|
NAPROXEN 375 MG TABLET [5392]
|
Facility
|
OP
|
$0.12
|
|
|
Service Code
|
NDC 6846218901
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Senior |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.10
|
| Rate for Payer: Riverside University Health System MISP |
$0.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO |
$0.06
|
| Rate for Payer: United Healthcare HMO Rider |
$0.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Vantage Medical Group Senior |
$0.10
|
|
|
NAPROXEN 500 MG TABLET [5393]
|
Facility
|
OP
|
$0.14
|
|
|
Service Code
|
NDC 6516219010
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Central Health Plan Commercial |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
| Rate for Payer: Riverside University Health System MISP |
$0.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO |
$0.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Vantage Medical Group Senior |
$0.12
|
|
|
NAPROXEN 500 MG TABLET [5393]
|
Facility
|
IP
|
$0.14
|
|
|
Service Code
|
NDC 6846219001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Central Health Plan Commercial |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
|
|
NAPROXEN 500 MG TABLET [5393]
|
Facility
|
OP
|
$0.14
|
|
|
Service Code
|
NDC 6846219001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Central Health Plan Commercial |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
| Rate for Payer: Riverside University Health System MISP |
$0.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO |
$0.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Vantage Medical Group Senior |
$0.12
|
|
|
NAPROXEN 500 MG TABLET [5393]
|
Facility
|
IP
|
$0.14
|
|
|
Service Code
|
NDC 6516219010
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Central Health Plan Commercial |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
|
|
NASAL ENDOSCOPY, DIAGNOSTIC, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 31231
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$84.52 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$256.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$385.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$282.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$256.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$393.03
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$385.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$282.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$256.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$423.60
|
| Rate for Payer: EPIC Health Plan Senior |
$282.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$421.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$84.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$256.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$93.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$359.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$344.02
|
| Rate for Payer: Multiplan WC |
$393.03
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$256.73
|
| Rate for Payer: Preferred Health Network WC |
$401.05
|
| Rate for Payer: Prime Health Services Medicare |
$272.13
|
| Rate for Payer: Prime Health Services WC |
$389.02
|
| Rate for Payer: Riverside University Health System MISP |
$282.40
|
| 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 |
$256.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$385.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$282.40
|
| Rate for Payer: Vantage Medical Group Senior |
$256.73
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL; WITH BIOPSY, POLYPECTOMY OR DEBRIDEMENT (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 31237
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$176.09 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Upland Medical Group Pediatric |
$2,289.25
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,289.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,518.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,289.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,491.15
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,518.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,289.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,777.26
|
| Rate for Payer: EPIC Health Plan Senior |
$2,518.18
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,754.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$176.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,289.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$194.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,204.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,067.59
|
| Rate for Payer: Multiplan WC |
$3,491.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,289.25
|
| Rate for Payer: Preferred Health Network WC |
$3,562.40
|
| Rate for Payer: Prime Health Services Medicare |
$2,426.61
|
| Rate for Payer: Prime Health Services WC |
$3,455.53
|
| Rate for Payer: Riverside University Health System MISP |
$2,518.18
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,518.18
|
| Rate for Payer: Vantage Medical Group Senior |
$2,289.25
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL; WITH CONCHA BULLOSA RESECTION
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 31240
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$227.33 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,289.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,518.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,289.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,491.15
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,518.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,289.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,777.26
|
| Rate for Payer: EPIC Health Plan Senior |
$2,518.18
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,754.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$227.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,289.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$251.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,204.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,067.59
|
| Rate for Payer: Multiplan WC |
$3,491.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,289.25
|
| Rate for Payer: Preferred Health Network WC |
$3,562.40
|
| Rate for Payer: Prime Health Services Medicare |
$2,426.61
|
| Rate for Payer: Prime Health Services WC |
$3,455.53
|
| Rate for Payer: Riverside University Health System MISP |
$2,518.18
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,289.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,518.18
|
| Rate for Payer: Vantage Medical Group Senior |
$2,289.25
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL; WITH DACRYOCYSTORHINOSTOMY
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 31239
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$780.59 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,795.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,274.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,795.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$7,464.14
|
| Rate for Payer: Blue Shield of California Commercial |
