|
HC REP EXT TEND HAND PRI/SEC
|
Facility
|
IP
|
$6,877.00
|
|
|
Service Code
|
CPT 26410
|
| Hospital Charge Code |
900501074
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,375.40 |
| Max. Negotiated Rate |
$5,845.45 |
| Rate for Payer: Adventist Health Commercial |
$1,375.40
|
| Rate for Payer: Cash Price |
$3,782.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,750.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,750.80
|
| Rate for Payer: Galaxy Health WC |
$5,845.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,126.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,586.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,620.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,256.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,650.48
|
| Rate for Payer: Multiplan Commercial |
$5,501.60
|
| Rate for Payer: Networks By Design Commercial |
$4,470.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,845.45
|
|
|
HC REP EXT TENDON/FINGER/PRIM OR
|
Facility
|
OP
|
$9,968.00
|
|
|
Service Code
|
CPT 26418
|
| Hospital Charge Code |
900501232
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$556.70 |
| Max. Negotiated Rate |
$12,491.00 |
| Rate for Payer: Adventist Health Commercial |
$1,993.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,033.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Cash Price |
$5,482.40
|
| Rate for Payer: Cash Price |
$5,482.40
|
| Rate for Payer: Cash Price |
$5,482.40
|
| Rate for Payer: Cigna of CA HMO |
$6,379.52
|
| Rate for Payer: Cigna of CA PPO |
$7,376.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,236.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,033.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,745.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,033.48
|
| Rate for Payer: Galaxy Health WC |
$8,472.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,980.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,334.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,033.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,648.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$556.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,033.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,392.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,562.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,724.86
|
| Rate for Payer: Multiplan Commercial |
$7,974.40
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$6,479.20
|
| Rate for Payer: Prime Health Services Commercial |
$8,472.80
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,980.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,984.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,984.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,984.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,033.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Vantage Medical Group Senior |
$2,033.48
|
|
|
HC REP EXT TENDON/FINGER/PRIM OR
|
Facility
|
IP
|
$9,968.00
|
|
|
Service Code
|
CPT 26418
|
| Hospital Charge Code |
900501232
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,993.60 |
| Max. Negotiated Rate |
$8,472.80 |
| Rate for Payer: Adventist Health Commercial |
$1,993.60
|
| Rate for Payer: Cash Price |
$5,482.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,987.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,987.20
|
| Rate for Payer: Galaxy Health WC |
$8,472.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,980.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,648.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,797.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,170.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,392.32
|
| Rate for Payer: Multiplan Commercial |
$7,974.40
|
| Rate for Payer: Networks By Design Commercial |
$6,479.20
|
| Rate for Payer: Prime Health Services Commercial |
$8,472.80
|
|
|
HC REP FACE COM EA ADDL 5CM OR LT
|
Facility
|
OP
|
$1,751.00
|
|
|
Service Code
|
CPT 13153
|
| Hospital Charge Code |
900501490
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$36.08 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Adventist Health Commercial |
$350.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,488.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$963.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,313.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$963.05
|
| Rate for Payer: Cash Price |
$963.05
|
| Rate for Payer: Cash Price |
$963.05
|
| Rate for Payer: Cigna of CA HMO |
$1,120.64
|
| Rate for Payer: Cigna of CA PPO |
$1,295.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,488.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,488.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,488.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$700.40
|
| Rate for Payer: EPIC Health Plan Senior |
$700.40
|
| Rate for Payer: Galaxy Health WC |
$1,488.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,050.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,167.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,083.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$420.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,225.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,225.70
|
| Rate for Payer: Multiplan Commercial |
$1,400.80
|
| Rate for Payer: Networks By Design Commercial |
$1,138.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,488.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,050.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$875.50
|
| Rate for Payer: United Healthcare All Other HMO |
$875.50
|
| Rate for Payer: United Healthcare HMO Rider |
