|
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 |
$269.10
|
| Rate for Payer: Cash Price |
$269.10
|
| Rate for Payer: Cash Price |
$269.10
|
| 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/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 |
$269.10
|
| 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 |
$269.10
|
| Rate for Payer: Cash Price |
$269.10
|
| Rate for Payer: Cash Price |
$269.10
|
| 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
|
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 |
$269.10
|
| 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/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 |
$319.05
|
| Rate for Payer: Cash Price |
$319.05
|
| Rate for Payer: Cash Price |
$319.05
|
| 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
|
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 |
$319.05
|
| Rate for Payer: Cash Price |
$319.05
|
| Rate for Payer: Cash Price |
$319.05
|
| 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
|
230
|
| Min. Negotiated Rate |
$141.80 |
| Max. Negotiated Rate |
$602.65 |
| Rate for Payer: Adventist Health Commercial |
$141.80
|
| Rate for Payer: Cash Price |
$319.05
|
| 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
|
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 |
$319.05
|
| 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
|
IP
|
$878.00
|
|
|
Service Code
|
CPT 70370
|
| Hospital Charge Code |
909001253
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$175.60 |
| Max. Negotiated Rate |
$746.30 |
| Rate for Payer: Adventist Health Commercial |
$175.60
|
| Rate for Payer: Cash Price |
$395.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$351.20
|
| Rate for Payer: EPIC Health Plan Senior |
$351.20
|
| Rate for Payer: Galaxy Health WC |
$746.30
|
| Rate for Payer: Global Benefits Group Commercial |
$526.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$585.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$334.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$543.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.72
|
| 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
|
|
|
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 |
$395.10
|
| Rate for Payer: Cash Price |
$395.10
|
| 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
|
|
|
HC NASOPHARYNGOSCOPY W/ENDOSCOPE
|
Facility
|
OP
|
$715.00
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
905601701
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$79.40 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$143.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| 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 |
$321.75
|
| Rate for Payer: Cash Price |
$321.75
|
| Rate for Payer: Cash Price |
$321.75
|
| Rate for Payer: Cigna of CA HMO |
$457.60
|
| Rate for Payer: Cigna of CA PPO |
$529.10
|
| 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 |
$607.75
|
| Rate for Payer: Global Benefits Group Commercial |
$429.00
|
| 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 |
$476.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$246.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.60
|
| 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 |
$572.00
|
| Rate for Payer: Multiplan WC |
$393.03
|
| Rate for Payer: Networks By Design Commercial |
$464.75
|
| Rate for Payer: Prime Health Services Commercial |
$607.75
|
| Rate for Payer: Prime Health Services WC |
$389.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$429.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$357.50
|
| Rate for Payer: United Healthcare All Other HMO |
$357.50
|
| Rate for Payer: United Healthcare HMO Rider |
$357.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$357.50
|
| 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 NASOPHARYNGOSCOPY W/ENDOSCOPE
|
Facility
|
IP
|
$715.00
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
905601701
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$143.00 |
| Max. Negotiated Rate |
$607.75 |
| Rate for Payer: Adventist Health Commercial |
$143.00
|
| Rate for Payer: Cash Price |
$321.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$286.00
|
| Rate for Payer: EPIC Health Plan Senior |
$286.00
|
| Rate for Payer: Galaxy Health WC |
$607.75
|
| Rate for Payer: Global Benefits Group Commercial |
$429.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$476.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$272.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$442.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.60
|
| Rate for Payer: Multiplan Commercial |
$572.00
|
| Rate for Payer: Networks By Design Commercial |
$464.75
|
| Rate for Payer: Prime Health Services Commercial |
$607.75
|
|
|
HC NASOPHARYNGOSCOPY W ENDOSCOPE MCAL
|
Facility
|
OP
|
$715.00
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
907000031
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$70.21 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$293.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| 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 |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$321.75
|
| Rate for Payer: Cash Price |
$321.75
|
| Rate for Payer: Cash Price |
$321.75
|
| Rate for Payer: Cigna of CA HMO |
$457.60
|
| Rate for Payer: Cigna of CA PPO |
$529.10
|
| 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 |
$607.75
|
| Rate for Payer: Global Benefits Group Commercial |
