|
HC ROOM TRAUMA ICU ISOLATION
|
Facility
|
IP
|
$26,391.00
|
|
| Hospital Charge Code |
902314715
|
|
Hospital Revenue Code
|
209
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$22,432.35 |
| Rate for Payer: Adventist Health Commercial |
$5,278.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,521.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,170.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,053.00
|
| Rate for Payer: Cash Price |
$14,515.05
|
| Rate for Payer: Cash Price |
$14,515.05
|
| Rate for Payer: Cash Price |
$14,515.05
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,556.40
|
| Rate for Payer: EPIC Health Plan Senior |
$10,556.40
|
| Rate for Payer: Galaxy Health WC |
$22,432.35
|
| Rate for Payer: Global Benefits Group Commercial |
$15,834.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,602.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,054.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,336.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,333.84
|
| Rate for Payer: Multiplan Commercial |
$21,112.80
|
| Rate for Payer: Prime Health Services Commercial |
$22,432.35
|
|
|
HC ROOM TRAUMA ICU ISOLATION 1:1
|
Facility
|
IP
|
$25,623.00
|
|
| Hospital Charge Code |
992314715
|
|
Hospital Revenue Code
|
209
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$21,779.55 |
| Rate for Payer: Adventist Health Commercial |
$5,124.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,521.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,170.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,053.00
|
| Rate for Payer: Cash Price |
$14,092.65
|
| Rate for Payer: Cash Price |
$14,092.65
|
| Rate for Payer: Cash Price |
$14,092.65
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,249.20
|
| Rate for Payer: EPIC Health Plan Senior |
$10,249.20
|
| Rate for Payer: Galaxy Health WC |
$21,779.55
|
| Rate for Payer: Global Benefits Group Commercial |
$15,373.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,090.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,762.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,860.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,149.52
|
| Rate for Payer: Multiplan Commercial |
$20,498.40
|
| Rate for Payer: Prime Health Services Commercial |
$21,779.55
|
|
|
HC ROTABLATOR ADVANCER
|
Facility
|
OP
|
$2,201.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081507
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$440.20 |
| Max. Negotiated Rate |
$1,870.85 |
| Rate for Payer: Adventist Health Commercial |
$440.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,870.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,210.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,650.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,274.82
|
| Rate for Payer: Blue Shield of California Commercial |
$1,624.34
|
| Rate for Payer: Blue Shield of California EPN |
$1,069.69
|
| Rate for Payer: Cash Price |
$1,210.55
|
| Rate for Payer: Cigna of CA HMO |
$1,540.70
|
| Rate for Payer: Cigna of CA PPO |
$1,540.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,870.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,870.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,870.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$880.40
|
| Rate for Payer: EPIC Health Plan Senior |
$880.40
|
| Rate for Payer: Galaxy Health WC |
$1,870.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,320.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,468.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$838.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,362.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$528.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,540.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,540.70
|
| Rate for Payer: Multiplan Commercial |
$1,760.80
|
| Rate for Payer: Networks By Design Commercial |
$1,100.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,870.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,320.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,320.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$826.04
|
| Rate for Payer: United Healthcare All Other HMO |
$804.03
|
| Rate for Payer: United Healthcare HMO Rider |
$786.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$720.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,870.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,870.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,870.85
|
|
|
HC ROTABLATOR ADVANCER
|
Facility
|
IP
|
$2,201.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081507
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$440.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$440.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,210.55
|
| Rate for Payer: Cash Price |
$1,210.55
|
| Rate for Payer: Cigna of CA HMO |
$1,540.70
|
| Rate for Payer: Cigna of CA PPO |
$1,540.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$880.40
|
| Rate for Payer: EPIC Health Plan Senior |
$880.40
|
| Rate for Payer: Galaxy Health WC |
$1,870.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,320.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,468.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$838.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,362.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$528.24
|
| Rate for Payer: Multiplan Commercial |
$1,760.80
|
| Rate for Payer: Networks By Design Commercial |
$1,100.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,870.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$826.04
|
| Rate for Payer: United Healthcare All Other HMO |
$804.03
|
| Rate for Payer: United Healthcare HMO Rider |
