|
HC NASAL BONES
|
Facility
|
OP
|
$971.00
|
|
|
Service Code
|
CPT 70160
|
| Hospital Charge Code |
909001104
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$47.10 |
| Max. Negotiated Rate |
$825.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$156.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.24
|
| Rate for Payer: Blue Distinction Transplant |
$582.60
|
| Rate for Payer: Blue Shield of California Commercial |
$573.86
|
| Rate for Payer: Blue Shield of California EPN |
$455.40
|
| Rate for Payer: Cash Price |
$436.95
|
| Rate for Payer: Cash Price |
$436.95
|
| Rate for Payer: Cigna of CA HMO |
$621.44
|
| Rate for Payer: Cigna of CA PPO |
$718.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$825.35
|
| Rate for Payer: Global Benefits Group Commercial |
$582.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$728.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$186.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$186.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$183.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$183.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$647.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$776.80
|
| Rate for Payer: Networks By Design Commercial |
$631.15
|
| Rate for Payer: Prime Health Services Commercial |
$825.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$582.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$582.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC NASAL BONES
|
Facility
|
IP
|
$971.00
|
|
|
Service Code
|
CPT 70160
|
| Hospital Charge Code |
909001104
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$233.04 |
| Max. Negotiated Rate |
$825.35 |
| Rate for Payer: Cash Price |
$436.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$388.40
|
| Rate for Payer: Galaxy Health WC |
$825.35
|
| Rate for Payer: Global Benefits Group Commercial |
$582.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$647.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$369.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.04
|
| Rate for Payer: Multiplan Commercial |
$776.80
|
| Rate for Payer: Networks By Design Commercial |
$631.15
|
| Rate for Payer: Prime Health Services Commercial |
$825.35
|
|
|
HC NASAL ENDOSCOPY DIAGNOSTIC
|
Facility
|
OP
|
$763.00
|
|
|
Service Code
|
CPT 31231
|
| Hospital Charge Code |
900501401
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$93.37 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$371.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$272.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$247.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$457.80
|
| Rate for Payer: Cash Price |
$343.35
|
| Rate for Payer: Cash Price |
$343.35
|
| Rate for Payer: Cash Price |
$343.35
|
| Rate for Payer: Cigna of CA PPO |
$564.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$371.24
|
| Rate for Payer: Dignity Health Media |
$247.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$272.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$334.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$247.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$247.49
|
| Rate for Payer: Galaxy Health WC |
$648.55
|
| Rate for Payer: Global Benefits Group Commercial |
$457.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$572.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$405.88
|
| Rate for Payer: Heritage Provider Network Transplant |
$405.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$247.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$508.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$247.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$311.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$331.64
|
| Rate for Payer: Multiplan Commercial |
$610.40
|
| Rate for Payer: Networks By Design Commercial |
$495.95
|
| Rate for Payer: Prime Health Services Commercial |
$648.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$457.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$381.50
|
| Rate for Payer: United Healthcare All Other HMO |
$381.50
|
| Rate for Payer: United Healthcare HMO Rider |
$381.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$381.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$371.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$272.24
|
| Rate for Payer: Vantage Medical Group Senior |
$247.49
|
|
|
HC NASAL ENDOSCOPY DIAGNOSTIC
|
Facility
|
IP
|
$763.00
|
|
|
Service Code
|
CPT 31231
|
| Hospital Charge Code |
900501401
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$183.12 |
| Max. Negotiated Rate |
$648.55 |
| Rate for Payer: Cash Price |
$343.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.20
|
| Rate for Payer: Galaxy Health WC |
$648.55
|
| Rate for Payer: Global Benefits Group Commercial |
$457.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$508.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$290.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.12
|
| Rate for Payer: Multiplan Commercial |
$610.40
|
| Rate for Payer: Networks By Design Commercial |
$495.95
|
| Rate for Payer: Prime Health Services Commercial |
$648.55
|
|
|
HC NASAL ENDOSCOPY W/CONT HEMORRH
|
Facility
|
IP
|
$7,432.00
|
|
|
Service Code
|
CPT 31238
|
| Hospital Charge Code |
900501753
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,783.68 |
| Max. Negotiated Rate |
$6,317.20 |
| Rate for Payer: Cash Price |
$3,344.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,972.80
|
| Rate for Payer: Galaxy Health WC |
