|
HC NARROW ML PREFAB KAFO
|
Facility
|
OP
|
$1,176.00
|
|
|
Service Code
|
CPT L2526
|
| Hospital Charge Code |
905352526
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$282.24 |
| Max. Negotiated Rate |
$999.60 |
| Rate for Payer: Adventist Health Commercial |
$482.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$999.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$646.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$882.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$681.14
|
| Rate for Payer: Blue Shield of California Commercial |
$867.89
|
| Rate for Payer: Blue Shield of California EPN |
$571.54
|
| Rate for Payer: Cash Price |
$646.80
|
| Rate for Payer: Cash Price |
$646.80
|
| Rate for Payer: Cigna of CA HMO |
$823.20
|
| Rate for Payer: Cigna of CA PPO |
$823.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$999.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$999.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$999.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$470.40
|
| Rate for Payer: EPIC Health Plan Senior |
$470.40
|
| Rate for Payer: Galaxy Health WC |
$999.60
|
| Rate for Payer: Global Benefits Group Commercial |
$705.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$336.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$784.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$380.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$727.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$282.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$823.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$823.20
|
| Rate for Payer: Multiplan Commercial |
$940.80
|
| Rate for Payer: Networks By Design Commercial |
$588.00
|
| Rate for Payer: Prime Health Services Commercial |
$999.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$705.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$705.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$441.35
|
| Rate for Payer: United Healthcare All Other HMO |
$429.59
|
| Rate for Payer: United Healthcare HMO Rider |
$420.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$385.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$999.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$999.60
|
| Rate for Payer: Vantage Medical Group Senior |
$999.60
|
|
|
HC NARROW ML PREFAB KAFO
|
Facility
|
OP
|
$1,176.00
|
|
|
Service Code
|
CPT L2526
|
| Hospital Charge Code |
915352526
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$282.24 |
| Max. Negotiated Rate |
$999.60 |
| Rate for Payer: Adventist Health Commercial |
$482.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$999.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$646.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$882.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$681.14
|
| Rate for Payer: Blue Shield of California Commercial |
$867.89
|
| Rate for Payer: Blue Shield of California EPN |
$571.54
|
| Rate for Payer: Cash Price |
$646.80
|
| Rate for Payer: Cash Price |
$646.80
|
| Rate for Payer: Cigna of CA HMO |
$823.20
|
| Rate for Payer: Cigna of CA PPO |
$823.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$999.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$999.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$999.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$470.40
|
| Rate for Payer: EPIC Health Plan Senior |
$470.40
|
| Rate for Payer: Galaxy Health WC |
$999.60
|
| Rate for Payer: Global Benefits Group Commercial |
$705.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$336.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$784.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$380.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$727.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$282.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$823.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$823.20
|
| Rate for Payer: Multiplan Commercial |
$940.80
|
| Rate for Payer: Networks By Design Commercial |
$588.00
|
| Rate for Payer: Prime Health Services Commercial |
$999.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$705.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$705.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$441.35
|
| Rate for Payer: United Healthcare All Other HMO |
$429.59
|
| Rate for Payer: United Healthcare HMO Rider |
$420.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$385.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$999.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$999.60
|
| Rate for Payer: Vantage Medical Group Senior |
$999.60
|
|
|
HC NARROW ML PREFAB KAFO
|
Facility
|
IP
|
$1,176.00
|
|
|
Service Code
|
CPT L2526
|
| Hospital Charge Code |
915352526
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$235.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$235.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$646.80
|
| Rate for Payer: Cash Price |
$646.80
|
| Rate for Payer: Cigna of CA HMO |
$823.20
|
| Rate for Payer: Cigna of CA PPO |
$823.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$470.40
|
| Rate for Payer: EPIC Health Plan Senior |
