|
HC CNTRL NASAL HEMORRHAGE COMPLEX
|
Facility
|
OP
|
$1,021.00
|
|
|
Service Code
|
CPT 30903
|
| Hospital Charge Code |
900501115
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$159.60 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$612.60
|
| Rate for Payer: Caremore Medicare Advantage |
$159.60
|
| Rate for Payer: Cash Price |
$459.45
|
| Rate for Payer: Cash Price |
$459.45
|
| Rate for Payer: Cash Price |
$459.45
|
| Rate for Payer: Cash Price |
$459.45
|
| Rate for Payer: Central Health Plan Commercial |
$816.80
|
| Rate for Payer: Cigna of CA PPO |
$755.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Media |
$159.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.46
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$159.60
|
| Rate for Payer: Galaxy Health WC |
$867.85
|
| Rate for Payer: Global Benefits Group Commercial |
$612.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$918.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$765.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$261.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$159.60
|
| Rate for Payer: InnovAge PACE Commercial |
$239.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$681.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$439.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$213.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$213.86
|
| Rate for Payer: Multiplan Commercial |
$765.75
|
| Rate for Payer: Networks By Design Commercial |
$663.65
|
| Rate for Payer: Prime Health Services Commercial |
$867.85
|
| Rate for Payer: Prime Health Services Medicare |
$169.18
|
| Rate for Payer: Riverside University Health System MISP |
$175.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$612.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$510.50
|
| Rate for Payer: United Healthcare All Other HMO |
$510.50
|
| Rate for Payer: United Healthcare HMO Rider |
$510.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$510.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC CNTRL NASAL HEMORRHAGE COMPLEX
|
Facility
|
OP
|
$1,021.00
|
|
|
Service Code
|
CPT 30903
|
| Hospital Charge Code |
900501115
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$159.60 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$159.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$612.60
|
| Rate for Payer: Blue Shield of California Commercial |
$642.21
|
| Rate for Payer: Blue Shield of California EPN |
$499.27
|
| Rate for Payer: Caremore Medicare Advantage |
$159.60
|
| Rate for Payer: Cash Price |
$459.45
|
| Rate for Payer: Cash Price |
$459.45
|
| Rate for Payer: Cash Price |
$459.45
|
| Rate for Payer: Central Health Plan Commercial |
$816.80
|
| Rate for Payer: Cigna of CA HMO |
$653.44
|
| Rate for Payer: Cigna of CA PPO |
$755.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Media |
$159.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.46
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$159.60
|
| Rate for Payer: Galaxy Health WC |
$867.85
|
| Rate for Payer: Global Benefits Group Commercial |
$612.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$918.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$765.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$261.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$263.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$159.60
|
| Rate for Payer: InnovAge PACE Commercial |
$239.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$681.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$439.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$213.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$213.86
|
| Rate for Payer: Multiplan Commercial |
$765.75
|
| Rate for Payer: Networks By Design Commercial |
$663.65
|
| Rate for Payer: Prime Health Services Commercial |
$867.85
|
| Rate for Payer: Prime Health Services Medicare |
$169.18
|
| Rate for Payer: Riverside University Health System MISP |
$175.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$612.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$612.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$510.50
|
| Rate for Payer: United Healthcare All Other HMO |
$510.50
|
| Rate for Payer: United Healthcare HMO Rider |
$510.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$510.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC CNTRL NASAL HEMORRHAGE COMPLEX
|
Facility
|
IP
|
$1,021.00
|
|
|
Service Code
|
CPT 30903
|
| Hospital Charge Code |
900501115
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$204.20 |
| Max. Negotiated Rate |
$918.90 |
| Rate for Payer: Cash Price |
$459.45
|
| Rate for Payer: Central Health Plan Commercial |
$816.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$408.40
|
| Rate for Payer: Galaxy Health WC |
$867.85
|
| Rate for Payer: Global Benefits Group Commercial |
$612.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$918.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$681.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$389.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.20
