|
HC GASTRIC EMPTYING
|
Facility
|
OP
|
$3,393.00
|
|
|
Service Code
|
CPT 78264
|
| Hospital Charge Code |
909301364
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$515.32 |
| Max. Negotiated Rate |
$2,884.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,520.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,021.55
|
| Rate for Payer: Blue Distinction Transplant |
$2,035.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,005.26
|
| Rate for Payer: Blue Shield of California EPN |
$1,591.32
|
| Rate for Payer: Cash Price |
$1,526.85
|
| Rate for Payer: Cash Price |
$1,526.85
|
| Rate for Payer: Cigna of CA HMO |
$2,171.52
|
| Rate for Payer: Cigna of CA PPO |
$2,510.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Media |
$515.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| 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 |
$2,884.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,035.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,544.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$845.12
|
| Rate for Payer: Heritage Provider Network Transplant |
$845.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$834.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$834.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,263.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$561.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$814.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$690.53
|
| Rate for Payer: Multiplan Commercial |
$2,714.40
|
| Rate for Payer: Networks By Design Commercial |
$2,205.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,884.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,035.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,035.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$623.82
|
| Rate for Payer: United Healthcare All Other HMO |
$623.82
|
| Rate for Payer: United Healthcare HMO Rider |
$623.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$623.82
|
| 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 GASTRIC INTUB W/ASPIRATIOIN
|
Facility
|
IP
|
$888.00
|
|
|
Service Code
|
CPT 43753
|
| Hospital Charge Code |
900501762
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$213.12 |
| Max. Negotiated Rate |
$754.80 |
| Rate for Payer: Cash Price |
$399.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$355.20
|
| Rate for Payer: Galaxy Health WC |
$754.80
|
| Rate for Payer: Global Benefits Group Commercial |
$532.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$592.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$338.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.12
|
| Rate for Payer: Multiplan Commercial |
$710.40
|
| Rate for Payer: Networks By Design Commercial |
$577.20
|
| Rate for Payer: Prime Health Services Commercial |
$754.80
|
|
|
HC GASTRIC INTUB W/ASPIRATIOIN
|
Facility
|
OP
|
$888.00
|
|
|
Service Code
|
CPT 43753
|
| Hospital Charge Code |
900501762
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$32.85 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$532.80
|
| Rate for Payer: Cash Price |
$399.60
|
| Rate for Payer: Cash Price |
$399.60
|
| Rate for Payer: Cash Price |
$399.60
|
| Rate for Payer: Cigna of CA PPO |
$657.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Media |
$392.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$392.17
|
| Rate for Payer: Galaxy Health WC |
$754.80
|
| Rate for Payer: Global Benefits Group Commercial |
$532.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$666.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$643.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$643.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$392.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$592.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$494.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.51
|
| Rate for Payer: Multiplan Commercial |
$710.40
|
| Rate for Payer: Networks By Design Commercial |
$577.20
|
| Rate for Payer: Prime Health Services Commercial |
$754.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$532.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$444.00
|
| Rate for Payer: United Healthcare All Other HMO |
$444.00
|
| Rate for Payer: United Healthcare HMO Rider |
$444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$444.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC GASTRIC MOTIL MANOMETRC STUDY
|
Facility
|
OP
|
$1,212.00
|
|
|
Service Code
|
CPT 91020
|
| Hospital Charge Code |
906791020
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$174.97 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$736.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$669.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$722.11
|
| Rate for Payer: Blue Distinction Transplant |
$727.20
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$545.40
|
| Rate for Payer: Cash Price |
$545.40
|
| Rate for Payer: Cash Price |
$545.40
|
| Rate for Payer: Cigna of CA PPO |
$896.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Dignity Health Media |
$669.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$736.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$904.07
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$669.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$669.68
|
| Rate for Payer: Galaxy Health WC |
$1,030.20
|
| Rate for Payer: Global Benefits Group Commercial |
$727.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$909.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,098.28
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,098.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,084.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,084.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$669.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$808.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$174.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$669.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$290.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$843.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$897.37
|
| Rate for Payer: Multiplan Commercial |
$969.60
|
| Rate for Payer: Networks By Design Commercial |
$787.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,030.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$727.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$803.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$736.65
|
| Rate for Payer: Vantage Medical Group Senior |
$669.68
|
|
|
HC GASTRIC MOTIL MANOMETRC STUDY
|
Facility
|
IP
|
$2,001.00
|
|
|
Service Code
|
CPT 91020
|
| Hospital Charge Code |
906791020
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$480.24 |
| Max. Negotiated Rate |
$1,700.85 |
| Rate for Payer: Cash Price |
$900.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$800.40
|
| Rate for Payer: Galaxy Health WC |
