|
HC GASTRODUODENOSTOMY
|
Facility
|
IP
|
$5,927.00
|
|
|
Service Code
|
CPT 43810
|
| Hospital Charge Code |
906743810
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,185.40 |
| Max. Negotiated Rate |
$5,037.95 |
| Rate for Payer: Adventist Health Commercial |
$1,185.40
|
| Rate for Payer: Cash Price |
$3,259.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,370.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,370.80
|
| Rate for Payer: Galaxy Health WC |
$5,037.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,556.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,953.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,258.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,668.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,422.48
|
| Rate for Payer: Multiplan Commercial |
$4,741.60
|
| Rate for Payer: Networks By Design Commercial |
$3,852.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,037.95
|
|
|
HC GASTRODUODENOSTOMY
|
Facility
|
OP
|
$5,927.00
|
|
|
Service Code
|
CPT 43810
|
| Hospital Charge Code |
906743810
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$185.14 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,185.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,037.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,259.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,445.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,339.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$3,259.85
|
| Rate for Payer: Cash Price |
$3,259.85
|
| Rate for Payer: Cash Price |
$3,259.85
|
| Rate for Payer: Cigna of CA HMO |
$3,793.28
|
| Rate for Payer: Cigna of CA PPO |
$4,385.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,037.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,037.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,037.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,370.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,370.80
|
| Rate for Payer: Galaxy Health WC |
$5,037.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,556.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$185.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,953.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$209.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,668.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,422.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,148.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,148.90
|
| Rate for Payer: Multiplan Commercial |
$4,741.60
|
| Rate for Payer: Networks By Design Commercial |
$3,852.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,037.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,556.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,556.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,037.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,037.95
|
| Rate for Payer: Vantage Medical Group Senior |
$5,037.95
|
|
|
HC GASTROESOPHAGEAL REFLUX
|
Facility
|
OP
|
$1,720.00
|
|
|
Service Code
|
CPT 78262
|
| Hospital Charge Code |
909301365
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$181.68 |
| Max. Negotiated Rate |
$1,462.00 |
| Rate for Payer: Adventist Health Commercial |
$344.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,128.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,056.25
|
| Rate for Payer: Blue Shield of California Commercial |
$1,052.64
|
| Rate for Payer: Blue Shield of California EPN |
$694.88
|
| Rate for Payer: Cash Price |
$946.00
|
| Rate for Payer: Cash Price |
$946.00
|
| Rate for Payer: Cigna of CA HMO |
$1,100.80
|
| Rate for Payer: Cigna of CA PPO |
$1,272.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$689.27
|
| Rate for Payer: EPIC Health Plan Senior |
$510.57
|
| Rate for Payer: Galaxy Health WC |
$1,462.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,032.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$837.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$181.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,147.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$510.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$412.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$684.16
|
| Rate for Payer: Multiplan Commercial |
$1,376.00
|
| Rate for Payer: Networks By Design Commercial |
$1,118.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,462.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,032.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,032.00
|
| 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: Upland Medical Group Pediatric |
$510.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC GASTROESOPHAGEAL REFLUX
|
Facility
|
IP
|
$1,720.00
|
|
|
Service Code
|
CPT 78262
|
| Hospital Charge Code |
909301365
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$344.00 |
| Max. Negotiated Rate |
$1,462.00 |
| Rate for Payer: Adventist Health Commercial |
$344.00
|
| Rate for Payer: Cash Price |
$946.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$688.00
|
| Rate for Payer: EPIC Health Plan Senior |
$688.00
|
| Rate for Payer: Galaxy Health WC |
$1,462.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,032.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,147.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$655.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,064.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$412.80
|
| Rate for Payer: Multiplan Commercial |
$1,376.00
|
| Rate for Payer: Networks By Design Commercial |
$1,118.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,462.00
|
|
|
HC GASTROESOPHAGEAL REFLUX TEST
|
Facility
|
OP
|
$4,836.00
|
|
|
Service Code
|
CPT 91035
|
| Hospital Charge Code |
906791035