$429.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$404.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$70.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$246.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$476.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$246.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.60
|
| 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 |
$572.00
|
| Rate for Payer: Networks By Design Commercial |
$464.75
|
| Rate for Payer: Prime Health Services Commercial |
$607.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$429.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$296.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| 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 NASOPHARYNGOSCOPY W ENDOSCOPE MCAL
|
Facility
|
IP
|
$715.00
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
907000031
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$143.00 |
| Max. Negotiated Rate |
$607.75 |
| Rate for Payer: Adventist Health Commercial |
$143.00
|
| Rate for Payer: Cash Price |
$321.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$286.00
|
| Rate for Payer: EPIC Health Plan Senior |
$286.00
|
| Rate for Payer: Galaxy Health WC |
$607.75
|
| Rate for Payer: Global Benefits Group Commercial |
$429.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$476.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$272.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$442.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.60
|
| Rate for Payer: Multiplan Commercial |
$572.00
|
| Rate for Payer: Networks By Design Commercial |
$464.75
|
| Rate for Payer: Prime Health Services Commercial |
$607.75
|
|
|
HC NASOTRACHEAL SUCTIONING
|
Facility
|
IP
|
$326.00
|
|
|
Service Code
|
CPT 31720
|
| Hospital Charge Code |
900800380
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$65.20 |
| Max. Negotiated Rate |
$277.10 |
| Rate for Payer: Adventist Health Commercial |
$65.20
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.40
|
| Rate for Payer: EPIC Health Plan Senior |
$130.40
|
| Rate for Payer: Galaxy Health WC |
$277.10
|
| Rate for Payer: Global Benefits Group Commercial |
$195.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$217.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$201.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.24
|
| Rate for Payer: Multiplan Commercial |
$260.80
|
| Rate for Payer: Networks By Design Commercial |
$211.90
|
| Rate for Payer: Prime Health Services Commercial |
$277.10
|
|
|
HC NASOTRACHEAL SUCTIONING
|
Facility
|
IP
|
$326.00
|
|
|
Service Code
|
CPT 31720
|
| Hospital Charge Code |
900800380
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$65.20 |
| Max. Negotiated Rate |
$277.10 |
| Rate for Payer: Adventist Health Commercial |
$65.20
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.40
|
| Rate for Payer: EPIC Health Plan Senior |
$130.40
|
| Rate for Payer: Galaxy Health WC |
$277.10
|
| Rate for Payer: Global Benefits Group Commercial |
$195.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$217.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$201.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.24
|
| Rate for Payer: Multiplan Commercial |
$260.80
|
| Rate for Payer: Networks By Design Commercial |
$211.90
|
| Rate for Payer: Prime Health Services Commercial |
$277.10
|
|
|
HC NASOTRACHEAL SUCTIONING
|
Facility
|
OP
|
$326.00
|
|
|
Service Code
|
CPT 31720
|
| Hospital Charge Code |
900800380
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$65.20 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$65.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cigna of CA HMO |
$208.64
|
| Rate for Payer: Cigna of CA PPO |
$241.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$284.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.88
|
| Rate for Payer: EPIC Health Plan Senior |
$258.43
|
| Rate for Payer: Galaxy Health WC |
$277.10
|
| Rate for Payer: Global Benefits Group Commercial |
$195.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$423.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$85.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$217.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$258.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$346.30
|
| Rate for Payer: Multiplan Commercial |
$260.80
|
| Rate for Payer: Networks By Design Commercial |
$211.90
|
| Rate for Payer: Prime Health Services Commercial |
$277.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$195.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$195.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$163.00
|
| Rate for Payer: United Healthcare All Other HMO |
$163.00
|
| Rate for Payer: United Healthcare HMO Rider |
$163.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$163.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Vantage Medical Group Senior |
$258.43
|
|
|
HC NASOTRACHEAL SUCTIONING
|
Facility
|
OP
|
$326.00
|
|
|
Service Code
|
CPT 31720
|
| Hospital Charge Code |
900800380
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$65.20 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$65.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cigna of CA HMO |
$208.64
|
| Rate for Payer: Cigna of CA PPO |
$241.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$284.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.88
|
| Rate for Payer: EPIC Health Plan Senior |
$258.43
|
| Rate for Payer: Galaxy Health WC |
$277.10
|