|
| Rate for Payer: Multiplan Commercial |
$765.75
|
| Rate for Payer: Networks By Design Commercial |
$663.65
|
| Rate for Payer: Prime Health Services Commercial |
$867.85
|
|
|
HC CNTRL NASAL HEMORRHAGE COMPLEX
|
Facility
|
IP
|
$1,021.00
|
|
|
Service Code
|
CPT 30903
|
| Hospital Charge Code |
900501115
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$204.20 |
| Max. Negotiated Rate |
$918.90 |
| Rate for Payer: Cash Price |
$459.45
|
| Rate for Payer: Central Health Plan Commercial |
$816.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$408.40
|
| Rate for Payer: Galaxy Health WC |
$867.85
|
| Rate for Payer: Global Benefits Group Commercial |
$612.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$918.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$681.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$389.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.20
|
| Rate for Payer: Multiplan Commercial |
$765.75
|
| Rate for Payer: Networks By Design Commercial |
$663.65
|
| Rate for Payer: Prime Health Services Commercial |
$867.85
|
|
|
HC CNTRL NASAL HEMORRHAGE SIMPLE
|
Facility
|
IP
|
$1,116.00
|
|
|
Service Code
|
CPT 30901
|
| Hospital Charge Code |
900501114
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$223.20 |
| Max. Negotiated Rate |
$1,004.40 |
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Central Health Plan Commercial |
$892.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$446.40
|
| Rate for Payer: Galaxy Health WC |
$948.60
|
| Rate for Payer: Global Benefits Group Commercial |
$669.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,004.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$744.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$425.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.20
|
| Rate for Payer: Multiplan Commercial |
$837.00
|
| Rate for Payer: Networks By Design Commercial |
$725.40
|
| Rate for Payer: Prime Health Services Commercial |
$948.60
|
|
|
HC CNTRL NASAL HEMORRHAGE SIMPLE
|
Facility
|
OP
|
$1,116.00
|
|
|
Service Code
|
CPT 30901
|
| Hospital Charge Code |
900501114
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$103.99 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$159.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$669.60
|
| Rate for Payer: Blue Shield of California Commercial |
$701.96
|
| Rate for Payer: Blue Shield of California EPN |
$545.72
|
| Rate for Payer: Caremore Medicare Advantage |
$159.60
|
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Central Health Plan Commercial |
$892.80
|
| Rate for Payer: Cigna of CA HMO |
$714.24
|
| Rate for Payer: Cigna of CA PPO |
$825.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Media |
$159.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.46
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$159.60
|
| Rate for Payer: Galaxy Health WC |
$948.60
|
| Rate for Payer: Global Benefits Group Commercial |
$669.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,004.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$837.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$261.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$263.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$159.60
|
| Rate for Payer: InnovAge PACE Commercial |
$239.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$744.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$213.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$213.86
|
| Rate for Payer: Multiplan Commercial |
$837.00
|
| Rate for Payer: Networks By Design Commercial |
$725.40
|
| Rate for Payer: Prime Health Services Commercial |
$948.60
|
| Rate for Payer: Prime Health Services Medicare |
$169.18
|
| Rate for Payer: Riverside University Health System MISP |
$175.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$669.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$669.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$558.00
|
| Rate for Payer: United Healthcare All Other HMO |
$558.00
|
| Rate for Payer: United Healthcare HMO Rider |
$558.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$558.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC CNTRL NASAL HEMORRHAGE SIMPLE
|
Facility
|
OP
|
$1,116.00
|
|
|
Service Code
|
CPT 30901
|
| Hospital Charge Code |
900501114
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$103.99 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$669.60
|
| Rate for Payer: Caremore Medicare Advantage |
$159.60
|
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Central Health Plan Commercial |
$892.80
|
| Rate for Payer: Cigna of CA PPO |
$825.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Media |
$159.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.46
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$159.60
|
| Rate for Payer: Galaxy Health WC |
$948.60
|
| Rate for Payer: Global Benefits Group Commercial |
$669.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,004.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$837.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$261.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$159.60
