|
HC NARROW ML BRIM KAFO
|
Facility
|
IP
|
$2,855.00
|
|
|
Service Code
|
CPT L2525
|
| Hospital Charge Code |
915352525
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$571.00 |
| Max. Negotiated Rate |
$2,569.50 |
| Rate for Payer: Adventist Health Commercial |
$571.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,289.71
|
| Rate for Payer: Blue Shield of California EPN |
$1,438.92
|
| Rate for Payer: Cash Price |
$1,284.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,284.00
|
| Rate for Payer: Cigna of CA HMO |
$1,998.50
|
| Rate for Payer: Cigna of CA PPO |
$1,998.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,998.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,142.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,142.00
|
| Rate for Payer: Galaxy Health WC |
$2,426.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,713.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,569.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,812.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,684.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$571.00
|
| Rate for Payer: Multiplan Commercial |
$2,141.25
|
| Rate for Payer: Networks By Design Commercial |
$1,855.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,426.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,071.48
|
| Rate for Payer: United Healthcare All Other HMO |
$1,042.93
|
| Rate for Payer: United Healthcare HMO Rider |
$1,020.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$935.01
|
|
|
HC NARROW ML BRIM KAFO
|
Facility
|
IP
|
$2,855.00
|
|
|
Service Code
|
CPT L2525
|
| Hospital Charge Code |
905352525
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$571.00 |
| Max. Negotiated Rate |
$2,569.50 |
| Rate for Payer: Adventist Health Commercial |
$571.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,289.71
|
| Rate for Payer: Blue Shield of California EPN |
$1,438.92
|
| Rate for Payer: Cash Price |
$1,284.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,284.00
|
| Rate for Payer: Cigna of CA HMO |
$1,998.50
|
| Rate for Payer: Cigna of CA PPO |
$1,998.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,998.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,142.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,142.00
|
| Rate for Payer: Galaxy Health WC |
$2,426.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,713.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,569.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,812.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,684.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$571.00
|
| Rate for Payer: Multiplan Commercial |
$2,141.25
|
| Rate for Payer: Networks By Design Commercial |
$1,855.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,426.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,071.48
|
| Rate for Payer: United Healthcare All Other HMO |
$1,042.93
|
| Rate for Payer: United Healthcare HMO Rider |
$1,020.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$935.01
|
|
|
HC NARROW ML PREFAB KAFO
|
Facility
|
IP
|
$1,176.00
|
|
|
Service Code
|
CPT L2526
|
| Hospital Charge Code |
905352526
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$235.20 |
| Max. Negotiated Rate |
$1,058.40 |
| Rate for Payer: Adventist Health Commercial |
$235.20
|
| Rate for Payer: Blue Shield of California Commercial |
$943.15
|
| Rate for Payer: Blue Shield of California EPN |
$592.70
|
| Rate for Payer: Cash Price |
$529.20
|
| Rate for Payer: Central Health Plan Commercial |
$940.80
|
| Rate for Payer: Cigna of CA HMO |
$823.20
|
| Rate for Payer: Cigna of CA PPO |
$823.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$823.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$470.40
|
| Rate for Payer: EPIC Health Plan Senior |
$470.40
|
| Rate for Payer: Galaxy Health WC |
$999.60
|
| Rate for Payer: Global Benefits Group Commercial |
$705.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,058.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$746.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$693.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.20
|
| Rate for Payer: Multiplan Commercial |
$882.00
|
| Rate for Payer: Networks By Design Commercial |
$764.40
|
| Rate for Payer: Prime Health Services Commercial |
$999.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$441.35
|
| Rate for Payer: United Healthcare All Other HMO |
$429.59
|
| Rate for Payer: United Healthcare HMO Rider |
$420.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$385.14
|
|
|
HC NARROW ML PREFAB KAFO
|
Facility
|
IP
|
$1,176.00
|
|
|
Service Code
|
CPT L2526
|
| Hospital Charge Code |
915352526
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$235.20 |
| Max. Negotiated Rate |
$1,058.40 |
| Rate for Payer: Adventist Health Commercial |
$235.20
|
| Rate for Payer: Blue Shield of California Commercial |
$943.15
|
| Rate for Payer: Blue Shield of California EPN |
$592.70
|
| Rate for Payer: Cash Price |
$529.20
|
| Rate for Payer: Central Health Plan Commercial |
$940.80
|
| Rate for Payer: Cigna of CA HMO |
$823.20
|
| Rate for Payer: Cigna of CA PPO |
$823.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$823.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$470.40