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$172.08 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$967.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$741.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$674.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,969.79
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$2,659.80
|
| Rate for Payer: Cash Price |
$2,659.80
|
| Rate for Payer: Cash Price |
$2,659.80
|
| Rate for Payer: Cigna of CA HMO |
$3,095.04
|
| Rate for Payer: Cigna of CA PPO |
$3,578.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$741.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$674.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$910.14
|
| Rate for Payer: EPIC Health Plan Senior |
$674.18
|
| Rate for Payer: Galaxy Health WC |
$4,110.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,901.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,105.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$172.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$674.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,225.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$194.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$674.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,160.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$849.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$903.40
|
| Rate for Payer: Multiplan Commercial |
$3,868.80
|
| Rate for Payer: Networks By Design Commercial |
$3,143.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,110.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,901.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$809.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$674.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$741.60
|
| Rate for Payer: Vantage Medical Group Senior |
$674.18
|
|
|
HC GASTROESOPHAGEAL REFLUX TEST
|
Facility
|
IP
|
$3,494.00
|
|
|
Service Code
|
CPT 91034
|
| Hospital Charge Code |
906791034
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$698.80 |
| Max. Negotiated Rate |
$2,969.90 |
| Rate for Payer: Adventist Health Commercial |
$698.80
|
| Rate for Payer: Cash Price |
$1,921.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,397.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,397.60
|
| Rate for Payer: Galaxy Health WC |
$2,969.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,096.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,330.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,331.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,162.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$838.56
|
| Rate for Payer: Multiplan Commercial |
$2,795.20
|
| Rate for Payer: Networks By Design Commercial |
$2,271.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,969.90
|
|
|
HC GASTROESOPHAGEAL REFLUX TEST
|
Facility
|
OP
|
$3,494.00
|
|
|
Service Code
|
CPT 91034
|
| Hospital Charge Code |
906791034
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$130.38 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$698.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$741.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$674.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,145.67
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$1,921.70
|
| Rate for Payer: Cash Price |
$1,921.70
|
| Rate for Payer: Cash Price |
$1,921.70
|
| Rate for Payer: Cigna of CA HMO |
$2,236.16
|
| Rate for Payer: Cigna of CA PPO |
$2,585.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$741.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$674.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$910.14
|
| Rate for Payer: EPIC Health Plan Senior |
$674.18
|
| Rate for Payer: Galaxy Health WC |
$2,969.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,096.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,105.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$130.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$674.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,330.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$147.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$674.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$838.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$849.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$903.40
|
| Rate for Payer: Multiplan Commercial |
$2,795.20
|
| Rate for Payer: Networks By Design Commercial |
$2,271.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,969.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,096.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$809.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$674.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$741.60
|
| Rate for Payer: Vantage Medical Group Senior |
$674.18
|
|
|
HC GASTROESOPHAGEAL REFLUX TEST
|
Facility
|
IP
|
$4,836.00
|
|
|
Service Code
|
CPT 91035
|
| Hospital Charge Code |
906791035
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$967.20 |
| Max. Negotiated Rate |
$4,110.60 |
| Rate for Payer: Adventist Health Commercial |
$967.20
|
| Rate for Payer: Cash Price |
$2,659.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,934.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,934.40
|
| Rate for Payer: Galaxy Health WC |
$4,110.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,901.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,225.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,842.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,993.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,160.64
|
| Rate for Payer: Multiplan Commercial |
$3,868.80
|
| Rate for Payer: Networks By Design Commercial |
$3,143.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,110.60
|
|
|
HC GASTROJEJUNOSTOMY SET D/L
|
Facility
|
OP
|
$928.00
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
909001042
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$222.72 |
| Max. Negotiated Rate |
