|
HC GASTROESOPHAGEAL REFLUX TEST
|
Facility
|
IP
|
$4,700.00
|
|
|
Service Code
|
CPT 91035
|
| Hospital Charge Code |
906791035
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$940.00 |
| Max. Negotiated Rate |
$4,230.00 |
| Rate for Payer: Adventist Health Commercial |
$940.00
|
| Rate for Payer: Cash Price |
$2,115.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,760.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,290.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,880.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,880.00
|
| Rate for Payer: Galaxy Health WC |
$3,995.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,820.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,230.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,984.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,773.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$940.00
|
| Rate for Payer: Multiplan Commercial |
$3,525.00
|
| Rate for Payer: Networks By Design Commercial |
$3,055.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,995.00
|
|
|
HC GASTROESOPHAGEAL REFLUX TEST
|
Facility
|
OP
|
$4,728.00
|
|
|
Service Code
|
CPT 91034
|
| Hospital Charge Code |
906791034
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$133.49 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$945.60
|
| Rate for Payer: Adventist Health Commercial |
$417.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$479.94
|
| Rate for Payer: Adventist Health Medi-Cal |
$479.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$719.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$719.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$527.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$527.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$479.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$479.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,370.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,370.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,750.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,214.01
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$939.15
|
| Rate for Payer: Cash Price |
$939.15
|
| Rate for Payer: Cash Price |
$2,127.60
|
| Rate for Payer: Cash Price |
$2,127.60
|
| Rate for Payer: Cash Price |
$2,127.60
|
| Rate for Payer: Cash Price |
$939.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,669.60
|
| Rate for Payer: Central Health Plan Commercial |
$3,782.40
|
| Rate for Payer: Cigna of CA HMO |
$3,025.92
|
| Rate for Payer: Cigna of CA HMO |
$1,335.68
|
| Rate for Payer: Cigna of CA PPO |
$1,544.38
|
| Rate for Payer: Cigna of CA PPO |
$3,498.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$719.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$719.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$527.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$527.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$479.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$479.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,309.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,460.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$791.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$791.90
|
| Rate for Payer: EPIC Health Plan Senior |
$527.93
|
| Rate for Payer: EPIC Health Plan Senior |
$527.93
|
| Rate for Payer: Galaxy Health WC |
$1,773.95
|
| Rate for Payer: Galaxy Health WC |
$4,018.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,836.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,252.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,255.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,878.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$787.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$787.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$133.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$133.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$479.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$479.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,325.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,002.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$147.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$147.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$671.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$671.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$417.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$945.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$643.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$643.12
|
| Rate for Payer: Multiplan Commercial |
$1,565.25
|
| Rate for Payer: Multiplan Commercial |
$3,546.00
|
| Rate for Payer: Networks By Design Commercial |
$1,356.55
|
| Rate for Payer: Networks By Design Commercial |
$3,073.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$479.94
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$479.94
|
| Rate for Payer: Prime Health Services Commercial |
$4,018.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,773.95
|
| Rate for Payer: Prime Health Services Medicare |
$508.74
|
| Rate for Payer: Prime Health Services Medicare |
$508.74
|
| Rate for Payer: Riverside University Health System MISP |
$527.93
|
| Rate for Payer: Riverside University Health System MISP |
$527.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,836.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,252.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$575.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$575.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,364.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,043.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| 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 HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$479.94
|
| Rate for Payer: Upland Medical Group Pediatric |
$479.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$719.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$719.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$527.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$527.93
|
| Rate for Payer: Vantage Medical Group Senior |
$479.94
|
| Rate for Payer: Vantage Medical Group Senior |
$479.94
|
|
|
HC GASTROJEJUNOSTOMY SET D/L
|
Facility
|
IP
|
$928.00
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