|
| Rate for Payer: EPIC Health Plan Senior |
$470.40
|
| Rate for Payer: Galaxy Health WC |
$999.60
|
| Rate for Payer: Global Benefits Group Commercial |
$705.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,058.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$746.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$693.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.20
|
| Rate for Payer: Multiplan Commercial |
$882.00
|
| Rate for Payer: Networks By Design Commercial |
$764.40
|
| Rate for Payer: Prime Health Services Commercial |
$999.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$441.35
|
| Rate for Payer: United Healthcare All Other HMO |
$429.59
|
| Rate for Payer: United Healthcare HMO Rider |
$420.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$385.14
|
|
|
HC NARROW ML PREFAB KAFO
|
Facility
|
OP
|
$1,176.00
|
|
|
Service Code
|
CPT L2526
|
| Hospital Charge Code |
905352526
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$344.83 |
| Max. Negotiated Rate |
$1,058.40 |
| Rate for Payer: Adventist Health Commercial |
$482.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$999.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$646.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$882.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$684.08
|
| Rate for Payer: Blue Shield of California Commercial |
$943.15
|
| Rate for Payer: Blue Shield of California EPN |
$592.70
|
| Rate for Payer: Cash Price |
$529.20
|
| Rate for Payer: Cash Price |
$529.20
|
| Rate for Payer: Central Health Plan Commercial |
$940.80
|
| Rate for Payer: Cigna of CA HMO |
$823.20
|
| Rate for Payer: Cigna of CA PPO |
$823.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$999.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$999.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$999.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$823.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$470.40
|
| Rate for Payer: EPIC Health Plan Senior |
$470.40
|
| Rate for Payer: Galaxy Health WC |
$999.60
|
| Rate for Payer: Global Benefits Group Commercial |
$705.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,058.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$344.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$746.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$380.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$693.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$482.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$823.20
|
| Rate for Payer: Multiplan Commercial |
$882.00
|
| Rate for Payer: Networks By Design Commercial |
$588.00
|
| Rate for Payer: Prime Health Services Commercial |
$999.60
|
| Rate for Payer: Riverside University Health System MISP |
$470.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$705.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$705.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$441.35
|
| Rate for Payer: United Healthcare All Other HMO |
$429.59
|
| Rate for Payer: United Healthcare HMO Rider |
$420.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$385.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$999.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$999.60
|
| Rate for Payer: Vantage Medical Group Senior |
$999.60
|
|
|
HC NARROW ML PREFAB KAFO
|
Facility
|
OP
|
$1,176.00
|
|
|
Service Code
|
CPT L2526
|
| Hospital Charge Code |
915352526
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$344.83 |
| Max. Negotiated Rate |
$1,058.40 |
| Rate for Payer: Adventist Health Commercial |
$482.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$999.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$646.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$882.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$684.08
|
| Rate for Payer: Blue Shield of California Commercial |
$943.15
|
| Rate for Payer: Blue Shield of California EPN |
$592.70
|
| Rate for Payer: Cash Price |
$529.20
|
| Rate for Payer: Cash Price |
$529.20
|
| Rate for Payer: Central Health Plan Commercial |
$940.80
|
| Rate for Payer: Cigna of CA HMO |
$823.20
|
| Rate for Payer: Cigna of CA PPO |
$823.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$999.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$999.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$999.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$823.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$470.40
|
| Rate for Payer: EPIC Health Plan Senior |
$470.40
|
| Rate for Payer: Galaxy Health WC |
$999.60
|
| Rate for Payer: Global Benefits Group Commercial |
$705.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,058.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$344.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$746.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$380.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$693.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$482.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$823.20
|
| Rate for Payer: Multiplan Commercial |
$882.00
|
| Rate for Payer: Networks By Design Commercial |
$588.00
|
| Rate for Payer: Prime Health Services Commercial |
$999.60
|
| Rate for Payer: Riverside University Health System MISP |
