|
HC MYOCARDIAL STRAIN IMAGING
|
Facility
OP
|
$2,434.00
|
|
|
Service Code
|
CPT 93356
|
| Hospital Charge Code |
900200356
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$71.24 |
| Max. Negotiated Rate |
$2,190.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$71.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,068.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,338.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,338.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$282.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,438.01
|
| Rate for Payer: BCBS Transplant Transplant |
$1,460.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,504.21
|
| Rate for Payer: Blue Shield of California EPN |
$1,182.92
|
| Rate for Payer: Cash Price |
$1,095.30
|
| Rate for Payer: Cash Price |
$1,095.30
|
| Rate for Payer: Cash Price |
$1,095.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,947.20
|
| Rate for Payer: Cigna of CA HMO |
$1,557.76
|
| Rate for Payer: Cigna of CA PPO |
$1,801.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,068.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$973.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$973.60
|
| Rate for Payer: Galaxy Health WC |
$2,068.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,460.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,190.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,825.50
|
| Rate for Payer: IEHP medi-cal |
$851.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,623.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$486.80
|
| Rate for Payer: Multiplan Commercial |
$1,825.50
|
| Rate for Payer: Networks By Design Commercial |
$1,582.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,068.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,460.40
|
| Rate for Payer: Riverside University Health MISP |
$973.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,460.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,460.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$919.00
|
| Rate for Payer: United Healthcare All Other HMO |
$935.00
|
| Rate for Payer: United Healthcare HMO Rider |
$792.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$724.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,068.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,068.90
|
|
|
HC MYOCARD INFAR/PYP
|
Facility
IP
|
$1,606.00
|
|
|
Service Code
|
CPT 78466
|
| Hospital Charge Code |
909301382
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$321.20 |
| Max. Negotiated Rate |
$1,445.40 |
| Rate for Payer: Cash Price |
$722.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,284.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$642.40
|
| Rate for Payer: Galaxy Health WC |
$1,365.10
|
| Rate for Payer: Global Benefits Group Commercial |
$963.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,445.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,071.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.20
|
| Rate for Payer: Multiplan Commercial |
$1,204.50
|
| Rate for Payer: Networks By Design Commercial |
$1,043.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,365.10
|
|
|
HC MYOCARD INFAR/PYP
|
Facility
OP
|
$1,606.00
|
|
|
Service Code
|
CPT 78466
|
| Hospital Charge Code |
909301382
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$321.20 |
| Max. Negotiated Rate |
$1,445.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$515.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$816.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$546.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$948.82
|
| Rate for Payer: BCBS Transplant Transplant |
$963.60
|
| Rate for Payer: Blue Shield of California Commercial |
$992.51
|
| Rate for Payer: Blue Shield of California EPN |
$780.52
|
| Rate for Payer: Caremore Medicare Advantage |
$515.32
|
| Rate for Payer: Cash Price |
$722.70
|
| Rate for Payer: Cash Price |
$722.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,284.80
|
| Rate for Payer: Cigna of CA HMO |
$1,027.84
|
| Rate for Payer: Cigna of CA PPO |
$1,188.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$695.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$515.32
|
| Rate for Payer: Galaxy Health WC |
$1,365.10
|
| Rate for Payer: Global Benefits Group Commercial |
$963.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,445.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,204.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$845.12
|
| Rate for Payer: IEHP medi-cal |
$850.28
|
| Rate for Payer: IEHP Medicare Advantage |
$515.32
|
| Rate for Payer: Innovage PACE Commercial |
$772.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,071.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$690.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$690.53
|
| Rate for Payer: Multiplan Commercial |
$1,204.50
|
| Rate for Payer: Networks By Design Commercial |
$1,043.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,365.10
|
| Rate for Payer: Prime Health Services Medicare |
$546.24
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$963.60
|
| Rate for Payer: Riverside University Health MISP |
$566.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$963.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$963.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$761.81
|
| Rate for Payer: United Healthcare All Other HMO |
$761.81
|
| Rate for Payer: United Healthcare HMO Rider |
$761.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$761.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC MYOFACIAL RELEASE SOFT TISSUE OT
|
Facility
OP
|