$875.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$875.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,488.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,488.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,488.35
|
|
|
HC REP FACE COM EA ADDL 5CM OR LT
|
Facility
|
IP
|
$1,751.00
|
|
|
Service Code
|
CPT 13153
|
| Hospital Charge Code |
900501490
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$350.20 |
| Max. Negotiated Rate |
$1,488.35 |
| Rate for Payer: Adventist Health Commercial |
$350.20
|
| Rate for Payer: Cash Price |
$963.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$700.40
|
| Rate for Payer: EPIC Health Plan Senior |
$700.40
|
| Rate for Payer: Galaxy Health WC |
$1,488.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,050.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,167.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$667.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,083.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$420.24
|
| Rate for Payer: Multiplan Commercial |
$1,400.80
|
| Rate for Payer: Networks By Design Commercial |
$1,138.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,488.35
|
|
|
HC REP HAND/FOOT NERVE,ULNAR MOTO
|
Facility
|
OP
|
$11,046.00
|
|
|
Service Code
|
CPT 64836
|
| Hospital Charge Code |
900501556
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$192.41 |
| Max. Negotiated Rate |
$13,344.70 |
| Rate for Payer: Adventist Health Commercial |
$2,209.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,205.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,950.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,137.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Cash Price |
$6,075.30
|
| Rate for Payer: Cash Price |
$6,075.30
|
| Rate for Payer: Cash Price |
$6,075.30
|
| Rate for Payer: Cigna of CA HMO |
$7,069.44
|
| Rate for Payer: Cigna of CA PPO |
$8,174.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,205.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,950.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,137.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,984.96
|
| Rate for Payer: EPIC Health Plan Senior |
$8,137.01
|
| Rate for Payer: Galaxy Health WC |
$9,389.10
|
| Rate for Payer: Global Benefits Group Commercial |
$6,627.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,344.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,137.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,367.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$192.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,137.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,651.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,252.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,903.59
|
| Rate for Payer: Multiplan Commercial |
$8,836.80
|
| Rate for Payer: Multiplan WC |
$12,964.88
|
| Rate for Payer: Networks By Design Commercial |
$7,179.90
|
| Rate for Payer: Prime Health Services Commercial |
$9,389.10
|
| Rate for Payer: Prime Health Services WC |
$12,832.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,627.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,523.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,523.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,523.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,523.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$8,137.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,205.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,950.71
|
| Rate for Payer: Vantage Medical Group Senior |
$8,137.01
|
|
|
HC REP HAND/FOOT NERVE,ULNAR MOTO
|
Facility
|
IP
|
$11,046.00
|
|
|
Service Code
|
CPT 64836
|
| Hospital Charge Code |
900501556
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,209.20 |
| Max. Negotiated Rate |
$9,389.10 |
| Rate for Payer: Adventist Health Commercial |
$2,209.20
|
| Rate for Payer: Cash Price |
$6,075.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,418.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,418.40
|
| Rate for Payer: Galaxy Health WC |
$9,389.10
|
| Rate for Payer: Global Benefits Group Commercial |
$6,627.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,367.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,208.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,837.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,651.04
|
| Rate for Payer: Multiplan Commercial |
$8,836.80
|
| Rate for Payer: Networks By Design Commercial |
$7,179.90
|
| Rate for Payer: Prime Health Services Commercial |
$9,389.10
|
|
|
HC REP INCARCERATED HERNIA REDUCT
|
Facility
|
OP
|
$6,618.00
|
|
|
Service Code
|
CPT 49507
|
| Hospital Charge Code |
900501638
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$157.74 |
| Max. Negotiated Rate |
$12,491.00 |
| Rate for Payer: Adventist Health Commercial |
$1,323.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,726.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,932.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,484.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Cash Price |
$3,639.90
|
| Rate for Payer: Cash Price |
$3,639.90
|
| Rate for Payer: Cash Price |
$3,639.90
|
| Rate for Payer: Cigna of CA HMO |
$4,235.52
|
| Rate for Payer: Cigna of CA PPO |
$4,897.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,726.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,932.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,484.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,053.43
|
| Rate for Payer: EPIC Health Plan Senior |
$4,484.02
|
| Rate for Payer: Galaxy Health WC |