909001042
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$185.60 |
| Max. Negotiated Rate |
$835.20 |
| Rate for Payer: Adventist Health Commercial |
$185.60
|
| Rate for Payer: Blue Shield of California Commercial |
$744.26
|
| Rate for Payer: Blue Shield of California EPN |
$467.71
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Central Health Plan Commercial |
$742.40
|
| Rate for Payer: Cigna of CA HMO |
$649.60
|
| Rate for Payer: Cigna of CA PPO |
$649.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$649.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$371.20
|
| Rate for Payer: EPIC Health Plan Senior |
$371.20
|
| Rate for Payer: Galaxy Health WC |
$788.80
|
| Rate for Payer: Global Benefits Group Commercial |
$556.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$835.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$589.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$547.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.60
|
| Rate for Payer: Multiplan Commercial |
$696.00
|
| Rate for Payer: Networks By Design Commercial |
$603.20
|
| Rate for Payer: Prime Health Services Commercial |
$788.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$348.28
|
| Rate for Payer: United Healthcare All Other HMO |
$339.00
|
| Rate for Payer: United Healthcare HMO Rider |
$331.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$303.92
|
|
|
HC GASTROJEJUNOSTOMY SET D/L
|
Facility
|
OP
|
$928.00
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
909001042
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$303.92 |
| Max. Negotiated Rate |
$835.20 |
| Rate for Payer: Adventist Health Commercial |
$380.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$788.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$510.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$696.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$539.82
|
| Rate for Payer: Blue Shield of California Commercial |
$744.26
|
| Rate for Payer: Blue Shield of California EPN |
$467.71
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Central Health Plan Commercial |
$742.40
|
| Rate for Payer: Cigna of CA HMO |
$649.60
|
| Rate for Payer: Cigna of CA PPO |
$649.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$788.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$788.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$788.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$649.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$371.20
|
| Rate for Payer: EPIC Health Plan Senior |
$371.20
|
| Rate for Payer: Galaxy Health WC |
$788.80
|
| Rate for Payer: Global Benefits Group Commercial |
$556.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$835.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$589.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$336.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$547.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$380.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$649.60
|
| Rate for Payer: Multiplan Commercial |
$696.00
|
| Rate for Payer: Networks By Design Commercial |
$464.00
|
| Rate for Payer: Prime Health Services Commercial |
$788.80
|
| Rate for Payer: Riverside University Health System MISP |
$371.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$556.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$556.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$348.28
|
| Rate for Payer: United Healthcare All Other HMO |
$339.00
|
| Rate for Payer: United Healthcare HMO Rider |
$331.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$303.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$788.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$788.80
|
| Rate for Payer: Vantage Medical Group Senior |
$788.80
|
|
|
HC GASTROJEJUNOSTOMY SET SGL/LMN
|
Facility
|
OP
|
$619.00
|
|
| Hospital Charge Code |
909001041
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$202.72 |
| Max. Negotiated Rate |
$557.10 |
| Rate for Payer: Adventist Health Commercial |
$253.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$526.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$340.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$464.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$360.07
|
| Rate for Payer: Blue Shield of California Commercial |
$496.44
|
| Rate for Payer: Blue Shield of California EPN |
$311.98
|
| Rate for Payer: Cash Price |
$278.55
|
| Rate for Payer: Central Health Plan Commercial |
$495.20
|
| Rate for Payer: Cigna of CA HMO |
$433.30
|
| Rate for Payer: Cigna of CA PPO |
$433.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$526.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$526.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$526.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$433.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$247.60
|
| Rate for Payer: EPIC Health Plan Senior |
$247.60
|
| Rate for Payer: Galaxy Health WC |
$526.15
|
| Rate for Payer: Global Benefits Group Commercial |
$371.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$557.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$393.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$224.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$365.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$433.30
|
| Rate for Payer: Multiplan Commercial |
$464.25
|
| Rate for Payer: Networks By Design Commercial |
$309.50
|
| Rate for Payer: Prime Health Services Commercial |
$526.15
|
| Rate for Payer: Riverside University Health System MISP |
$247.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$371.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$371.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$232.31
|
| Rate for Payer: United Healthcare All Other HMO |
$226.12
|
| Rate for Payer: United Healthcare HMO Rider |
$221.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$202.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$526.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$526.15
|
| Rate for Payer: Vantage Medical Group Senior |
$526.15
|
|
|
HC GASTROJEJUNOSTOMY SET SGL/LMN
|
Facility
|
IP
|
$619.00
|
|
| Hospital Charge Code |
909001041
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$123.80 |
| Max. Negotiated Rate |
$557.10 |
| Rate for Payer: Adventist Health Commercial |