$6,317.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,459.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,957.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,831.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,783.68
|
| Rate for Payer: Multiplan Commercial |
$5,945.60
|
| Rate for Payer: Networks By Design Commercial |
$4,830.80
|
| Rate for Payer: Prime Health Services Commercial |
$6,317.20
|
|
|
HC NASAL ENDOSCOPY W/CONT HEMORRH
|
Facility
|
OP
|
$7,432.00
|
|
|
Service Code
|
CPT 31238
|
| Hospital Charge Code |
900501753
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$331.06 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,332.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,120.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,459.20
|
| Rate for Payer: Cash Price |
$3,344.40
|
| Rate for Payer: Cash Price |
$3,344.40
|
| Rate for Payer: Cash Price |
$3,344.40
|
| Rate for Payer: Cigna of CA PPO |
$5,499.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Dignity Health Media |
$2,120.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,332.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,862.84
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,120.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,120.62
|
| Rate for Payer: Galaxy Health WC |
$6,317.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,459.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,574.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,477.82
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,477.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,120.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,957.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$331.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,120.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,783.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,671.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,841.63
|
| Rate for Payer: Multiplan Commercial |
$5,945.60
|
| Rate for Payer: Networks By Design Commercial |
$4,830.80
|
| Rate for Payer: Prime Health Services Commercial |
$6,317.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,459.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,716.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,716.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,716.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,716.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,332.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2,120.62
|
|
|
HC NASAL I&D OF ABSCESS
|
Facility
|
IP
|
$1,408.00
|
|
|
Service Code
|
CPT 30000
|
| Hospital Charge Code |
902890339
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$337.92 |
| Max. Negotiated Rate |
$1,196.80 |
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$563.20
|
| Rate for Payer: Galaxy Health WC |
$1,196.80
|
| Rate for Payer: Global Benefits Group Commercial |
$844.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$939.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$536.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$337.92
|
| Rate for Payer: Multiplan Commercial |
$1,126.40
|
| Rate for Payer: Networks By Design Commercial |
$915.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,196.80
|
|
|
HC NASAL I&D OF ABSCESS
|
Facility
|
OP
|
$1,408.00
|
|
|
Service Code
|
CPT 30000
|
| Hospital Charge Code |
902890339
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$118.12 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$305.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$844.80
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cigna of CA PPO |
$1,041.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.78
|
| Rate for Payer: Dignity Health Media |
$305.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.01
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$305.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$305.19
|
| Rate for Payer: Galaxy Health WC |
$1,196.80
|
| Rate for Payer: Global Benefits Group Commercial |
$844.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,056.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$500.51
|
| Rate for Payer: Heritage Provider Network Transplant |
$500.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$305.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$939.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$305.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$337.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.95
|
| Rate for Payer: Multiplan Commercial |
$1,126.40
|
| Rate for Payer: Networks By Design Commercial |
$915.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,196.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$844.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$704.00
|
| Rate for Payer: United Healthcare All Other HMO |
$704.00
|
| Rate for Payer: United Healthcare HMO Rider |
$704.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$704.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Vantage Medical Group Senior |
$305.19
|
|
|
HC NASO/ORGSTRC TUBE PLCM FS GDNC
|
Facility
|
IP
|
$613.00
|
|
|
Service Code
|
CPT 43752
|
| Hospital Charge Code |
906743752
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$147.12 |
| Max. Negotiated Rate |
$521.05 |
| Rate for Payer: Cash Price |
$275.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$245.20
|
| Rate for Payer: Galaxy Health WC |
$521.05
|
| Rate for Payer: Global Benefits Group Commercial |
$367.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$408.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$233.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.12