|
| Rate for Payer: InnovAge PACE Commercial |
$239.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$744.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$213.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$213.86
|
| Rate for Payer: Multiplan Commercial |
$837.00
|
| Rate for Payer: Networks By Design Commercial |
$725.40
|
| Rate for Payer: Prime Health Services Commercial |
$948.60
|
| Rate for Payer: Prime Health Services Medicare |
$169.18
|
| Rate for Payer: Riverside University Health System MISP |
$175.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$669.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$558.00
|
| Rate for Payer: United Healthcare All Other HMO |
$558.00
|
| Rate for Payer: United Healthcare HMO Rider |
$558.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$558.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC CNTRL NASAL HEMORRHAGE SIMPLE
|
Facility
|
IP
|
$1,116.00
|
|
|
Service Code
|
CPT 30901
|
| Hospital Charge Code |
900501114
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$223.20 |
| Max. Negotiated Rate |
$1,004.40 |
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Central Health Plan Commercial |
$892.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$446.40
|
| Rate for Payer: Galaxy Health WC |
$948.60
|
| Rate for Payer: Global Benefits Group Commercial |
$669.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,004.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$744.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$425.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.20
|
| Rate for Payer: Multiplan Commercial |
$837.00
|
| Rate for Payer: Networks By Design Commercial |
$725.40
|
| Rate for Payer: Prime Health Services Commercial |
$948.60
|
|
|
HC CNTRL NASAL HEM POSTERIOR
|
Facility
|
IP
|
$970.00
|
|
|
Service Code
|
CPT 30905
|
| Hospital Charge Code |
900501116
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$194.00 |
| Max. Negotiated Rate |
$873.00 |
| Rate for Payer: Cash Price |
$436.50
|
| Rate for Payer: Central Health Plan Commercial |
$776.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$388.00
|
| Rate for Payer: Galaxy Health WC |
$824.50
|
| Rate for Payer: Global Benefits Group Commercial |
$582.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$873.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$646.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$369.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.00
|
| Rate for Payer: Multiplan Commercial |
$727.50
|
| Rate for Payer: Networks By Design Commercial |
$630.50
|
| Rate for Payer: Prime Health Services Commercial |
$824.50
|
|
|
HC CNTRL NASAL HEM POSTERIOR
|
Facility
|
OP
|
$970.00
|
|
|
Service Code
|
CPT 30905
|
| Hospital Charge Code |
900501116
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$159.60 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$159.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$582.00
|
| Rate for Payer: Blue Shield of California Commercial |
$610.13
|
| Rate for Payer: Blue Shield of California EPN |
$474.33
|
| Rate for Payer: Caremore Medicare Advantage |
$159.60
|
| Rate for Payer: Cash Price |
$436.50
|
| Rate for Payer: Cash Price |
$436.50
|
| Rate for Payer: Cash Price |
$436.50
|
| Rate for Payer: Central Health Plan Commercial |
$776.00
|
| Rate for Payer: Cigna of CA HMO |
$620.80
|
| Rate for Payer: Cigna of CA PPO |
$717.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Media |
$159.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.46
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$159.60
|
| Rate for Payer: Galaxy Health WC |
$824.50
|
| Rate for Payer: Global Benefits Group Commercial |
$582.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$873.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$727.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$261.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$263.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$159.60
|
| Rate for Payer: InnovAge PACE Commercial |
$239.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$646.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$199.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$213.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$213.86
|
| Rate for Payer: Multiplan Commercial |
$727.50
|
| Rate for Payer: Networks By Design Commercial |
$630.50
|
| Rate for Payer: Prime Health Services Commercial |
$824.50
|
| Rate for Payer: Prime Health Services Medicare |
$169.18
|
| Rate for Payer: Riverside University Health System MISP |
$175.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$582.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$582.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$485.00
|
| Rate for Payer: United Healthcare All Other HMO |
$485.00
|
| Rate for Payer: United Healthcare HMO Rider |
$485.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$485.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC CNTRL NASAL HEM POSTERIOR
|
Facility
|
OP
|