$6,228.07
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,274.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,795.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,912.21
|
| Rate for Payer: EPIC Health Plan Senior |
$5,274.81
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,864.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$780.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,795.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$862.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,713.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,425.68
|
| Rate for Payer: Multiplan WC |
$7,464.14
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,795.28
|
| Rate for Payer: Preferred Health Network WC |
$7,616.47
|
| Rate for Payer: Prime Health Services Medicare |
$5,083.00
|
| Rate for Payer: Prime Health Services WC |
$7,387.98
|
| Rate for Payer: Riverside University Health System MISP |
$5,274.81
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,795.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,274.81
|
| Rate for Payer: Vantage Medical Group Senior |
$4,795.28
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL WITH ETHMOIDECTOMY; PARTIAL (ANTERIOR)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 31254
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$411.11 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$9,077.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,984.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,077.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$14,014.35
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,984.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,077.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,977.17
|
| Rate for Payer: EPIC Health Plan Senior |
$9,984.78
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14,886.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$411.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,077.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$454.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,707.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,163.27
|
| Rate for Payer: Multiplan WC |
$14,014.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9,077.07
|
| Rate for Payer: Preferred Health Network WC |
$14,300.36
|
| Rate for Payer: Prime Health Services Medicare |
$9,621.69
|
| Rate for Payer: Prime Health Services WC |
$13,871.35
|
| Rate for Payer: Riverside University Health System MISP |
$9,984.78
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,077.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,984.78
|
| Rate for Payer: Vantage Medical Group Senior |
$9,077.07
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL WITH ETHMOIDECTOMY; TOTAL (ANTERIOR AND POSTERIOR)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 31255
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$616.65 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$9,077.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,984.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,077.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$14,014.35
|
| Rate for Payer: Blue Shield of California Commercial |
$7,080.44
|
| Rate for Payer: Blue Shield of California EPN |
$4,450.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,984.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,077.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,977.17
|
| Rate for Payer: EPIC Health Plan Senior |
$9,984.78
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14,886.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$616.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,077.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$681.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,707.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,163.27
|
| Rate for Payer: Multiplan WC |
$14,014.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9,077.07
|
| Rate for Payer: Preferred Health Network WC |
$14,300.36
|
| Rate for Payer: Prime Health Services Medicare |
$9,621.69
|
| Rate for Payer: Prime Health Services WC |
$13,871.35
|
| Rate for Payer: Riverside University Health System MISP |
$9,984.78
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,077.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,984.78
|
| Rate for Payer: Vantage Medical Group Senior |
$9,077.07
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL WITH ETHMOIDECTOMY; TOTAL (ANTERIOR AND POSTERIOR), INCLUDING FRONTAL SINUS EXPLORATION, WITH REMOVAL OF TISSUE FROM FRONTAL SINUS, WHEN PERFORMED
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 31253
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$734.49 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$9,077.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,984.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,077.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$14,014.35
|
| Rate for Payer: Blue Shield of California Commercial |
$7,080.44
|
| Rate for Payer: Blue Shield of California EPN |
$4,450.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,984.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,077.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,977.17
|
| Rate for Payer: EPIC Health Plan Senior |
$9,984.78
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14,886.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$734.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,077.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$811.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,707.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,163.27
|
| Rate for Payer: Multiplan WC |
$14,014.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9,077.07
|
| Rate for Payer: Preferred Health Network WC |
$14,300.36
|
| Rate for Payer: Prime Health Services Medicare |
$9,621.69
|
| Rate for Payer: Prime Health Services WC |
$13,871.35
|
| Rate for Payer: Riverside University Health System MISP |
$9,984.78
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,077.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,984.78
|
| Rate for Payer: Vantage Medical Group Senior |
$9,077.07
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL WITH ETHMOIDECTOMY; TOTAL (ANTERIOR AND POSTERIOR), INCLUDING SPHENOIDOTOMY
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 31257
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$654.44 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$9,077.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,984.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,077.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$14,014.35
|
| Rate for Payer: Blue Shield of California Commercial |
$7,080.44
|
| Rate for Payer: Blue Shield of California EPN |
$4,450.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,984.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,077.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,977.17
|
| Rate for Payer: EPIC Health Plan Senior |
$9,984.78