$123.80
|
| Rate for Payer: Blue Shield of California Commercial |
$496.44
|
| Rate for Payer: Blue Shield of California EPN |
$311.98
|
| Rate for Payer: Cash Price |
$278.55
|
| Rate for Payer: Central Health Plan Commercial |
$495.20
|
| Rate for Payer: Cigna of CA HMO |
$433.30
|
| Rate for Payer: Cigna of CA PPO |
$433.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$433.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$247.60
|
| Rate for Payer: EPIC Health Plan Senior |
$247.60
|
| Rate for Payer: Galaxy Health WC |
$526.15
|
| Rate for Payer: Global Benefits Group Commercial |
$371.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$557.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$393.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$365.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.80
|
| Rate for Payer: Multiplan Commercial |
$464.25
|
| Rate for Payer: Networks By Design Commercial |
$402.35
|
| Rate for Payer: Prime Health Services Commercial |
$526.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$232.31
|
| Rate for Payer: United Healthcare All Other HMO |
$226.12
|
| Rate for Payer: United Healthcare HMO Rider |
$221.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$202.72
|
|
|
HC GASTRO PANEL NUCLEIC ACID
|
Facility
|
IP
|
$1,762.00
|
|
|
Service Code
|
CPT 87507
|
| Hospital Charge Code |
900913644
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$352.40 |
| Max. Negotiated Rate |
$1,585.80 |
| Rate for Payer: Adventist Health Commercial |
$352.40
|
| Rate for Payer: Cash Price |
$792.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,409.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,233.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$704.80
|
| Rate for Payer: EPIC Health Plan Senior |
$704.80
|
| Rate for Payer: Galaxy Health WC |
$1,497.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,057.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,585.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,118.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,039.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$352.40
|
| Rate for Payer: Multiplan Commercial |
$1,321.50
|
| Rate for Payer: Networks By Design Commercial |
$1,145.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,497.70
|
|
|
HC GASTRO PANEL NUCLEIC ACID
|
Facility
|
OP
|
$1,482.00
|
|
|
Service Code
|
CPT 87507
|
| Hospital Charge Code |
900913644
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$296.40 |
| Max. Negotiated Rate |
$3,162.37 |
| Rate for Payer: Adventist Health Commercial |
$296.40
|
| Rate for Payer: Adventist Health Commercial |
$352.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$416.78
|
| Rate for Payer: Adventist Health Medi-Cal |
$416.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,958.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,958.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$625.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$625.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$458.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$458.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$416.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$416.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,274.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,274.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,162.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,162.37
|
| Rate for Payer: Blue Shield of California Commercial |
$1,110.06
|
| Rate for Payer: Blue Shield of California Commercial |
$933.66
|
| Rate for Payer: Blue Shield of California EPN |
$699.51
|
| Rate for Payer: Blue Shield of California EPN |
$588.35
|
| Rate for Payer: Cash Price |
$792.90
|
| Rate for Payer: Cash Price |
$792.90
|
| Rate for Payer: Cash Price |
$666.90
|
| Rate for Payer: Cash Price |
$666.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,185.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,409.60
|
| Rate for Payer: Cigna of CA HMO |
$1,127.68
|
| Rate for Payer: Cigna of CA HMO |
$948.48
|
| Rate for Payer: Cigna of CA PPO |
$1,303.88
|
| Rate for Payer: Cigna of CA PPO |
$1,096.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$625.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$625.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$458.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$458.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$416.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$416.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,037.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,233.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$687.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$687.69
|
| Rate for Payer: EPIC Health Plan Senior |
$458.46
|
| Rate for Payer: EPIC Health Plan Senior |
$458.46
|
| Rate for Payer: Galaxy Health WC |
$1,497.70
|
| Rate for Payer: Galaxy Health WC |
$1,259.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,057.20
|
| Rate for Payer: Global Benefits Group Commercial |
$889.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,585.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,333.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$683.52
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$683.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$637.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$637.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$416.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$416.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$941.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,118.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$703.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$703.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$583.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$583.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$296.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$352.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$558.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$558.49
|
| Rate for Payer: Multiplan Commercial |
$1,321.50
|
| Rate for Payer: Multiplan Commercial |
$1,111.50
|
| Rate for Payer: Networks By Design Commercial |
$963.30
|
| Rate for Payer: Networks By Design Commercial |