$970.00
|
|
|
Service Code
|
CPT 30905
|
| Hospital Charge Code |
900501116
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$159.60 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$582.00
|
| Rate for Payer: Caremore Medicare Advantage |
$159.60
|
| Rate for Payer: Cash Price |
$436.50
|
| Rate for Payer: Cash Price |
$436.50
|
| Rate for Payer: Cash Price |
$436.50
|
| Rate for Payer: Cash Price |
$436.50
|
| Rate for Payer: Central Health Plan Commercial |
$776.00
|
| Rate for Payer: Cigna of CA PPO |
$717.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Media |
$159.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.46
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$159.60
|
| Rate for Payer: Galaxy Health WC |
$824.50
|
| Rate for Payer: Global Benefits Group Commercial |
$582.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$873.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$727.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$261.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$159.60
|
| Rate for Payer: InnovAge PACE Commercial |
$239.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$646.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$199.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$213.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$213.86
|
| Rate for Payer: Multiplan Commercial |
$727.50
|
| Rate for Payer: Networks By Design Commercial |
$630.50
|
| Rate for Payer: Prime Health Services Commercial |
$824.50
|
| Rate for Payer: Prime Health Services Medicare |
$169.18
|
| Rate for Payer: Riverside University Health System MISP |
$175.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$582.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$485.00
|
| Rate for Payer: United Healthcare All Other HMO |
$485.00
|
| Rate for Payer: United Healthcare HMO Rider |
$485.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$485.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC CNTRL NASAL HEM POSTERIOR
|
Facility
|
IP
|
$970.00
|
|
|
Service Code
|
CPT 30905
|
| Hospital Charge Code |
900501116
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$194.00 |
| Max. Negotiated Rate |
$873.00 |
| Rate for Payer: Cash Price |
$436.50
|
| Rate for Payer: Central Health Plan Commercial |
$776.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$388.00
|
| Rate for Payer: Galaxy Health WC |
$824.50
|
| Rate for Payer: Global Benefits Group Commercial |
$582.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$873.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$646.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$369.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.00
|
| Rate for Payer: Multiplan Commercial |
$727.50
|
| Rate for Payer: Networks By Design Commercial |
$630.50
|
| Rate for Payer: Prime Health Services Commercial |
$824.50
|
|
|
HC CNTRL NASAL HEM POST SUBSQ
|
Facility
|
OP
|
$739.00
|
|
|
Service Code
|
CPT 30906
|
| Hospital Charge Code |
900501117
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$147.80 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$305.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$443.40
|
| Rate for Payer: Caremore Medicare Advantage |
$305.19
|
| Rate for Payer: Cash Price |
$332.55
|
| Rate for Payer: Cash Price |
$332.55
|
| Rate for Payer: Cash Price |
$332.55
|
| Rate for Payer: Cash Price |
$332.55
|
| Rate for Payer: Central Health Plan Commercial |
$591.20
|
| Rate for Payer: Cigna of CA PPO |
$546.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.78
|
| Rate for Payer: Dignity Health Media |
$305.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.01
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$305.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$305.19
|
| Rate for Payer: Galaxy Health WC |
$628.15
|
| Rate for Payer: Global Benefits Group Commercial |
$443.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$665.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$554.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$500.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$305.19
|
| Rate for Payer: InnovAge PACE Commercial |
$457.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$492.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$666.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$305.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$408.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.95
|
| Rate for Payer: Multiplan Commercial |
$554.25
|
| Rate for Payer: Networks By Design Commercial |
$480.35
|
| Rate for Payer: Prime Health Services Commercial |
$628.15
|
| Rate for Payer: Prime Health Services Medicare |
$323.50
|
| Rate for Payer: Riverside University Health System MISP |
$335.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$443.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$369.50
|
| Rate for Payer: United Healthcare All Other HMO |
$369.50
|
| Rate for Payer: United Healthcare HMO Rider |
$369.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$369.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Vantage Medical Group Senior |