$1,700.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,200.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,334.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$762.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$480.24
|
| Rate for Payer: Multiplan Commercial |
$1,600.80
|
| Rate for Payer: Networks By Design Commercial |
$1,300.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,700.85
|
|
|
HC GASTROESOPHAGEAL REFLUX
|
Facility
|
OP
|
$2,023.00
|
|
|
Service Code
|
CPT 78262
|
| Hospital Charge Code |
909301365
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$205.47 |
| Max. Negotiated Rate |
$1,719.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,349.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,205.30
|
| Rate for Payer: Blue Distinction Transplant |
$1,213.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,195.59
|
| Rate for Payer: Blue Shield of California EPN |
$948.79
|
| Rate for Payer: Cash Price |
$910.35
|
| Rate for Payer: Cash Price |
$910.35
|
| Rate for Payer: Cigna of CA HMO |
$1,294.72
|
| Rate for Payer: Cigna of CA PPO |
$1,497.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Media |
$515.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| 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 |
$1,719.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,213.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,517.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$845.12
|
| Rate for Payer: Heritage Provider Network Transplant |
$845.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$834.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$834.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,349.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$485.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$690.53
|
| Rate for Payer: Multiplan Commercial |
$1,618.40
|
| Rate for Payer: Networks By Design Commercial |
$1,314.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,719.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,213.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,213.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$623.82
|
| Rate for Payer: United Healthcare All Other HMO |
$623.82
|
| Rate for Payer: United Healthcare HMO Rider |
$623.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$623.82
|
| 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 GASTROESOPHAGEAL REFLUX
|
Facility
|
IP
|
$2,023.00
|
|
|
Service Code
|
CPT 78262
|
| Hospital Charge Code |
909301365
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$485.52 |
| Max. Negotiated Rate |
$1,719.55 |
| Rate for Payer: Cash Price |
$910.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$809.20
|
| Rate for Payer: Galaxy Health WC |
$1,719.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,213.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,349.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$770.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$485.52
|
| Rate for Payer: Multiplan Commercial |
$1,618.40
|
| Rate for Payer: Networks By Design Commercial |
$1,314.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,719.55
|
|
|
HC GASTROESOPHAGEAL REFLUX TEST
|
Facility
|
IP
|
$3,575.00
|
|
|
Service Code
|
CPT 91034
|
| Hospital Charge Code |
906791034
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$858.00 |
| Max. Negotiated Rate |
$3,038.75 |
| Rate for Payer: Cash Price |
$1,608.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,430.00
|
| Rate for Payer: Galaxy Health WC |
$3,038.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,145.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,384.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,362.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$858.00
|
| Rate for Payer: Multiplan Commercial |
$2,860.00
|
| Rate for Payer: Networks By Design Commercial |
$2,323.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,038.75
|
|
|
HC GASTROESOPHAGEAL REFLUX TEST
|
Facility
|
IP
|
$4,947.00
|
|
|
Service Code
|
CPT 91035
|
| Hospital Charge Code |
906791035
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,187.28 |
| Max. Negotiated Rate |
$4,204.95 |
| Rate for Payer: Cash Price |
$2,226.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,978.80
|
| Rate for Payer: Galaxy Health WC |
$4,204.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,968.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,299.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,884.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,187.28
|
| Rate for Payer: Multiplan Commercial |
$3,957.60
|
| Rate for Payer: Networks By Design Commercial |
$3,215.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,204.95
|
|
|
HC GASTROESOPHAGEAL REFLUX TEST
|
Facility
|
OP
|
$2,731.00
|
|
|
Service Code
|
CPT 91035
|
| Hospital Charge Code |
906791035
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$194.62 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,765.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$736.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$669.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,627.13
|
| Rate for Payer: Blue Distinction Transplant |
$1,638.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$1,228.95
|
| Rate for Payer: Cash Price |
$1,228.95
|
| Rate for Payer: Cash Price |
$1,228.95
|
| Rate for Payer: Cigna of CA PPO |
$2,020.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Dignity Health Media |
$669.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$736.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$904.07
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$669.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$669.68
|
| Rate for Payer: Galaxy Health WC |
$2,321.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,638.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,048.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,098.28
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,098.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,084.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,084.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$669.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,821.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$194.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$669.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$655.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$843.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$897.37
|
| Rate for Payer: Multiplan Commercial |
$2,184.80
|
| Rate for Payer: Networks By Design Commercial |
$1,775.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,321.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,638.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$803.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$736.65