$1,145.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$416.78
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$416.78
|
| Rate for Payer: Prime Health Services Commercial |
$1,497.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,259.70
|
| Rate for Payer: Prime Health Services Medicare |
$441.79
|
| Rate for Payer: Prime Health Services Medicare |
$441.79
|
| Rate for Payer: Riverside University Health System MISP |
$458.46
|
| Rate for Payer: Riverside University Health System MISP |
$458.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$889.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,057.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,057.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$889.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$337.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$337.59
|
| Rate for Payer: United Healthcare All Other HMO |
$337.59
|
| Rate for Payer: United Healthcare All Other HMO |
$337.59
|
| Rate for Payer: United Healthcare HMO Rider |
$337.59
|
| Rate for Payer: United Healthcare HMO Rider |
$337.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$337.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$337.59
|
| Rate for Payer: Upland Medical Group Pediatric |
$416.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$416.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$625.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$625.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$458.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$458.46
|
| Rate for Payer: Vantage Medical Group Senior |
$416.78
|
| Rate for Payer: Vantage Medical Group Senior |
$416.78
|
|
|
HC GASTROSTOMY TUBE PERCUT
|
Facility
|
IP
|
$7,627.00
|
|
|
Service Code
|
CPT 49440
|
| Hospital Charge Code |
906743750
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,525.40 |
| Max. Negotiated Rate |
$6,864.30 |
| Rate for Payer: Adventist Health Commercial |
$1,525.40
|
| Rate for Payer: Cash Price |
$3,432.15
|
| Rate for Payer: Central Health Plan Commercial |
$6,101.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,338.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,050.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,050.80
|
| Rate for Payer: Galaxy Health WC |
$6,482.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,576.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,864.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,843.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,499.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,525.40
|
| Rate for Payer: Multiplan Commercial |
$5,720.25
|
| Rate for Payer: Networks By Design Commercial |
$4,957.55
|
| Rate for Payer: Prime Health Services Commercial |
$6,482.95
|
|
|
HC GASTROSTOMY TUBE PERCUT
|
Facility
|
OP
|
$7,627.00
|
|
|
Service Code
|
CPT 49440
|
| Hospital Charge Code |
906743750
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,525.40 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,525.40
|
| Rate for Payer: Adventist Health Commercial |
$673.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,468.04
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,468.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,840.40
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,840.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$1,515.60
|
| Rate for Payer: Cash Price |
$1,515.60
|
| Rate for Payer: Cash Price |
$1,515.60
|
| Rate for Payer: Cash Price |
$3,432.15
|
| Rate for Payer: Cash Price |
$3,432.15
|
| Rate for Payer: Cash Price |
$3,432.15
|
| Rate for Payer: Central Health Plan Commercial |
$6,101.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,694.40
|
| Rate for Payer: Cigna of CA HMO |
$2,155.52
|
| Rate for Payer: Cigna of CA HMO |
$4,881.28
|
| Rate for Payer: Cigna of CA PPO |
$5,643.98
|
| Rate for Payer: Cigna of CA PPO |
$2,492.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,357.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,338.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: Galaxy Health WC |
$6,482.95
|
| Rate for Payer: Galaxy Health WC |
$2,862.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4,576.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,020.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,031.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,864.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,583.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,583.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,843.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,138.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,749.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,749.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$673.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,525.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$5,720.25
|
| Rate for Payer: Multiplan Commercial |
$2,526.00
|
| Rate for Payer: Multiplan WC |
$3,840.40
|
| Rate for Payer: Multiplan WC |
$3,840.40
|
| Rate for Payer: Networks By Design Commercial |
$2,189.20
|
| Rate for Payer: Networks By Design Commercial |
$4,957.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,468.04
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Preferred Health Network WC |
$3,918.78
|
| Rate for Payer: Preferred Health Network WC |
$3,918.78
|
| Rate for Payer: Prime Health Services Commercial |
$6,482.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,862.80
|
| Rate for Payer: Prime Health Services Medicare |
$2,616.12
|
| Rate for Payer: Prime Health Services Medicare |
$2,616.12
|
| Rate for Payer: Prime Health Services WC |
$3,801.22
|
| Rate for Payer: Prime Health Services WC |
$3,801.22
|
| Rate for Payer: Riverside University Health System MISP |
$2,714.84
|
| Rate for Payer: Riverside University Health System MISP |
$2,714.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,576.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,020.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,684.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,813.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
|
|
HC GASTROSTOMY TUBE PERCUT
|
Facility
|
OP
|
$7,627.00
|
|
|
Service Code
|
CPT 49440
|
| Hospital Charge Code |
906743750
