |
900803503
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$666.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,287.71
|
| 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 HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,031.30
|
| Rate for Payer: Blue Shield of California EPN |
$1,625.04
|
| Rate for Payer: Cash Price |
$1,831.50
|
| Rate for Payer: Cash Price |
$1,831.50
|
| Rate for Payer: Cash Price |
$1,831.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,164.50
|
| 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 Senior |
$2,191.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,191.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,061.27
|
| Rate for Payer: Heritage Provider Network Senior |
$2,061.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$326.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,191.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,588.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$602.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,519.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$832.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,760.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,760.80
|
| Rate for Payer: Multiplan Commercial |
$2,497.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,410.22
|
| Rate for Payer: TriValley Medical Group Senior |
$2,410.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,665.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,665.00
|
| 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
|
$3,330.00
|
|
|
Service Code
|
CPT 31625
|
| Hospital Charge Code |
900803503
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$602.73 |
| Max. Negotiated Rate |
$2,497.50 |
| Rate for Payer: Adventist Health Commercial |
$666.00
|
| Rate for Payer: Cash Price |
$1,831.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,254.41
|
| Rate for Payer: Heritage Provider Network Senior |
$2,254.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$602.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$832.50
|
| Rate for Payer: Multiplan Commercial |
$2,497.50
|
|
|
HC DIAGNOSTIC BRONCH W/BRUSHING
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
CPT 31623
|
| Hospital Charge Code |
900803501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$600.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,061.00
|
| 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 HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,650.00
|
| Rate for Payer: Cash Price |
$1,650.00
|
| Rate for Payer: Cash Price |
$1,650.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,950.00
|
| 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 Senior |
$2,191.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,191.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,857.00
|
| Rate for Payer: Heritage Provider Network Senior |
$2,695.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$342.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,191.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,163.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$543.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,519.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$750.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,760.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,760.80
|
| Rate for Payer: Multiplan Commercial |
$2,250.00
|
| Rate for Payer: Multiplan WC |
$3,491.15
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,410.22
|
| Rate for Payer: TriValley Medical Group Senior |
$2,410.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| 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
|
$3,000.00
|
|
|
Service Code
|
CPT 31623
|
| Hospital Charge Code |
900803501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$543.00 |
| Max. Negotiated Rate |
$2,250.00 |
| Rate for Payer: Adventist Health Commercial |
$600.00
|
| Rate for Payer: Cash Price |
$1,650.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,031.00
|
| Rate for Payer: Heritage Provider Network Senior |
$2,031.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$543.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$750.00
|
| Rate for Payer: Multiplan Commercial |
$2,250.00
|
|
|
HC DIAGNOSTIC LARYNGOSCOPY
|
Facility
|
OP
|
$6,255.00
|
|
|
Service Code
|
CPT 31525
|
| Hospital Charge Code |
900803512
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,251.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,297.19
|
| 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 HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$3,440.25
|
| Rate for Payer: Cash Price |
$3,440.25
|
| Rate for Payer: Cash Price |
$3,440.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,065.75
|
| 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 Senior |
$2,191.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,191.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,234.64
|
| Rate for Payer: Heritage Provider Network Senior |
$4,234.64
|
| 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: Kaiser Permanente of CA Commercial |
$2,983.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,132.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,519.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,563.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,760.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,760.80
|
| Rate for Payer: Multiplan Commercial |
$4,691.25
|
| Rate for Payer: Multiplan WC |
$3,491.15
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,250.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,071.03
|
| 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
|
$6,255.00
|
|
|
Service Code
|
CPT 31525
|
| Hospital Charge Code |
900803512
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,132.15 |
| Max. Negotiated Rate |
$4,691.25 |
| Rate for Payer: Adventist Health Commercial |
$1,251.00
|
| Rate for Payer: Cash Price |
$3,440.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,234.64
|
| Rate for Payer: Heritage Provider Network Senior |
$4,234.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,132.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,563.75
|
| Rate for Payer: Multiplan Commercial |
$4,691.25
|
|
|
HC DIAGNOSTIC LARYNGOSCOPY
|
Facility
|
OP
|
$6,255.00
|
|
|
Service Code
|
CPT 31525
|
| Hospital Charge Code |
900803512
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,251.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,297.19
|
| 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 HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$3,440.25
|
| Rate for Payer: Cash Price |
$3,440.25
|
| Rate for Payer: Cash Price |
$3,440.25
|
| Rate for Payer: Cash Price |
$3,440.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,065.75
|
| 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 Senior |
$2,191.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,191.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,871.84
|
| Rate for Payer: Heritage Provider Network Senior |