$5,625.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,970.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,353.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,484.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,414.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,484.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,588.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,649.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,008.59
|
| Rate for Payer: Multiplan Commercial |
$5,294.40
|
| Rate for Payer: Multiplan WC |
$7,144.49
|
| Rate for Payer: Networks By Design Commercial |
$4,301.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,625.30
|
| Rate for Payer: Prime Health Services WC |
$7,071.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,970.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,309.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,309.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,309.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,309.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,484.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,726.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,932.42
|
| Rate for Payer: Vantage Medical Group Senior |
$4,484.02
|
|
|
HC REP INCARCERATED HERNIA REDUCT
|
Facility
|
IP
|
$6,618.00
|
|
|
Service Code
|
CPT 49507
|
| Hospital Charge Code |
900501638
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,323.60 |
| Max. Negotiated Rate |
$5,625.30 |
| Rate for Payer: Adventist Health Commercial |
$1,323.60
|
| Rate for Payer: Cash Price |
$3,639.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,647.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,647.20
|
| Rate for Payer: Galaxy Health WC |
$5,625.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,970.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,414.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,521.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,096.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,588.32
|
| Rate for Payer: Multiplan Commercial |
$5,294.40
|
| Rate for Payer: Networks By Design Commercial |
$4,301.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,625.30
|
|
|
HC REP INT WNDS 7.6-12.5CM
|
Facility
|
OP
|
$1,836.00
|
|
|
Service Code
|
CPT 12044
|
| Hospital Charge Code |
900501231
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$205.14 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$367.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$855.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$777.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$1,009.80
|
| Rate for Payer: Cash Price |
$1,009.80
|
| Rate for Payer: Cash Price |
$1,009.80
|
| Rate for Payer: Cigna of CA HMO |
$1,175.04
|
| Rate for Payer: Cigna of CA PPO |
$1,358.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$855.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$777.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,049.99
|
| Rate for Payer: EPIC Health Plan Senior |
$777.77
|
| Rate for Payer: Galaxy Health WC |
$1,560.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,101.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,275.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$777.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,224.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$777.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$440.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$979.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,042.21
|
| Rate for Payer: Multiplan Commercial |
$1,468.80
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: Networks By Design Commercial |
$1,193.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,560.60
|
| Rate for Payer: Prime Health Services WC |
$1,226.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,101.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$918.00
|
| Rate for Payer: United Healthcare All Other HMO |
$918.00
|
| Rate for Payer: United Healthcare HMO Rider |
$918.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$918.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$777.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$855.55
|
| Rate for Payer: Vantage Medical Group Senior |
$777.77
|
|
|
HC REP INT WNDS 7.6-12.5CM
|
Facility
|
IP
|
$1,836.00
|
|
|
Service Code
|
CPT 12044
|
| Hospital Charge Code |
900501231
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$367.20 |
| Max. Negotiated Rate |
$1,560.60 |
| Rate for Payer: Adventist Health Commercial |
$367.20
|
| Rate for Payer: Cash Price |
$1,009.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$734.40
|
| Rate for Payer: EPIC Health Plan Senior |
$734.40
|
| Rate for Payer: Galaxy Health WC |
$1,560.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,101.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,224.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$699.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,136.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$440.64
|
| Rate for Payer: Multiplan Commercial |
$1,468.80
|
| Rate for Payer: Networks By Design Commercial |
$1,193.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,560.60
|
|
|
HC REP INT WNDS FACE 7.6-12.5CM
|
Facility
|
IP
|
$2,683.00
|
|
|
Service Code
|
CPT 12054
|
| Hospital Charge Code |
900501038
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$536.60 |
| Max. Negotiated Rate |
$2,280.55 |
| Rate for Payer: Adventist Health Commercial |
$536.60
|
| Rate for Payer: Cash Price |
$1,475.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,073.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,073.20
|
| Rate for Payer: Galaxy Health WC |
