|
HC NARROW ML BRIM KAFO
|
Facility
|
OP
|
$2,855.00
|
|
|
Service Code
|
CPT L2525
|
| Hospital Charge Code |
915352525
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$714.69 |
| Max. Negotiated Rate |
$2,569.50 |
| Rate for Payer: Adventist Health Commercial |
$1,170.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,426.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,570.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,141.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,676.74
|
| Rate for Payer: Blue Shield of California Commercial |
$2,206.91
|
| Rate for Payer: Blue Shield of California EPN |
$1,438.92
|
| Rate for Payer: Cash Price |
$1,570.25
|
| Rate for Payer: Cash Price |
$1,570.25
|
| 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: Dignity Health Commercial/Exchange |
$2,426.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,426.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,426.75
|
| 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: Inland Empire Health Plan (IEHP) medi-cal |
$714.69
|
| Rate for Payer: InnovAge PACE Commercial |
$1,427.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,904.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$789.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,767.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,170.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,998.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,998.50
|
| Rate for Payer: Multiplan Commercial |
$2,141.25
|
| Rate for Payer: Networks By Design Commercial |
$1,427.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,426.75
|
| Rate for Payer: Riverside University Health System MISP |
$1,142.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,713.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,713.00
|
| 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
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,426.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,426.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2,426.75
|
|
|
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 |
$2,206.91
|
| Rate for Payer: Blue Shield of California EPN |
$1,438.92
|
| Rate for Payer: Cash Price |
$1,570.25
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$1,904.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,087.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,767.24
|
| 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 |
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 |
$2,206.91
|
| Rate for Payer: Blue Shield of California EPN |
$1,438.92
|
| Rate for Payer: Cash Price |
$1,570.25
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$1,904.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,087.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,767.24
|
| 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 |
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 |
$909.05
|
| Rate for Payer: Blue Shield of California EPN |
$592.70
|
| Rate for Payer: Cash Price |
$646.80
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$784.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$448.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$727.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 |
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 |
$690.66
|
| Rate for Payer: Blue Shield of California Commercial |
$909.05
|
| Rate for Payer: Blue Shield of California EPN |
$592.70
|
| Rate for Payer: Cash Price |
$646.80
|
| Rate for Payer: Cash Price |
$646.80
|
| 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: 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: InnovAge PACE Commercial |
$588.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$784.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$380.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$727.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$482.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$823.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$823.20
|
| Rate for Payer: Multiplan Commercial |
$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 |
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 |
$690.66
|
| Rate for Payer: Blue Shield of California Commercial |
$909.05
|
| Rate for Payer: Blue Shield of California EPN |
$592.70
|
| Rate for Payer: Cash Price |
$646.80
|
| Rate for Payer: Cash Price |
$646.80
|
| 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: 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: InnovAge PACE Commercial |
$588.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$784.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$380.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$727.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$482.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$823.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$823.20
|
| Rate for Payer: Multiplan Commercial |
$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
|
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 |
$909.05
|
| Rate for Payer: Blue Shield of California EPN |
$592.70
|
| Rate for Payer: Cash Price |
$646.80
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$784.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$448.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$727.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 NASAL BONES
|
Facility
|
OP
|
$1,173.00
|
|
|
Service Code
|
CPT 70160
|
| Hospital Charge Code |
909001104
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$22.05 |
| Max. Negotiated Rate |
$1,055.70 |
| Rate for Payer: Adventist Health Commercial |
$234.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$712.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$108.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.05
|
| Rate for Payer: Blue Shield of California Commercial |
$712.01
|
| Rate for Payer: Blue Shield of California EPN |
$465.68
|
| Rate for Payer: Cash Price |
$645.15
|
| Rate for Payer: Cash Price |
$645.15
|
| 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 |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$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 |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$42.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: InnovAge PACE Commercial |
$167.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$782.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| 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 |
$111.88
|
| Rate for Payer: Prime Health Services Commercial |
$997.05
|
| Rate for Payer: Prime Health Services Medicare |
$118.59
|
| Rate for Payer: Riverside University Health System MISP |
$123.07
|
| 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 |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC NASAL 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 |
$645.15
|
| Rate for Payer: Central Health Plan Commercial |
$938.40
|
| 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 Permanente of CA Commercial/Self Funded |
$782.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$446.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$726.09
|
| 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 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 |
$6,248.00 |
| 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 |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$370.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$271.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$246.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$393.03
|
| Rate for Payer: Cash Price |
$568.15
|
| Rate for Payer: Cash Price |
$568.15
|
| Rate for Payer: Cash Price |
$568.15
|
| Rate for Payer: Cash Price |
$568.15
|
| 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 |
$370.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$271.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$246.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$333.00