$322.00
|
|
|
Service Code
|
CPT 97250
|
| Hospital Charge Code |
905104148
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$112.70 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$195.55
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$273.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$177.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$177.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$193.20
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Central Health Plan Commercial |
$257.60
|
| Rate for Payer: Cigna of CA HMO |
$206.08
|
| Rate for Payer: Cigna of CA PPO |
$238.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$273.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$128.80
|
| Rate for Payer: Galaxy Health WC |
$273.70
|
| Rate for Payer: Global Benefits Group Commercial |
$193.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$289.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$241.50
|
| Rate for Payer: IEHP medi-cal |
$112.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$214.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.02
|
| Rate for Payer: Multiplan Commercial |
$241.50
|
| Rate for Payer: Networks By Design Commercial |
$209.30
|
| Rate for Payer: Prime Health Services Commercial |
$273.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$193.20
|
| Rate for Payer: Riverside University Health MISP |
$128.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$193.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$193.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$273.70
|
| Rate for Payer: Vantage Medical Group Senior |
$273.70
|
|
|
HC MYOFACIAL RELEASE SOFT TISSUE OT
|
Facility
IP
|
$322.00
|
|
|
Service Code
|
CPT 97250
|
| Hospital Charge Code |
905104148
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$64.40 |
| Max. Negotiated Rate |
$289.80 |
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Central Health Plan Commercial |
$257.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.80
|
| Rate for Payer: Galaxy Health WC |
$273.70
|
| Rate for Payer: Global Benefits Group Commercial |
$193.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$289.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$214.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.40
|
| Rate for Payer: Multiplan Commercial |
$241.50
|
| Rate for Payer: Networks By Design Commercial |
$209.30
|
| Rate for Payer: Prime Health Services Commercial |
$273.70
|
|
|
HC MYOGLOBIN SCREEN
|
Facility
IP
|
$98.00
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
900910387
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Central Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.20
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$88.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.60
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
|
|
HC MYOGLOBIN SCREEN
|
Facility
OP
|
$11.00
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
900910387
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.83 |
| Max. Negotiated Rate |
$19.95 |
| Rate for Payer: Adventist Health Medi-Cal |
$2.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.95
|
| Rate for Payer: BCBS Transplant Transplant |
$6.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6.80
|
| Rate for Payer: Blue Shield of California EPN |
$5.35
|
| Rate for Payer: Caremore Medicare Advantage |
$2.25
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Central Health Plan Commercial |
$8.80
|
| Rate for Payer: Cigna of CA HMO |
$7.04
|
| Rate for Payer: Cigna of CA PPO |
$8.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.04
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2.25
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.25
|
| Rate for Payer: Galaxy Health WC |
$9.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3.69
|
| Rate for Payer: IEHP medi-cal |
$3.71
|
| Rate for Payer: IEHP Medicare Advantage |
$2.25
|
| Rate for Payer: Innovage PACE Commercial |
$3.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.02
|
| Rate for Payer: Multiplan Commercial |
$8.25
|
| Rate for Payer: Networks By Design Commercial |
$7.15
|
| Rate for Payer: Prime Health Services Commercial |
$9.35
|
| Rate for Payer: Prime Health Services Medicare |
$2.38
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.60
|
| Rate for Payer: Riverside University Health MISP |
$2.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.83
|
| Rate for Payer: United Healthcare All Other HMO |
$1.83
|
| Rate for Payer: United Healthcare HMO Rider |
$1.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.48
|
| Rate for Payer: Vantage Medical Group Senior |
$2.25
|
|
|
HC MYOGLOBIN (SERUM)
|
Facility
OP
|
$20.00
|
|
|
Service Code
|
CPT 83874
|
| Hospital Charge Code |
900910825
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$114.94 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.21
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$94.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.94
|
| Rate for Payer: BCBS Transplant Transplant |
$12.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12.36
|
| Rate for Payer: Blue Shield of California EPN |
$9.72
|
| Rate for Payer: Caremore Medicare Advantage |
$12.92
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.92
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$15.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.19
|
| Rate for Payer: IEHP medi-cal |
$21.32
|
| Rate for Payer: IEHP Medicare Advantage |
$12.92
|
| Rate for Payer: Innovage PACE Commercial |
$19.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.31