$786.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$720.83
|
|
|
HC ROTABLATOR GUIDE WIRE
|
Facility
|
OP
|
$535.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081508
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.00 |
| Max. Negotiated Rate |
$454.75 |
| Rate for Payer: Adventist Health Commercial |
$107.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$350.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$454.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$401.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$328.54
|
| Rate for Payer: Cash Price |
$294.25
|
| Rate for Payer: Cigna of CA HMO |
$342.40
|
| Rate for Payer: Cigna of CA PPO |
$395.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$454.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$454.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$454.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$214.00
|
| Rate for Payer: EPIC Health Plan Senior |
$214.00
|
| Rate for Payer: Galaxy Health WC |
$454.75
|
| Rate for Payer: Global Benefits Group Commercial |
$321.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$356.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$203.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$331.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$374.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$374.50
|
| Rate for Payer: Multiplan Commercial |
$428.00
|
| Rate for Payer: Networks By Design Commercial |
$347.75
|
| Rate for Payer: Prime Health Services Commercial |
$454.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$321.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$321.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$267.50
|
| Rate for Payer: United Healthcare All Other HMO |
$267.50
|
| Rate for Payer: United Healthcare HMO Rider |
$267.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$267.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$454.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$454.75
|
| Rate for Payer: Vantage Medical Group Senior |
$454.75
|
|
|
HC ROTABLATOR GUIDE WIRE
|
Facility
|
IP
|
$535.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081508
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.00 |
| Max. Negotiated Rate |
$454.75 |
| Rate for Payer: Adventist Health Commercial |
$107.00
|
| Rate for Payer: Cash Price |
$294.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$214.00
|
| Rate for Payer: EPIC Health Plan Senior |
$214.00
|
| Rate for Payer: Galaxy Health WC |
$454.75
|
| Rate for Payer: Global Benefits Group Commercial |
$321.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$356.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$203.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$331.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.40
|
| Rate for Payer: Multiplan Commercial |
$428.00
|
| Rate for Payer: Networks By Design Commercial |
$347.75
|
| Rate for Payer: Prime Health Services Commercial |
$454.75
|
|
|
HC ROTATABLE OVAL SNARE
|
Facility
|
OP
|
$1,404.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
900803816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$280.80 |
| Max. Negotiated Rate |
$1,193.40 |
| Rate for Payer: Adventist Health Commercial |
$280.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$920.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,193.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$772.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,053.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$862.20
|
| Rate for Payer: Cash Price |
$772.20
|
| Rate for Payer: Cigna of CA HMO |
$898.56
|
| Rate for Payer: Cigna of CA PPO |
$1,038.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,193.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,193.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,193.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$561.60
|
| Rate for Payer: EPIC Health Plan Senior |
$561.60
|
| Rate for Payer: Galaxy Health WC |
$1,193.40
|
| Rate for Payer: Global Benefits Group Commercial |
$842.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$936.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$534.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$869.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$336.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$982.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$982.80
|
| Rate for Payer: Multiplan Commercial |
$1,123.20
|
| Rate for Payer: Networks By Design Commercial |
$912.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,193.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$842.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$842.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$702.00
|
| Rate for Payer: United Healthcare All Other HMO |
$702.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$702.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,193.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,193.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,193.40
|
|
|
HC ROTATABLE OVAL SNARE
|
Facility
|
IP
|
$1,404.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
900803816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$280.80 |
| Max. Negotiated Rate |
$1,193.40 |
| Rate for Payer: Adventist Health Commercial |
$280.80
|
| Rate for Payer: Cash Price |
$772.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$561.60
|
| Rate for Payer: EPIC Health Plan Senior |
$561.60
|
| Rate for Payer: Galaxy Health WC |
$1,193.40
|
| Rate for Payer: Global Benefits Group Commercial |
