|
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 |
$561.72
|
| Rate for Payer: Blue Shield of California Commercial |
$470.50
|
| Rate for Payer: Blue Shield of California Commercial |
$713.63
|
| Rate for Payer: Cash Price |
$417.60
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$589.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$336.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$547.52
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$185.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Cigna of CA HMO |
$649.60
|
| Rate for Payer: Cigna of CA PPO |
$649.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$589.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$547.52
|
| 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 |
$603.20
|
| 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 HMO Rider |
$331.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$303.92
|
|
|
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 |
$374.68
|
| Rate for Payer: Blue Shield of California Commercial |
$313.83
|
| Rate for Payer: Blue Shield of California Commercial |
$476.01
|
| Rate for Payer: Cash Price |
$278.55
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$393.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$224.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$365.21
|
| 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 GASTROJEJUNOSTOMY SET SGL/LMN
|
Facility
|
IP
|
$619.00
|
|
| Hospital Charge Code |
909001041
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$123.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$123.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$278.55
|
| Rate for Payer: Cash Price |
$278.55
|
| Rate for Payer: Cigna of CA HMO |
$433.30
|
| Rate for Payer: Cigna of CA PPO |
$433.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$393.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$365.21
|
| 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 |
$402.35
|
| 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 GASTRO PANEL NUCLEIC ACID
|
Facility
|
OP
|
$1,482.00
|
|
|
Service Code
|
CPT 87507
|
| Hospital Charge Code |
900913644
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$296.40 |
| Max. Negotiated Rate |
$3,351.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,351.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$458.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$458.46
|
| Rate for Payer: Vantage Medical Group Senior |
$416.78
|
| Rate for Payer: Vantage Medical Group Senior |
$416.78
|
| Rate for Payer: Adventist Health Commercial |
$296.40
|
| Rate for Payer: Adventist Health Commercial |
$352.40
|
| 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 Commercial/Exchange |
$625.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$458.46
|
| 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: Alpha Care Medical Group Medicare Advantage/Dual Product |
$416.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,227.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,227.35
|
| Rate for Payer: Blue Shield of California Commercial |
$1,228.11
|
| Rate for Payer: Blue Shield of California Commercial |
$1,032.95
|
| Rate for Payer: Blue Shield of California Commercial |
$812.28
|
| Rate for Payer: Blue Shield of California Commercial |
$683.20
|
| Rate for Payer: Cash Price |
$792.90
|
| Rate for Payer: Cash Price |
$792.90
|
| Rate for Payer: Cash Price |
$666.90
|
| Rate for Payer: Cash Price |
$666.90
|
| Rate for Payer: Cigna of CA HMO |
$1,127.68
|
| Rate for Payer: Cigna of CA HMO |
$948.48
|
| Rate for Payer: Cigna of CA PPO |
$1,096.68
|
| Rate for Payer: Cigna of CA PPO |
$1,303.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$625.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$625.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$458.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$458.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$416.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$416.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,037.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,233.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$687.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$687.69
|
| Rate for Payer: EPIC Health Plan Senior |
$458.46
|
| Rate for Payer: EPIC Health Plan Senior |
$458.46
|
| Rate for Payer: Galaxy Health WC |
$1,259.70
|
| Rate for Payer: Galaxy Health WC |
$1,497.70
|
| Rate for Payer: Global Benefits Group Commercial |
$889.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,057.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$683.52
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$683.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$622.39
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$416.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$941.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,118.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$703.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$703.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$583.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$583.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$355.68
|
| 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 Medi-Cal |
$525.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$558.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$558.49
|
| Rate for Payer: Multiplan Commercial |
$1,409.60
|
| Rate for Payer: Multiplan Commercial |
$1,185.60
|
| Rate for Payer: Networks By Design Commercial |
$1,145.30
|
| Rate for Payer: Networks By Design Commercial |
$963.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,259.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,497.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$889.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,057.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$889.20
|
| 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 Commercial |
$337.59
|
| Rate for Payer: United Healthcare All Other HMO |
$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 HMO Rider |
$337.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$337.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$337.59
|
| Rate for Payer: Upland Medical Group Pediatric |
$416.78
|
| 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 Commercial/Exchange |
$625.17
|
|
|
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: Adventist Health Commercial |
$352.40
|
| Rate for Payer: Cash Price |
$792.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,233.40
|
| 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: Global Benefits Group Commercial |
$1,057.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,118.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,039.58
|
| 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 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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,127.40
|
| Rate for Payer: Adventist Health Commercial |
$673.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Cash Price |
$1,515.60
|
| Rate for Payer: Cash Price |
$2,536.65
|
| Rate for Payer: Cash Price |
$2,536.65
|
| Rate for Payer: Cash Price |
$1,515.60
|
| Rate for Payer: Cash Price |
$1,515.60
|
| Rate for Payer: Cash Price |
$2,536.65
|
| Rate for Payer: Cigna of CA HMO |