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Prime Health Services Medicare |
$13.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: Riverside University Health MISP |
$14.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.47
|
| Rate for Payer: United Healthcare All Other HMO |
$10.47
|
| Rate for Payer: United Healthcare HMO Rider |
$10.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.21
|
| Rate for Payer: Vantage Medical Group Senior |
$12.92
|
|
|
HC MYOGLOBIN (SERUM)
|
Facility
IP
|
$218.00
|
|
|
Service Code
|
CPT 83874
|
| Hospital Charge Code |
900910825
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.60 |
| Max. Negotiated Rate |
$196.20 |
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Central Health Plan Commercial |
$174.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.20
|
| Rate for Payer: Galaxy Health WC |
$185.30
|
| Rate for Payer: Global Benefits Group Commercial |
$130.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$196.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$145.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.60
|
| Rate for Payer: Multiplan Commercial |
$163.50
|
| Rate for Payer: Networks By Design Commercial |
$141.70
|
| Rate for Payer: Prime Health Services Commercial |
$185.30
|
|
|
HC MYO-ORTHOSIS
|
Facility
IP
|
$6,567.00
|
|
|
Service Code
|
CPT E0770
|
| Hospital Charge Code |
905370770
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$1,313.40 |
| Max. Negotiated Rate |
$5,910.30 |
| Rate for Payer: Cash Price |
$2,955.15
|
| Rate for Payer: Central Health Plan Commercial |
$5,253.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,626.80
|
| Rate for Payer: Galaxy Health WC |
$5,581.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,940.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,910.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,380.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,313.40
|
| Rate for Payer: Multiplan Commercial |
$4,925.25
|
| Rate for Payer: Networks By Design Commercial |
$4,268.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,581.95
|
|
|
HC MYO-ORTHOSIS
|
Facility
OP
|
$6,567.00
|
|
|
Service Code
|
CPT E0770
|
| Hospital Charge Code |
905370770
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$1,313.40 |
| Max. Negotiated Rate |
$5,910.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4,479.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,581.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,611.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,611.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,179.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,879.78
|
| Rate for Payer: BCBS Transplant Transplant |
$3,940.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,130.64
|
| Rate for Payer: Blue Shield of California EPN |
$3,211.26
|
| Rate for Payer: Cash Price |
$2,955.15
|
| Rate for Payer: Cash Price |
$2,955.15
|
| Rate for Payer: Central Health Plan Commercial |
$5,253.60
|
| Rate for Payer: Cigna of CA HMO |
$4,202.88
|
| Rate for Payer: Cigna of CA PPO |
$4,859.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,581.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,626.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,626.80
|
| Rate for Payer: Galaxy Health WC |
$5,581.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,940.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,910.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,925.25
|
| Rate for Payer: IEHP medi-cal |
$2,298.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,380.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,313.40
|
| Rate for Payer: Multiplan Commercial |
$4,925.25
|
| Rate for Payer: Networks By Design Commercial |
$4,268.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,581.95
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3,940.20
|
| Rate for Payer: Riverside University Health MISP |
$2,626.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,940.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,940.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,283.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,283.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,283.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,283.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,581.95
|
| Rate for Payer: Vantage Medical Group Senior |
$5,581.95
|
|
|
HC MYRINGOTOMY TUBE INFLATION
|
Facility
IP
|
$2,383.00
|
|
|
Service Code
|
CPT 69420
|
| Hospital Charge Code |
900501377
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$476.60 |
| Max. Negotiated Rate |
$2,144.70 |
| Rate for Payer: Cash Price |
$1,072.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,906.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$953.20
|
| Rate for Payer: Galaxy Health WC |
$2,025.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,429.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,144.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,589.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$476.60
|
| Rate for Payer: Multiplan Commercial |
$1,787.25
|
| Rate for Payer: Networks By Design Commercial |
$1,548.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,025.55
|
|
|
HC MYRINGOTOMY TUBE INFLATION
|
Facility
OP
|
$2,383.00
|
|
|
Service Code
|
CPT 69420
|
| Hospital Charge Code |
900501377
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$305.19 |
| Max. Negotiated Rate |
$8,114.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$305.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,429.80
|
| Rate for Payer: Caremore Medicare Advantage |