$3,871.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$273.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,191.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,983.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,132.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,519.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,563.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,760.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,760.80
|
| Rate for Payer: Multiplan Commercial |
$4,691.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$376.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$319.00
|
| 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
|
$6,255.00
|
|
|
Service Code
|
CPT 31525
|
| Hospital Charge Code |
900803512
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,132.15 |
| Max. Negotiated Rate |
$4,691.25 |
| Rate for Payer: Adventist Health Commercial |
$1,251.00
|
| Rate for Payer: Cash Price |
$3,440.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,234.64
|
| Rate for Payer: Heritage Provider Network Senior |
$4,234.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,132.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,563.75
|
| Rate for Payer: Multiplan Commercial |
$4,691.25
|
|
|
HC DIAGNOSTIC LARYNGOSCOPY W/MICR
|
Facility
|
IP
|
$4,417.00
|
|
|
Service Code
|
CPT 31526
|
| Hospital Charge Code |
900501508
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$799.48 |
| Max. Negotiated Rate |
$3,312.75 |
| Rate for Payer: Adventist Health Commercial |
$883.40
|
| Rate for Payer: Cash Price |
$2,429.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,990.31
|
| Rate for Payer: Heritage Provider Network Senior |
$2,990.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$799.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,104.25
|
| Rate for Payer: Multiplan Commercial |
$3,312.75
|
|
|
HC DIAGNOSTIC LARYNGOSCOPY W/MICR
|
Facility
|
OP
|
$4,417.00
|
|
|
Service Code
|
CPT 31526
|
| Hospital Charge Code |
900501508
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$883.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,034.48
|
| 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 HMO/PPO |
$4,959.00
|
| Rate for Payer: Cash Price |
$2,429.35
|
| Rate for Payer: Cash Price |
$2,429.35
|
| Rate for Payer: Cash Price |
$2,429.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,871.05
|
| 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 Senior |
$2,191.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,191.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,990.31
|
| Rate for Payer: Heritage Provider Network Senior |
$2,990.31
|
| 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: Kaiser Permanente of CA Commercial |
$2,106.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$799.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,519.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,104.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,760.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,760.80
|
| Rate for Payer: Multiplan Commercial |
$3,312.75
|
| Rate for Payer: Multiplan WC |
$3,491.15
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,589.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,462.47
|
| 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 W/MICR
|
Facility
|
IP
|
$4,417.00
|
|
|
Service Code
|
CPT 31526
|
| Hospital Charge Code |
900501508
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$799.48 |
| Max. Negotiated Rate |
$3,312.75 |
| Rate for Payer: Adventist Health Commercial |
$883.40
|
| Rate for Payer: Cash Price |
$2,429.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,990.31
|
| Rate for Payer: Heritage Provider Network Senior |
$2,990.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$799.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,104.25
|
| Rate for Payer: Multiplan Commercial |
$3,312.75
|
|
|
HC DIAGNOSTIC LARYNGOSCOPY W/MICR
|
Facility
|
OP
|
$4,417.00
|
|
|
Service Code
|
CPT 31526
|
| Hospital Charge Code |
900501508
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$883.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,034.48
|
| 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 HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,429.35
|
| Rate for Payer: Cash Price |
$2,429.35
|
| Rate for Payer: Cash Price |
$2,429.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,871.05
|
| 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 Senior |
$2,191.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,191.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,734.12
|
| Rate for Payer: Heritage Provider Network Senior |
$2,695.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$223.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,191.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,163.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$799.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,519.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,104.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,760.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,760.80
|
| Rate for Payer: Multiplan Commercial |
$3,312.75
|
| Rate for Payer: Multiplan WC |
$3,491.15
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,410.22
|
| Rate for Payer: TriValley Medical Group Senior |
$2,410.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| 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 W/MICR
|
Facility
|
OP
|
$4,417.00
|
|
|
Service Code
|
CPT 31526
|
| Hospital Charge Code |
900501508
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$883.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,034.48
|
| 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 HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,694.37
|
| Rate for Payer: Blue Shield of California EPN |
$2,155.50
|
| Rate for Payer: Cash Price |
$2,429.35
|
| Rate for Payer: Cash Price |
$2,429.35
|
| Rate for Payer: Cash Price |
$2,429.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,871.05
|
| 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 Senior |
$2,191.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,191.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,734.12
|
| Rate for Payer: Heritage Provider Network Senior |
$2,734.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$223.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,191.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,106.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$799.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,519.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,104.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,760.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,760.80
|
| Rate for Payer: Multiplan Commercial |
$3,312.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,410.22
|
| Rate for Payer: TriValley Medical Group Senior |
$2,410.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,208.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,208.50
|
| 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 W/MICR
|
Facility