|
| Rate for Payer: Vantage Medical Group Senior |
$669.68
|
|
|
HC GASTROESOPHAGEAL REFLUX TEST
|
Facility
|
OP
|
$1,578.00
|
|
|
Service Code
|
CPT 91034
|
| Hospital Charge Code |
906791034
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$147.46 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,006.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$736.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$669.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$940.17
|
| Rate for Payer: Blue Distinction Transplant |
$946.80
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$710.10
|
| Rate for Payer: Cash Price |
$710.10
|
| Rate for Payer: Cash Price |
$710.10
|
| Rate for Payer: Cigna of CA PPO |
$1,167.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Dignity Health Media |
$669.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$736.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$904.07
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$669.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$669.68
|
| Rate for Payer: Galaxy Health WC |
$1,341.30
|
| Rate for Payer: Global Benefits Group Commercial |
$946.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,183.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,098.28
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,098.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,084.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,084.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$669.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,052.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$147.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$669.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$378.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$843.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$897.37
|
| Rate for Payer: Multiplan Commercial |
$1,262.40
|
| Rate for Payer: Networks By Design Commercial |
$1,025.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,341.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$946.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$803.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$736.65
|
| Rate for Payer: Vantage Medical Group Senior |
$669.68
|
|
|
HC GASTRO PANEL NUCLEIC ACID
|
Facility
|
OP
|
$644.00
|
|
|
Service Code
|
CPT 87507
|
| Hospital Charge Code |
900913644
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$154.56 |
| Max. Negotiated Rate |
$3,351.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,351.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$625.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$458.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$416.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,852.78
|
| Rate for Payer: Blue Distinction Transplant |
$386.40
|
| Rate for Payer: Blue Shield of California Commercial |
$416.02
|
| Rate for Payer: Blue Shield of California EPN |
$329.73
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: Cigna of CA HMO |
$412.16
|
| Rate for Payer: Cigna of CA PPO |
$476.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$625.17
|
| Rate for Payer: Dignity Health Media |
$416.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$458.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$562.65
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$416.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$416.78
|
| Rate for Payer: Galaxy Health WC |
$547.40
|
| Rate for Payer: Global Benefits Group Commercial |
$386.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$483.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$683.52
|
| Rate for Payer: Heritage Provider Network Transplant |
$683.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$675.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$675.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$416.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$429.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$703.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$416.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$525.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$558.49
|
| Rate for Payer: Multiplan Commercial |
$515.20
|
| Rate for Payer: Networks By Design Commercial |
$418.60
|
| Rate for Payer: Prime Health Services Commercial |
$547.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$386.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$386.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$337.59
|
| Rate for Payer: United Healthcare All Other HMO |
$337.59
|
| Rate for Payer: United Healthcare HMO Rider |
$337.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$337.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$625.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$458.46
|
| Rate for Payer: Vantage Medical Group Senior |
$416.78
|
|
|
HC GASTROSTOMY TUBE PERCUT
|
Facility
|
IP
|
$5,767.00
|
|
|
Service Code
|
CPT 49440
|
| Hospital Charge Code |
906743750
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,384.08 |
| Max. Negotiated Rate |
$4,901.95 |
| Rate for Payer: Cash Price |
$2,595.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,306.80
|
| Rate for Payer: Galaxy Health WC |
$4,901.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,460.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,846.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,197.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,384.08
|
| Rate for Payer: Multiplan Commercial |
$4,613.60
|
| Rate for Payer: Networks By Design Commercial |
$3,748.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,901.95
|
|
|
HC GASTROSTOMY TUBE PERCUT
|
Facility
|
OP
|
$2,547.00
|
|
|
Service Code
|
CPT 49440
|
| Hospital Charge Code |
906743750
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$611.28 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,528.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,612.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,351.09
|
| Rate for Payer: Cash Price |
$1,146.15
|
| Rate for Payer: Cash Price |
$1,146.15
|
| Rate for Payer: Cigna of CA PPO |
$1,884.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Media |
$2,377.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Galaxy Health WC |
$2,164.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,528.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,910.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,899.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,899.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,851.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,851.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,698.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,749.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$611.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Multiplan Commercial |