$842.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$936.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$534.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$869.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$336.96
|
| Rate for Payer: Multiplan Commercial |
$1,123.20
|
| Rate for Payer: Networks By Design Commercial |
$912.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,193.40
|
|
|
HC ROTOVIRUS AG
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 87425
|
| Hospital Charge Code |
900910976
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$34.40 |
| Max. Negotiated Rate |
$146.20 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Cash Price |
$94.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.80
|
| Rate for Payer: EPIC Health Plan Senior |
$68.80
|
| Rate for Payer: Galaxy Health WC |
$146.20
|
| Rate for Payer: Global Benefits Group Commercial |
$103.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$106.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.28
|
| Rate for Payer: Multiplan Commercial |
$137.60
|
| Rate for Payer: Networks By Design Commercial |
$111.80
|
| Rate for Payer: Prime Health Services Commercial |
$146.20
|
|
|
HC ROTOVIRUS AG
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT 87425
|
| Hospital Charge Code |
900910976
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.70 |
| Max. Negotiated Rate |
$146.20 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$112.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.77
|
| Rate for Payer: Blue Shield of California Commercial |
$115.07
|
| Rate for Payer: Blue Shield of California EPN |
$76.02
|
| Rate for Payer: Cash Price |
$94.60
|
| Rate for Payer: Cash Price |
$94.60
|
| Rate for Payer: Cigna of CA HMO |
$110.08
|
| Rate for Payer: Cigna of CA PPO |
$127.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.17
|
| Rate for Payer: EPIC Health Plan Senior |
$11.98
|
| Rate for Payer: Galaxy Health WC |
$146.20
|
| Rate for Payer: Global Benefits Group Commercial |
$103.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.05
|
| Rate for Payer: Multiplan Commercial |
$137.60
|
| Rate for Payer: Networks By Design Commercial |
$111.80
|
| Rate for Payer: Prime Health Services Commercial |
$146.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$103.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$103.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.70
|
| Rate for Payer: United Healthcare All Other HMO |
$9.70
|
| Rate for Payer: United Healthcare HMO Rider |
$9.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC ROUND CALIPER AND PLATE ADDITION LE
|
Facility
|
OP
|
$401.00
|
|
|
Service Code
|
CPT L2240
|
| Hospital Charge Code |
905352240
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$85.43 |
| Max. Negotiated Rate |
$340.85 |
| Rate for Payer: Adventist Health Commercial |
$164.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$340.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$220.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$300.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$232.26
|
| Rate for Payer: Blue Shield of California Commercial |
$295.94
|
| Rate for Payer: Blue Shield of California EPN |
$194.89
|
| Rate for Payer: Cash Price |
$220.55
|
| Rate for Payer: Cash Price |
$220.55
|
| Rate for Payer: Cigna of CA HMO |
$280.70
|
| Rate for Payer: Cigna of CA PPO |
$280.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$340.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$340.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$340.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.40
|
| Rate for Payer: EPIC Health Plan Senior |
$160.40
|
| Rate for Payer: Galaxy Health WC |
$340.85
|
| Rate for Payer: Global Benefits Group Commercial |
$240.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$85.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$267.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$248.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$280.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$280.70
|
| Rate for Payer: Multiplan Commercial |
$320.80
|
| Rate for Payer: Networks By Design Commercial |
$200.50
|
| Rate for Payer: Prime Health Services Commercial |
$340.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$240.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$240.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.50
|
| Rate for Payer: United Healthcare All Other HMO |
$146.49
|
| Rate for Payer: United Healthcare HMO Rider |
$143.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$131.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$340.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$340.85
|
| Rate for Payer: Vantage Medical Group Senior |
$340.85
|
|
|
HC ROUND CALIPER AND PLATE ADDITION LE
|
Facility
|
OP
|
$401.00
|
|
|
Service Code
|
CPT L2240
|
| Hospital Charge Code |
915352240
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$85.43 |
| Max. Negotiated Rate |
$340.85 |
| Rate for Payer: Adventist Health Commercial |
$164.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$340.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$220.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$300.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$232.26
|
| Rate for Payer: Blue Shield of California Commercial |
$295.94
|
| Rate for Payer: Blue Shield of California EPN |
$194.89
|
| Rate for Payer: Cash Price |
$220.55
|
| Rate for Payer: Cash Price |
$220.55
|
| Rate for Payer: Cigna of CA HMO |
$280.70
|
| Rate for Payer: Cigna of CA PPO |
$280.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$340.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$340.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$340.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.40