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,525.40 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,525.40
|
| Rate for Payer: Adventist Health Commercial |
$673.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,468.04
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,468.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$3,432.15
|
| Rate for Payer: Cash Price |
$3,432.15
|
| Rate for Payer: Cash Price |
$1,515.60
|
| Rate for Payer: Cash Price |
$3,432.15
|
| Rate for Payer: Cash Price |
$1,515.60
|
| Rate for Payer: Cash Price |
$1,515.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,694.40
|
| Rate for Payer: Central Health Plan Commercial |
$6,101.60
|
| Rate for Payer: Cigna of CA HMO |
$2,155.52
|
| Rate for Payer: Cigna of CA HMO |
$4,881.28
|
| Rate for Payer: Cigna of CA PPO |
$5,643.98
|
| Rate for Payer: Cigna of CA PPO |
$2,492.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,357.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,338.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: Galaxy Health WC |
$6,482.95
|
| Rate for Payer: Galaxy Health WC |
$2,862.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,020.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4,576.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,031.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,864.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,583.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,583.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,138.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,843.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,749.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,749.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,525.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$673.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$5,720.25
|
| Rate for Payer: Multiplan Commercial |
$2,526.00
|
| Rate for Payer: Networks By Design Commercial |
$4,957.55
|
| Rate for Payer: Networks By Design Commercial |
$2,189.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,468.04
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Prime Health Services Commercial |
$2,862.80
|
| Rate for Payer: Prime Health Services Commercial |
$6,482.95
|
| Rate for Payer: Prime Health Services Medicare |
$2,616.12
|
| Rate for Payer: Prime Health Services Medicare |
$2,616.12
|
| Rate for Payer: Riverside University Health System MISP |
$2,714.84
|
| Rate for Payer: Riverside University Health System MISP |
$2,714.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,020.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,576.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,961.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,961.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,813.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,684.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
|
|
HC GASTROSTOMY TUBE PERCUT
|
Facility
|
IP
|
$7,627.00
|
|
|
Service Code
|
CPT 49440
|
| Hospital Charge Code |
906743750
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,525.40 |
| Max. Negotiated Rate |
$6,864.30 |
| Rate for Payer: Adventist Health Commercial |
$1,525.40
|
| Rate for Payer: Cash Price |
$3,432.15
|
| Rate for Payer: Central Health Plan Commercial |
$6,101.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,338.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,050.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,050.80
|
| Rate for Payer: Galaxy Health WC |
$6,482.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,576.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,864.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,843.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,499.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,525.40
|
| Rate for Payer: Multiplan Commercial |
$5,720.25
|
| Rate for Payer: Networks By Design Commercial |
$4,957.55
|
| Rate for Payer: Prime Health Services Commercial |
$6,482.95
|
|
|
HC GASTROSTOMY TUBE REPOSITION
|
Facility
|
IP
|
$3,174.00
|
|
|
Service Code
|
CPT 43761
|
| Hospital Charge Code |
906743761
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$634.80 |
| Max. Negotiated Rate |
$2,856.60 |
| Rate for Payer: Adventist Health Commercial |
$634.80
|
| Rate for Payer: Cash Price |
$1,428.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,539.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,221.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,269.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,269.60
|
| Rate for Payer: Galaxy Health WC |
$2,697.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,904.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,856.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,015.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,872.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$634.80
|
| Rate for Payer: Multiplan Commercial |
$2,380.50
|
| Rate for Payer: Networks By Design Commercial |
$2,063.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,697.90
|
|
|
HC GASTROSTOMY TUBE REPOSITION
|
Facility
|
IP
|
$3,174.00
|
|
|
Service Code
|
CPT 43761
|
| Hospital Charge Code |
906743761
|
|
Hospital Revenue Code
|
949
|
| Min. Negotiated Rate |
$634.80 |
| Max. Negotiated Rate |
$2,856.60 |
| Rate for Payer: Adventist Health Commercial |
$634.80
|
| Rate for Payer: Cash Price |
$1,428.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,539.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,221.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,269.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,269.60
|
| Rate for Payer: Galaxy Health WC |
$2,697.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,904.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,856.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,015.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,872.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$634.80
|
| Rate for Payer: Multiplan Commercial |
$2,380.50
|
| Rate for Payer: Networks By Design Commercial |
$2,063.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,697.90
|
|
|
HC GASTROSTOMY TUBE REPOSITION
|
Facility
|
OP
|
$3,174.00
|
|
|
Service Code
|
CPT 43761
|
| Hospital Charge Code |
906743761