$305.19
|
| Rate for Payer: Cash Price |
$1,072.35
|
| Rate for Payer: Cash Price |
$1,072.35
|
| Rate for Payer: Cash Price |
$1,072.35
|
| Rate for Payer: Cash Price |
$1,072.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,906.40
|
| Rate for Payer: Cigna of CA PPO |
$1,763.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.01
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$305.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$305.19
|
| Rate for Payer: Galaxy Health WC |
$2,025.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,429.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,144.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,787.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$500.51
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$305.19
|
| Rate for Payer: Innovage PACE Commercial |
$457.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,589.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$305.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$476.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$408.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.95
|
| Rate for Payer: Multiplan Commercial |
$1,787.25
|
| Rate for Payer: Networks By Design Commercial |
$1,548.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,025.55
|
| Rate for Payer: Prime Health Services Medicare |
$323.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,429.80
|
| Rate for Payer: Riverside University Health MISP |
$335.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,429.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,191.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,191.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,191.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,191.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Vantage Medical Group Senior |
$305.19
|
|
|
HC NA (POC)
|
Facility
IP
|
$82.00
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
900912116
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC NA (POC)
|
Facility
OP
|
$82.00
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
900912116
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$4.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.53
|
| Rate for Payer: BCBS Transplant Transplant |
$49.20
|
| Rate for Payer: Blue Shield of California Commercial |
$50.68
|
| Rate for Payer: Blue Shield of California EPN |
$39.85
|
| Rate for Payer: Caremore Medicare Advantage |
$4.81
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.49
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.81
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.81
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$61.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.89
|
| Rate for Payer: IEHP medi-cal |
$7.94
|
| Rate for Payer: IEHP Medicare Advantage |
$4.81
|
| Rate for Payer: Innovage PACE Commercial |
$7.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.45
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Prime Health Services Medicare |
$5.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: Riverside University Health MISP |
$5.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.90
|
| Rate for Payer: United Healthcare All Other HMO |
$3.90
|
| Rate for Payer: United Healthcare HMO Rider |
$3.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.29
|
| Rate for Payer: Vantage Medical Group Senior |
$4.81
|
|
|
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: Blue Shield of California EPN |
$1,524.57
|
| 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: EPIC Health Plan Commercial |
$1,142.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 |
$1,904.28
|
| 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 |
$1,427.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,426.75
|
|
|
HC NARROW ML BRIM KAFO
|
Facility
OP
|
$2,855.00
|
|
|
Service Code
|
CPT L2525
|
| Hospital Charge Code |
905352525
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$999.25 |
| Max. Negotiated Rate |
$5,060.79 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5,060.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,426.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,570.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,570.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,382.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,686.73
|
| Rate for Payer: BCBS Transplant Transplant |
$1,713.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,141.25
|
| Rate for Payer: Blue Shield of California EPN |
$1,553.12
|
| Rate for Payer: Cash Price |
$1,284.75
|
| 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: Dignity Health Commercial/Exchange |
$2,426.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,142.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$2,141.25
|
| Rate for Payer: IEHP medi-cal |
$999.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,904.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,170.55
|
| 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 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 |
$1,427.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,427.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,427.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,427.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,426.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2,426.75
|
|
|
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: Blue Shield of California EPN |
$627.98
|
| 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: EPIC Health Plan Commercial |