| Rate for Payer: Global Benefits Group Commercial |
$195.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$423.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$85.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$217.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$258.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$346.30
|
| Rate for Payer: Multiplan Commercial |
$260.80
|
| Rate for Payer: Networks By Design Commercial |
$211.90
|
| Rate for Payer: Prime Health Services Commercial |
$277.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$195.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$195.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$163.00
|
| Rate for Payer: United Healthcare All Other HMO |
$163.00
|
| Rate for Payer: United Healthcare HMO Rider |
$163.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$163.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Vantage Medical Group Senior |
$258.43
|
|
|
HC N BLOCK,SPHENOPALATINE GANGLIN
|
Facility
|
IP
|
$1,351.00
|
|
|
Service Code
|
CPT 64505
|
| Hospital Charge Code |
900501686
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$270.20 |
| Max. Negotiated Rate |
$1,148.35 |
| Rate for Payer: Adventist Health Commercial |
$270.20
|
| Rate for Payer: Cash Price |
$607.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$540.40
|
| Rate for Payer: EPIC Health Plan Senior |
$540.40
|
| Rate for Payer: Galaxy Health WC |
$1,148.35
|
| Rate for Payer: Global Benefits Group Commercial |
$810.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$901.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$514.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$836.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.24
|
| Rate for Payer: Multiplan Commercial |
$1,080.80
|
| Rate for Payer: Networks By Design Commercial |
$878.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,148.35
|
|
|
HC N BLOCK,SPHENOPALATINE GANGLIN
|
Facility
|
OP
|
$1,351.00
|
|
|
Service Code
|
CPT 64505
|
| Hospital Charge Code |
900501686
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$115.29 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$270.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$375.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$607.95
|
| Rate for Payer: Cash Price |
$607.95
|
| Rate for Payer: Cash Price |
$607.95
|
| Rate for Payer: Cigna of CA HMO |
$864.64
|
| Rate for Payer: Cigna of CA PPO |
$999.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$562.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$412.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$375.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.34
|
| Rate for Payer: EPIC Health Plan Senior |
$375.07
|
| Rate for Payer: Galaxy Health WC |
$1,148.35
|
| Rate for Payer: Global Benefits Group Commercial |
$810.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$615.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$375.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$901.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$375.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$472.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$502.59
|
| Rate for Payer: Multiplan Commercial |
$1,080.80
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: Networks By Design Commercial |
$878.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,148.35
|
| Rate for Payer: Prime Health Services WC |
$591.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$810.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$675.50
|
| Rate for Payer: United Healthcare All Other HMO |
$675.50
|
| Rate for Payer: United Healthcare HMO Rider |
$675.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$675.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$375.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Vantage Medical Group Senior |
$375.07
|
|
|
HC N-CARDIAC VASC FLOW IMAG
|
Facility
|
IP
|
$1,724.00
|
|
|
Service Code
|
CPT 78445
|
| Hospital Charge Code |
909301349
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$344.80 |
| Max. Negotiated Rate |
$1,465.40 |
| Rate for Payer: Adventist Health Commercial |
$344.80
|
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$689.60
|
| Rate for Payer: EPIC Health Plan Senior |
$689.60
|
| Rate for Payer: Galaxy Health WC |
$1,465.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,034.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,149.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$656.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,067.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$413.76
|
| Rate for Payer: Multiplan Commercial |
$1,379.20
|
| Rate for Payer: Networks By Design Commercial |
$1,120.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,465.40
|
|
|
HC N-CARDIAC VASC FLOW IMAG
|
Facility
|
OP
|
$1,724.00
|
|
|
Service Code
|
CPT 78445
|
| Hospital Charge Code |
909301349
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$202.99 |
| Max. Negotiated Rate |
$1,465.40 |
| Rate for Payer: Adventist Health Commercial |
$344.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,130.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,058.71
|
| Rate for Payer: Blue Shield of California Commercial |
$1,055.09
|
| Rate for Payer: Blue Shield of California EPN |
$696.50
|
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: Cigna of CA HMO |
$1,103.36
|
| Rate for Payer: Cigna of CA PPO |
$1,275.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$689.27