$470.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$705.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$705.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$441.35
|
| Rate for Payer: United Healthcare All Other HMO |
$429.59
|
| Rate for Payer: United Healthcare HMO Rider |
$420.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$385.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$999.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$999.60
|
| Rate for Payer: Vantage Medical Group Senior |
$999.60
|
|
|
HC NASAL BONES
|
Facility
|
IP
|
$1,173.00
|
|
|
Service Code
|
CPT 70160
|
| Hospital Charge Code |
909001104
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$234.60 |
| Max. Negotiated Rate |
$1,055.70 |
| Rate for Payer: Adventist Health Commercial |
$234.60
|
| Rate for Payer: Cash Price |
$527.85
|
| Rate for Payer: Central Health Plan Commercial |
$938.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$821.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$469.20
|
| Rate for Payer: EPIC Health Plan Senior |
$469.20
|
| Rate for Payer: Galaxy Health WC |
$997.05
|
| Rate for Payer: Global Benefits Group Commercial |
$703.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,055.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$744.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$692.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.60
|
| Rate for Payer: Multiplan Commercial |
$879.75
|
| Rate for Payer: Networks By Design Commercial |
$762.45
|
| Rate for Payer: Prime Health Services Commercial |
$997.05
|
|
|
HC NASAL BONES
|
Facility
|
OP
|
$1,173.00
|
|
|
Service Code
|
CPT 70160
|
| Hospital Charge Code |
909001104
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$42.64 |
| Max. Negotiated Rate |
$1,055.70 |
| Rate for Payer: Adventist Health Commercial |
$234.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$156.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$108.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$151.02
|
| Rate for Payer: Blue Shield of California Commercial |
$738.99
|
| Rate for Payer: Blue Shield of California EPN |
$465.68
|
| Rate for Payer: Cash Price |
$527.85
|
| Rate for Payer: Cash Price |
$527.85
|
| Rate for Payer: Central Health Plan Commercial |
$938.40
|
| Rate for Payer: Cigna of CA HMO |
$750.72
|
| Rate for Payer: Cigna of CA PPO |
$868.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$821.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$997.05
|
| Rate for Payer: Global Benefits Group Commercial |
$703.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,055.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$42.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$744.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$47.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$879.75
|
| Rate for Payer: Networks By Design Commercial |
$762.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.93
|
| Rate for Payer: Prime Health Services Commercial |
$997.05
|
| Rate for Payer: Prime Health Services Medicare |
$118.65
|
| Rate for Payer: Riverside University Health System MISP |
$123.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$703.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$703.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC NASAL ENDOSCOPY DIAGNOSTIC
|
Facility
|
OP
|
$1,033.00
|
|
|
Service Code
|
CPT 31231
|
| Hospital Charge Code |
900501401
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$93.37 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$423.53
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$436.49
|
| 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 |
$1,833.00
|
| 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: Cash Price |
$464.85
|
| Rate for Payer: Cash Price |
$464.85
|
| Rate for Payer: Cash Price |
$464.85
|
| Rate for Payer: Cash Price |
$464.85
|
| Rate for Payer: Central Health Plan Commercial |
$826.40
|
| Rate for Payer: Cigna of CA HMO |
$661.12
|
| Rate for Payer: Cigna of CA PPO |
$764.42
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$723.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$423.60
|
| Rate for Payer: EPIC Health Plan Senior |
$282.40
|
| Rate for Payer: Galaxy Health WC |
$878.05
|
| Rate for Payer: Global Benefits Group Commercial |
$619.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$929.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$421.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$256.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$655.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$93.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$275.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$344.02
|
| Rate for Payer: Multiplan Commercial |
$774.75
|
| Rate for Payer: Multiplan WC |
$393.03
|
| Rate for Payer: Networks By Design Commercial |
$671.45
|
| 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 Commercial |
$878.05
|
| 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: Temecula Valley Physicians Medical Group Commercial |
$619.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$619.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| 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