$470.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: LLUH Dept of Risk Management WC |
$235.20
|
| 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
|
|
|
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 |
$411.60 |
| Max. Negotiated Rate |
$2,843.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,843.65
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$999.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$646.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$646.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$569.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$694.78
|
| Rate for Payer: BCBS Transplant Transplant |
$705.60
|
| Rate for Payer: Blue Shield of California Commercial |
$882.00
|
| Rate for Payer: Blue Shield of California EPN |
$639.74
|
| 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: EPIC Health Plan Commercial |
$470.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$882.00
|
| Rate for Payer: IEHP medi-cal |
$411.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$784.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$482.16
|
| 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 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 |
$588.00
|
| Rate for Payer: United Healthcare All Other HMO |
$588.00
|
| Rate for Payer: United Healthcare HMO Rider |
$588.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$588.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$999.60
|
| Rate for Payer: Vantage Medical Group Senior |
$999.60
|
|
|
HC NASAL BONES
|
Facility
IP
|
$1,057.00
|
|
|
Service Code
|
CPT 70160
|
| Hospital Charge Code |
909001104
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$211.40 |
| Max. Negotiated Rate |
$951.30 |
| Rate for Payer: Cash Price |
$475.65
|
| Rate for Payer: Central Health Plan Commercial |
$845.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$422.80
|
| Rate for Payer: Galaxy Health WC |
$898.45
|
| Rate for Payer: Global Benefits Group Commercial |
$634.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$951.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$705.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.40
|
| Rate for Payer: Multiplan Commercial |
$792.75
|
| Rate for Payer: Networks By Design Commercial |
$687.05
|
| Rate for Payer: Prime Health Services Commercial |
$898.45
|
|
|
HC NASAL BONES
|
Facility
OP
|
$1,057.00
|
|
|
Service Code
|
CPT 70160
|
| Hospital Charge Code |
909001104
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.63 |
| Max. Negotiated Rate |
$951.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$113.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$138.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$108.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.50
|
| Rate for Payer: BCBS Transplant Transplant |
$634.20
|
| Rate for Payer: Blue Shield of California Commercial |
$653.23
|
| Rate for Payer: Blue Shield of California EPN |
$513.70
|
| Rate for Payer: Caremore Medicare Advantage |
$113.54
|
| Rate for Payer: Cash Price |
$475.65
|
| Rate for Payer: Cash Price |
$475.65
|
| Rate for Payer: Central Health Plan Commercial |
$845.60
|
| Rate for Payer: Cigna of CA HMO |
$676.48
|
| Rate for Payer: Cigna of CA PPO |
$782.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$898.45
|
| Rate for Payer: Global Benefits Group Commercial |
$634.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$951.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$792.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$186.21
|
| Rate for Payer: IEHP medi-cal |
$187.34
|
| Rate for Payer: IEHP Medicare Advantage |
$113.54
|
| Rate for Payer: Innovage PACE Commercial |
$170.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$705.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$152.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$792.75
|
| Rate for Payer: Networks By Design Commercial |
$687.05
|
| Rate for Payer: Prime Health Services Commercial |
$898.45
|
| Rate for Payer: Prime Health Services Medicare |
$120.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$634.20
|
| Rate for Payer: Riverside University Health MISP |
$124.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$634.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$634.20
|
| 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: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC NASAL ENDOSCOPY DIAGNOSTIC
|
Facility
IP
|
$877.00
|
|
|
Service Code
|
CPT 31231
|
| Hospital Charge Code |
900501401
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$175.40 |
| Max. Negotiated Rate |
$789.30 |
| Rate for Payer: Cash Price |
$394.65
|
| Rate for Payer: Central Health Plan Commercial |
$701.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$350.80
|
| Rate for Payer: Galaxy Health WC |
$745.45
|
| Rate for Payer: Global Benefits Group Commercial |
$526.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$789.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$584.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.40
|
| Rate for Payer: Multiplan Commercial |
$657.75
|
| Rate for Payer: Networks By Design Commercial |
$570.05
|
| Rate for Payer: Prime Health Services Commercial |
$745.45
|
|
|
HC NASAL ENDOSCOPY DIAGNOSTIC
|
Facility
OP
|
$877.00
|
|
|
Service Code
|
CPT 31231
|
| Hospital Charge Code |
900501401
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$175.40 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$247.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$371.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$272.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$247.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: BCBS Transplant Transplant |