|
| Rate for Payer: Multiplan Commercial |
$490.40
|
| Rate for Payer: Networks By Design Commercial |
$398.45
|
| Rate for Payer: Prime Health Services Commercial |
$521.05
|
|
|
HC NASO/ORGSTRC TUBE PLCM FS GDNC
|
Facility
|
OP
|
$613.00
|
|
|
Service Code
|
CPT 43752
|
| Hospital Charge Code |
906743752
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$147.12 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$746.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$547.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$497.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$367.80
|
| Rate for Payer: Cash Price |
$275.85
|
| Rate for Payer: Cash Price |
$275.85
|
| Rate for Payer: Cash Price |
$275.85
|
| Rate for Payer: Cigna of CA PPO |
$453.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$746.73
|
| Rate for Payer: Dignity Health Media |
$497.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$547.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.06
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$497.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$497.82
|
| Rate for Payer: Galaxy Health WC |
$521.05
|
| Rate for Payer: Global Benefits Group Commercial |
$367.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$459.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$816.42
|
| Rate for Payer: Heritage Provider Network Transplant |
$816.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$497.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$408.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$246.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$497.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.08
|
| Rate for Payer: Multiplan Commercial |
$490.40
|
| Rate for Payer: Networks By Design Commercial |
$398.45
|
| Rate for Payer: Prime Health Services Commercial |
$521.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$367.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$306.50
|
| Rate for Payer: United Healthcare All Other HMO |
$306.50
|
| Rate for Payer: United Healthcare HMO Rider |
$306.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$306.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$746.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$547.60
|
| Rate for Payer: Vantage Medical Group Senior |
$497.82
|
|
|
HC NASO/ORGSTRC TUBE PLCM FS GDNC
|
Facility
|
IP
|
$613.00
|
|
|
Service Code
|
CPT 43752
|
| Hospital Charge Code |
906743752
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$147.12 |
| Max. Negotiated Rate |
$521.05 |
| Rate for Payer: Cash Price |
$275.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$245.20
|
| Rate for Payer: Galaxy Health WC |
$521.05
|
| Rate for Payer: Global Benefits Group Commercial |
$367.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$408.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$233.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.12
|
| Rate for Payer: Multiplan Commercial |
$490.40
|
| Rate for Payer: Networks By Design Commercial |
$398.45
|
| Rate for Payer: Prime Health Services Commercial |
$521.05
|
|
|
HC NASO/ORGSTRC TUBE PLCM FS GDNC
|
Facility
|
OP
|
$613.00
|
|
|
Service Code
|
CPT 43752
|
| Hospital Charge Code |
906743752
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$147.12 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$746.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$547.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$497.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$367.80
|
| Rate for Payer: Blue Shield of California Commercial |
$833.61
|
| Rate for Payer: Blue Shield of California EPN |
$542.56
|
| Rate for Payer: Cash Price |
$275.85
|
| Rate for Payer: Cash Price |
$275.85
|
| Rate for Payer: Cigna of CA PPO |
$453.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$746.73
|
| Rate for Payer: Dignity Health Media |
$497.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$547.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.06
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$497.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$497.82
|
| Rate for Payer: Galaxy Health WC |
$521.05
|
| Rate for Payer: Global Benefits Group Commercial |
$367.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$459.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$816.42
|
| Rate for Payer: Heritage Provider Network Transplant |
$816.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$806.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$806.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$497.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$408.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$246.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$497.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.08
|
| Rate for Payer: Multiplan Commercial |
$490.40
|
| Rate for Payer: Networks By Design Commercial |
$398.45
|
| Rate for Payer: Prime Health Services Commercial |
$521.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$367.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$597.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$746.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$547.60
|
| Rate for Payer: Vantage Medical Group Senior |
$497.82
|
|
|
HC NASO/OROGASTRIC TUBE PLACEMENT
|
Facility
|
OP
|
$795.00
|
|
|
Service Code
|
CPT 43753
|
| Hospital Charge Code |
900501188
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$32.85 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$477.00