$2,037.60
|
| Rate for Payer: Networks By Design Commercial |
$1,655.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,164.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,528.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,852.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC GASTROSTOMY TUBE PERCUT
|
Facility
|
OP
|
$2,547.00
|
|
|
Service Code
|
CPT 49440
|
| Hospital Charge Code |
906743750
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$611.28 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,528.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,612.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,351.09
|
| Rate for Payer: Cash Price |
$1,146.15
|
| Rate for Payer: Cash Price |
$1,146.15
|
| Rate for Payer: Cigna of CA PPO |
$1,884.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Media |
$2,377.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Galaxy Health WC |
$2,164.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,528.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,910.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,899.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,899.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,851.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,851.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,698.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,749.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$611.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Multiplan Commercial |
$2,037.60
|
| Rate for Payer: Networks By Design Commercial |
$1,655.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,164.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,528.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC GASTROSTOMY TUBE PERCUT
|
Facility
|
IP
|
$5,767.00
|
|
|
Service Code
|
CPT 49440
|
| Hospital Charge Code |
906743750
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,384.08 |
| Max. Negotiated Rate |
$4,901.95 |
| Rate for Payer: Cash Price |
$2,595.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,306.80
|
| Rate for Payer: Galaxy Health WC |
$4,901.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,460.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,846.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,197.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,384.08
|
| Rate for Payer: Multiplan Commercial |
$4,613.60
|
| Rate for Payer: Networks By Design Commercial |
$3,748.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,901.95
|
|
|
HC GASTROSTOMY TUBE REPOSITION
|
Facility
|
IP
|
$3,341.00
|
|
|
Service Code
|
CPT 43761
|
| Hospital Charge Code |
906743761
|
|
Hospital Revenue Code
|
949
|
| Min. Negotiated Rate |
$801.84 |
| Max. Negotiated Rate |
$2,839.85 |
| Rate for Payer: Cash Price |
$1,503.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,336.40
|
| Rate for Payer: Galaxy Health WC |
$2,839.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,004.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,228.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,272.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$801.84
|
| Rate for Payer: Multiplan Commercial |
$2,672.80
|
| Rate for Payer: Networks By Design Commercial |
$2,171.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,839.85
|
|
|
HC GASTROSTOMY TUBE REPOSITION
|
Facility
|
OP
|
$3,341.00
|
|
|
Service Code
|
CPT 43761
|
| Hospital Charge Code |
906743761
|
|
Hospital Revenue Code
|
949
|
| Min. Negotiated Rate |
$150.67 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$308.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,004.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,462.32
|
| Rate for Payer: Blue Shield of California EPN |
$1,951.14
|
| Rate for Payer: Cash Price |
$1,503.45
|
| Rate for Payer: Cash Price |
$1,503.45
|
| Rate for Payer: Cash Price |
$1,503.45
|
| Rate for Payer: Cigna of CA HMO |
$2,138.24
|
| Rate for Payer: Cigna of CA PPO |
$2,472.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.18
|
| Rate for Payer: Dignity Health Media |
$308.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$416.87
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$308.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$308.79
|
| Rate for Payer: Galaxy Health WC |
$2,839.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,004.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,505.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$506.42
|
| Rate for Payer: Heritage Provider Network Transplant |
$506.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$500.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$500.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$308.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,228.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$150.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$308.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$801.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$413.78
|
| Rate for Payer: Multiplan Commercial |
$2,672.80
|
| Rate for Payer: Networks By Design Commercial |
$2,171.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,839.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,004.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,004.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$762.00
|
| Rate for Payer: United Healthcare All Other HMO |
$515.00
|
| Rate for Payer: United Healthcare HMO Rider |
$312.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$285.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Vantage Medical Group Senior |
$308.79
|
|
|
HC GASTRO TUBE PLACEMENT
|
Facility
|
IP
|
$2,287.00
|
|
|
Service Code
|
CPT 44500
|
| Hospital Charge Code |
906744500
|
|
Hospital Revenue Code
|
949
|
| Min. Negotiated Rate |
$548.88 |
| Max. Negotiated Rate |
$1,943.95 |
| Rate for Payer: Cash Price |
$1,029.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$914.80
|
| Rate for Payer: Galaxy Health WC |
$1,943.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,372.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,525.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$871.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$548.88
|
| Rate for Payer: Multiplan Commercial |
$1,829.60
|
| Rate for Payer: Networks By Design Commercial |
$1,486.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,943.95
|
|
|
HC GASTRO TUBE PLACEMENT
|
Facility
|
OP
|
$2,287.00
|
|
|
Service Code
|
CPT 44500
|
| Hospital Charge Code |
906744500
|
|
Hospital Revenue Code
|
949
|
| Min. Negotiated Rate |
$36.78 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$147.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,372.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,685.52
|
| Rate for Payer: Blue Shield of California EPN |