|
| Rate for Payer: EPIC Health Plan Senior |
$160.40
|
| Rate for Payer: Galaxy Health WC |
$340.85
|
| Rate for Payer: Global Benefits Group Commercial |
$240.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$85.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$267.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$248.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$280.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$280.70
|
| Rate for Payer: Multiplan Commercial |
$320.80
|
| Rate for Payer: Networks By Design Commercial |
$200.50
|
| Rate for Payer: Prime Health Services Commercial |
$340.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$240.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$240.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.50
|
| Rate for Payer: United Healthcare All Other HMO |
$146.49
|
| Rate for Payer: United Healthcare HMO Rider |
$143.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$131.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$340.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$340.85
|
| Rate for Payer: Vantage Medical Group Senior |
$340.85
|
|
|
HC ROUND CALIPER AND PLATE ADDITION LE
|
Facility
|
IP
|
$401.00
|
|
|
Service Code
|
CPT L2240
|
| Hospital Charge Code |
905352240
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$80.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$80.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$220.55
|
| Rate for Payer: Cash Price |
$220.55
|
| Rate for Payer: Cigna of CA HMO |
$280.70
|
| Rate for Payer: Cigna of CA PPO |
$280.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.40
|
| Rate for Payer: EPIC Health Plan Senior |
$160.40
|
| Rate for Payer: Galaxy Health WC |
$340.85
|
| Rate for Payer: Global Benefits Group Commercial |
$240.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$267.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$152.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$248.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.24
|
| Rate for Payer: Multiplan Commercial |
$320.80
|
| Rate for Payer: Networks By Design Commercial |
$200.50
|
| Rate for Payer: Prime Health Services Commercial |
$340.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.50
|
| Rate for Payer: United Healthcare All Other HMO |
$146.49
|
| Rate for Payer: United Healthcare HMO Rider |
$143.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$131.33
|
|
|
HC ROUND CALIPER AND PLATE ADDITION LE
|
Facility
|
IP
|
$401.00
|
|
|
Service Code
|
CPT L2240
|
| Hospital Charge Code |
915352240
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$80.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$80.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$220.55
|
| Rate for Payer: Cash Price |
$220.55
|
| Rate for Payer: Cigna of CA HMO |
$280.70
|
| Rate for Payer: Cigna of CA PPO |
$280.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.40
|
| Rate for Payer: EPIC Health Plan Senior |
$160.40
|
| Rate for Payer: Galaxy Health WC |
$340.85
|
| Rate for Payer: Global Benefits Group Commercial |
$240.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$267.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$152.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$248.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.24
|
| Rate for Payer: Multiplan Commercial |
$320.80
|
| Rate for Payer: Networks By Design Commercial |
$200.50
|
| Rate for Payer: Prime Health Services Commercial |
$340.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.50
|
| Rate for Payer: United Healthcare All Other HMO |
$146.49
|
| Rate for Payer: United Healthcare HMO Rider |
$143.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$131.33
|
|
|
HC ROUTINE URINALYSIS
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
CPT 81001
|
| Hospital Charge Code |
900910167
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$114.75 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.19
|
| Rate for Payer: Blue Shield of California Commercial |
$90.31
|
| Rate for Payer: Blue Shield of California EPN |
$59.67
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cigna of CA HMO |
$86.40
|
| Rate for Payer: Cigna of CA PPO |
$99.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.28
|
| Rate for Payer: EPIC Health Plan Senior |
$3.17
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.25
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$87.75
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.56
|
| Rate for Payer: United Healthcare All Other HMO |
$2.56
|
| Rate for Payer: United Healthcare HMO Rider |
$2.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.49
|
| Rate for Payer: Vantage Medical Group Senior |
$3.17
|
|
|
HC ROUTINE URINALYSIS
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT 81001
|
| Hospital Charge Code |
900910167
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$114.75 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.00
|
| Rate for Payer: EPIC Health Plan Senior |
$54.00
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$83.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.40
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$87.75
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
|
|
HC RPL GTUBE NOT RQ RV GSTRST TRC
|
Facility
|
IP
|
$2,179.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
906743760
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$435.80 |
| Max. Negotiated Rate |
$1,852.15 |
| Rate for Payer: Adventist Health Commercial |
$435.80
|
| Rate for Payer: Cash Price |
$1,198.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$871.60
|
| Rate for Payer: EPIC Health Plan Senior |
$871.60
|