$2,280.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,609.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,789.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,022.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,660.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$643.92
|
| Rate for Payer: Multiplan Commercial |
$2,146.40
|
| Rate for Payer: Networks By Design Commercial |
$1,743.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,280.55
|
|
|
HC REP INT WNDS FACE 7.6-12.5CM
|
Facility
|
OP
|
$2,683.00
|
|
|
Service Code
|
CPT 12054
|
| Hospital Charge Code |
900501038
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$296.38 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$536.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$1,475.65
|
| Rate for Payer: Cash Price |
$1,475.65
|
| Rate for Payer: Cash Price |
$1,475.65
|
| Rate for Payer: Cigna of CA HMO |
$1,717.12
|
| Rate for Payer: Cigna of CA PPO |
$1,985.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.31
|
| Rate for Payer: EPIC Health Plan Senior |
$507.64
|
| Rate for Payer: Galaxy Health WC |
$2,280.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,609.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$832.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,789.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$296.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$643.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$639.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| Rate for Payer: Multiplan Commercial |
$2,146.40
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$1,743.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,280.55
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,609.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,341.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,341.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,341.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,341.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$507.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC REPLACE DUODENAL/JEJUN TUBE
|
Facility
|
OP
|
$4,958.00
|
|
|
Service Code
|
CPT 49451
|
| Hospital Charge Code |
909020006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$991.60 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$991.60
|
| 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 |
$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 |
$2,726.90
|
| Rate for Payer: Cash Price |
$2,726.90
|
| Rate for Payer: Cash Price |
$2,726.90
|
| Rate for Payer: Cigna of CA HMO |
$3,173.12
|
| Rate for Payer: Cigna of CA PPO |
$3,668.92
|
| 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 |
$4,214.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,974.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,138.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,306.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,288.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,189.92
|
| 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 |
$3,966.40
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Networks By Design Commercial |
$3,222.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,214.30
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,974.80
|
| 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 REPLACE DUODENAL/JEJUN TUBE
|
Facility
|
IP
|
$4,958.00
|
|
|
Service Code
|
CPT 49451
|
| Hospital Charge Code |
909020006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$991.60 |
| Max. Negotiated Rate |
$4,214.30 |
| Rate for Payer: Adventist Health Commercial |
$991.60
|
| Rate for Payer: Cash Price |
$2,726.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,983.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,983.20
|
| Rate for Payer: Galaxy Health WC |
$4,214.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,974.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,306.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,889.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,069.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,189.92
|
| Rate for Payer: Multiplan Commercial |
$3,966.40
|
| Rate for Payer: Networks By Design Commercial |
$3,222.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,214.30
|
|
|
HC REPLACE FOOT DROP SPINT
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
CPT L4394
|
| Hospital Charge Code |
905354394
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$6.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$18.15
|
| Rate for Payer: Cash Price |
$18.15
|
| Rate for Payer: Cigna of CA HMO |
$23.10
|
| Rate for Payer: Cigna of CA PPO |
$23.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.20
|
| Rate for Payer: EPIC Health Plan Senior |
$13.20
|
| Rate for Payer: Galaxy Health WC |
$28.05
|
| Rate for Payer: Global Benefits Group Commercial |
$19.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.92
|
| Rate for Payer: Multiplan Commercial |
$26.40
|
| Rate for Payer: Networks By Design Commercial |
$16.50
|
| Rate for Payer: Prime Health Services Commercial |
$28.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.38
|
| Rate for Payer: United Healthcare All Other HMO |
$12.05
|
| Rate for Payer: United Healthcare HMO Rider |
$11.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.81
|
|
|
HC REPLACE FOOT DROP SPINT
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
CPT L4394
|
| Hospital Charge Code |
915354394
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.92 |
| Max. Negotiated Rate |
$28.05 |
| Rate for Payer: Adventist Health Commercial |
$13.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.11
|
| Rate for Payer: Blue Shield of California Commercial |
$24.35
|
| Rate for Payer: Blue Shield of California EPN |
$16.04
|
| Rate for Payer: Cash Price |
$18.15
|