$3,607.68
|
| Rate for Payer: Cigna of CA HMO |
$2,155.52
|
| Rate for Payer: Cigna of CA PPO |
$2,492.32
|
| Rate for Payer: Cigna of CA PPO |
$4,171.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,945.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,357.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: Galaxy Health WC |
$4,791.45
|
| Rate for Payer: Galaxy Health WC |
$2,862.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,020.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,382.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,546.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,546.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,579.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,138.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,749.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,749.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$808.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,352.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,109.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,109.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,307.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$2,694.40
|
| Rate for Payer: Multiplan Commercial |
$4,509.60
|
| Rate for Payer: Networks By Design Commercial |
$3,664.05
|
| Rate for Payer: Networks By Design Commercial |
$2,189.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,791.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,862.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,382.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,020.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,961.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,961.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,684.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,818.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| 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 HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
|
|
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: EPIC Health Plan Commercial |
$2,254.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,254.80
|
| Rate for Payer: Adventist Health Commercial |
$1,127.40
|
| Rate for Payer: Cash Price |
$2,536.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,945.90
|
| Rate for Payer: Galaxy Health WC |
$4,791.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,382.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,579.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,325.83
|
| 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 |
$2,536.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,945.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3,579.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,325.83
|
| 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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,127.40
|
| Rate for Payer: Adventist Health Commercial |
$673.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Cash Price |
$1,515.60
|
| Rate for Payer: Cash Price |
$1,515.60
|
| Rate for Payer: Cash Price |
$2,536.65
|
| Rate for Payer: Cash Price |
$1,515.60
|
| Rate for Payer: Cash Price |
$2,536.65
|
| Rate for Payer: Cash Price |
$2,536.65
|
| Rate for Payer: Cigna of CA HMO |
$2,155.52
|
| Rate for Payer: Cigna of CA HMO |
$3,607.68
|
| Rate for Payer: Cigna of CA PPO |
$4,171.38
|
| Rate for Payer: Cigna of CA PPO |
$2,492.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,357.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,945.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: Galaxy Health WC |
$4,791.45
|
| Rate for Payer: Galaxy Health WC |
$2,862.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,382.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,020.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,546.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,546.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,579.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,138.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,749.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,749.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,352.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$808.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,109.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,109.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,307.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$2,694.40
|
| Rate for Payer: Multiplan Commercial |
$4,509.60
|
| Rate for Payer: Multiplan WC |
$3,840.40
|
| Rate for Payer: Multiplan WC |
$3,840.40
|
| Rate for Payer: Networks By Design Commercial |
$3,664.05
|
| Rate for Payer: Networks By Design Commercial |
$2,189.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,791.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,862.80
|
| Rate for Payer: Prime Health Services WC |
$3,801.22
|
| 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: Temecula Valley Physicians Medical Group Commercial |
$2,020.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,818.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,684.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| 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 HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
|
|
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 |
$1,469.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,286.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,073.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,926.94
|
| 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 |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$653.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$675.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$321.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$1,469.70
|
| Rate for Payer: Cash Price |
$1,469.70
|
| Rate for Payer: Cash Price |
$1,469.70
|
| Rate for Payer: Cash Price |
$1,469.70
|
| 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 |
$482.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$353.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$321.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,286.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$530.23
|
| Rate for Payer: EPIC Health Plan Senior |
$353.49
|
| 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/Senior |
$527.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$133.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$321.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,073.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$150.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$449.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$783.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$404.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$430.61
|
| 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 |
$321.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Vantage Medical Group Senior |
$321.35
|
|
|
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 |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$447.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$158.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$1,006.20
|
| Rate for Payer: Cash Price |
$1,006.20
|
| Rate for Payer: Cash Price |
$1,006.20