| Rate for Payer: Galaxy Health WC |
$1,852.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,307.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,453.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$830.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,348.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$522.96
|
| Rate for Payer: Multiplan Commercial |
$1,743.20
|
| Rate for Payer: Networks By Design Commercial |
$1,416.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,852.15
|
|
|
HC RPL GTUBE NOT RQ RV GSTRST TRC
|
Facility
|
OP
|
$2,179.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
906743760
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$309.02 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$435.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$1,198.45
|
| Rate for Payer: Cash Price |
$1,198.45
|
| Rate for Payer: Cash Price |
$1,198.45
|
| Rate for Payer: Cigna of CA HMO |
$1,394.56
|
| Rate for Payer: Cigna of CA PPO |
$1,612.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$309.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$417.18
|
| Rate for Payer: EPIC Health Plan Senior |
$309.02
|
| Rate for Payer: Galaxy Health WC |
$1,852.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,307.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$506.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$344.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$309.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,453.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$389.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$309.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$522.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$414.09
|
| Rate for Payer: Multiplan Commercial |
$1,743.20
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: Networks By Design Commercial |
$1,416.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,852.15
|
| Rate for Payer: Prime Health Services WC |
$487.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,307.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$309.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Vantage Medical Group Senior |
$309.02
|
|
|
HC RPL GTUBE NOT RQ RV GSTRST TRC
|
Facility
|
OP
|
$2,179.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
906743760
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$309.02 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$435.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$1,198.45
|
| Rate for Payer: Cash Price |
$1,198.45
|
| Rate for Payer: Cash Price |
$1,198.45
|
| Rate for Payer: Cigna of CA HMO |
$1,394.56
|
| Rate for Payer: Cigna of CA PPO |
$1,612.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$309.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$417.18
|
| Rate for Payer: EPIC Health Plan Senior |
$309.02
|
| Rate for Payer: Galaxy Health WC |
$1,852.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,307.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$506.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$309.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,453.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$389.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$309.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$522.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$414.09
|
| Rate for Payer: Multiplan Commercial |
$1,743.20
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: Networks By Design Commercial |
$1,416.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,852.15
|
| Rate for Payer: Prime Health Services WC |
$487.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,307.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,089.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,089.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,089.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,089.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$309.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Vantage Medical Group Senior |
$309.02
|
|
|
HC RPL GTUBE NOT RQ RV GSTRST TRC
|
Facility
|
IP
|
$2,179.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
906743760
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$435.80 |
| Max. Negotiated Rate |
$1,852.15 |
| Rate for Payer: Adventist Health Commercial |
$435.80
|
| Rate for Payer: Cash Price |
$1,198.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$871.60
|
| Rate for Payer: EPIC Health Plan Senior |
$871.60
|
| Rate for Payer: Galaxy Health WC |
$1,852.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,307.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,453.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$830.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,348.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$522.96
|
| Rate for Payer: Multiplan Commercial |
$1,743.20
|
| Rate for Payer: Networks By Design Commercial |
$1,416.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,852.15
|
|
|
HC RPL GTUBE NOT RQ RV GSTRST TRC
|
Facility
|
IP
|
$2,179.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
906743760
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$435.80 |
| Max. Negotiated Rate |
$1,852.15 |
| Rate for Payer: Adventist Health Commercial |
$435.80
|
| Rate for Payer: Cash Price |
$1,198.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$871.60
|
| Rate for Payer: EPIC Health Plan Senior |
$871.60
|
| Rate for Payer: Galaxy Health WC |
$1,852.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,307.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,453.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$830.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,348.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$522.96