$788.80 |
| Rate for Payer: Adventist Health Commercial |
$380.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$788.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$510.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$696.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$537.50
|
| Rate for Payer: Blue Shield of California Commercial |
$684.86
|
| Rate for Payer: Blue Shield of California EPN |
$451.01
|
| Rate for Payer: Cash Price |
$510.40
|
| Rate for Payer: Cigna of CA HMO |
$649.60
|
| Rate for Payer: Cigna of CA PPO |
$649.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$788.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$788.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$788.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$371.20
|
| Rate for Payer: EPIC Health Plan Senior |
$371.20
|
| Rate for Payer: Galaxy Health WC |
$788.80
|
| Rate for Payer: Global Benefits Group Commercial |
$556.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$618.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$353.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$574.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$649.60
|
| Rate for Payer: Multiplan Commercial |
$742.40
|
| Rate for Payer: Networks By Design Commercial |
$464.00
|
| Rate for Payer: Prime Health Services Commercial |
$788.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$556.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$556.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$348.28
|
| Rate for Payer: United Healthcare All Other HMO |
$339.00
|
| Rate for Payer: United Healthcare HMO Rider |
$331.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$303.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$788.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$788.80
|
| Rate for Payer: Vantage Medical Group Senior |
$788.80
|
|
|
HC GASTROJEJUNOSTOMY SET D/L
|
Facility
|
IP
|
$928.00
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
909001042
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$185.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: United Healthcare HMO Rider |
$331.67
|
| Rate for Payer: Adventist Health Commercial |
$185.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$510.40
|
| Rate for Payer: Cash Price |
$510.40
|
| Rate for Payer: Cigna of CA HMO |
$649.60
|
| Rate for Payer: Cigna of CA PPO |
$649.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$371.20
|
| Rate for Payer: EPIC Health Plan Senior |
$371.20
|
| Rate for Payer: Galaxy Health WC |
$788.80
|
| Rate for Payer: Global Benefits Group Commercial |
$556.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$618.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$353.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$574.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.72
|
| Rate for Payer: Multiplan Commercial |
$742.40
|
| Rate for Payer: Networks By Design Commercial |
$464.00
|
| Rate for Payer: Prime Health Services Commercial |
$788.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$348.28
|
| Rate for Payer: United Healthcare All Other HMO |
$339.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$303.92
|
|
|
HC GASTROJEJUNOSTOMY SET SGL/LMN
|
Facility
|
IP
|
$619.00
|
|
| Hospital Charge Code |
909001041
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$123.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$123.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$340.45
|
| Rate for Payer: Cash Price |
$340.45
|
| Rate for Payer: Cigna of CA HMO |
$433.30
|
| Rate for Payer: Cigna of CA PPO |
$433.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$247.60
|
| Rate for Payer: EPIC Health Plan Senior |
$247.60
|
| Rate for Payer: Galaxy Health WC |
$526.15
|
| Rate for Payer: Global Benefits Group Commercial |
$371.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$412.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$235.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$383.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.56
|
| Rate for Payer: Multiplan Commercial |
$495.20
|
| Rate for Payer: Networks By Design Commercial |
$309.50
|
| Rate for Payer: Prime Health Services Commercial |
$526.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$232.31
|
| Rate for Payer: United Healthcare All Other HMO |
$226.12
|
| Rate for Payer: United Healthcare HMO Rider |
$221.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$202.72
|
|
|
HC GASTROJEJUNOSTOMY SET SGL/LMN
|
Facility
|
OP
|
$619.00
|
|
| Hospital Charge Code |
909001041
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$148.56 |
| Max. Negotiated Rate |
$526.15 |
| Rate for Payer: Adventist Health Commercial |
$253.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$526.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$340.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$464.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$358.52
|
| Rate for Payer: Blue Shield of California Commercial |
$456.82
|
| Rate for Payer: Blue Shield of California EPN |
$300.83
|
| Rate for Payer: Cash Price |
$340.45
|
| Rate for Payer: Cigna of CA HMO |
$433.30
|
| Rate for Payer: Cigna of CA PPO |
$433.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$526.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$526.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$526.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$247.60
|
| Rate for Payer: EPIC Health Plan Senior |
$247.60
|
| Rate for Payer: Galaxy Health WC |
$526.15
|
| Rate for Payer: Global Benefits Group Commercial |
$371.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$412.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$235.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$383.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$433.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$433.30