|
IP
|
$4,417.00
|
|
|
Service Code
|
CPT 31526
|
| Hospital Charge Code |
900501508
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$799.48 |
| Max. Negotiated Rate |
$3,312.75 |
| Rate for Payer: Adventist Health Commercial |
$883.40
|
| Rate for Payer: Cash Price |
$2,429.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,990.31
|
| Rate for Payer: Heritage Provider Network Senior |
$2,990.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$799.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,104.25
|
| Rate for Payer: Multiplan Commercial |
$3,312.75
|
|
|
HC DIALYSIS ACCESS DOPPLER
|
Facility
|
OP
|
$1,268.00
|
|
|
Service Code
|
CPT 93990
|
| Hospital Charge Code |
906601660
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$116.23 |
| Max. Negotiated Rate |
$1,077.00 |
| Rate for Payer: Adventist Health Commercial |
$253.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$677.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$871.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Blue Shield of California Commercial |
$705.89
|
| Rate for Payer: Blue Shield of California EPN |
$567.65
|
| Rate for Payer: Cash Price |
$697.40
|
| Rate for Payer: Cash Price |
$697.40
|
| Rate for Payer: Cash Price |
$697.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$824.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Senior |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$824.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$135.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$784.89
|
| Rate for Payer: Heritage Provider Network Senior |
$784.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$116.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$604.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$229.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$317.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.25
|
| Rate for Payer: Multiplan Commercial |
$951.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$148.63
|
| Rate for Payer: TriValley Medical Group Senior |
$135.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,077.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$908.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC DIALYSIS ACCESS DOPPLER
|
Facility
|
IP
|
$1,268.00
|
|
|
Service Code
|
CPT 93990
|
| Hospital Charge Code |
906601660
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$229.51 |
| Max. Negotiated Rate |
$951.00 |
| Rate for Payer: Adventist Health Commercial |
$253.60
|
| Rate for Payer: Cash Price |
$697.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$858.44
|
| Rate for Payer: Heritage Provider Network Senior |
$858.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$229.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$317.00
|
| Rate for Payer: Multiplan Commercial |
$951.00
|
|
|
HC DIALYSIS CRCT VASC EMBO OR OCC
|
Facility
|
IP
|
$6,172.00
|
|
|
Service Code
|
CPT 36909
|
| Hospital Charge Code |
909036909
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,117.13 |
| Max. Negotiated Rate |
$4,629.00 |
| Rate for Payer: Adventist Health Commercial |
$1,234.40
|
| Rate for Payer: Cash Price |
$3,394.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,178.44
|
| Rate for Payer: Heritage Provider Network Senior |
$4,178.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,117.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,543.00
|
| Rate for Payer: Multiplan Commercial |
$4,629.00
|
|
|
HC DIALYSIS CRCT VASC EMBO OR OCC
|
Facility
|
OP
|
$6,172.00
|
|
|
Service Code
|
CPT 36909
|
| Hospital Charge Code |
909036909
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,234.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,240.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,246.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,394.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,629.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$3,394.60
|
| Rate for Payer: Cash Price |
$3,394.60
|
| Rate for Payer: Cash Price |
$3,394.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,011.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,246.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,246.20
|
| Rate for Payer: Dignity Health Senior |
$5,246.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,820.47
|
| Rate for Payer: Heritage Provider Network Senior |
$3,820.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,925.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,944.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,117.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,543.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,320.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,320.40
|
| Rate for Payer: Multiplan Commercial |
$4,629.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,246.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,246.20
|
| Rate for Payer: Vantage Medical Group Senior |
$5,246.20
|
|
|
HC DIALYSIS PERITONEAL/CCPD
|
Facility
|
OP
|
$1,259.00
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
944000100
|
|
Hospital Revenue Code
|
804
|
| Min. Negotiated Rate |
$116.90 |
| Max. Negotiated Rate |
$944.25 |
| Rate for Payer: Adventist Health Commercial |
$251.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$672.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$864.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$811.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$595.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$541.05
|
| Rate for Payer: Blue Shield of California Commercial |
$767.99
|
| Rate for Payer: Blue Shield of California EPN |
$614.39
|
| Rate for Payer: Cash Price |
$692.45
|
| Rate for Payer: Cash Price |
$692.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$818.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$811.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$595.15
|
| Rate for Payer: Dignity Health Senior |
$541.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$805.76
|
| Rate for Payer: EPIC Health Plan Medicare |
$541.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$779.32
|
| Rate for Payer: Heritage Provider Network Senior |
$779.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$116.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$541.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$600.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$227.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$622.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$314.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$681.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$681.72
|
| Rate for Payer: Multiplan Commercial |
$944.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$595.15
|
| Rate for Payer: TriValley Medical Group Senior |
$541.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$629.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$629.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$811.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$595.15
|
| Rate for Payer: Vantage Medical Group Senior |
$541.05
|
|