|
|
|
HC NASAL ENDOSCOPY DIAGNOSTIC
|
Facility
|
IP
|
$1,033.00
|
|
|
Service Code
|
CPT 31231
|
| Hospital Charge Code |
900501401
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$206.60 |
| Max. Negotiated Rate |
$929.70 |
| Rate for Payer: Adventist Health Commercial |
$206.60
|
| Rate for Payer: Cash Price |
$464.85
|
| Rate for Payer: Central Health Plan Commercial |
$826.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$723.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.20
|
| Rate for Payer: EPIC Health Plan Senior |
$413.20
|
| Rate for Payer: Galaxy Health WC |
$878.05
|
| Rate for Payer: Global Benefits Group Commercial |
$619.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$929.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$655.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$609.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.60
|
| Rate for Payer: Multiplan Commercial |
$774.75
|
| Rate for Payer: Networks By Design Commercial |
$671.45
|
| Rate for Payer: Prime Health Services Commercial |
$878.05
|
|
|
HC NASAL ENDOSCOPY DIAGNOSTIC
|
Facility
|
OP
|
$1,033.00
|
|
|
Service Code
|
CPT 31231
|
| Hospital Charge Code |
900501401
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$93.37 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$206.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| 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 |
$1,833.00
|
| 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: Cash Price |
$464.85
|
| Rate for Payer: Cash Price |
$464.85
|
| Rate for Payer: Cash Price |
$464.85
|
| Rate for Payer: Cash Price |
$464.85
|
| Rate for Payer: Central Health Plan Commercial |
$826.40
|
| Rate for Payer: Cigna of CA HMO |
$661.12
|
| Rate for Payer: Cigna of CA PPO |
$764.42
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$723.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$423.60
|
| Rate for Payer: EPIC Health Plan Senior |
$282.40
|
| Rate for Payer: Galaxy Health WC |
$878.05
|
| Rate for Payer: Global Benefits Group Commercial |
$619.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$929.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$421.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$256.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$655.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$93.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$275.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$344.02
|
| Rate for Payer: Multiplan Commercial |
$774.75
|
| Rate for Payer: Multiplan WC |
$393.03
|
| Rate for Payer: Networks By Design Commercial |
$671.45
|
| 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 Commercial |
$878.05
|
| 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: Temecula Valley Physicians Medical Group Commercial |
$619.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$516.50
|
| Rate for Payer: United Healthcare All Other HMO |
$516.50
|
| Rate for Payer: United Healthcare HMO Rider |
$516.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$516.50
|
| 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
|
|
|
HC NASAL ENDOSCOPY DIAGNOSTIC
|
Facility
|
IP
|
$1,033.00
|
|
|
Service Code
|
CPT 31231
|
| Hospital Charge Code |
900501401
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$206.60 |
| Max. Negotiated Rate |
$929.70 |
| Rate for Payer: Adventist Health Commercial |
$206.60
|
| Rate for Payer: Cash Price |
$464.85
|
| Rate for Payer: Central Health Plan Commercial |
$826.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$723.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.20
|
| Rate for Payer: EPIC Health Plan Senior |
$413.20
|
| Rate for Payer: Galaxy Health WC |
$878.05
|
| Rate for Payer: Global Benefits Group Commercial |
$619.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$929.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$655.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$609.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.60
|
| Rate for Payer: Multiplan Commercial |
$774.75
|
| Rate for Payer: Networks By Design Commercial |
$671.45
|
| Rate for Payer: Prime Health Services Commercial |
$878.05
|
|
|
HC NASAL ENDOSCOPY DIAGNOSTIC
|
Facility
|
OP
|
$898.00
|
|
|
Service Code
|
CPT 31231
|
| Hospital Charge Code |
900800914
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$84.52 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$179.60
|
| 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: Cash Price |
$404.10
|
| Rate for Payer: Cash Price |
$404.10
|
| Rate for Payer: Cash Price |
$404.10
|
| Rate for Payer: Central Health Plan Commercial |
$718.40
|
| Rate for Payer: Cigna of CA HMO |
$574.72
|
| Rate for Payer: Cigna of CA PPO |
$664.52
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$628.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$423.60
|
| Rate for Payer: EPIC Health Plan Senior |
$282.40
|
| Rate for Payer: Galaxy Health WC |
$763.30
|
| Rate for Payer: Global Benefits Group Commercial |
$538.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$808.20
|
| 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 Commercial/Self Funded |