|
| Rate for Payer: EPIC Health Plan Senior |
$510.57
|
| Rate for Payer: Galaxy Health WC |
$1,465.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,034.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$837.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$202.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,149.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$229.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$510.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$413.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$684.16
|
| Rate for Payer: Multiplan Commercial |
$1,379.20
|
| Rate for Payer: Networks By Design Commercial |
$1,120.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,465.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,034.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,034.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.46
|
| Rate for Payer: United Healthcare All Other HMO |
$396.46
|
| Rate for Payer: United Healthcare HMO Rider |
$396.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$396.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$510.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC NECK SOFT TISSUE
|
Facility
|
OP
|
$723.00
|
|
|
Service Code
|
CPT 70360
|
| Hospital Charge Code |
909001201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.06 |
| Max. Negotiated Rate |
$614.55 |
| Rate for Payer: Adventist Health Commercial |
$144.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$474.22
|
| 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 |
$120.09
|
| Rate for Payer: Blue Shield of California Commercial |
$442.48
|
| Rate for Payer: Blue Shield of California EPN |
$292.09
|
| Rate for Payer: Cash Price |
$325.35
|
| Rate for Payer: Cash Price |
$325.35
|
| Rate for Payer: Cigna of CA HMO |
$462.72
|
| Rate for Payer: Cigna of CA PPO |
$535.02
|
| 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 |
$614.55
|
| Rate for Payer: Global Benefits Group Commercial |
$433.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$482.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.52
|
| 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 |
$578.40
|
| Rate for Payer: Networks By Design Commercial |
$469.95
|
| Rate for Payer: Prime Health Services Commercial |
$614.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$433.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$433.80
|
| 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 NECK SOFT TISSUE
|
Facility
|
IP
|
$723.00
|
|
|
Service Code
|
CPT 70360
|
| Hospital Charge Code |
909001201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$144.60 |
| Max. Negotiated Rate |
$614.55 |
| Rate for Payer: Adventist Health Commercial |
$144.60
|
| Rate for Payer: Cash Price |
$325.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$289.20
|
| Rate for Payer: EPIC Health Plan Senior |
$289.20
|
| Rate for Payer: Galaxy Health WC |
$614.55
|
| Rate for Payer: Global Benefits Group Commercial |
$433.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$482.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$275.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$447.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.52
|
| Rate for Payer: Multiplan Commercial |
$578.40
|
| Rate for Payer: Networks By Design Commercial |
$469.95
|
| Rate for Payer: Prime Health Services Commercial |
$614.55
|
|
|
HC NEDL BARD TRANS-SEPTAL
|
Facility
|
OP
|
$1,012.00
|
|
| Hospital Charge Code |
906812363
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$202.40 |
| Max. Negotiated Rate |
$860.20 |
| Rate for Payer: Adventist Health Commercial |
$202.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$663.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$860.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$556.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$759.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$621.47
|
| Rate for Payer: Cash Price |
$455.40
|
| Rate for Payer: Cigna of CA HMO |
$647.68
|
| Rate for Payer: Cigna of CA PPO |
$748.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$860.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$860.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$860.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$404.80
|
| Rate for Payer: EPIC Health Plan Senior |
$404.80
|
| Rate for Payer: Galaxy Health WC |
$860.20
|
| Rate for Payer: Global Benefits Group Commercial |
$607.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$675.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$385.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$626.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$242.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$708.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$708.40
|
| Rate for Payer: Multiplan Commercial |
$809.60
|
| Rate for Payer: Networks By Design Commercial |
$657.80
|
| Rate for Payer: Prime Health Services Commercial |
$860.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$607.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$607.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$506.00
|
| Rate for Payer: United Healthcare HMO Rider |
$506.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$506.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$860.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$860.20
|
| Rate for Payer: Vantage Medical Group Senior |
$860.20
|
|