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14,886.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$654.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,077.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$722.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,707.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,163.27
|
| Rate for Payer: Multiplan WC |
$14,014.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9,077.07
|
| Rate for Payer: Preferred Health Network WC |
$14,300.36
|
| Rate for Payer: Prime Health Services Medicare |
$9,621.69
|
| Rate for Payer: Prime Health Services WC |
$13,871.35
|
| Rate for Payer: Riverside University Health System MISP |
$9,984.78
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,077.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,984.78
|
| Rate for Payer: Vantage Medical Group Senior |
$9,077.07
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL WITH ETHMOIDECTOMY; TOTAL (ANTERIOR AND POSTERIOR), INCLUDING SPHENOIDOTOMY, WITH REMOVAL OF TISSUE FROM THE SPHENOID SINUS
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 31259
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$693.50 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$9,077.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,984.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,077.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$14,014.35
|
| Rate for Payer: Blue Shield of California Commercial |
$7,080.44
|
| Rate for Payer: Blue Shield of California EPN |
$4,450.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,984.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,077.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,977.17
|
| Rate for Payer: EPIC Health Plan Senior |
$9,984.78
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14,886.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$693.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,077.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$766.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,707.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,163.27
|
| Rate for Payer: Multiplan WC |
$14,014.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9,077.07
|
| Rate for Payer: Preferred Health Network WC |
$14,300.36
|
| Rate for Payer: Prime Health Services Medicare |
$9,621.69
|
| Rate for Payer: Prime Health Services WC |
$13,871.35
|
| Rate for Payer: Riverside University Health System MISP |
$9,984.78
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,077.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,984.78
|
| Rate for Payer: Vantage Medical Group Senior |
$9,077.07
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL, WITH FRONTAL SINUS EXPLORATION, INCLUDING REMOVAL OF TISSUE FROM FRONTAL SINUS, WHEN PERFORMED
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 31276
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$580.81 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$9,077.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,984.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,077.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$14,014.35
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,984.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,077.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,977.17
|
| Rate for Payer: EPIC Health Plan Senior |
$9,984.78
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14,886.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$580.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,077.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$641.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,707.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,163.27
|
| Rate for Payer: Multiplan WC |
$14,014.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9,077.07
|
| Rate for Payer: Preferred Health Network WC |
$14,300.36
|
| Rate for Payer: Prime Health Services Medicare |
$9,621.69
|
| Rate for Payer: Prime Health Services WC |
$13,871.35
|
| Rate for Payer: Riverside University Health System MISP |
$9,984.78
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,077.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,984.78
|
| Rate for Payer: Vantage Medical Group Senior |
$9,077.07
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL, WITH MAXILLARY ANTROSTOMY;
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 31256
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$291.37 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Prime Health Services WC |
$7,387.98
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,795.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,274.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,795.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$7,464.14
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,274.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,795.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,912.21
|
| Rate for Payer: EPIC Health Plan Senior |
$5,274.81
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,864.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$291.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,795.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$321.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,713.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,425.68
|
| Rate for Payer: Multiplan WC |
$7,464.14
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,795.28
|
| Rate for Payer: Preferred Health Network WC |
$7,616.47
|
| Rate for Payer: Prime Health Services Medicare |
$5,083.00
|
| Rate for Payer: Riverside University Health System MISP |
$5,274.81
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,795.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,274.81
|
| Rate for Payer: Vantage Medical Group Senior |
$4,795.28
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL, WITH MAXILLARY ANTROSTOMY; WITH REMOVAL OF TISSUE FROM MAXILLARY SINUS
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 31267
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$446.32 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$9,077.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,984.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,077.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$14,014.35
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,984.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,077.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,977.17
|
| Rate for Payer: EPIC Health Plan Senior |
$9,984.78
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14,886.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$446.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,077.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$493.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,707.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,163.27
|
| Rate for Payer: Multiplan WC |
$14,014.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9,077.07
|
| Rate for Payer: Preferred Health Network WC |
$14,300.36
|
| Rate for Payer: Prime Health Services Medicare |
$9,621.69
|
| Rate for Payer: Prime Health Services WC |
$13,871.35