$305.19
|
|
|
HC CNTRL NASAL HEM POST SUBSQ
|
Facility
|
IP
|
$739.00
|
|
|
Service Code
|
CPT 30906
|
| Hospital Charge Code |
900501117
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$147.80 |
| Max. Negotiated Rate |
$665.10 |
| Rate for Payer: Cash Price |
$332.55
|
| Rate for Payer: Central Health Plan Commercial |
$591.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$295.60
|
| Rate for Payer: Galaxy Health WC |
$628.15
|
| Rate for Payer: Global Benefits Group Commercial |
$443.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$665.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$492.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$281.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.80
|
| Rate for Payer: Multiplan Commercial |
$554.25
|
| Rate for Payer: Networks By Design Commercial |
$480.35
|
| Rate for Payer: Prime Health Services Commercial |
$628.15
|
|
|
HC CNTRL NASAL HEM POST SUBSQ
|
Facility
|
IP
|
$739.00
|
|
|
Service Code
|
CPT 30906
|
| Hospital Charge Code |
900501117
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$147.80 |
| Max. Negotiated Rate |
$665.10 |
| Rate for Payer: Cash Price |
$332.55
|
| Rate for Payer: Central Health Plan Commercial |
$591.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$295.60
|
| Rate for Payer: Galaxy Health WC |
$628.15
|
| Rate for Payer: Global Benefits Group Commercial |
$443.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$665.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$492.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$281.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.80
|
| Rate for Payer: Multiplan Commercial |
$554.25
|
| Rate for Payer: Networks By Design Commercial |
$480.35
|
| Rate for Payer: Prime Health Services Commercial |
$628.15
|
|
|
HC CNTRL NASAL HEM POST SUBSQ
|
Facility
|
OP
|
$739.00
|
|
|
Service Code
|
CPT 30906
|
| Hospital Charge Code |
900501117
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$147.80 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$305.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$305.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$443.40
|
| Rate for Payer: Blue Shield of California Commercial |
$464.83
|
| Rate for Payer: Blue Shield of California EPN |
$361.37
|
| Rate for Payer: Caremore Medicare Advantage |
$305.19
|
| Rate for Payer: Cash Price |
$332.55
|
| Rate for Payer: Cash Price |
$332.55
|
| Rate for Payer: Cash Price |
$332.55
|
| Rate for Payer: Central Health Plan Commercial |
$591.20
|
| Rate for Payer: Cigna of CA HMO |
$472.96
|
| Rate for Payer: Cigna of CA PPO |
$546.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.78
|
| Rate for Payer: Dignity Health Media |
$305.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.01
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$305.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$305.19
|
| Rate for Payer: Galaxy Health WC |
$628.15
|
| Rate for Payer: Global Benefits Group Commercial |
$443.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$665.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$554.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$500.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$503.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$305.19
|
| Rate for Payer: InnovAge PACE Commercial |
$457.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$492.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$666.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$305.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$408.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.95
|
| Rate for Payer: Multiplan Commercial |
$554.25
|
| Rate for Payer: Networks By Design Commercial |
$480.35
|
| Rate for Payer: Prime Health Services Commercial |
$628.15
|
| Rate for Payer: Prime Health Services Medicare |
$323.50
|
| Rate for Payer: Riverside University Health System MISP |
$335.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$443.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$443.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$369.50
|
| Rate for Payer: United Healthcare All Other HMO |
$369.50
|
| Rate for Payer: United Healthcare HMO Rider |
$369.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$369.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Vantage Medical Group Senior |
$305.19
|
|
|
HC CNTRL ORO HEM W SURG INTRV
|
Facility
|
OP
|
$8,200.00
|
|
|
Service Code
|
CPT 42962
|
| Hospital Charge Code |
900542962
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$7,380.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,022.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,920.00
|
| Rate for Payer: Caremore Medicare Advantage |
$4,022.69
|
| Rate for Payer: Cash Price |
$3,690.00
|
| Rate for Payer: Cash Price |
$3,690.00
|
| Rate for Payer: Cash Price |
$3,690.00
|
| Rate for Payer: Cash Price |
$3,690.00
|
| Rate for Payer: Central Health Plan Commercial |
$6,560.00
|
| Rate for Payer: Cigna of CA PPO |