$570.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$93.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$359.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$179.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$344.02
|
| Rate for Payer: Multiplan Commercial |
$673.50
|
| Rate for Payer: Multiplan WC |
$393.03
|
| Rate for Payer: Networks By Design Commercial |
$583.70
|
| 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 Commercial |
$763.30
|
| 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: Temecula Valley Physicians Medical Group Commercial |
$538.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$449.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$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
|
|
|
HC NASAL ENDOSCOPY DIAGNOSTIC
|
Facility
|
IP
|
$898.00
|
|
|
Service Code
|
CPT 31231
|
| Hospital Charge Code |
900800914
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$179.60 |
| Max. Negotiated Rate |
$808.20 |
| Rate for Payer: Adventist Health Commercial |
$179.60
|
| Rate for Payer: Cash Price |
$404.10
|
| Rate for Payer: Central Health Plan Commercial |
$718.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$628.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$359.20
|
| Rate for Payer: EPIC Health Plan Senior |
$359.20
|
| Rate for Payer: Galaxy Health WC |
$763.30
|
| Rate for Payer: Global Benefits Group Commercial |
$538.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$808.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$570.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$529.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$179.60
|
| Rate for Payer: Multiplan Commercial |
$673.50
|
| Rate for Payer: Networks By Design Commercial |
$583.70
|
| Rate for Payer: Prime Health Services Commercial |
$763.30
|
|
|
HC NASAL ENDOSCOPY W/CONT HEMORRH
|
Facility
|
OP
|
$10,066.00
|
|
|
Service Code
|
CPT 31238
|
| Hospital Charge Code |
900501753
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$331.06 |
| Max. Negotiated Rate |
$9,059.40 |
| Rate for Payer: Adventist Health Commercial |
$2,013.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| 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 |
$1,833.00
|
| 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: Cash Price |
$4,529.70
|
| Rate for Payer: Cash Price |
$4,529.70
|
| Rate for Payer: Cash Price |
$4,529.70
|
| Rate for Payer: Cash Price |
$4,529.70
|
| Rate for Payer: Central Health Plan Commercial |
$8,052.80
|
| Rate for Payer: Cigna of CA HMO |
$6,442.24
|
| Rate for Payer: Cigna of CA PPO |
$7,448.84
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,046.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,777.26
|
| Rate for Payer: EPIC Health Plan Senior |
$2,518.18
|
| Rate for Payer: Galaxy Health WC |
$8,556.10
|
| Rate for Payer: Global Benefits Group Commercial |
$6,039.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,059.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,754.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,289.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,391.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$331.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,460.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,013.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,067.59
|
| Rate for Payer: Multiplan Commercial |
$7,549.50
|
| Rate for Payer: Multiplan WC |
$3,491.15
|
| Rate for Payer: Networks By Design Commercial |
$6,542.90
|
| 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 Commercial |
$8,556.10
|
| 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: Temecula Valley Physicians Medical Group Commercial |
$6,039.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,033.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,033.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,033.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,033.00
|
| 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
|
|
|
HC NASAL ENDOSCOPY W/CONT HEMORRH
|
Facility
|
IP
|
$10,066.00
|
|
|
Service Code
|
CPT 31238
|
| Hospital Charge Code |
900501753
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,013.20 |
| Max. Negotiated Rate |
$9,059.40 |
| Rate for Payer: Adventist Health Commercial |
$2,013.20
|
| Rate for Payer: Cash Price |
$4,529.70
|
| Rate for Payer: Central Health Plan Commercial |
$8,052.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,046.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,026.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,026.40
|
| Rate for Payer: Galaxy Health WC |
$8,556.10
|
| Rate for Payer: Global Benefits Group Commercial |
$6,039.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,059.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,391.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,938.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,013.20
|
| Rate for Payer: Multiplan Commercial |
$7,549.50
|
| Rate for Payer: Networks By Design Commercial |
$6,542.90
|
| Rate for Payer: Prime Health Services Commercial |
$8,556.10
|
|
|
HC NASAL I&D OF ABSCESS
|
Facility
|
IP
|
$1,862.00
|
|
|
Service Code
|
CPT 30000
|
| Hospital Charge Code |
902890339
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$372.40 |
| Max. Negotiated Rate |
$1,675.80 |