$470.40
|
| Rate for Payer: Galaxy Health WC |
$999.60
|
| Rate for Payer: Global Benefits Group Commercial |
$705.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$784.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$448.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$727.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$282.24
|
| Rate for Payer: Multiplan Commercial |
$940.80
|
| Rate for Payer: Networks By Design Commercial |
$588.00
|
| Rate for Payer: Prime Health Services Commercial |
$999.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$441.35
|
| Rate for Payer: United Healthcare All Other HMO |
$429.59
|
| Rate for Payer: United Healthcare HMO Rider |
$420.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$385.14
|
|
|
HC NARROW ML PREFAB KAFO
|
Facility
|
IP
|
$1,176.00
|
|
|
Service Code
|
CPT L2526
|
| Hospital Charge Code |
905352526
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$235.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$235.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$646.80
|
| Rate for Payer: Cash Price |
$646.80
|
| Rate for Payer: Cigna of CA HMO |
$823.20
|
| Rate for Payer: Cigna of CA PPO |
$823.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$470.40
|
| Rate for Payer: EPIC Health Plan Senior |
$470.40
|
| Rate for Payer: Galaxy Health WC |
$999.60
|
| Rate for Payer: Global Benefits Group Commercial |
$705.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$784.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$448.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$727.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$282.24
|
| Rate for Payer: Multiplan Commercial |
$940.80
|
| Rate for Payer: Networks By Design Commercial |
$588.00
|
| Rate for Payer: Prime Health Services Commercial |
$999.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$441.35
|
| Rate for Payer: United Healthcare All Other HMO |
$429.59
|
| Rate for Payer: United Healthcare HMO Rider |
$420.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$385.14
|
|
|
HC NASAL BONES
|
Facility
|
IP
|
$825.00
|
|
|
Service Code
|
CPT 70160
|
| Hospital Charge Code |
909001104
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$701.25 |
| Rate for Payer: Adventist Health Commercial |
$165.00
|
| Rate for Payer: Cash Price |
$453.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$330.00
|
| Rate for Payer: EPIC Health Plan Senior |
$330.00
|
| Rate for Payer: Galaxy Health WC |
$701.25
|
| Rate for Payer: Global Benefits Group Commercial |
$495.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$550.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$314.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$510.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.00
|
| Rate for Payer: Multiplan Commercial |
$660.00
|
| Rate for Payer: Networks By Design Commercial |
$536.25
|
| Rate for Payer: Prime Health Services Commercial |
$701.25
|
|
|
HC NASAL BONES
|
Facility
|
OP
|
$825.00
|
|
|
Service Code
|
CPT 70160
|
| Hospital Charge Code |
909001104
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$41.65 |
| Max. Negotiated Rate |
$701.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$541.12
|
| Rate for Payer: Adventist Health Commercial |
$165.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.49
|
| Rate for Payer: Blue Shield of California Commercial |
$504.90
|
| Rate for Payer: Blue Shield of California EPN |
$333.30
|
| Rate for Payer: Cash Price |
$453.75
|
| Rate for Payer: Cash Price |
$453.75
|
| Rate for Payer: Cigna of CA HMO |
$528.00
|
| Rate for Payer: Cigna of CA PPO |
$610.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$701.25
|
| Rate for Payer: Global Benefits Group Commercial |
$495.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$41.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$550.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$660.00
|
| Rate for Payer: Networks By Design Commercial |
$536.25
|
| Rate for Payer: Prime Health Services Commercial |
$701.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$495.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$495.00
|
| 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: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC NASAL ENDOSCOPY DIAGNOSTIC
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
CPT 31231
|
| Hospital Charge Code |
900800914
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$82.56 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$149.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$370.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$271.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$246.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$409.75
|
| Rate for Payer: Cash Price |
$409.75
|
| Rate for Payer: Cash Price |
$409.75
|
| Rate for Payer: Cigna of CA HMO |
$476.80
|
| Rate for Payer: Cigna of CA PPO |
$551.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$370.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$271.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$246.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$333.00