|
| Rate for Payer: Multiplan Commercial |
$1,743.20
|
| Rate for Payer: Networks By Design Commercial |
$1,416.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,852.15
|
|
|
HC RPL GTUBE NOT RQ RV GSTRST TRC
|
Facility
|
OP
|
$2,179.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
906743760
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$309.02 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$435.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$1,198.45
|
| Rate for Payer: Cash Price |
$1,198.45
|
| Rate for Payer: Cash Price |
$1,198.45
|
| Rate for Payer: Cigna of CA HMO |
$1,394.56
|
| Rate for Payer: Cigna of CA PPO |
$1,612.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$309.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$417.18
|
| Rate for Payer: EPIC Health Plan Senior |
$309.02
|
| Rate for Payer: Galaxy Health WC |
$1,852.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,307.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$506.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$344.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$309.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,453.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$389.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$309.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$522.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$414.09
|
| Rate for Payer: Multiplan Commercial |
$1,743.20
|
| Rate for Payer: Networks By Design Commercial |
$1,416.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,852.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,307.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$370.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$309.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Vantage Medical Group Senior |
$309.02
|
|
|
HC RPL GTUBE NOT RQ RV GSTRST TRC
|
Facility
|
IP
|
$2,179.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
906743760
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$435.80 |
| Max. Negotiated Rate |
$1,852.15 |
| Rate for Payer: Adventist Health Commercial |
$435.80
|
| Rate for Payer: Cash Price |
$1,198.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$871.60
|
| Rate for Payer: EPIC Health Plan Senior |
$871.60
|
| Rate for Payer: Galaxy Health WC |
$1,852.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,307.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,453.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$830.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,348.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$522.96
|
| Rate for Payer: Multiplan Commercial |
$1,743.20
|
| Rate for Payer: Networks By Design Commercial |
$1,416.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,852.15
|
|
|
HC RPL GTUBE NOT RQ RV GSTRST TRC
|
Facility
|
OP
|
$2,179.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
906743760
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$309.02 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$435.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$1,198.45
|
| Rate for Payer: Cash Price |
$1,198.45
|
| Rate for Payer: Cash Price |
$1,198.45
|
| Rate for Payer: Cigna of CA HMO |
$1,394.56
|
| Rate for Payer: Cigna of CA PPO |
$1,612.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$309.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$417.18
|
| Rate for Payer: EPIC Health Plan Senior |
$309.02
|
| Rate for Payer: Galaxy Health WC |
$1,852.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,307.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$506.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$344.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$309.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,453.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$389.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$309.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$522.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$414.09
|
| Rate for Payer: Multiplan Commercial |
$1,743.20
|
| Rate for Payer: Networks By Design Commercial |
$1,416.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,852.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,307.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,307.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,089.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,089.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,089.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,089.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$309.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Vantage Medical Group Senior |
$309.02
|
|
|
HC RPOS PRV CCM DFIB TRNSVNS ELTRD
|
Facility
|
IP
|
$1,688.00
|
|
|
Service Code
|
CPT 0924T
|
| Hospital Charge Code |
906811512
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$337.60 |
| Max. Negotiated Rate |
$1,434.80 |
| Rate for Payer: Adventist Health Commercial |
$337.60
|
| Rate for Payer: Cash Price |
$928.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$675.20
|
| Rate for Payer: EPIC Health Plan Senior |
$675.20
|
| Rate for Payer: Galaxy Health WC |
$1,434.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,012.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,125.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$643.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,044.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$405.12
|
| Rate for Payer: Multiplan Commercial |
$1,350.40
|
| Rate for Payer: Networks By Design Commercial |
$1,097.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,434.80
|
|