$1,335.61
|
| Rate for Payer: Cash Price |
$1,029.15
|
| Rate for Payer: Cash Price |
$1,029.15
|
| Rate for Payer: Cash Price |
$1,029.15
|
| Rate for Payer: Cigna of CA HMO |
$1,463.68
|
| Rate for Payer: Cigna of CA PPO |
$1,692.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$1,943.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,372.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,715.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,857.45
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,857.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,834.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,834.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,525.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$548.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$1,829.60
|
| Rate for Payer: Networks By Design Commercial |
$1,486.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,943.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,372.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,372.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$762.00
|
| Rate for Payer: United Healthcare All Other HMO |
$515.00
|
| Rate for Payer: United Healthcare HMO Rider |
$312.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$285.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC GASTRO TUBE REMOVAL
|
Facility
|
IP
|
$6,617.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
900100022
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,588.08 |
| Max. Negotiated Rate |
$5,624.45 |
| Rate for Payer: Cash Price |
$2,977.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,646.80
|
| Rate for Payer: Galaxy Health WC |
$5,624.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,970.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,413.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,521.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,588.08
|
| Rate for Payer: Multiplan Commercial |
$5,293.60
|
| Rate for Payer: Networks By Design Commercial |
$4,301.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,624.45
|
|
|
HC GASTRO TUBE REMOVAL
|
Facility
|
OP
|
$4,245.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
900100022
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,018.80 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,529.17
|
| Rate for Payer: Blue Distinction Transplant |
$2,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$1,910.25
|
| Rate for Payer: Cash Price |
$1,910.25
|
| Rate for Payer: Cigna of CA PPO |
$3,141.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$3,608.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,547.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,183.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,857.45
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,857.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,834.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,834.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,831.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,018.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$3,396.00
|
| Rate for Payer: Networks By Design Commercial |
$2,759.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,608.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,547.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,359.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC GASTRO UGI SNGL CNTRST
|
Facility
|
OP
|
$1,307.00
|
|
|
Service Code
|
CPT 74240
|
| Hospital Charge Code |
909001873
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$193.86 |
| Max. Negotiated Rate |
$1,110.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$494.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$382.61
|
| Rate for Payer: Blue Distinction Transplant |
$784.20
|
| Rate for Payer: Blue Shield of California Commercial |
$772.44
|
| Rate for Payer: Blue Shield of California EPN |
$612.98
|
| Rate for Payer: Cash Price |
$588.15
|
| Rate for Payer: Cash Price |
$588.15
|
| Rate for Payer: Cigna of CA HMO |
$836.48
|
| Rate for Payer: Cigna of CA PPO |
$967.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Media |
$229.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$229.56
|
| Rate for Payer: Galaxy Health WC |
$1,110.95
|
| Rate for Payer: Global Benefits Group Commercial |
$784.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$980.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$376.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$376.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$371.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$371.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$871.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$193.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$307.61
|
| Rate for Payer: Multiplan Commercial |
$1,045.60
|
| Rate for Payer: Networks By Design Commercial |
$849.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,110.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$784.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$784.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.73
|
| Rate for Payer: United Healthcare All Other HMO |
$219.73
|
| Rate for Payer: United Healthcare HMO Rider |
$219.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC GASTRO UGI SNGL CNTRST
|
Facility
|
IP
|
$1,307.00
|
|
|
Service Code
|
CPT 74240
|
| Hospital Charge Code |
909001873
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.68 |
| Max. Negotiated Rate |
$1,110.95 |
| Rate for Payer: Cash Price |
$588.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$522.80
|
| Rate for Payer: Galaxy Health WC |
$1,110.95
|
| Rate for Payer: Global Benefits Group Commercial |
$784.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$871.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$497.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.68
|
| Rate for Payer: Multiplan Commercial |
$1,045.60
|
| Rate for Payer: Networks By Design Commercial |
$849.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,110.95
|
|
|
HC GATED BLOOD POOL- MUGA
|
Facility
|
IP
|
$4,307.00
|
|
|
Service Code
|
CPT 78472
|
| Hospital Charge Code |
909301381
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,033.68 |
| Max. Negotiated Rate |
$3,660.95 |
| Rate for Payer: Cash Price |
$1,938.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,722.80
|
| Rate for Payer: Galaxy Health WC |
$3,660.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,584.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,872.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,640.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,033.68
|
| Rate for Payer: Multiplan Commercial |
$3,445.60
|
| Rate for Payer: Networks By Design Commercial |
$2,799.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,660.95
|
|