|
| Rate for Payer: Riverside University Health System MISP |
$9,984.78
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,077.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,984.78
|
| Rate for Payer: Vantage Medical Group Senior |
$9,077.07
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL, WITH SPHENOIDOTOMY;
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 31287
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$347.08 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Vantage Medical Group Senior |
$9,077.07
|
| Rate for Payer: Adventist Health Medi-Cal |
$9,077.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,984.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,077.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$14,014.35
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,984.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,077.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,977.17
|
| Rate for Payer: EPIC Health Plan Senior |
$9,984.78
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14,886.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$347.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,077.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$383.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,707.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,163.27
|
| Rate for Payer: Multiplan WC |
$14,014.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9,077.07
|
| Rate for Payer: Preferred Health Network WC |
$14,300.36
|
| Rate for Payer: Prime Health Services Medicare |
$9,621.69
|
| Rate for Payer: Prime Health Services WC |
$13,871.35
|
| Rate for Payer: Riverside University Health System MISP |
$9,984.78
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,077.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,984.78
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL, WITH SPHENOIDOTOMY; WITH REMOVAL OF TISSUE FROM THE SPHENOID SINUS
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 31288
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$405.35 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$9,077.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,984.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,077.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$14,014.35
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,984.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,077.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,977.17
|
| Rate for Payer: EPIC Health Plan Senior |
$9,984.78
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14,886.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$405.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,077.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$447.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,707.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,163.27
|
| Rate for Payer: Multiplan WC |
$14,014.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9,077.07
|
| Rate for Payer: Preferred Health Network WC |
$14,300.36
|
| Rate for Payer: Prime Health Services Medicare |
$9,621.69
|
| Rate for Payer: Prime Health Services WC |
$13,871.35
|
| Rate for Payer: Riverside University Health System MISP |
$9,984.78
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,077.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,984.78
|
| Rate for Payer: Vantage Medical Group Senior |
$9,077.07
|
|
|
NASOPHARYNGOSCOPY, SURGICAL, WITH DILATION OF EUSTACHIAN TUBE (IE, BALLOON DILATION); BILATERAL
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 69706
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$639.21 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,613.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,375.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,613.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$11,976.10
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,375.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,613.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,562.92
|
| Rate for Payer: EPIC Health Plan Senior |
$8,375.28
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,486.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,051.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,613.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,579.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,659.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,202.61
|
| Rate for Payer: Multiplan WC |
$11,976.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,613.89
|
| Rate for Payer: Preferred Health Network WC |
$12,220.51
|
| Rate for Payer: Prime Health Services Medicare |
$8,070.72
|
| Rate for Payer: Prime Health Services WC |
$11,853.89
|
| Rate for Payer: Riverside University Health System MISP |
$8,375.28
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,613.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,375.28
|
| Rate for Payer: Vantage Medical Group Senior |
$7,613.89
|
|
|
NATALIZUMAB 300 MG/15 ML INTRAVENOUS SOLUTION [40120]
|
Facility
|
OP
|
$710.34
|
|
|
Service Code
|
HCPCS J2323
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.01 |
| Max. Negotiated Rate |
$639.31 |
| Rate for Payer: Adventist Health Commercial |
$142.07
|
| Rate for Payer: Adventist Health Medi-Cal |
$24.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$151.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.73
|
| Rate for Payer: Blue Shield of California Commercial |
$37.56
|
| Rate for Payer: Blue Shield of California EPN |
$34.15
|
| Rate for Payer: Cash Price |
$319.65
|
| Rate for Payer: Cash Price |
$319.65
|
| Rate for Payer: Central Health Plan Commercial |
$568.27
|
| Rate for Payer: Cigna of CA HMO |
$497.24
|
| Rate for Payer: Cigna of CA PPO |
$497.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$497.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.28
|
| Rate for Payer: EPIC Health Plan Senior |
$26.85
|
| Rate for Payer: Galaxy Health WC |
$603.79
|
| Rate for Payer: Global Benefits Group Commercial |
$426.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$639.31
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$40.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$451.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32.71
|
| Rate for Payer: Multiplan Commercial |
$532.75
|
| Rate for Payer: Networks By Design Commercial |
$355.17
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$24.41
|
| Rate for Payer: Prime Health Services Commercial |
$603.79
|
| Rate for Payer: Prime Health Services Medicare |
$25.87
|
| Rate for Payer: Riverside University Health System MISP |
$26.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$426.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$426.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$266.59
|
| Rate for Payer: United Healthcare All Other HMO |
$259.49
|
| Rate for Payer: United Healthcare HMO Rider |
$253.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$232.64
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.85
|
| Rate for Payer: Vantage Medical Group Senior |
$26.85
|
|
|