|
| Rate for Payer: Multiplan Commercial |
$495.20
|
| Rate for Payer: Networks By Design Commercial |
$309.50
|
| Rate for Payer: Prime Health Services Commercial |
$526.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$371.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$371.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$232.31
|
| Rate for Payer: United Healthcare All Other HMO |
$226.12
|
| Rate for Payer: United Healthcare HMO Rider |
$221.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$202.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$526.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$526.15
|
| Rate for Payer: Vantage Medical Group Senior |
$526.15
|
|
|
HC GASTRO PANEL NUCLEIC ACID
|
Facility
|
IP
|
$1,762.00
|
|
|
Service Code
|
CPT 87507
|
| Hospital Charge Code |
900913644
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$352.40 |
| Max. Negotiated Rate |
$1,497.70 |
| Rate for Payer: EPIC Health Plan Commercial |
$704.80
|
| Rate for Payer: EPIC Health Plan Senior |
$704.80
|
| Rate for Payer: Galaxy Health WC |
$1,497.70
|
| Rate for Payer: Cash Price |
$969.10
|
| Rate for Payer: Adventist Health Commercial |
$352.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,057.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,175.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$671.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,090.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$422.88
|
| Rate for Payer: Multiplan Commercial |
$1,409.60
|
| Rate for Payer: Networks By Design Commercial |
$1,145.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,497.70
|
|
|
HC GASTRO PANEL NUCLEIC ACID
|
Facility
|
OP
|
$1,762.00
|
|
|
Service Code
|
CPT 87507
|
| Hospital Charge Code |
900913644
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$337.59 |
| Max. Negotiated Rate |
$3,088.39 |
| Rate for Payer: Adventist Health Commercial |
$352.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,155.70
|
| 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 |
$3,088.39
|
| Rate for Payer: Blue Shield of California Commercial |
$1,178.78
|
| Rate for Payer: Blue Shield of California EPN |
$778.80
|
| Rate for Payer: Cash Price |
$969.10
|
| Rate for Payer: Cash Price |
$969.10
|
| Rate for Payer: Cigna of CA HMO |
$1,127.68
|
| Rate for Payer: Cigna of CA PPO |
$1,303.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$625.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$458.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$416.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$562.65
|
| Rate for Payer: EPIC Health Plan Senior |
$416.78
|
| Rate for Payer: Galaxy Health WC |
$1,497.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,057.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$683.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$622.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$416.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,175.25
|
| 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 |
$422.88
|
| 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 |
$1,409.60
|
| Rate for Payer: Networks By Design Commercial |
$1,145.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,497.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,057.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,057.20
|
| 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: Upland Medical Group Pediatric |
$416.78
|
| 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
|
OP
|
$5,637.00
|
|
|
Service Code
|
CPT 49440
|
| Hospital Charge Code |
906743750
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,127.40 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$1,127.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,410.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$3,100.35
|
| Rate for Payer: Cash Price |
$3,100.35
|
| Rate for Payer: Cash Price |
$3,100.35
|
| Rate for Payer: Cigna of CA HMO |
$3,607.68
|
| Rate for Payer: Cigna of CA PPO |
$4,171.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,651.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,410.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,253.93
|
| Rate for Payer: EPIC Health Plan Senior |
$2,410.32
|
| Rate for Payer: Galaxy Health WC |
$4,791.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,382.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,546.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,759.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,749.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,352.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,037.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,229.83
|
| Rate for Payer: Multiplan Commercial |
$4,509.60
|
| Rate for Payer: Networks By Design Commercial |
$3,664.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,791.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,382.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,892.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,410.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,410.32
|
|
|
HC GASTROSTOMY TUBE PERCUT
|
Facility
|
IP
|
$5,637.00
|
|
|
Service Code
|
CPT 49440
|
| Hospital Charge Code |
906743750
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,127.40 |
| Max. Negotiated Rate |
$4,791.45 |
| Rate for Payer: Adventist Health Commercial |
$1,127.40
|
| Rate for Payer: Cash Price |
$3,100.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,254.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,254.80
|
| Rate for Payer: Galaxy Health WC |
$4,791.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,382.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,759.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,147.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,489.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,352.88