$6,068.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Dignity Health Media |
$4,022.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,424.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,430.63
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,022.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,022.69
|
| Rate for Payer: Galaxy Health WC |
$6,970.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,920.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,380.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,150.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,597.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,022.69
|
| Rate for Payer: InnovAge PACE Commercial |
$6,034.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,469.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$783.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,022.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,640.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,390.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,390.40
|
| Rate for Payer: Multiplan Commercial |
$6,150.00
|
| Rate for Payer: Networks By Design Commercial |
$5,330.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,970.00
|
| Rate for Payer: Prime Health Services Medicare |
$4,264.05
|
| Rate for Payer: Riverside University Health System MISP |
$4,424.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,920.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,100.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,100.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,100.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,100.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Vantage Medical Group Senior |
$4,022.69
|
|
|
HC CNTRL ORO HEM W SURG INTRV
|
Facility
|
IP
|
$8,200.00
|
|
|
Service Code
|
CPT 42962
|
| Hospital Charge Code |
900542962
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,640.00 |
| Max. Negotiated Rate |
$7,380.00 |
| Rate for Payer: Cash Price |
$3,690.00
|
| Rate for Payer: Central Health Plan Commercial |
$6,560.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,280.00
|
| Rate for Payer: Galaxy Health WC |
$6,970.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,920.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,380.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,469.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,124.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,640.00
|
| Rate for Payer: Multiplan Commercial |
$6,150.00
|
| Rate for Payer: Networks By Design Commercial |
$5,330.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,970.00
|
|
|
HC CNTRL VNS CATH KIT 4FR DL
|
Facility
|
OP
|
$603.38
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698700
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$120.68 |
| Max. Negotiated Rate |
$543.04 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$512.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$331.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$331.86
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$275.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$336.08
|
| Rate for Payer: Blue Distinction Transplant |
$362.03
|
| Rate for Payer: Blue Shield of California Commercial |
$452.54
|
| Rate for Payer: Blue Shield of California EPN |
$328.24
|
| Rate for Payer: Cash Price |
$271.52
|
| Rate for Payer: Central Health Plan Commercial |
$482.70
|
| Rate for Payer: Cigna of CA HMO |
$422.37
|
| Rate for Payer: Cigna of CA PPO |
$422.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$512.87
|
| Rate for Payer: Dignity Health Media |
$512.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$512.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$241.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$241.35
|
| Rate for Payer: Galaxy Health WC |
$512.87
|
| Rate for Payer: Global Benefits Group Commercial |
$362.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$543.04
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$452.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$211.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$402.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$229.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.68
|
| Rate for Payer: Multiplan Commercial |
$452.54
|
| Rate for Payer: Networks By Design Commercial |
$301.69
|
| Rate for Payer: Prime Health Services Commercial |
$512.87
|
| Rate for Payer: Riverside University Health System MISP |
$241.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$362.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$362.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$301.69
|
| Rate for Payer: United Healthcare All Other HMO |
$301.69
|
| Rate for Payer: United Healthcare HMO Rider |
$301.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$301.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$512.87
|
| Rate for Payer: Vantage Medical Group Senior |
$512.87
|
|
|
HC CNTRL VNS CATH KIT 4FR DL
|
Facility
|
IP
|
$603.38
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698700