|
| Rate for Payer: EPIC Health Plan Senior |
$246.67
|
| Rate for Payer: Galaxy Health WC |
$633.25
|
| Rate for Payer: Global Benefits Group Commercial |
$447.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$404.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$82.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$246.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$496.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$246.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$310.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$330.54
|
| Rate for Payer: Multiplan Commercial |
$596.00
|
| Rate for Payer: Multiplan WC |
$393.03
|
| Rate for Payer: Networks By Design Commercial |
$484.25
|
| Rate for Payer: Prime Health Services Commercial |
$633.25
|
| Rate for Payer: Prime Health Services WC |
$389.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$447.00
|
| 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 |
$246.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$370.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$271.34
|
| Rate for Payer: Vantage Medical Group Senior |
$246.67
|
|
|
HC NASAL ENDOSCOPY DIAGNOSTIC
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
CPT 31231
|
| Hospital Charge Code |
900800914
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$149.00 |
| Max. Negotiated Rate |
$633.25 |
| Rate for Payer: Adventist Health Commercial |
$149.00
|
| Rate for Payer: Cash Price |
$409.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$298.00
|
| Rate for Payer: EPIC Health Plan Senior |
$298.00
|
| Rate for Payer: Galaxy Health WC |
$633.25
|
| Rate for Payer: Global Benefits Group Commercial |
$447.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$496.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$283.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$461.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.80
|
| Rate for Payer: Multiplan Commercial |
$596.00
|
| Rate for Payer: Networks By Design Commercial |
$484.25
|
| Rate for Payer: Prime Health Services Commercial |
$633.25
|
|
|
HC NASAL ENDOSCOPY DIAGNOSTIC
|
Facility
|
IP
|
$649.00
|
|
|
Service Code
|
CPT 31231
|
| Hospital Charge Code |
900501401
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$129.80 |
| Max. Negotiated Rate |
$551.65 |
| Rate for Payer: Adventist Health Commercial |
$129.80
|
| Rate for Payer: Cash Price |
$356.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$259.60
|
| Rate for Payer: EPIC Health Plan Senior |
$259.60
|
| Rate for Payer: Galaxy Health WC |
$551.65
|
| Rate for Payer: Global Benefits Group Commercial |
$389.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$432.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$247.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$401.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.76
|
| Rate for Payer: Multiplan Commercial |
$519.20
|
| Rate for Payer: Networks By Design Commercial |
$421.85
|
| Rate for Payer: Prime Health Services Commercial |
$551.65
|
|
|
HC NASAL ENDOSCOPY DIAGNOSTIC
|
Facility
|
OP
|
$649.00
|
|
|
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: Adventist Health Commercial |
$129.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$370.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$271.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$246.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$356.95
|
| Rate for Payer: Cash Price |
$356.95
|
| Rate for Payer: Cash Price |
$356.95
|
| Rate for Payer: Cigna of CA HMO |
$415.36
|
| Rate for Payer: Cigna of CA PPO |
$480.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$370.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$271.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$246.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$333.00
|
| Rate for Payer: EPIC Health Plan Senior |
$246.67
|
| Rate for Payer: Galaxy Health WC |
$551.65
|
| Rate for Payer: Global Benefits Group Commercial |
$389.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$404.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$246.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$432.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$246.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$310.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$330.54
|
| Rate for Payer: Multiplan Commercial |
$519.20
|
| Rate for Payer: Multiplan WC |
$393.03
|
| Rate for Payer: Networks By Design Commercial |
$421.85
|
| Rate for Payer: Prime Health Services Commercial |
$551.65
|
| Rate for Payer: Prime Health Services WC |
$389.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$389.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$324.50
|
| Rate for Payer: United Healthcare All Other HMO |
$324.50
|
| Rate for Payer: United Healthcare HMO Rider |
$324.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$324.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$246.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$370.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$271.34
|
| Rate for Payer: Vantage Medical Group Senior |