|
| Rate for Payer: Multiplan Commercial |
$4,509.60
|
| Rate for Payer: Networks By Design Commercial |
$3,664.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,791.45
|
|
|
HC GASTROSTOMY TUBE PERCUT
|
Facility
|
IP
|
$5,637.00
|
|
|
Service Code
|
CPT 49440
|
| Hospital Charge Code |
906743750
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,127.40 |
| Max. Negotiated Rate |
$4,791.45 |
| Rate for Payer: Adventist Health Commercial |
$1,127.40
|
| Rate for Payer: Cash Price |
$3,100.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,254.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,254.80
|
| Rate for Payer: Galaxy Health WC |
$4,791.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,382.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,759.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,147.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,489.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,352.88
|
| Rate for Payer: Multiplan Commercial |
$4,509.60
|
| Rate for Payer: Networks By Design Commercial |
$3,664.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,791.45
|
|
|
HC GASTROSTOMY TUBE PERCUT
|
Facility
|
OP
|
$5,637.00
|
|
|
Service Code
|
CPT 49440
|
| Hospital Charge Code |
906743750
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,127.40 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$1,127.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,410.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$3,100.35
|
| Rate for Payer: Cash Price |
$3,100.35
|
| Rate for Payer: Cash Price |
$3,100.35
|
| Rate for Payer: Cigna of CA HMO |
$3,607.68
|
| Rate for Payer: Cigna of CA PPO |
$4,171.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,651.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,410.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,253.93
|
| Rate for Payer: EPIC Health Plan Senior |
$2,410.32
|
| Rate for Payer: Galaxy Health WC |
$4,791.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,382.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,546.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,759.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,749.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,352.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,037.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,229.83
|
| Rate for Payer: Multiplan Commercial |
$4,509.60
|
| Rate for Payer: Multiplan WC |
$3,840.40
|
| Rate for Payer: Networks By Design Commercial |
$3,664.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,791.45
|
| Rate for Payer: Prime Health Services WC |
$3,801.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,382.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,410.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,410.32
|
|
|
HC GASTROSTOMY TUBE REPOSITION
|
Facility
|
IP
|
$3,266.00
|
|
|
Service Code
|
CPT 43761
|
| Hospital Charge Code |
906743761
|
|
Hospital Revenue Code
|
949
|
| Min. Negotiated Rate |
$653.20 |
| Max. Negotiated Rate |
$2,776.10 |
| Rate for Payer: Adventist Health Commercial |
$653.20
|
| Rate for Payer: Cash Price |
$1,796.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,306.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,306.40
|
| Rate for Payer: Galaxy Health WC |
$2,776.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,959.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,178.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,244.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,021.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$783.84
|
| Rate for Payer: Multiplan Commercial |
$2,612.80
|
| Rate for Payer: Networks By Design Commercial |
$2,122.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,776.10
|
|
|
HC GASTROSTOMY TUBE REPOSITION
|
Facility
|
OP
|
$3,266.00
|
|
|
Service Code
|
CPT 43761
|
| Hospital Charge Code |
906743761
|
|
Hospital Revenue Code
|
949
|
| Min. Negotiated Rate |
$133.22 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$653.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$1,796.30
|
| Rate for Payer: Cash Price |
$1,796.30
|
| Rate for Payer: Cash Price |
$1,796.30
|
| Rate for Payer: Cigna of CA HMO |
$2,090.24
|
| Rate for Payer: Cigna of CA PPO |
$2,416.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$309.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$417.18
|
| Rate for Payer: EPIC Health Plan Senior |
$309.02
|
| Rate for Payer: Galaxy Health WC |
$2,776.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,959.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$506.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$133.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$309.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,178.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$150.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$309.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$783.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$414.09
|
| Rate for Payer: Multiplan Commercial |
$2,612.80
|
| Rate for Payer: Networks By Design Commercial |
$2,122.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,776.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,959.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,959.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$803.00
|
| Rate for Payer: United Healthcare All Other HMO |
$541.00
|
| Rate for Payer: United Healthcare HMO Rider |
$328.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$300.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$309.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Vantage Medical Group Senior |
$309.02
|
|
|
HC GASTRO TUBE PLACEMENT