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$120.68 |
| Max. Negotiated Rate |
$543.04 |
| Rate for Payer: Blue Shield of California EPN |
$322.20
|
| Rate for Payer: Cash Price |
$271.52
|
| Rate for Payer: Central Health Plan Commercial |
$482.70
|
| Rate for Payer: Cigna of CA HMO |
$422.37
|
| Rate for Payer: Cigna of CA PPO |
$422.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$241.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$241.35
|
| Rate for Payer: Galaxy Health WC |
$512.87
|
| Rate for Payer: Global Benefits Group Commercial |
$362.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$543.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$402.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$229.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.68
|
| Rate for Payer: Multiplan Commercial |
$452.54
|
| Rate for Payer: Prime Health Services Commercial |
$512.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$227.84
|
| Rate for Payer: United Healthcare All Other HMO |
$222.53
|
| Rate for Payer: United Healthcare HMO Rider |
$217.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$199.12
|
|
|
HC CNTRL VNS CATH KIT DL 4FR
|
Facility
|
OP
|
$422.24
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698610
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.45 |
| Max. Negotiated Rate |
$380.02 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$358.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$232.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$232.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$192.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$235.19
|
| Rate for Payer: Blue Distinction Transplant |
$253.34
|
| Rate for Payer: Blue Shield of California Commercial |
$316.68
|
| Rate for Payer: Blue Shield of California EPN |
$229.70
|
| Rate for Payer: Cash Price |
$190.01
|
| Rate for Payer: Central Health Plan Commercial |
$337.79
|
| Rate for Payer: Cigna of CA HMO |
$295.57
|
| Rate for Payer: Cigna of CA PPO |
$295.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$358.90
|
| Rate for Payer: Dignity Health Media |
$358.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$358.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$168.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$168.90
|
| Rate for Payer: Galaxy Health WC |
$358.90
|
| Rate for Payer: Global Benefits Group Commercial |
$253.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$380.02
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$316.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$147.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$281.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.45
|
| Rate for Payer: Multiplan Commercial |
$316.68
|
| Rate for Payer: Networks By Design Commercial |
$211.12
|
| Rate for Payer: Prime Health Services Commercial |
$358.90
|
| Rate for Payer: Riverside University Health System MISP |
$168.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$253.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$253.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$211.12
|
| Rate for Payer: United Healthcare All Other HMO |
$211.12
|
| Rate for Payer: United Healthcare HMO Rider |
$211.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$211.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$358.90
|
| Rate for Payer: Vantage Medical Group Senior |
$358.90
|
|
|
HC CNTRL VNS CATH KIT DL 4FR
|
Facility
|
IP
|
$422.24
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698610
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.45 |
| Max. Negotiated Rate |
$380.02 |
| Rate for Payer: Blue Shield of California EPN |
$225.48
|
| Rate for Payer: Cash Price |
$190.01
|
| Rate for Payer: Central Health Plan Commercial |
$337.79
|
| Rate for Payer: Cigna of CA HMO |
$295.57
|
| Rate for Payer: Cigna of CA PPO |
$295.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$168.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$168.90
|
| Rate for Payer: Galaxy Health WC |
$358.90
|
| Rate for Payer: Global Benefits Group Commercial |
$253.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$380.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$281.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.45
|
| Rate for Payer: Multiplan Commercial |
$316.68
|
| Rate for Payer: Prime Health Services Commercial |
$358.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$159.44
|
| Rate for Payer: United Healthcare All Other HMO |
$155.72
|
| Rate for Payer: United Healthcare HMO Rider |
$152.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$139.34
|
|
|
HC CNTRL VNS CATH KIT DL 8FR 16CM
|
Facility
|
OP
|
$678.04
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698539
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.61 |
| Max. Negotiated Rate |
$1,019.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,019.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$576.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$372.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$372.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$328.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$400.59