| Rate for Payer: Adventist Health Commercial |
$372.40
|
| Rate for Payer: Cash Price |
$837.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,489.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,303.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$744.80
|
| Rate for Payer: EPIC Health Plan Senior |
$744.80
|
| Rate for Payer: Galaxy Health WC |
$1,582.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,117.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,675.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,182.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,098.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$372.40
|
| Rate for Payer: Multiplan Commercial |
$1,396.50
|
| Rate for Payer: Networks By Design Commercial |
$1,210.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,582.70
|
|
|
HC NASAL I&D OF ABSCESS
|
Facility
|
IP
|
$1,862.00
|
|
|
Service Code
|
CPT 30000
|
| Hospital Charge Code |
902890339
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$372.40 |
| Max. Negotiated Rate |
$1,675.80 |
| Rate for Payer: Adventist Health Commercial |
$372.40
|
| Rate for Payer: Cash Price |
$837.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,489.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,303.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$744.80
|
| Rate for Payer: EPIC Health Plan Senior |
$744.80
|
| Rate for Payer: Galaxy Health WC |
$1,582.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,117.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,675.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,182.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,098.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$372.40
|
| Rate for Payer: Multiplan Commercial |
$1,396.50
|
| Rate for Payer: Networks By Design Commercial |
$1,210.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,582.70
|
|
|
HC NASAL I&D OF ABSCESS
|
Facility
|
OP
|
$1,862.00
|
|
|
Service Code
|
CPT 30000
|
| Hospital Charge Code |
902890339
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$118.12 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$372.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$470.13
|
| Rate for Payer: Cash Price |
$837.90
|
| Rate for Payer: Cash Price |
$837.90
|
| Rate for Payer: Cash Price |
$837.90
|
| Rate for Payer: Cash Price |
$837.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,489.60
|
| Rate for Payer: Cigna of CA HMO |
$1,191.68
|
| Rate for Payer: Cigna of CA PPO |
$1,377.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$456.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,303.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$502.64
|
| Rate for Payer: EPIC Health Plan Senior |
$335.09
|
| Rate for Payer: Galaxy Health WC |
$1,582.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,117.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,675.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$499.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,182.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$118.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$327.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$372.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$408.20
|
| Rate for Payer: Multiplan Commercial |
$1,396.50
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: Networks By Design Commercial |
$1,210.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$304.63
|
| Rate for Payer: Preferred Health Network WC |
$479.72
|
| Rate for Payer: Prime Health Services Commercial |
$1,582.70
|
| Rate for Payer: Prime Health Services Medicare |
$322.91
|
| Rate for Payer: Prime Health Services WC |
$465.33
|
| Rate for Payer: Riverside University Health System MISP |
$335.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,117.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$931.00
|
| Rate for Payer: United Healthcare All Other HMO |
$931.00
|
| Rate for Payer: United Healthcare HMO Rider |
$931.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$931.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$304.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Vantage Medical Group Senior |
$304.63
|
|
|
HC NASAL I&D OF ABSCESS
|
Facility
|
OP
|
$1,862.00
|
|
|
Service Code
|
CPT 30000
|
| Hospital Charge Code |
902890339
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$118.12 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$763.42
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$673.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$470.13
|
| Rate for Payer: Cash Price |
$837.90
|
| Rate for Payer: Cash Price |
$837.90
|
| Rate for Payer: Cash Price |
$837.90
|
| Rate for Payer: Cash Price |
$837.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,489.60
|
| Rate for Payer: Cigna of CA HMO |
$1,191.68
|
| Rate for Payer: Cigna of CA PPO |
$1,377.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$456.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,303.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$502.64
|
| Rate for Payer: EPIC Health Plan Senior |
$335.09
|
| Rate for Payer: Galaxy Health WC |