|
| Rate for Payer: Blue Shield of California Commercial |
$585.92
|
| Rate for Payer: Blue Shield of California EPN |
$464.28
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cigna of CA HMO |
$508.80
|
| Rate for Payer: Cigna of CA PPO |
$588.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Media |
$392.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$392.17
|
| Rate for Payer: Galaxy Health WC |
$675.75
|
| Rate for Payer: Global Benefits Group Commercial |
$477.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$596.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$643.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$643.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$635.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$635.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$392.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$494.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.51
|
| Rate for Payer: Multiplan Commercial |
$636.00
|
| Rate for Payer: Networks By Design Commercial |
$516.75
|
| Rate for Payer: Prime Health Services Commercial |
$675.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$477.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$477.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$397.50
|
| Rate for Payer: United Healthcare All Other HMO |
$397.50
|
| Rate for Payer: United Healthcare HMO Rider |
$397.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$397.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC NASO/OROGASTRIC TUBE PLACEMENT
|
Facility
|
OP
|
$795.00
|
|
|
Service Code
|
CPT 43753
|
| Hospital Charge Code |
900501188
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$32.85 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$477.00
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cigna of CA PPO |
$588.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Media |
$392.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$392.17
|
| Rate for Payer: Galaxy Health WC |
$675.75
|
| Rate for Payer: Global Benefits Group Commercial |
$477.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$596.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$643.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$643.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$392.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$494.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.51
|
| Rate for Payer: Multiplan Commercial |
$636.00
|
| Rate for Payer: Networks By Design Commercial |
$516.75
|
| Rate for Payer: Prime Health Services Commercial |
$675.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$477.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$397.50
|
| Rate for Payer: United Healthcare All Other HMO |
$397.50
|
| Rate for Payer: United Healthcare HMO Rider |
$397.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$397.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC NASO/OROGASTRIC TUBE PLACEMENT
|
Facility
|
IP
|
$795.00
|
|
|
Service Code
|
CPT 43753
|
| Hospital Charge Code |
900501188
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$190.80 |
| Max. Negotiated Rate |
$675.75 |
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.00
|
| Rate for Payer: Galaxy Health WC |
$675.75
|
| Rate for Payer: Global Benefits Group Commercial |
$477.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$302.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.80
|
| Rate for Payer: Multiplan Commercial |
$636.00
|
| Rate for Payer: Networks By Design Commercial |
$516.75
|
| Rate for Payer: Prime Health Services Commercial |
$675.75
|
|
|
HC NASO/OROGASTRIC TUBE PLACEMENT
|
Facility
|
IP
|
$795.00
|
|
|
Service Code
|
CPT 43753
|
| Hospital Charge Code |
900501188
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$190.80 |
| Max. Negotiated Rate |
$675.75 |
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.00
|
| Rate for Payer: Galaxy Health WC |
$675.75
|
| Rate for Payer: Global Benefits Group Commercial |
$477.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$302.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.80
|
| Rate for Payer: Multiplan Commercial |
$636.00
|
| Rate for Payer: Networks By Design Commercial |
$516.75
|
| Rate for Payer: Prime Health Services Commercial |
$675.75
|
|
|
HC NASOPHARYNGOGRAM
|
Facility
|
OP
|
$934.00
|
|
|
Service Code
|
CPT 70370
|
| Hospital Charge Code |
909001253
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$72.37 |
| Max. Negotiated Rate |
$793.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$418.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$340.10
|
| Rate for Payer: Blue Distinction Transplant |
$560.40
|
| Rate for Payer: Blue Shield of California Commercial |
$551.99
|
| Rate for Payer: Blue Shield of California EPN |
$438.05
|
| Rate for Payer: Cash Price |
$420.30
|
| Rate for Payer: Cash Price |
$420.30
|
| Rate for Payer: Cigna of CA HMO |
$597.76
|
| Rate for Payer: Cigna of CA PPO |
$691.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$793.90
|
| Rate for Payer: Global Benefits Group Commercial |
$560.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$700.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$186.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$186.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$183.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$183.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$622.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$224.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$747.20