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$136.40 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$634.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$321.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$321.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$492.37
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$1,428.30
|
| Rate for Payer: Cash Price |
$1,428.30
|
| Rate for Payer: Cash Price |
$1,428.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,539.20
|
| Rate for Payer: Cigna of CA HMO |
$2,031.36
|
| Rate for Payer: Cigna of CA PPO |
$2,348.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$482.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$353.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$321.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,221.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$530.23
|
| Rate for Payer: EPIC Health Plan Senior |
$353.49
|
| Rate for Payer: Galaxy Health WC |
$2,697.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,904.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,856.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$527.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$136.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$321.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,015.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$150.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$449.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$634.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$430.61
|
| Rate for Payer: Multiplan Commercial |
$2,380.50
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: Networks By Design Commercial |
$2,063.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$321.35
|
| Rate for Payer: Preferred Health Network WC |
$502.42
|
| Rate for Payer: Prime Health Services Commercial |
$2,697.90
|
| Rate for Payer: Prime Health Services Medicare |
$340.63
|
| Rate for Payer: Prime Health Services WC |
$487.35
|
| Rate for Payer: Riverside University Health System MISP |
$353.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,904.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,587.00
|
| 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 |
$321.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Vantage Medical Group Senior |
$321.35
|
|
|
HC GASTROSTOMY TUBE REPOSITION
|
Facility
|
IP
|
$3,174.00
|
|
|
Service Code
|
CPT 43761
|
| Hospital Charge Code |
906743761
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$634.80 |
| Max. Negotiated Rate |
$2,856.60 |
| Rate for Payer: Adventist Health Commercial |
$634.80
|
| Rate for Payer: Cash Price |
$1,428.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,539.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,221.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,269.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,269.60
|
| Rate for Payer: Galaxy Health WC |
$2,697.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,904.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,856.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,015.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,872.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$634.80
|
| Rate for Payer: Multiplan Commercial |
$2,380.50
|
| Rate for Payer: Networks By Design Commercial |
$2,063.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,697.90
|
|
|
HC GASTROSTOMY TUBE REPOSITION
|
Facility
|
OP
|
$3,174.00
|
|
|
Service Code
|
CPT 43761
|
| Hospital Charge Code |
906743761
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$136.40 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$634.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$321.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$321.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$1,428.30
|
| Rate for Payer: Cash Price |
$1,428.30
|
| Rate for Payer: Cash Price |
$1,428.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,539.20
|
| Rate for Payer: Cigna of CA HMO |
$2,031.36
|
| Rate for Payer: Cigna of CA PPO |
$2,348.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$482.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$353.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$321.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,221.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$530.23
|
| Rate for Payer: EPIC Health Plan Senior |
$353.49
|
| Rate for Payer: Galaxy Health WC |
$2,697.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,904.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,856.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$527.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$136.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$321.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,015.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$150.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$449.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$634.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$430.61
|
| Rate for Payer: Multiplan Commercial |
$2,380.50
|
| Rate for Payer: Networks By Design Commercial |
$2,063.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$321.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,697.90
|
| Rate for Payer: Prime Health Services Medicare |
$340.63
|
| Rate for Payer: Riverside University Health System MISP |
$353.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,904.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$385.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,587.00
|
| 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 |
$321.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Vantage Medical Group Senior |
$321.35
|
|
|
HC GASTROSTOMY TUBE REPOSITION
|
Facility
|
OP
|
$3,174.00
|
|
|
Service Code
|
CPT 43761
|
| Hospital Charge Code |
906743761
|
|
Hospital Revenue Code
|
949
|
| Min. Negotiated Rate |
$136.40 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$634.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$321.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$595.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$321.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,012.32
|
| Rate for Payer: Blue Shield of California EPN |
$1,266.43
|
| Rate for Payer: Cash Price |
$1,428.30
|
| Rate for Payer: Cash Price |
$1,428.30
|
| Rate for Payer: Cash Price |
$1,428.30
|