|
| Rate for Payer: Cash Price |
$1,006.20
|
| 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 |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,565.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| 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/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,419.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$536.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,469.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,563.15
|
| 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 |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
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 |
$1,006.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,565.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,419.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,319.24
|
| 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 REMOVAL
|
Facility
|
OP
|
$5,614.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
900100022
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,122.80 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,122.80
|
| Rate for Payer: Adventist Health Commercial |
$1,068.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,602.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,428.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Cash Price |
$2,404.35
|
| Rate for Payer: Cash Price |
$2,404.35
|
| Rate for Payer: Cash Price |
$2,526.30
|
| Rate for Payer: Cash Price |
$2,526.30
|
| Rate for Payer: Cash Price |
$2,526.30
|
| Rate for Payer: Cash Price |
$2,404.35
|
| Rate for Payer: Cigna of CA HMO |
$3,592.96
|
| Rate for Payer: Cigna of CA HMO |
$3,419.52
|
| Rate for Payer: Cigna of CA PPO |
$3,953.82
|
| Rate for Payer: Cigna of CA PPO |
$4,154.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,929.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,740.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: Galaxy Health WC |
$4,541.55
|
| Rate for Payer: Galaxy Health WC |
$4,771.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,205.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,368.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,392.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,564.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,282.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,347.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,469.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,469.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,563.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$4,491.20
|
| Rate for Payer: Multiplan Commercial |
$4,274.40
|
| Rate for Payer: Networks By Design Commercial |
$3,649.10
|
| Rate for Payer: Networks By Design Commercial |
$3,472.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,541.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,771.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,368.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,205.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,399.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,399.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,807.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,671.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| 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 HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
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 |
$2,404.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,740.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3,392.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,152.37
|
| 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 |
$944.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,469.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,332.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,238.41
|
| 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
|
|
|
HC GASTRO UGI SMB W WO KUB
|
Facility
|
OP
|
$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: Aetna of CA HMO/PPO |
$1,376.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,784.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,154.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,574.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$656.81
|
| Rate for Payer: Blue Shield of California Commercial |
$1,339.16
|
| Rate for Payer: Blue Shield of California Commercial |
$883.68
|
| Rate for Payer: Cash Price |
$944.55
|
| Rate for Payer: Cash Price |
$944.55
|
| Rate for Payer: Cigna of CA HMO |
$1,343.36
|
| Rate for Payer: Cigna of CA PPO |
$1,553.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,784.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,784.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,784.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,469.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,332.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$761.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,238.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$503.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,469.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,469.30
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,259.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,259.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,049.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,049.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,049.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,049.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,784.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,784.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,784.15
|
|
|
HC GASTRO UGI SNGL CNTRST
|
Facility
|
OP
|
$1,228.00
|
|
|
Service Code
|
CPT 74240
|
| Hospital Charge Code |
909001873
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$171.41 |
| Max. Negotiated Rate |
$1,043.80 |
| Rate for Payer: Adventist Health Commercial |
$245.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$559.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$432.85
|
| Rate for Payer: Blue Shield of California Commercial |
$516.99
|
| Rate for Payer: Blue Shield of California Commercial |
$783.46
|
| Rate for Payer: Cash Price |
$552.60
|
| Rate for Payer: Cash Price |
$552.60
|
| Rate for Payer: Cigna of CA HMO |
$785.92
|
| Rate for Payer: Cigna of CA PPO |
$908.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$859.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: Galaxy Health WC |
$1,043.80
|
| Rate for Payer: Global Benefits Group Commercial |
$736.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$171.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$779.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$193.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$294.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$284.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$982.40
|
| Rate for Payer: Networks By Design Commercial |
$798.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,043.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$736.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$736.80
|
| 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: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
|
HC GASTRO UGI SNGL CNTRST
|
Facility
|
