|
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 |
$4,970.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,732.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$7,014.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,517.14
|
| 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
|
456
|
| Min. Negotiated Rate |
$157.74 |
| Max. Negotiated Rate |
$9,104.00 |
| Rate for Payer: Adventist Health Commercial |
$2,713.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,966.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,907.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,065.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,604.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,104.00
|
| Rate for Payer: Cash Price |
$2,978.10
|
| Rate for Payer: Cash Price |
$2,978.10
|
| Rate for Payer: Cash Price |
$2,978.10
|
| 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 |
$6,907.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,065.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,604.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,632.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,598.23
|
| Rate for Payer: EPIC Health Plan Senior |
$5,065.49
|
| 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/Senior |
$7,552.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,604.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,202.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$157.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,950.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,588.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,802.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,170.69
|
| 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: TriValley Medical Group Commercial/Senior |
$3,970.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,604.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,907.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,065.49
|
| Rate for Payer: Vantage Medical Group Senior |
$4,604.99
|
|
|
HC REP INCARCERATED HERNIA REDUCT
|
Facility
|
IP
|
$6,618.00
|
|
|
Service Code
|
CPT 49507
|
| Hospital Charge Code |
900501638
|
|
Hospital Revenue Code
|
456
|
| 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 |
$2,978.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,632.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$4,202.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,904.62
|
| 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 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 |
$2,978.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,632.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$4,202.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,904.62
|
| 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 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 |
$9,104.00 |
| Rate for Payer: Adventist Health Commercial |
$1,323.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,907.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,065.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,604.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,104.00
|
| Rate for Payer: Cash Price |
$2,978.10
|
| Rate for Payer: Cash Price |
$2,978.10
|
| Rate for Payer: Cash Price |
$2,978.10
|
| 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 |
$6,907.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,065.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,604.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,632.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,598.23
|
| Rate for Payer: EPIC Health Plan Senior |
$5,065.49
|
| 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/Senior |
$7,552.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,604.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,202.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$157.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,950.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,588.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,802.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,170.69
|
| 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 |
$4,604.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,907.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,065.49
|
| Rate for Payer: Vantage Medical Group Senior |
$4,604.99
|
|
|
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 |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$367.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$950.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$826.20
|
| Rate for Payer: Cash Price |
$826.20
|
| Rate for Payer: Cash Price |
$826.20
|
| 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 |
$1,425.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,045.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$950.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,285.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,568.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1,045.63
|
| 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/Senior |
$1,558.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$950.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,165.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$205.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,021.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$440.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,197.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,273.76
|
| 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 |
$950.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Vantage Medical Group Senior |
$950.57
|
|
|
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 |
$826.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,285.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,165.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,083.24
|
| 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
|
OP
|
$2,683.00
|
|
|
Service Code
|
CPT 12054
|
| Hospital Charge Code |
900501038
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$296.38 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$1,100.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,415.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$1,207.35
|
| Rate for Payer: Cash Price |
$1,207.35
|
| Rate for Payer: Cash Price |
$1,207.35
|
| 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 |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,878.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| 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/Senior |
$857.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,703.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$296.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$643.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$658.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$700.62
|
| 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: TriValley Medical Group Commercial/Senior |
$1,609.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$522.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
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 |
$1,207.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,878.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,703.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,582.97
|
| 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
|
IP
|
$2,683.00
|
|
|
Service Code
|
CPT 12054
|
| Hospital Charge Code |
900501038
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$536.60 |
| Max. Negotiated Rate |
$2,280.55 |
| Rate for Payer: Adventist Health Commercial |
$536.60
|
| Rate for Payer: Cash Price |
$1,207.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,878.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,703.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,582.97
|
| 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 |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$536.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$1,207.35
|
| Rate for Payer: Cash Price |
$1,207.35
|
| Rate for Payer: Cash Price |
$1,207.35
|
| 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 |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,878.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| 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/Senior |