$1,582.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,117.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,675.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$499.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,182.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$118.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$327.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$372.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$408.20
|
| Rate for Payer: Multiplan Commercial |
$1,396.50
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: Networks By Design Commercial |
$1,210.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$304.63
|
| Rate for Payer: Preferred Health Network WC |
$479.72
|
| Rate for Payer: Prime Health Services Commercial |
$1,582.70
|
| Rate for Payer: Prime Health Services Medicare |
$322.91
|
| Rate for Payer: Prime Health Services WC |
$465.33
|
| Rate for Payer: Riverside University Health System MISP |
$335.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,117.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,117.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$304.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Vantage Medical Group Senior |
$304.63
|
|
|
HC NASOGASTRIC CORTRAK EAS
|
Facility
|
OP
|
$433.55
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901606374
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.24 |
| Max. Negotiated Rate |
$390.19 |
| Rate for Payer: Adventist Health Commercial |
$86.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$64.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$368.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$238.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$325.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$209.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$252.20
|
| Rate for Payer: Blue Shield of California Commercial |
$274.87
|
| Rate for Payer: Blue Shield of California EPN |
$172.99
|
| Rate for Payer: Cash Price |
$195.10
|
| Rate for Payer: Cash Price |
$195.10
|
| Rate for Payer: Central Health Plan Commercial |
$346.84
|
| Rate for Payer: Cigna of CA HMO |
$277.47
|
| Rate for Payer: Cigna of CA PPO |
$320.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$368.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$368.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$368.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$303.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$173.42
|
| Rate for Payer: EPIC Health Plan Senior |
$173.42
|
| Rate for Payer: Galaxy Health WC |
$368.52
|
| Rate for Payer: Global Benefits Group Commercial |
$260.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$390.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$275.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$157.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$255.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$303.49
|
| Rate for Payer: Multiplan Commercial |
$325.16
|
| Rate for Payer: Networks By Design Commercial |
$281.81
|
| Rate for Payer: Prime Health Services Commercial |
$368.52
|
| Rate for Payer: Riverside University Health System MISP |
$173.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$260.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$260.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$216.78
|
| Rate for Payer: United Healthcare All Other HMO |
$216.78
|
| Rate for Payer: United Healthcare HMO Rider |
$216.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$216.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$368.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$368.52
|
| Rate for Payer: Vantage Medical Group Senior |
$368.52
|
|
|
HC NASOGASTRIC CORTRAK EAS
|
Facility
|
IP
|
$433.55
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901606374
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$86.71 |
| Max. Negotiated Rate |
$390.19 |
| Rate for Payer: Adventist Health Commercial |
$86.71
|
| Rate for Payer: Cash Price |
$195.10
|
| Rate for Payer: Central Health Plan Commercial |
$346.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$303.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$173.42
|
| Rate for Payer: EPIC Health Plan Senior |
$173.42
|
| Rate for Payer: Galaxy Health WC |
$368.52
|
| Rate for Payer: Global Benefits Group Commercial |
$260.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$390.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$275.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$255.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.71
|
| Rate for Payer: Multiplan Commercial |
$325.16
|
| Rate for Payer: Networks By Design Commercial |
$281.81
|
| Rate for Payer: Prime Health Services Commercial |
$368.52
|
|
|
HC NASO/ORGSTRC TUBE PLCM FS GDNC
|
Facility
|
OP
|
$811.00
|
|
|
Service Code
|
CPT 43752
|
| Hospital Charge Code |
906743752
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$162.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$162.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$574.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$574.56
|
| 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 |
$807.84
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$364.95
|
| Rate for Payer: Cash Price |
$364.95
|
| Rate for Payer: Cash Price |
$364.95