|
| Rate for Payer: Networks By Design Commercial |
$607.10
|
| Rate for Payer: Prime Health Services Commercial |
$793.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$560.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$560.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$225.63
|
| Rate for Payer: United Healthcare All Other HMO |
$225.63
|
| Rate for Payer: United Healthcare HMO Rider |
$225.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$225.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC NASOPHARYNGOGRAM
|
Facility
|
IP
|
$934.00
|
|
|
Service Code
|
CPT 70370
|
| Hospital Charge Code |
909001253
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$224.16 |
| Max. Negotiated Rate |
$793.90 |
| Rate for Payer: Cash Price |
$420.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$373.60
|
| Rate for Payer: Galaxy Health WC |
$793.90
|
| Rate for Payer: Global Benefits Group Commercial |
$560.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$622.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$355.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$224.16
|
| Rate for Payer: Multiplan Commercial |
$747.20
|
| Rate for Payer: Networks By Design Commercial |
$607.10
|
| Rate for Payer: Prime Health Services Commercial |
$793.90
|
|
|
HC NASOPHARYNGOSCOPY W/ENDOSCOPE
|
Facility
|
IP
|
$886.00
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
905601701
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$212.64 |
| Max. Negotiated Rate |
$753.10 |
| Rate for Payer: Cash Price |
$398.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$354.40
|
| Rate for Payer: Galaxy Health WC |
$753.10
|
| Rate for Payer: Global Benefits Group Commercial |
$531.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$590.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$337.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$212.64
|
| Rate for Payer: Multiplan Commercial |
$708.80
|
| Rate for Payer: Networks By Design Commercial |
$575.90
|
| Rate for Payer: Prime Health Services Commercial |
$753.10
|
|
|
HC NASOPHARYNGOSCOPY W/ENDOSCOPE
|
Facility
|
OP
|
$886.00
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
905601701
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$79.40 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$371.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$272.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$247.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$531.60
|
| Rate for Payer: Cash Price |
$398.70
|
| Rate for Payer: Cash Price |
$398.70
|
| Rate for Payer: Cash Price |
$398.70
|
| Rate for Payer: Cigna of CA PPO |
$655.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$371.24
|
| Rate for Payer: Dignity Health Media |
$247.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$272.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$334.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$247.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$247.49
|
| Rate for Payer: Galaxy Health WC |
$753.10
|
| Rate for Payer: Global Benefits Group Commercial |
$531.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$664.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$405.88
|
| Rate for Payer: Heritage Provider Network Transplant |
$405.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$247.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$590.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$247.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$212.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$311.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$331.64
|
| Rate for Payer: Multiplan Commercial |
$708.80
|
| Rate for Payer: Networks By Design Commercial |
$575.90
|
| Rate for Payer: Prime Health Services Commercial |
$753.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$531.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$443.00
|
| Rate for Payer: United Healthcare All Other HMO |
$443.00
|
| Rate for Payer: United Healthcare HMO Rider |
$443.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$443.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$371.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$272.24
|
| Rate for Payer: Vantage Medical Group Senior |
$247.49
|
|
|
HC NASOPHARYNGOSCOPY W ENDOSCOPE MCAL
|
Facility
|
IP
|
$886.00
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
907000031
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$212.64 |
| Max. Negotiated Rate |
$753.10 |
| Rate for Payer: Cash Price |
$398.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$354.40
|
| Rate for Payer: Galaxy Health WC |
$753.10
|
| Rate for Payer: Global Benefits Group Commercial |
$531.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$590.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$337.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$212.64
|
| Rate for Payer: Multiplan Commercial |
$708.80
|
| Rate for Payer: Networks By Design Commercial |
$575.90
|
| Rate for Payer: Prime Health Services Commercial |
$753.10
|
|
|
HC NASOPHARYNGOSCOPY W ENDOSCOPE MCAL
|
Facility
|
OP
|
$886.00
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
907000031
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$79.40 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$371.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$272.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$247.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$531.60
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$398.70
|
| Rate for Payer: Cash Price |