NATALIZUMAB 300 MG/15 ML INTRAVENOUS SOLUTION [40120]
|
Facility
|
IP
|
$710.34
|
|
|
Service Code
|
HCPCS J2323
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$142.07 |
| Max. Negotiated Rate |
$639.31 |
| Rate for Payer: Adventist Health Commercial |
$142.07
|
| Rate for Payer: Blue Shield of California Commercial |
$569.69
|
| Rate for Payer: Blue Shield of California EPN |
$358.01
|
| Rate for Payer: Cash Price |
$319.65
|
| Rate for Payer: Central Health Plan Commercial |
$568.27
|
| Rate for Payer: Cigna of CA HMO |
$497.24
|
| Rate for Payer: Cigna of CA PPO |
$497.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$497.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.14
|
| Rate for Payer: EPIC Health Plan Senior |
$284.14
|
| Rate for Payer: Galaxy Health WC |
$603.79
|
| Rate for Payer: Global Benefits Group Commercial |
$426.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$639.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$451.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$419.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.07
|
| Rate for Payer: Multiplan Commercial |
$532.75
|
| Rate for Payer: Networks By Design Commercial |
$355.17
|
| Rate for Payer: Prime Health Services Commercial |
$603.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$266.59
|
| Rate for Payer: United Healthcare All Other HMO |
$259.49
|
| Rate for Payer: United Healthcare HMO Rider |
$253.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$232.64
|
|
|
NAXITAMAB-GQGK 4 MG/ML INTRAVENOUS SOLUTION [229812]
|
Facility
|
OP
|
$3,127.91
|
|
|
Service Code
|
HCPCS J9348
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$625.58 |
| Max. Negotiated Rate |
$3,977.47 |
| Rate for Payer: Adventist Health Commercial |
$625.58
|
| Rate for Payer: Adventist Health Medi-Cal |
$684.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,977.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,027.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$753.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$684.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,043.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,301.58
|
| Rate for Payer: Blue Shield of California Commercial |
$803.90
|
| Rate for Payer: Blue Shield of California EPN |
$730.82
|
| Rate for Payer: Cash Price |
$1,407.56
|
| Rate for Payer: Cash Price |
$1,407.56
|
| Rate for Payer: Central Health Plan Commercial |
$2,502.33
|
| Rate for Payer: Cigna of CA HMO |
$2,189.54
|
| Rate for Payer: Cigna of CA PPO |
$2,189.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$856.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$753.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$753.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,189.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,130.09
|
| Rate for Payer: EPIC Health Plan Senior |
$753.39
|
| Rate for Payer: Galaxy Health WC |
$2,658.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1,876.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,815.12
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,123.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$684.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$684.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,986.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,303.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$958.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$625.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$917.77
|
| Rate for Payer: Multiplan Commercial |
$2,345.93
|
| Rate for Payer: Networks By Design Commercial |
$1,563.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$684.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,658.72
|
| Rate for Payer: Prime Health Services Medicare |
$725.99
|
| Rate for Payer: Riverside University Health System MISP |
$753.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,876.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,876.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,173.90
|
| Rate for Payer: United Healthcare All Other HMO |
$1,142.63
|
| Rate for Payer: United Healthcare HMO Rider |
$1,117.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,024.39
|
| Rate for Payer: Upland Medical Group Pediatric |
$684.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$856.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$753.39
|
| Rate for Payer: Vantage Medical Group Senior |
$753.39
|
|
|
NAXITAMAB-GQGK 4 MG/ML INTRAVENOUS SOLUTION [229812]
|
Facility
|
IP
|
$3,127.91
|
|
|
Service Code
|
HCPCS J9348
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$625.58 |
| Max. Negotiated Rate |
$2,815.12 |
| Rate for Payer: Adventist Health Commercial |
$625.58
|
| Rate for Payer: Blue Shield of California Commercial |
$2,508.58
|
| Rate for Payer: Blue Shield of California EPN |
$1,576.47
|
| Rate for Payer: Cash Price |
$1,407.56
|
| Rate for Payer: Central Health Plan Commercial |
$2,502.33
|
| Rate for Payer: Cigna of CA HMO |
$2,189.54
|
| Rate for Payer: Cigna of CA PPO |
$2,189.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,189.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,251.16
|
| Rate for Payer: EPIC Health Plan Senior |
$1,251.16
|
| Rate for Payer: Galaxy Health WC |
$2,658.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1,876.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,815.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,986.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,845.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$625.58
|
| Rate for Payer: Multiplan Commercial |
$2,345.93
|
| Rate for Payer: Networks By Design Commercial |
$1,563.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,658.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,173.90
|
| Rate for Payer: United Healthcare All Other HMO |
$1,142.63
|
| Rate for Payer: United Healthcare HMO Rider |
$1,117.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,024.39
|
|
|
NEBIVOLOL 10 MG TABLET [89286]
|
Facility
|
OP
|
$0.56
|
|
|
Service Code
|
NDC 6787739130
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.33
|
| Rate for Payer: Blue Shield of California Commercial |
$0.36
|
| Rate for Payer: Blue Shield of California EPN |
$0.22
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Central Health Plan Commercial |
$0.45
|
| Rate for Payer: Cigna of CA HMO |
$0.39
|
| Rate for Payer: Cigna of CA PPO |
$0.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Senior |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.48
|
| Rate for Payer: Global Benefits Group Commercial |
$0.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.39
|
| Rate for Payer: Multiplan Commercial |
$0.42
|
| Rate for Payer: Networks By Design Commercial |
$0.36
|
| Rate for Payer: Prime Health Services Commercial |
$0.48
|
| Rate for Payer: Riverside University Health System MISP |
$0.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.28
|
| Rate for Payer: United Healthcare All Other HMO |
$0.28
|
| Rate for Payer: United Healthcare HMO Rider |
$0.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Vantage Medical Group Senior |
$0.48
|
|