| Rate for Payer: Cigna of CA HMO |
$23.10
|
| Rate for Payer: Cigna of CA PPO |
$23.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.20
|
| Rate for Payer: EPIC Health Plan Senior |
$13.20
|
| Rate for Payer: Galaxy Health WC |
$28.05
|
| Rate for Payer: Global Benefits Group Commercial |
$19.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.10
|
| Rate for Payer: Multiplan Commercial |
$26.40
|
| Rate for Payer: Networks By Design Commercial |
$16.50
|
| Rate for Payer: Prime Health Services Commercial |
$28.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.38
|
| Rate for Payer: United Healthcare All Other HMO |
$12.05
|
| Rate for Payer: United Healthcare HMO Rider |
$11.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.05
|
| Rate for Payer: Vantage Medical Group Senior |
$28.05
|
|
|
HC REPLACE FOOT DROP SPINT
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
CPT L4394
|
| Hospital Charge Code |
915354394
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$6.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$18.15
|
| Rate for Payer: Cash Price |
$18.15
|
| Rate for Payer: Cigna of CA HMO |
$23.10
|
| Rate for Payer: Cigna of CA PPO |
$23.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.20
|
| Rate for Payer: EPIC Health Plan Senior |
$13.20
|
| Rate for Payer: Galaxy Health WC |
$28.05
|
| Rate for Payer: Global Benefits Group Commercial |
$19.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.92
|
| Rate for Payer: Multiplan Commercial |
$26.40
|
| Rate for Payer: Networks By Design Commercial |
$16.50
|
| Rate for Payer: Prime Health Services Commercial |
$28.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.38
|
| Rate for Payer: United Healthcare All Other HMO |
$12.05
|
| Rate for Payer: United Healthcare HMO Rider |
$11.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.81
|
|
|
HC REPLACE FOOT DROP SPINT
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
CPT L4394
|
| Hospital Charge Code |
905354394
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.92 |
| Max. Negotiated Rate |
$28.05 |
| Rate for Payer: Galaxy Health WC |
$28.05
|
| Rate for Payer: Adventist Health Commercial |
$13.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.11
|
| Rate for Payer: Blue Shield of California Commercial |
$24.35
|
| Rate for Payer: Blue Shield of California EPN |
$16.04
|
| Rate for Payer: Cash Price |
$18.15
|
| Rate for Payer: Cigna of CA HMO |
$23.10
|
| Rate for Payer: Cigna of CA PPO |
$23.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.20
|
| Rate for Payer: EPIC Health Plan Senior |
$13.20
|
| Rate for Payer: Global Benefits Group Commercial |
$19.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.10
|
| Rate for Payer: Multiplan Commercial |
$26.40
|
| Rate for Payer: Networks By Design Commercial |
$16.50
|
| Rate for Payer: Prime Health Services Commercial |
$28.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.38
|
| Rate for Payer: United Healthcare All Other HMO |
$12.05
|
| Rate for Payer: United Healthcare HMO Rider |
$11.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.05
|
| Rate for Payer: Vantage Medical Group Senior |
$28.05
|
|
|
HC REPLACE GAST/CECOSTOMY TUBE
|
Facility
|
OP
|
$4,292.00
|
|
|
Service Code
|
CPT 49450
|
| Hospital Charge Code |
906749450
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$858.40 |
| Max. Negotiated Rate |
$6,427.00 |
| Rate for Payer: Adventist Health Commercial |
$858.40
|
| 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 |
$6,427.00
|
| Rate for Payer: Cash Price |
$2,360.60
|
| Rate for Payer: Cash Price |
$2,360.60
|
| Rate for Payer: Cash Price |
$2,360.60
|
| Rate for Payer: Cigna of CA HMO |
$2,746.88
|
| Rate for Payer: Cigna of CA PPO |
$3,176.08
|
| 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 |
$3,648.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,575.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,862.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,216.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,030.08
|
| 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 |
$3,433.60
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Networks By Design Commercial |
$2,789.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,648.20
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,575.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,146.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,146.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,146.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,146.00
|
| 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 REPLACE GAST/CECOSTOMY TUBE
|
Facility
|
IP
|
$4,292.00
|
|
|
Service Code
|
CPT 49450
|
| Hospital Charge Code |
906749450
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$858.40 |
| Max. Negotiated Rate |
$3,648.20 |
| Rate for Payer: Adventist Health Commercial |
$858.40
|
| Rate for Payer: Cash Price |
$2,360.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,716.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,716.80
|
| Rate for Payer: Galaxy Health WC |
$3,648.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,575.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,862.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,635.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,656.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,030.08
|
| Rate for Payer: Multiplan Commercial |
$3,433.60
|
| Rate for Payer: Networks By Design Commercial |
$2,789.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,648.20
|
|
|
HC REPLACE GAST/CECOSTOMY TUBE
|
Facility
|
IP
|
$4,292.00
|
|
|
Service Code
|
CPT 49450
|
| Hospital Charge Code |
906749450