| Rate for Payer: Cash Price |
$1,428.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,539.20
|
| Rate for Payer: Cigna of CA HMO |
$2,031.36
|
| Rate for Payer: Cigna of CA PPO |
$2,348.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$482.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$353.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$321.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,221.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$530.23
|
| Rate for Payer: EPIC Health Plan Senior |
$353.49
|
| Rate for Payer: Galaxy Health WC |
$2,697.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,904.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,856.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$527.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$136.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$321.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,015.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$150.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$449.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$634.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$430.61
|
| Rate for Payer: Multiplan Commercial |
$2,380.50
|
| Rate for Payer: Networks By Design Commercial |
$2,063.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$321.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,697.90
|
| Rate for Payer: Prime Health Services Medicare |
$340.63
|
| Rate for Payer: Riverside University Health System MISP |
$353.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,904.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,904.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$803.00
|
| Rate for Payer: United Healthcare All Other HMO |
$541.00
|
| Rate for Payer: United Healthcare HMO Rider |
$328.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$300.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$321.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Vantage Medical Group Senior |
$321.35
|
|
|
HC GASTRO TUBE PLACEMENT
|
Facility
|
OP
|
$3,024.00
|
|
|
Service Code
|
CPT 44500
|
| Hospital Charge Code |
906744500
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$33.30 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$604.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,166.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,360.80
|
| Rate for Payer: Cash Price |
$1,360.80
|
| Rate for Payer: Cash Price |
$1,360.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,419.20
|
| Rate for Payer: Cigna of CA HMO |
$1,935.36
|
| Rate for Payer: Cigna of CA PPO |
$2,237.76
|
| 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 |
$2,116.80
|
| 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 |
$2,570.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,814.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,721.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$33.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,920.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$604.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$2,268.00
|
| Rate for Payer: Networks By Design Commercial |
$1,965.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Prime Health Services Commercial |
$2,570.40
|
| Rate for Payer: Prime Health Services Medicare |
$1,236.52
|
| Rate for Payer: Riverside University Health System MISP |
$1,283.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,814.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,399.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,512.00
|
| 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 GASTRO TUBE PLACEMENT
|
Facility
|
IP
|
$3,024.00
|
|
|
Service Code
|
CPT 44500
|
| Hospital Charge Code |
906744500
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$604.80 |
| Max. Negotiated Rate |
$2,721.60 |
| Rate for Payer: Adventist Health Commercial |
$604.80
|
| Rate for Payer: Cash Price |
$1,360.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,419.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,116.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,209.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,209.60
|
| Rate for Payer: Galaxy Health WC |
$2,570.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,814.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,721.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,920.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,784.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$604.80
|
| Rate for Payer: Multiplan Commercial |
$2,268.00
|
| Rate for Payer: Networks By Design Commercial |
$1,965.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,570.40
|
|
|
HC GASTRO TUBE PLACEMENT
|
Facility
|
IP
|
$3,024.00
|
|
|
Service Code
|
CPT 44500
|
| Hospital Charge Code |
906744500
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$604.80 |
| Max. Negotiated Rate |
$2,721.60 |
| Rate for Payer: Adventist Health Commercial |
$604.80
|
| Rate for Payer: Cash Price |
$1,360.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,419.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,116.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,209.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,209.60
|
| Rate for Payer: Galaxy Health WC |
$2,570.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,814.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,721.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,920.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,784.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$604.80
|
| Rate for Payer: Multiplan Commercial |
$2,268.00
|
| Rate for Payer: Networks By Design Commercial |
$1,965.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,570.40
|
|
|
HC GASTRO TUBE PLACEMENT
|
Facility
|
OP
|
$3,024.00
|
|
|
Service Code
|
CPT 44500
|
| Hospital Charge Code |
906744500
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$33.30 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$604.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,166.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,898.06
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,360.80
|
| Rate for Payer: Cash Price |
$1,360.80
|
| Rate for Payer: Cash Price |
$1,360.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,419.20
|
| Rate for Payer: Cigna of CA HMO |