$398.70
|
| Rate for Payer: Cash Price |
$398.70
|
| Rate for Payer: Cigna of CA HMO |
$567.04
|
| Rate for Payer: Cigna of CA PPO |
$655.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$371.24
|
| Rate for Payer: Dignity Health Media |
$247.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$272.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$334.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$247.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$247.49
|
| Rate for Payer: Galaxy Health WC |
$753.10
|
| Rate for Payer: Global Benefits Group Commercial |
$531.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$664.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$405.88
|
| Rate for Payer: Heritage Provider Network Transplant |
$405.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$400.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$400.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$247.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$590.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$247.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$212.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$311.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$331.64
|
| Rate for Payer: Multiplan Commercial |
$708.80
|
| Rate for Payer: Networks By Design Commercial |
$575.90
|
| Rate for Payer: Prime Health Services Commercial |
$753.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$531.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$296.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$371.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$272.24
|
| Rate for Payer: Vantage Medical Group Senior |
$247.49
|
|
|
HC NASOTRACHEAL SUCTIONING
|
Facility
|
IP
|
$365.00
|
|
|
Service Code
|
CPT 31720
|
| Hospital Charge Code |
900800380
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$87.60 |
| Max. Negotiated Rate |
$310.25 |
| Rate for Payer: Cash Price |
$164.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.00
|
| Rate for Payer: Galaxy Health WC |
$310.25
|
| Rate for Payer: Global Benefits Group Commercial |
$219.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$243.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.60
|
| Rate for Payer: Multiplan Commercial |
$292.00
|
| Rate for Payer: Networks By Design Commercial |
$237.25
|
| Rate for Payer: Prime Health Services Commercial |
$310.25
|
|
|
HC NASOTRACHEAL SUCTIONING
|
Facility
|
OP
|
$365.00
|
|
|
Service Code
|
CPT 31720
|
| Hospital Charge Code |
900800380
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$87.60 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$399.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$293.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$266.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$219.00
|
| Rate for Payer: Blue Shield of California Commercial |
$269.00
|
| Rate for Payer: Blue Shield of California EPN |
$213.16
|
| Rate for Payer: Cash Price |
$164.25
|
| Rate for Payer: Cash Price |
$164.25
|
| Rate for Payer: Cigna of CA HMO |
$233.60
|
| Rate for Payer: Cigna of CA PPO |
$270.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$399.74
|
| Rate for Payer: Dignity Health Media |
$266.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$293.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$359.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$266.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$266.49
|
| Rate for Payer: Galaxy Health WC |
$310.25
|
| Rate for Payer: Global Benefits Group Commercial |
$219.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$273.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$437.04
|
| Rate for Payer: Heritage Provider Network Transplant |
$437.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$431.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$431.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$266.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$243.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$266.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$335.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$357.10
|
| Rate for Payer: Multiplan Commercial |
$292.00
|
| Rate for Payer: Networks By Design Commercial |
$237.25
|
| Rate for Payer: Prime Health Services Commercial |
$310.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$219.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$219.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$182.50
|
| Rate for Payer: United Healthcare All Other HMO |
$182.50
|
| Rate for Payer: United Healthcare HMO Rider |
$182.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$182.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$399.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$293.14
|
| Rate for Payer: Vantage Medical Group Senior |
$266.49
|
|
|
HC NASOTRACHEAL SUCTIONING
|
Facility
|
IP
|
$365.00
|
|
|
Service Code
|
CPT 31720
|
| Hospital Charge Code |
900800380
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$87.60 |
| Max. Negotiated Rate |
$310.25 |
| Rate for Payer: Cash Price |
$164.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.00
|
| Rate for Payer: Galaxy Health WC |
$310.25
|
| Rate for Payer: Global Benefits Group Commercial |
$219.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$243.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.60
|
| Rate for Payer: Multiplan Commercial |
$292.00
|
| Rate for Payer: Networks By Design Commercial |
$237.25
|
| Rate for Payer: Prime Health Services Commercial |
$310.25
|
|