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$858.40 |
| Max. Negotiated Rate |
$3,648.20 |
| Rate for Payer: Adventist Health Commercial |
$858.40
|
| Rate for Payer: Cash Price |
$2,360.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,716.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,716.80
|
| Rate for Payer: Galaxy Health WC |
$3,648.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,575.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,862.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,635.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,656.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,030.08
|
| Rate for Payer: Multiplan Commercial |
$3,433.60
|
| Rate for Payer: Networks By Design Commercial |
$2,789.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,648.20
|
|
|
HC REPLACE GAST/CECOSTOMY TUBE
|
Facility
|
OP
|
$4,292.00
|
|
|
Service Code
|
CPT 49450
|
| Hospital Charge Code |
906749450
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$858.40 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$858.40
|
| 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 |
$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 |
$2,360.60
|
| Rate for Payer: Cash Price |
$2,360.60
|
| Rate for Payer: Cash Price |
$2,360.60
|
| Rate for Payer: Cigna of CA HMO |
$2,746.88
|
| Rate for Payer: Cigna of CA PPO |
$3,176.08
|
| 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 |
$3,648.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,575.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,075.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,862.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,216.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,030.08
|
| 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 |
$3,433.60
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Networks By Design Commercial |
$2,789.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,648.20
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,575.20
|
| 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 |
$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 REPLACE GIRDLE MILWAUKEE
|
Facility
|
IP
|
$1,971.00
|
|
|
Service Code
|
CPT L4000
|
| Hospital Charge Code |
905354000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$394.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$394.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,084.05
|
| Rate for Payer: Cash Price |
$1,084.05
|
| Rate for Payer: Cigna of CA HMO |
$1,379.70
|
| Rate for Payer: Cigna of CA PPO |
$1,379.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$788.40
|
| Rate for Payer: EPIC Health Plan Senior |
$788.40
|
| Rate for Payer: Galaxy Health WC |
$1,675.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,182.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,314.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$750.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,220.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$473.04
|
| Rate for Payer: Multiplan Commercial |
$1,576.80
|
| Rate for Payer: Networks By Design Commercial |
$985.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,675.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$739.72
|
| Rate for Payer: United Healthcare All Other HMO |
$720.01
|
| Rate for Payer: United Healthcare HMO Rider |
$704.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$645.50
|
|
|
HC REPLACE GIRDLE MILWAUKEE
|
Facility
|
OP
|
$1,971.00
|
|
|
Service Code
|
CPT L4000
|
| Hospital Charge Code |
915354000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$473.04 |
| Max. Negotiated Rate |
$1,675.35 |
| Rate for Payer: Adventist Health Commercial |
$808.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,675.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,084.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,478.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,141.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,454.60
|
| Rate for Payer: Blue Shield of California EPN |
$957.91
|
| Rate for Payer: Cash Price |
$1,084.05
|
| Rate for Payer: Cash Price |
$1,084.05
|
| Rate for Payer: Cigna of CA HMO |
$1,379.70
|
| Rate for Payer: Cigna of CA PPO |
$1,379.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,675.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,675.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,675.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$788.40
|
| Rate for Payer: EPIC Health Plan Senior |
$788.40
|
| Rate for Payer: Galaxy Health WC |
$1,675.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,182.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$662.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,314.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$748.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,220.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$473.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,379.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,379.70
|
| Rate for Payer: Multiplan Commercial |
$1,576.80
|
| Rate for Payer: Networks By Design Commercial |
$985.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,675.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,182.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,182.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$739.72
|
| Rate for Payer: United Healthcare All Other HMO |
$720.01
|
| Rate for Payer: United Healthcare HMO Rider |
$704.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$645.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,675.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,675.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,675.35
|
|