|
| Rate for Payer: EPIC Health Plan Senior |
$246.67
|
| Rate for Payer: Galaxy Health WC |
$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 |
$404.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$246.67
|
| Rate for Payer: InnovAge PACE Commercial |
$370.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$689.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$246.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$330.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$330.54
|
| 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 |
$246.67
|
| 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 |
$261.47
|
| Rate for Payer: Prime Health Services WC |
$389.02
|
| Rate for Payer: Riverside University Health System MISP |
$271.34
|
| 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 |
$246.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$370.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$271.34
|
| Rate for Payer: Vantage Medical Group Senior |
$246.67
|
|
|
HC NASAL ENDOSCOPY DIAGNOSTIC
|
Facility
|
IP
|
$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 |
$568.15
|
| Rate for Payer: Central Health Plan Commercial |
$826.40
|
| 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 Permanente of CA Commercial/Self Funded |
$689.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$393.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$639.43
|
| 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
|
456
|
| Min. Negotiated Rate |
$93.37 |
| Max. Negotiated Rate |
$6,248.00 |
| 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 |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$370.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$271.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$246.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$606.68
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$393.03
|
| Rate for Payer: Cash Price |
$568.15
|
| Rate for Payer: Cash Price |
$568.15
|
| Rate for Payer: Cash Price |
$568.15
|
| Rate for Payer: Cash Price |
$568.15
|
| 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 |
$370.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$271.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$246.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$333.00
|
| Rate for Payer: EPIC Health Plan Senior |
$246.67
|
| Rate for Payer: Galaxy Health WC |
$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 |
$404.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$246.67
|
| Rate for Payer: InnovAge PACE Commercial |
$370.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$689.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$246.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$330.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$330.54
|
| 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 |
$246.67
|
| 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 |
$261.47
|
| Rate for Payer: Prime Health Services WC |
$389.02
|
| Rate for Payer: Riverside University Health System MISP |
$271.34
|
| 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 |
$246.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$370.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$271.34
|
| Rate for Payer: Vantage Medical Group Senior |
$246.67
|
|
|
HC NASAL ENDOSCOPY DIAGNOSTIC
|
Facility
|
IP
|
$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 |
$568.15
|
| Rate for Payer: Central Health Plan Commercial |
$826.40
|
| 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 Permanente of CA Commercial/Self Funded |
$689.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$393.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$639.43
|
| 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
|
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 |
$493.90
|
| Rate for Payer: Central Health Plan Commercial |
$718.40
|
| 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 Permanente of CA Commercial/Self Funded |
$598.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$342.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$555.86
|
| 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 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 |
$6,248.00 |
| Rate for Payer: Adventist Health Commercial |
$179.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$246.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$370.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$271.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$246.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$434.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$527.40
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$393.03
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$493.90
|
| Rate for Payer: Cash Price |
$493.90
|
| Rate for Payer: Cash Price |
$493.90
|
| 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 |
$370.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$271.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$246.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$333.00
|
| Rate for Payer: EPIC Health Plan Senior |
$246.67
|
| Rate for Payer: Galaxy Health WC |
$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 |
$404.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$84.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$246.67
|
| Rate for Payer: InnovAge PACE Commercial |
$370.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$598.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$246.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$179.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$330.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$330.54
|
| 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 |
$246.67
|
| 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 |
$261.47
|
| Rate for Payer: Prime Health Services WC |
$389.02
|
| Rate for Payer: Riverside University Health System MISP |
$271.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$538.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$246.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$370.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$271.34
|
| Rate for Payer: Vantage Medical Group Senior |
$246.67
|
|
|
HC NASAL ENDOSCOPY 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 |
$5,536.30
|
| Rate for Payer: Central Health Plan Commercial |
$8,052.80
|
| 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 Permanente of CA Commercial/Self Funded |
$6,714.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,835.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,230.85
|
| 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 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 |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,286.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,410.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,191.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,491.15
|
| Rate for Payer: Cash Price |
$5,536.30
|
| Rate for Payer: Cash Price |
$5,536.30
|
| Rate for Payer: Cash Price |
$5,536.30
|
| Rate for Payer: Cash Price |
$5,536.30
|
| 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 |
$3,286.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,410.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,191.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,958.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,191.11
|
| Rate for Payer: Galaxy Health WC |
$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 |
$3,593.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,191.11
|
| Rate for Payer: InnovAge PACE Commercial |
$3,286.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,714.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$331.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,191.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,013.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,936.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,936.09