|
| Rate for Payer: Central Health Plan Commercial |
$648.80
|
| Rate for Payer: Cigna of CA HMO |
$519.04
|
| Rate for Payer: Cigna of CA PPO |
$600.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$861.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$632.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$574.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$567.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$948.02
|
| Rate for Payer: EPIC Health Plan Senior |
$632.02
|
| Rate for Payer: Galaxy Health WC |
$689.35
|
| Rate for Payer: Global Benefits Group Commercial |
$486.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$729.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$942.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$223.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$574.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$514.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$246.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$804.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$769.91
|
| Rate for Payer: Multiplan Commercial |
$608.25
|
| Rate for Payer: Multiplan WC |
$807.84
|
| Rate for Payer: Networks By Design Commercial |
$527.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$574.56
|
| Rate for Payer: Preferred Health Network WC |
$824.33
|
| Rate for Payer: Prime Health Services Commercial |
$689.35
|
| Rate for Payer: Prime Health Services Medicare |
$609.03
|
| Rate for Payer: Prime Health Services WC |
$799.60
|
| Rate for Payer: Riverside University Health System MISP |
$632.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$486.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$405.50
|
| 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 |
$574.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Vantage Medical Group Senior |
$574.56
|
|
|
HC NASO/ORGSTRC TUBE PLCM FS GDNC
|
Facility
|
OP
|
$811.00
|
|
|
Service Code
|
CPT 43752
|
| Hospital Charge Code |
906743752
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$162.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$162.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$574.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$574.56
|
| 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: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$364.95
|
| Rate for Payer: Cash Price |
$364.95
|
| Rate for Payer: Cash Price |
$364.95
|
| Rate for Payer: Central Health Plan Commercial |
$648.80
|
| Rate for Payer: Cigna of CA HMO |
$519.04
|
| Rate for Payer: Cigna of CA PPO |
$600.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$861.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$632.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$574.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$567.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$948.02
|
| Rate for Payer: EPIC Health Plan Senior |
$632.02
|
| Rate for Payer: Galaxy Health WC |
$689.35
|
| Rate for Payer: Global Benefits Group Commercial |
$486.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$729.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$942.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$223.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$574.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$514.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$246.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$804.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$769.91
|
| Rate for Payer: Multiplan Commercial |
$608.25
|
| Rate for Payer: Networks By Design Commercial |
$527.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$574.56
|
| Rate for Payer: Prime Health Services Commercial |
$689.35
|
| Rate for Payer: Prime Health Services Medicare |
$609.03
|
| Rate for Payer: Riverside University Health System MISP |
$632.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$486.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$689.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$405.50
|
| 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 |
$574.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Vantage Medical Group Senior |
$574.56
|
|
|
HC NASO/ORGSTRC TUBE PLCM FS GDNC
|
Facility
|
IP
|
$811.00
|
|
|
Service Code
|
CPT 43752
|
| Hospital Charge Code |
906743752
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$162.20 |
| Max. Negotiated Rate |
$729.90 |
| Rate for Payer: Adventist Health Commercial |
$162.20
|
| Rate for Payer: Cash Price |
$364.95
|
| Rate for Payer: Central Health Plan Commercial |
$648.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$567.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$324.40
|
| Rate for Payer: EPIC Health Plan Senior |
$324.40
|
| Rate for Payer: Galaxy Health WC |
$689.35
|
| Rate for Payer: Global Benefits Group Commercial |
$486.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$729.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$514.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$478.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.20
|
| Rate for Payer: Multiplan Commercial |
$608.25
|
| Rate for Payer: Networks By Design Commercial |
$527.15
|
| Rate for Payer: Prime Health Services Commercial |
$689.35
|
|