$857.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,703.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$296.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$643.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$658.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$700.62
|
| 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 |
$522.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
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 |
$2,231.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,470.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3,148.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,925.22
|
| 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 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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$991.60
|
| 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 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 |
$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: Cash Price |
$2,231.10
|
| Rate for Payer: Cash Price |
$2,231.10
|
| Rate for Payer: Cash Price |
$2,231.10
|
| 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 |
$1,749.80
|
| 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 |
$3,470.60
|
| 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 |
$4,214.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,974.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,138.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,148.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,288.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,189.92
|
| 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 |
$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 |
$2,479.00
|
| 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 |
$1,166.53
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$6.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$14.85
|
| Rate for Payer: Cash Price |
$14.85
|
| Rate for Payer: Cigna of CA HMO |
$23.10
|
| Rate for Payer: Cigna of CA PPO |
$23.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$20.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.47
|
| 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 |
$21.45
|
| 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 |
$19.97
|
| Rate for Payer: Blue Shield of California Commercial |
$16.73
|
| Rate for Payer: Blue Shield of California Commercial |
$25.38
|
| Rate for Payer: Cash Price |
$14.85
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$20.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.47
|
| 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 |
905354394
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$6.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$14.85
|
| Rate for Payer: Cash Price |
$14.85
|
| Rate for Payer: Cigna of CA HMO |
$23.10
|
| Rate for Payer: Cigna of CA PPO |
$23.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$20.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.47
|
| 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 |
$21.45
|
| 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: 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 |
$19.97
|
| Rate for Payer: Blue Shield of California Commercial |
$16.73
|
| Rate for Payer: Blue Shield of California Commercial |
$25.38
|
| Rate for Payer: Cash Price |
$14.85
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$20.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.47
|
| 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 |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$858.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| 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 |
$6,716.00
|
| Rate for Payer: Cash Price |
$1,931.40
|
| Rate for Payer: Cash Price |
$1,931.40
|
| Rate for Payer: Cash Price |
$1,931.40
|
| 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 |
$1,749.80
|
| 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 |
$3,004.40
|
| 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 |
$3,648.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,575.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,725.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,216.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,254.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,030.08
|
| 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 |
$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 |
$1,166.53
|
| 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 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 |
$1,931.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,004.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,725.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,532.28
|
| 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
|
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 |
$1,931.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,004.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,725.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,532.28
|
| 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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$858.40
|
| 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 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 |
$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: Cash Price |
$1,931.40
|
| Rate for Payer: Cash Price |
$1,931.40
|
| Rate for Payer: Cash Price |
$1,931.40
|
| 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 |
$1,749.80
|
| 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 |
$3,004.40
|
| 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 |
$3,648.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,575.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,075.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,725.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,216.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,030.08
|
| 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 |
$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 |
$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 |
$1,166.53
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$394.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$886.95
|
| Rate for Payer: Cash Price |
$886.95
|
| Rate for Payer: Cigna of CA HMO |
$1,379.70
|
| Rate for Payer: Cigna of CA PPO |
$1,379.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,251.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,162.89
|
| 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 |
$1,281.15
|
| 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 |
$1,193.05
|
| Rate for Payer: Blue Shield of California Commercial |
$999.30
|
| Rate for Payer: Blue Shield of California Commercial |
$1,515.70
|
| Rate for Payer: Cash Price |
$886.95
|
| Rate for Payer: Cash Price |
$886.95
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$662.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,251.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$748.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,162.89
|
| 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
|
|
|
HC REPLACE GIRDLE MILWAUKEE
|
Facility
|
OP
|
$1,971.00
|
|
|
Service Code
|
CPT L4000
|
| Hospital Charge Code |
905354000
|
|
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 |
$1,193.05
|
| Rate for Payer: Blue Shield of California Commercial |
$999.30
|
| Rate for Payer: Blue Shield of California Commercial |
$1,515.70
|
| Rate for Payer: Cash Price |
$886.95
|
| Rate for Payer: Cash Price |
$886.95
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$662.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,251.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$748.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,162.89
|
| 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
|
|
|
HC REPLACE GIRDLE MILWAUKEE
|
Facility
|
IP
|
$1,971.00
|
|
|
Service Code
|
CPT L4000
|
| Hospital Charge Code |
915354000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$394.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$394.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$886.95
|
| Rate for Payer: Cash Price |
$886.95
|
| Rate for Payer: Cigna of CA HMO |
$1,379.70
|
| Rate for Payer: Cigna of CA PPO |
$1,379.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,251.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,162.89
|
| 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 |
$1,281.15
|
| 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
|
|