$246.67
|
|
|
HC NASAL ENDOSCOPY W/CONT HEMORRH
|
Facility
|
OP
|
$6,001.00
|
|
|
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: Adventist Health Commercial |
$1,200.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| 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 |
$5,398.00
|
| Rate for Payer: Cash Price |
$3,300.55
|
| Rate for Payer: Cash Price |
$3,300.55
|
| Rate for Payer: Cash Price |
$3,300.55
|
| Rate for Payer: Cigna of CA HMO |
$3,840.64
|
| Rate for Payer: Cigna of CA PPO |
$4,440.74
|
| 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 |
$5,100.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,600.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$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: Kaiser Permanente of CA Commercial/Self Funded |
$4,002.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$331.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,191.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,440.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,760.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,936.09
|
| Rate for Payer: Multiplan Commercial |
$4,800.80
|
| Rate for Payer: Multiplan WC |
$3,491.15
|
| Rate for Payer: Networks By Design Commercial |
$3,900.65
|
| Rate for Payer: Prime Health Services Commercial |
$5,100.85
|
| Rate for Payer: Prime Health Services WC |
$3,455.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,600.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,000.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,000.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,000.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,000.50
|
| 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 NASAL ENDOSCOPY W/CONT HEMORRH
|
Facility
|
IP
|
$6,001.00
|
|
|
Service Code
|
CPT 31238
|
| Hospital Charge Code |
900501753
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,200.20 |
| Max. Negotiated Rate |
$5,100.85 |
| Rate for Payer: Adventist Health Commercial |
$1,200.20
|
| Rate for Payer: Cash Price |
$3,300.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,400.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,400.40
|
| Rate for Payer: Galaxy Health WC |
$5,100.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,600.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,002.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,286.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,714.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,440.24
|
| Rate for Payer: Multiplan Commercial |
$4,800.80
|
| Rate for Payer: Networks By Design Commercial |
$3,900.65
|
| Rate for Payer: Prime Health Services Commercial |
$5,100.85
|
|
|
HC NASAL I&D OF ABSCESS
|
Facility
|
OP
|
$1,197.00
|
|
|
Service Code
|
CPT 30000
|
| Hospital Charge Code |
902890339
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$118.12 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$239.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$295.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$658.35
|
| Rate for Payer: Cash Price |
$658.35
|
| Rate for Payer: Cash Price |
$658.35
|
| Rate for Payer: Cigna of CA HMO |
$766.08
|
| Rate for Payer: Cigna of CA PPO |
$885.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$295.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.33
|
| Rate for Payer: EPIC Health Plan Senior |
$295.06
|
| Rate for Payer: Galaxy Health WC |
$1,017.45
|
| Rate for Payer: Global Benefits Group Commercial |
$718.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$483.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$295.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$798.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$287.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$395.38
|
| Rate for Payer: Multiplan Commercial |
$957.60
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: Networks By Design Commercial |
$778.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,017.45
|
| Rate for Payer: Prime Health Services WC |
$465.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$718.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$598.50
|
| Rate for Payer: United Healthcare All Other HMO |
$598.50
|
| Rate for Payer: United Healthcare HMO Rider |
$598.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$598.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$295.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Vantage Medical Group Senior |
$295.06
|
|
|
HC NASAL I&D OF ABSCESS
|
Facility
|
IP
|
$1,197.00
|
|
|
Service Code
|
CPT 30000
|
| Hospital Charge Code |
902890339
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$239.40 |
| Max. Negotiated Rate |
$1,017.45 |
| Rate for Payer: Adventist Health Commercial |
$239.40
|
| Rate for Payer: Cash Price |
$658.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$478.80
|
| Rate for Payer: EPIC Health Plan Senior |
$478.80
|
| Rate for Payer: Galaxy Health WC |
$1,017.45
|
| Rate for Payer: Global Benefits Group Commercial |