$526.20
|
| Rate for Payer: Blue Shield of California Commercial |
$551.63
|
| Rate for Payer: Blue Shield of California EPN |
$428.85
|
| Rate for Payer: Caremore Medicare Advantage |
$247.49
|
| Rate for Payer: Cash Price |
$394.65
|
| Rate for Payer: Cash Price |
$394.65
|
| Rate for Payer: Cash Price |
$394.65
|
| Rate for Payer: Central Health Plan Commercial |
$701.60
|
| Rate for Payer: Cigna of CA HMO |
$561.28
|
| Rate for Payer: Cigna of CA PPO |
$648.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$371.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$334.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$247.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$247.49
|
| Rate for Payer: Galaxy Health WC |
$745.45
|
| Rate for Payer: Global Benefits Group Commercial |
$526.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$789.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$657.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$405.88
|
| Rate for Payer: IEHP medi-cal |
$408.36
|
| Rate for Payer: IEHP Medicare Advantage |
$247.49
|
| Rate for Payer: Innovage PACE Commercial |
$371.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$584.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$247.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$331.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$331.64
|
| Rate for Payer: Multiplan Commercial |
$657.75
|
| Rate for Payer: Networks By Design Commercial |
$570.05
|
| Rate for Payer: Prime Health Services Commercial |
$745.45
|
| Rate for Payer: Prime Health Services Medicare |
$262.34
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$526.20
|
| Rate for Payer: Riverside University Health MISP |
$272.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$526.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$526.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$438.50
|
| Rate for Payer: United Healthcare All Other HMO |
$438.50
|
| Rate for Payer: United Healthcare HMO Rider |
$438.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$438.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$371.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$272.24
|
| Rate for Payer: Vantage Medical Group Senior |
$247.49
|
|
|
HC NASAL ENDOSCOPY DIAGNOSTIC
|
Facility
OP
|
$877.00
|
|
|
Service Code
|
CPT 31231
|
| Hospital Charge Code |
900501401
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$175.40 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$371.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$272.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$247.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: BCBS Transplant Transplant |
$526.20
|
| Rate for Payer: Caremore Medicare Advantage |
$247.49
|
| Rate for Payer: Cash Price |
$394.65
|
| Rate for Payer: Cash Price |
$394.65
|
| Rate for Payer: Cash Price |
$394.65
|
| Rate for Payer: Cash Price |
$394.65
|
| Rate for Payer: Central Health Plan Commercial |
$701.60
|
| Rate for Payer: Cigna of CA PPO |
$648.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$371.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$334.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$247.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$247.49
|
| Rate for Payer: Galaxy Health WC |
$745.45
|
| Rate for Payer: Global Benefits Group Commercial |
$526.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$789.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$657.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$405.88
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$247.49
|
| Rate for Payer: Innovage PACE Commercial |
$371.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$584.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$247.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$331.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$331.64
|
| Rate for Payer: Multiplan Commercial |
$657.75
|
| Rate for Payer: Networks By Design Commercial |
$570.05
|
| Rate for Payer: Prime Health Services Commercial |
$745.45
|
| Rate for Payer: Prime Health Services Medicare |
$262.34
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$526.20
|
| Rate for Payer: Riverside University Health MISP |
$272.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$526.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$438.50
|
| Rate for Payer: United Healthcare All Other HMO |
$438.50
|
| Rate for Payer: United Healthcare HMO Rider |
$438.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$438.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$371.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$272.24
|
| Rate for Payer: Vantage Medical Group Senior |
$247.49
|
|
|
HC NASAL ENDOSCOPY DIAGNOSTIC
|
Facility
IP
|
$877.00
|
|
|
Service Code
|
CPT 31231
|
| Hospital Charge Code |
900501401
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$175.40 |
| Max. Negotiated Rate |
$789.30 |
| Rate for Payer: Cash Price |
$394.65
|
| Rate for Payer: Central Health Plan Commercial |
$701.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$350.80
|
| Rate for Payer: Galaxy Health WC |
$745.45
|
| Rate for Payer: Global Benefits Group Commercial |
$526.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$789.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$584.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.40
|
| Rate for Payer: Multiplan Commercial |
$657.75
|
| Rate for Payer: Networks By Design Commercial |
$570.05
|
| Rate for Payer: Prime Health Services Commercial |
$745.45
|
|