$1,935.36
|
| Rate for Payer: Cigna of CA PPO |
$2,237.76
|
| 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 |
$2,116.80
|
| 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 |
$2,570.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,814.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,721.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$33.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,920.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$604.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$2,268.00
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Networks By Design Commercial |
$1,965.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Preferred Health Network WC |
$1,936.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,570.40
|
| Rate for Payer: Prime Health Services Medicare |
$1,236.52
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Riverside University Health System MISP |
$1,283.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,814.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,512.00
|
| 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 GASTRO TUBE REMOVAL
|
Facility
|
OP
|
$5,614.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
900100022
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,122.80 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,122.80
|
| Rate for Payer: Adventist Health Commercial |
$2,118.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,166.53
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,166.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,129.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,718.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,265.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,162.53
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$2,526.30
|
| Rate for Payer: Cash Price |
$4,767.30
|
| Rate for Payer: Cash Price |
$4,767.30
|
| Rate for Payer: Cash Price |
$4,767.30
|
| Rate for Payer: Cash Price |
$2,526.30
|
| Rate for Payer: Cash Price |
$2,526.30
|
| Rate for Payer: Central Health Plan Commercial |
$8,475.20
|
| Rate for Payer: Central Health Plan Commercial |
$4,491.20
|
| Rate for Payer: Cigna of CA HMO |
$6,780.16
|
| Rate for Payer: Cigna of CA HMO |
$3,592.96
|
| Rate for Payer: Cigna of CA PPO |
$7,839.56
|
| Rate for Payer: Cigna of CA PPO |
$4,154.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,415.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,929.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: Galaxy Health WC |
$9,004.90
|
| Rate for Payer: Galaxy Health WC |
$4,771.90
|
| Rate for Payer: Global Benefits Group Commercial |
$6,356.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,368.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,052.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,534.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,564.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,727.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,122.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,118.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$4,210.50
|
| Rate for Payer: Multiplan Commercial |
$7,945.50
|
| Rate for Payer: Networks By Design Commercial |
$6,886.10
|
| Rate for Payer: Networks By Design Commercial |
$3,649.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,166.53
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Prime Health Services Commercial |
$4,771.90
|
| Rate for Payer: Prime Health Services Commercial |
$9,004.90
|
| Rate for Payer: Prime Health Services Medicare |
$1,236.52
|
| Rate for Payer: Prime Health Services Medicare |
$1,236.52
|
| Rate for Payer: Riverside University Health System MISP |
$1,283.18
|
| Rate for Payer: Riverside University Health System MISP |
$1,283.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,368.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,356.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,399.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,399.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,807.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,297.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC GASTRO TUBE REMOVAL
|
Facility
|
IP
|
$10,594.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
900100022
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,118.80 |
| Max. Negotiated Rate |
$9,534.60 |
| Rate for Payer: Adventist Health Commercial |
$2,118.80
|
| Rate for Payer: Cash Price |
$4,767.30
|
| Rate for Payer: Central Health Plan Commercial |
$8,475.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,415.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,237.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,237.60
|
| Rate for Payer: Galaxy Health WC |
$9,004.90
|
| Rate for Payer: Global Benefits Group Commercial |
$6,356.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,534.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,727.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,250.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,118.80
|
| Rate for Payer: Multiplan Commercial |
$7,945.50
|
| Rate for Payer: Networks By Design Commercial |
$6,886.10
|
| Rate for Payer: Prime Health Services Commercial |
$9,004.90
|
|
|
HC GASTRO UGI SMB W WO KUB
|
Facility
|
IP
|
$1,906.00
|
|
|
Service Code
|
CPT 74245
|
| Hospital Charge Code |
909001811
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$381.20 |
| Max. Negotiated Rate |
$1,715.40 |
| Rate for Payer: Adventist Health Commercial |
$381.20
|
| Rate for Payer: Cash Price |
$857.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,524.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,334.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$762.40
|
| Rate for Payer: EPIC Health Plan Senior |
$762.40
|
| Rate for Payer: Galaxy Health WC |
$1,620.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,143.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,715.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,210.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,124.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$381.20
|
| Rate for Payer: Multiplan Commercial |
$1,429.50
|
| Rate for Payer: Networks By Design Commercial |
$1,238.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,620.10
|
|