|
Facility
|
IP
|
$2,236.00
|
|
|
Service Code
|
CPT 44500
|
| Hospital Charge Code |
906744500
|
|
Hospital Revenue Code
|
949
|
| Min. Negotiated Rate |
$447.20 |
| Max. Negotiated Rate |
$1,900.60 |
| Rate for Payer: Adventist Health Commercial |
$447.20
|
| Rate for Payer: Cash Price |
$1,229.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$894.40
|
| Rate for Payer: EPIC Health Plan Senior |
$894.40
|
| Rate for Payer: Galaxy Health WC |
$1,900.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,341.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,491.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$851.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,384.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$536.64
|
| Rate for Payer: Multiplan Commercial |
$1,788.80
|
| Rate for Payer: Networks By Design Commercial |
$1,453.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,900.60
|
|
|
HC GASTRO TUBE PLACEMENT
|
Facility
|
OP
|
$2,236.00
|
|
|
Service Code
|
CPT 44500
|
| Hospital Charge Code |
906744500
|
|
Hospital Revenue Code
|
949
|
| Min. Negotiated Rate |
$32.52 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$447.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,466.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$1,229.80
|
| Rate for Payer: Cash Price |
$1,229.80
|
| Rate for Payer: Cash Price |
$1,229.80
|
| Rate for Payer: Cigna of CA HMO |
$1,431.04
|
| Rate for Payer: Cigna of CA PPO |
$1,654.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,608.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,191.26
|
| Rate for Payer: Galaxy Health WC |
$1,900.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,341.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,491.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$536.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,500.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,596.29
|
| Rate for Payer: Multiplan Commercial |
$1,788.80
|
| Rate for Payer: Networks By Design Commercial |
$1,453.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,900.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,341.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,341.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$803.00
|
| Rate for Payer: United Healthcare All Other HMO |
$541.00
|
| Rate for Payer: United Healthcare HMO Rider |
$328.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$300.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,191.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC GASTRO TUBE REMOVAL
|
Facility
|
OP
|
$5,343.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
900100022
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,068.60 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$1,068.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,281.14
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$2,938.65
|
| Rate for Payer: Cash Price |
$2,938.65
|
| Rate for Payer: Cash Price |
$2,938.65
|
| Rate for Payer: Cigna of CA HMO |
$3,419.52
|
| Rate for Payer: Cigna of CA PPO |
$3,953.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,608.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,191.26
|
| Rate for Payer: Galaxy Health WC |
$4,541.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,205.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,563.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,282.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,500.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,596.29
|
| Rate for Payer: Multiplan Commercial |
$4,274.40
|
| Rate for Payer: Networks By Design Commercial |
$3,472.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,541.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,205.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,429.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,191.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC GASTRO TUBE REMOVAL
|
Facility
|
IP
|
$5,343.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
900100022
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,068.60 |
| Max. Negotiated Rate |
$4,541.55 |
| Rate for Payer: Adventist Health Commercial |
$1,068.60
|
| Rate for Payer: Cash Price |
$2,938.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,137.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,137.20
|
| Rate for Payer: Galaxy Health WC |
$4,541.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,205.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,563.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,035.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,307.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,282.32
|
| Rate for Payer: Multiplan Commercial |
$4,274.40
|
| Rate for Payer: Networks By Design Commercial |
$3,472.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,541.55
|
|
|
HC GASTRO UGI SMB W WO KUB
|
Facility
|
IP
|
$2,099.00
|
|
|
Service Code
|
CPT 74245
|
| Hospital Charge Code |
909001811
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$419.80 |
| Max. Negotiated Rate |
$1,784.15 |
| Rate for Payer: Adventist Health Commercial |
$419.80
|
| Rate for Payer: Cash Price |
$1,154.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$839.60
|
| Rate for Payer: EPIC Health Plan Senior |
$839.60
|
| Rate for Payer: Galaxy Health WC |
$1,784.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,259.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,400.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$799.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,299.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$503.76
|
| Rate for Payer: Multiplan Commercial |
$1,679.20
|
| Rate for Payer: Networks By Design Commercial |
$1,364.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,784.15
|
|