|
| 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 |
$2,191.11
|
| 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 |
$2,322.58
|
| Rate for Payer: Prime Health Services WC |
$3,455.53
|
| Rate for Payer: Riverside University Health System MISP |
$2,410.22
|
| 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 |
$2,191.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,286.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,410.22
|
| Rate for Payer: Vantage Medical Group Senior |
$2,191.11
|
|
|
HC NASAL 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 |
$1,024.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,489.60
|
| 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 Permanente of CA Commercial/Self Funded |
$1,241.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$709.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,152.58
|
| 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 |
$2,901.00 |
| 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 |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$295.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$470.13
|
| Rate for Payer: Cash Price |
$1,024.10
|
| Rate for Payer: Cash Price |
$1,024.10
|
| Rate for Payer: Cash Price |
$1,024.10
|
| Rate for Payer: Cash Price |
$1,024.10
|
| 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 |
$442.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$295.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.33
|
| Rate for Payer: EPIC Health Plan Senior |
$295.06
|
| Rate for Payer: Galaxy Health WC |
$1,582.70
|
| 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 |
$483.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$295.06
|
| Rate for Payer: InnovAge PACE Commercial |
$442.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,241.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$372.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$395.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$395.38
|
| 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 |
$295.06
|
| 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 |
$312.76
|
| Rate for Payer: Prime Health Services WC |
$465.33
|
| Rate for Payer: Riverside University Health System MISP |
$324.57
|
| 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 |
$295.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Vantage Medical Group Senior |
$295.06
|
|
|
HC NASAL I&D OF ABSCESS
|
Facility
|
OP
|
$1,862.00
|
|
|
Service Code
|
CPT 30000
|
| Hospital Charge Code |
902890339
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$118.12 |
| Max. Negotiated Rate |
$5,311.00 |
| 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 |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$295.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$470.13
|
| Rate for Payer: Cash Price |
$1,024.10
|
| Rate for Payer: Cash Price |
$1,024.10
|
| Rate for Payer: Cash Price |
$1,024.10
|
| Rate for Payer: Cash Price |
$1,024.10
|
| 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 |
$442.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$295.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.33
|
| Rate for Payer: EPIC Health Plan Senior |
$295.06
|
| Rate for Payer: Galaxy Health WC |
$1,582.70
|
| 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 |
$483.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$295.06
|
| Rate for Payer: InnovAge PACE Commercial |
$442.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,241.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$372.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$395.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$395.38
|
| 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 |
$295.06
|
| 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 |
$312.76
|
| Rate for Payer: Prime Health Services WC |
$465.33
|
| Rate for Payer: Riverside University Health System MISP |
$324.57
|
| 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 |
$295.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Vantage Medical Group Senior |
$295.06
|
|
|
HC NASAL I&D OF ABSCESS
|
Facility
|
IP
|
$1,862.00
|
|
|
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 |
$1,024.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,489.60
|
| 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 Permanente of CA Commercial/Self Funded |
$1,241.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$709.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,152.58
|
| 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 NASOGASTRIC CORTRAK EAS
|
Facility
|
OP
|
$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: Aetna of CA HMO/PPO |
$263.29
|
| 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 |
$254.62
|
| Rate for Payer: Blue Shield of California Commercial |
$264.90
|
| Rate for Payer: Blue Shield of California EPN |
$172.99
|
| Rate for Payer: Cash Price |
$238.45
|
| 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: 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: InnovAge PACE Commercial |
$216.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$289.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$268.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$303.49
|
| Rate for Payer: Molina Healthcare of CA 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 |
$238.45
|
| Rate for Payer: Central Health Plan Commercial |
$346.84
|
| 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 Permanente of CA Commercial/Self Funded |
$289.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$268.37
|
| 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 |
$6,248.00 |
| Rate for Payer: Adventist Health Commercial |
$162.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$507.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$392.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$476.30
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$807.84
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$446.05
|
| Rate for Payer: Cash Price |
$446.05
|
| Rate for Payer: Cash Price |
$446.05
|
| 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 |
$760.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$557.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$684.48
|
| Rate for Payer: EPIC Health Plan Senior |
$507.02
|
| Rate for Payer: Galaxy Health WC |
$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 |
$831.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$223.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.02
|
| Rate for Payer: InnovAge PACE Commercial |
$760.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$540.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$246.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$679.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$679.41
|
| 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 |
$507.02
|
| 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 |
$537.44
|
| Rate for Payer: Prime Health Services WC |
$799.60
|
| Rate for Payer: Riverside University Health System MISP |
$557.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$486.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$507.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Vantage Medical Group Senior |
$507.02
|
|
|
HC NASO/ORGSTRC TUBE PLCM FS GDNC
|
Facility
|
IP
|
$811.00
|
|
|
Service Code
|
CPT 43752
|
| Hospital Charge Code |
906743752
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$162.20 |
| Max. Negotiated Rate |
$729.90 |
| Rate for Payer: Adventist Health Commercial |
$162.20
|
| Rate for Payer: Cash Price |
$446.05
|
| Rate for Payer: Central Health Plan Commercial |
$648.80
|
| 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 Permanente of CA Commercial/Self Funded |
$540.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$308.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$502.01
|
| 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
|
|