|
| Rate for Payer: Blue Distinction Transplant |
$406.82
|
| Rate for Payer: Blue Shield of California Commercial |
$426.49
|
| Rate for Payer: Blue Shield of California EPN |
$331.56
|
| Rate for Payer: Cash Price |
$305.12
|
| Rate for Payer: Cash Price |
$305.12
|
| Rate for Payer: Central Health Plan Commercial |
$542.43
|
| Rate for Payer: Cigna of CA HMO |
$433.95
|
| Rate for Payer: Cigna of CA PPO |
$501.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$576.33
|
| Rate for Payer: Dignity Health Media |
$576.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$576.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$271.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$271.22
|
| Rate for Payer: Galaxy Health WC |
$576.33
|
| Rate for Payer: Global Benefits Group Commercial |
$406.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$610.24
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$508.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$237.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$452.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$258.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.61
|
| Rate for Payer: Multiplan Commercial |
$508.53
|
| Rate for Payer: Networks By Design Commercial |
$440.73
|
| Rate for Payer: Prime Health Services Commercial |
$576.33
|
| Rate for Payer: Riverside University Health System MISP |
$271.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$406.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$406.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$339.02
|
| Rate for Payer: United Healthcare All Other HMO |
$339.02
|
| Rate for Payer: United Healthcare HMO Rider |
$339.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$339.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$576.33
|
| Rate for Payer: Vantage Medical Group Senior |
$576.33
|
|
|
HC CNTRL VNS CATH KIT DL 8FR 16CM
|
Facility
|
IP
|
$678.04
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698539
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.61 |
| Max. Negotiated Rate |
$610.24 |
| Rate for Payer: Cash Price |
$305.12
|
| Rate for Payer: Central Health Plan Commercial |
$542.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$271.22
|
| Rate for Payer: Galaxy Health WC |
$576.33
|
| Rate for Payer: Global Benefits Group Commercial |
$406.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$610.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$452.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$258.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.61
|
| Rate for Payer: Multiplan Commercial |
$508.53
|
| Rate for Payer: Networks By Design Commercial |
$440.73
|
| Rate for Payer: Prime Health Services Commercial |
$576.33
|
|
|
HC CNTRL VNS CATH KIT MAC DL 9FR
|
Facility
|
OP
|
$880.90
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698533
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$176.18 |
| Max. Negotiated Rate |
$792.81 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$748.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$484.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$484.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$402.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$490.66
|
| Rate for Payer: Blue Distinction Transplant |
$528.54
|
| Rate for Payer: Blue Shield of California Commercial |
$660.68
|
| Rate for Payer: Blue Shield of California EPN |
$479.21
|
| Rate for Payer: Cash Price |
$396.41
|
| Rate for Payer: Central Health Plan Commercial |
$704.72
|
| Rate for Payer: Cigna of CA HMO |
$616.63
|
| Rate for Payer: Cigna of CA PPO |
$616.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$748.76
|
| Rate for Payer: Dignity Health Media |
$748.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$748.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$352.36
|
| Rate for Payer: Galaxy Health WC |
$748.76
|
| Rate for Payer: Global Benefits Group Commercial |
$528.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$792.81
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$660.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$308.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$587.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$335.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.18
|
| Rate for Payer: Multiplan Commercial |
$660.68
|
| Rate for Payer: Networks By Design Commercial |
$440.45
|
| Rate for Payer: Prime Health Services Commercial |
$748.76
|
| Rate for Payer: Riverside University Health System MISP |
$352.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$528.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$528.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$440.45
|
| Rate for Payer: United Healthcare All Other HMO |
$440.45
|
| Rate for Payer: United Healthcare HMO Rider |
$440.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$748.76
|
| Rate for Payer: Vantage Medical Group Senior |
$748.76
|
|