IP
|
$1,228.00
|
|
|
Service Code
|
CPT 74240
|
| Hospital Charge Code |
909001873
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$245.60 |
| Max. Negotiated Rate |
$1,043.80 |
| Rate for Payer: Adventist Health Commercial |
$245.60
|
| Rate for Payer: Cash Price |
$552.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$859.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$491.20
|
| Rate for Payer: EPIC Health Plan Senior |
$491.20
|
| Rate for Payer: Galaxy Health WC |
$1,043.80
|
| Rate for Payer: Global Benefits Group Commercial |
$736.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$779.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$724.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$294.72
|
| Rate for Payer: Multiplan Commercial |
$982.40
|
| Rate for Payer: Networks By Design Commercial |
$798.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,043.80
|
|
|
HC GASTRO UGI WITH KUB
|
Facility
|
IP
|
$1,636.00
|
|
|
Service Code
|
CPT 74241
|
| Hospital Charge Code |
909001796
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$327.20 |
| Max. Negotiated Rate |
$1,390.60 |
| Rate for Payer: Adventist Health Commercial |
$327.20
|
| Rate for Payer: Cash Price |
$736.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,145.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$654.40
|
| Rate for Payer: EPIC Health Plan Senior |
$654.40
|
| Rate for Payer: Galaxy Health WC |
$1,390.60
|
| Rate for Payer: Global Benefits Group Commercial |
$981.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,038.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$965.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.64
|
| Rate for Payer: Multiplan Commercial |
$1,308.80
|
| Rate for Payer: Networks By Design Commercial |
$1,063.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,390.60
|
|
|
HC GASTRO UGI WITH KUB
|
Facility
|
OP
|
$1,636.00
|
|
|
Service Code
|
CPT 74241
|
| Hospital Charge Code |
909001796
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$327.20 |
| Max. Negotiated Rate |
$1,390.60 |
| Rate for Payer: Adventist Health Commercial |
$327.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,073.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,390.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$899.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,227.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$441.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1,043.77
|
| Rate for Payer: Blue Shield of California Commercial |
$688.76
|
| Rate for Payer: Cash Price |
$736.20
|
| Rate for Payer: Cash Price |
$736.20
|
| Rate for Payer: Cigna of CA HMO |
$1,047.04
|
| Rate for Payer: Cigna of CA PPO |
$1,210.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,390.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,390.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,390.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,145.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$654.40
|
| Rate for Payer: EPIC Health Plan Senior |
$654.40
|
| Rate for Payer: Galaxy Health WC |
$1,390.60
|
| Rate for Payer: Global Benefits Group Commercial |
$981.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,038.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$593.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$965.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,145.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,145.20
|
| Rate for Payer: Multiplan Commercial |
$1,308.80
|
| Rate for Payer: Networks By Design Commercial |
$1,063.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,390.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$981.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$981.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$818.00
|
| Rate for Payer: United Healthcare All Other HMO |
$818.00
|
| Rate for Payer: United Healthcare HMO Rider |
$818.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$818.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,390.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,390.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,390.60
|
|
|
HC GASTROVIEW PER ML
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT Q9960
|
| Hospital Charge Code |
909001017
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.51
|
| Rate for Payer: Blue Shield of California Commercial |
$0.77
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Senior |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
|
|
HC GASTROVIEW PER ML
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT Q9960
|
| Hospital Charge Code |
909001017
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.38
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO |
$0.64
|
| Rate for Payer: Cigna of CA PPO |
$0.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Senior |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO |
$0.50
|
| Rate for Payer: United Healthcare HMO Rider |
$0.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Vantage Medical Group Senior |
$0.85
|
|
|
HC GATED BLOOD POOL- MUGA
|
Facility
|
OP
|
$3,661.00
|
|
|
Service Code
|
CPT 78472
|
| Hospital Charge Code |
909301381
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$281.85 |
| Max. Negotiated Rate |
$3,111.85 |
| Rate for Payer: Adventist Health Commercial |
$732.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,459.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$514.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,349.26
|
| Rate for Payer: Blue Shield of California Commercial |
$2,335.72
|
| Rate for Payer: Blue Shield of California Commercial |
$1,541.28
|
| Rate for Payer: Cash Price |
$1,647.45
|
| Rate for Payer: Cash Price |
$1,647.45
|
| Rate for Payer: Cigna of CA HMO |
$2,343.04
|
| Rate for Payer: Cigna of CA PPO |
$2,709.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$771.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,562.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$848.38
|
| Rate for Payer: EPIC Health Plan Senior |
$565.59
|
| Rate for Payer: Galaxy Health WC |
$3,111.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,196.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$843.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$281.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$514.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,324.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$318.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$719.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$878.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$647.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$688.99
|
| Rate for Payer: Multiplan Commercial |
$2,928.80
|
| Rate for Payer: Networks By Design Commercial |
$2,379.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,111.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,196.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,196.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$761.81
|
| Rate for Payer: United Healthcare All Other HMO |
$761.81
|
| Rate for Payer: United Healthcare HMO Rider |
$761.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$761.81
|
| Rate for Payer: Upland Medical Group Pediatric |
$514.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Vantage Medical Group Senior |
$514.17
|
|