$718.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$798.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$456.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$740.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$287.28
|
| Rate for Payer: Multiplan Commercial |
$957.60
|
| Rate for Payer: Networks By Design Commercial |
$778.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,017.45
|
|
|
HC NASOGASTRIC CORTRAK EAS
|
Facility
|
OP
|
$421.95
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901606374
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$84.39 |
| Max. Negotiated Rate |
$358.66 |
| Rate for Payer: Adventist Health Commercial |
$84.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$276.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$358.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$232.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$316.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$259.12
|
| Rate for Payer: Cash Price |
$232.07
|
| Rate for Payer: Cigna of CA HMO |
$270.05
|
| Rate for Payer: Cigna of CA PPO |
$312.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$358.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$358.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$358.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$168.78
|
| Rate for Payer: EPIC Health Plan Senior |
$168.78
|
| Rate for Payer: Galaxy Health WC |
$358.66
|
| Rate for Payer: Global Benefits Group Commercial |
$253.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$281.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$261.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$295.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$295.37
|
| Rate for Payer: Multiplan Commercial |
$337.56
|
| Rate for Payer: Networks By Design Commercial |
$274.27
|
| Rate for Payer: Prime Health Services Commercial |
$358.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$253.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$253.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$210.97
|
| Rate for Payer: United Healthcare All Other HMO |
$210.97
|
| Rate for Payer: United Healthcare HMO Rider |
$210.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$210.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$358.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$358.66
|
| Rate for Payer: Vantage Medical Group Senior |
$358.66
|
|
|
HC NASOGASTRIC CORTRAK EAS
|
Facility
|
IP
|
$421.95
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901606374
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$84.39 |
| Max. Negotiated Rate |
$358.66 |
| Rate for Payer: Adventist Health Commercial |
$84.39
|
| Rate for Payer: Cash Price |
$232.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$168.78
|
| Rate for Payer: EPIC Health Plan Senior |
$168.78
|
| Rate for Payer: Galaxy Health WC |
$358.66
|
| Rate for Payer: Global Benefits Group Commercial |
$253.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$281.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$261.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.27
|
| Rate for Payer: Multiplan Commercial |
$337.56
|
| Rate for Payer: Networks By Design Commercial |
$274.27
|
| Rate for Payer: Prime Health Services Commercial |
$358.66
|
|
|
HC NASO/ORGSTRC TUBE PLCM FS GDNC
|
Facility
|
IP
|
$598.00
|
|
|
Service Code
|
CPT 43752
|
| Hospital Charge Code |
906743752
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$119.60 |
| Max. Negotiated Rate |
$508.30 |
| Rate for Payer: Adventist Health Commercial |
$119.60
|
| Rate for Payer: Cash Price |
$328.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$239.20
|
| Rate for Payer: EPIC Health Plan Senior |
$239.20
|
| Rate for Payer: Galaxy Health WC |
$508.30
|
| Rate for Payer: Global Benefits Group Commercial |
$358.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$398.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$227.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.52
|
| Rate for Payer: Multiplan Commercial |
$478.40
|
| Rate for Payer: Networks By Design Commercial |
$388.70
|
| Rate for Payer: Prime Health Services Commercial |
$508.30
|
|
|
HC NASO/ORGSTRC TUBE PLCM FS GDNC
|
Facility
|
IP
|
$598.00
|
|
|
Service Code
|
CPT 43752
|
| Hospital Charge Code |
906743752
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$119.60 |
| Max. Negotiated Rate |
$508.30 |
| Rate for Payer: Adventist Health Commercial |
$119.60
|
| Rate for Payer: Cash Price |
$328.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$239.20
|
| Rate for Payer: EPIC Health Plan Senior |
$239.20
|
| Rate for Payer: Galaxy Health WC |
$508.30
|
| Rate for Payer: Global Benefits Group Commercial |
$358.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$398.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$227.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.52
|
| Rate for Payer: Multiplan Commercial |
$478.40
|
| Rate for Payer: Networks By Design Commercial |
$388.70
|
| Rate for Payer: Prime Health Services Commercial |
$508.30
|
|
|
HC NASO/ORGSTRC TUBE PLCM FS GDNC
|
Facility
|
OP
|
$598.00
|
|
|
Service Code
|
CPT 43752
|
| Hospital Charge Code |
906743752
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$119.60 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$119.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$328.90
|
| Rate for Payer: Cash Price |
$328.90
|
| Rate for Payer: Cash Price |
$328.90
|
| Rate for Payer: Cigna of CA HMO |
$382.72
|
| Rate for Payer: Cigna of CA PPO |
$442.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$760.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$557.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$684.48
|
| Rate for Payer: EPIC Health Plan Senior |
$507.02
|
| Rate for Payer: Galaxy Health WC |
$508.30
|
| Rate for Payer: Global Benefits Group Commercial |
$358.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$831.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$398.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$246.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$638.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$679.41
|
| Rate for Payer: Multiplan Commercial |
$478.40
|
| Rate for Payer: Multiplan WC |
$807.84
|
| Rate for Payer: Networks By Design Commercial |
$388.70
|
| Rate for Payer: Prime Health Services Commercial |
$508.30
|
| Rate for Payer: Prime Health Services WC |
$799.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$358.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$299.00
|
| Rate for Payer: United Healthcare All Other HMO |
$299.00
|
| Rate for Payer: United Healthcare HMO Rider |
$299.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$299.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$507.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Vantage Medical Group Senior |
$507.02
|
|
|
HC NASO/ORGSTRC TUBE PLCM FS GDNC
|
Facility
|
OP
|
$598.00
|
|
|
Service Code
|
CPT 43752
|
| Hospital Charge Code |
906743752
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$119.60 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$119.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$328.90
|
| Rate for Payer: Cash Price |
$328.90
|
| Rate for Payer: Cash Price |
$328.90
|
| Rate for Payer: Cigna of CA HMO |
$382.72
|
| Rate for Payer: Cigna of CA PPO |
$442.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$760.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$557.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$684.48
|
| Rate for Payer: EPIC Health Plan Senior |
$507.02
|
| Rate for Payer: Galaxy Health WC |
$508.30
|
| Rate for Payer: Global Benefits Group Commercial |
$358.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$831.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$218.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$398.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$246.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$638.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$679.41
|
| Rate for Payer: Multiplan Commercial |
$478.40
|
| Rate for Payer: Networks By Design Commercial |
$388.70
|
| Rate for Payer: Prime Health Services Commercial |
$508.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$358.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$608.42
|
| 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 |
$507.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Vantage Medical Group Senior |
$507.02
|
|
|
HC NASO/OROGASTRIC TUBE PLACEMENT
|
Facility
|
OP
|
$709.00
|
|
|
Service Code
|
CPT 43753
|
| Hospital Charge Code |
900501188
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$28.78 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$141.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$395.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$389.95
|
| Rate for Payer: Cash Price |
$389.95
|
| Rate for Payer: Cash Price |
$389.95
|
| Rate for Payer: Cigna of CA HMO |
$453.76
|
| Rate for Payer: Cigna of CA PPO |
$524.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$435.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$395.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$534.14
|
| Rate for Payer: EPIC Health Plan Senior |
$395.66
|
| Rate for Payer: Galaxy Health WC |
$602.65
|
| Rate for Payer: Global Benefits Group Commercial |
$425.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$648.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$28.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$395.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$472.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$395.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$498.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$530.18
|
| Rate for Payer: Multiplan Commercial |
$567.20
|
| Rate for Payer: Networks By Design Commercial |
$460.85
|
| Rate for Payer: Prime Health Services Commercial |
$602.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$425.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$425.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$354.50
|
| Rate for Payer: United Healthcare All Other HMO |
$354.50
|
| Rate for Payer: United Healthcare HMO Rider |
$354.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$354.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$395.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Vantage Medical Group Senior |
$395.66
|
|
|
HC NASO/OROGASTRIC TUBE PLACEMENT
|
Facility
|
IP
|
$709.00
|
|
|
Service Code
|
CPT 43753
|
| Hospital Charge Code |
900501188
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$141.80 |
| Max. Negotiated Rate |
$602.65 |
| Rate for Payer: Adventist Health Commercial |
$141.80
|
| Rate for Payer: Cash Price |
$389.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$283.60
|
| Rate for Payer: EPIC Health Plan Senior |
$283.60
|
| Rate for Payer: Galaxy Health WC |
$602.65
|
| Rate for Payer: Global Benefits Group Commercial |
$425.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$472.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$438.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.16
|
| Rate for Payer: Multiplan Commercial |
$567.20
|
| Rate for Payer: Networks By Design Commercial |
$460.85
|
| Rate for Payer: Prime Health Services Commercial |
$602.65
|
|
|
HC NASO/OROGASTRIC TUBE PLACEMENT
|
Facility
|
OP
|
$709.00
|
|
|
Service Code
|
CPT 43753
|
| Hospital Charge Code |
900501188
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$32.55 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$141.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$395.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$389.95
|
| Rate for Payer: Cash Price |
$389.95
|
| Rate for Payer: Cash Price |
$389.95
|
| Rate for Payer: Cigna of CA HMO |
$453.76
|
| Rate for Payer: Cigna of CA PPO |
$524.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$435.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$395.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$534.14
|
| Rate for Payer: EPIC Health Plan Senior |
$395.66
|
| Rate for Payer: Galaxy Health WC |
$602.65
|
| Rate for Payer: Global Benefits Group Commercial |
$425.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$648.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$395.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$472.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$395.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$498.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$530.18
|
| Rate for Payer: Multiplan Commercial |
$567.20
|
| Rate for Payer: Multiplan WC |
$630.41
|
| Rate for Payer: Networks By Design Commercial |
$460.85
|
| Rate for Payer: Prime Health Services Commercial |
$602.65
|
| Rate for Payer: Prime Health Services WC |
$623.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$425.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$354.50
|
| Rate for Payer: United Healthcare All Other HMO |
$354.50
|
| Rate for Payer: United Healthcare HMO Rider |
$354.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$354.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$395.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Vantage Medical Group Senior |
$395.66
|
|
|
HC NASO/OROGASTRIC TUBE PLACEMENT
|
Facility
|
IP
|
$709.00
|
|
|
Service Code
|
CPT 43753
|
| Hospital Charge Code |
900501188
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$141.80 |
| Max. Negotiated Rate |
$602.65 |
| Rate for Payer: Adventist Health Commercial |
$141.80
|
| Rate for Payer: Cash Price |
$389.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$283.60
|
| Rate for Payer: EPIC Health Plan Senior |
$283.60
|
| Rate for Payer: Galaxy Health WC |
$602.65
|
| Rate for Payer: Global Benefits Group Commercial |
$425.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$472.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$438.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.16
|
| Rate for Payer: Multiplan Commercial |
$567.20
|
| Rate for Payer: Networks By Design Commercial |
$460.85
|
| Rate for Payer: Prime Health Services Commercial |
$602.65
|
|
|
HC NASOPHARYNGOGRAM
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
CPT 70370
|
| Hospital Charge Code |
909001253
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$63.99 |
| Max. Negotiated Rate |
$746.30 |
| Rate for Payer: Adventist Health Commercial |
$175.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$575.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$368.19
|
| Rate for Payer: Blue Shield of California Commercial |
$537.34
|
| Rate for Payer: Blue Shield of California EPN |
$354.71
|
| Rate for Payer: Cash Price |
$482.90
|
| Rate for Payer: Cash Price |
$482.90
|
| Rate for Payer: Cigna of CA HMO |
$561.92
|
| Rate for Payer: Cigna of CA PPO |
$649.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$746.30
|
| Rate for Payer: Global Benefits Group Commercial |
$526.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$63.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$585.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$702.40
|
| Rate for Payer: Networks By Design Commercial |
$570.70
|
| Rate for Payer: Prime Health Services Commercial |
$746.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$526.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$526.80
|
| 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: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
