|
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 |
$1,663.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,419.20
|
| 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 Permanente of CA Commercial/Self Funded |
$2,017.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,152.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,871.86
|
| 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
|
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 |
$1,191.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,663.20
|
| Rate for Payer: Cash Price |
$1,663.20
|
| Rate for Payer: Cash Price |
$1,663.20
|
| 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 |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,608.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,191.26
|
| Rate for Payer: Galaxy Health WC |
$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 |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$33.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: InnovAge PACE Commercial |
$1,786.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,017.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$604.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,596.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,596.29
|
| 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 |
$1,191.26
|
| Rate for Payer: Prime Health Services Commercial |
$2,570.40
|
| Rate for Payer: Prime Health Services Medicare |
$1,262.74
|
| Rate for Payer: Riverside University Health System MISP |
$1,310.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,814.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,429.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,191.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC 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 |
$1,191.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,898.06
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,663.20
|
| Rate for Payer: Cash Price |
$1,663.20
|
| Rate for Payer: Cash Price |
$1,663.20
|
| 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 |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,608.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,191.26
|
| Rate for Payer: Galaxy Health WC |
$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 |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$33.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: InnovAge PACE Commercial |
$1,786.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,017.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$604.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,596.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,596.29
|
| 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 |
$1,191.26
|
| 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 |
$1,262.74
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Riverside University Health System MISP |
$1,310.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,814.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,191.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC 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 |
$1,663.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,419.20
|
| 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 Permanente of CA Commercial/Self Funded |
$2,017.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,152.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,871.86
|
| 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 REMOVAL
|
Facility
|
IP
|
$5,614.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
900100022
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,122.80 |
| Max. Negotiated Rate |
$5,052.60 |
| Rate for Payer: Adventist Health Commercial |
$1,122.80
|
| Rate for Payer: Cash Price |
$3,087.70
|
| Rate for Payer: Central Health Plan Commercial |
$4,491.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,245.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,245.60
|
| Rate for Payer: Galaxy Health WC |
$4,771.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,368.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,052.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,744.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,138.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,475.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,122.80
|
| Rate for Payer: Multiplan Commercial |
$4,210.50
|
| Rate for Payer: Networks By Design Commercial |
$3,649.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,771.90
|
|
|
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 |
$7,378.00 |
| Rate for Payer: Adventist Health Commercial |
$1,122.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,191.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$3,087.70
|
| Rate for Payer: Cash Price |
$3,087.70
|
| Rate for Payer: Cash Price |
$3,087.70
|
| Rate for Payer: Central Health Plan Commercial |
$4,491.20
|
| Rate for Payer: Cigna of CA HMO |
$3,592.96
|
| Rate for Payer: Cigna of CA PPO |
$4,154.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,608.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,191.26
|
| Rate for Payer: Galaxy Health WC |
$4,771.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,368.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,052.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: InnovAge PACE Commercial |
$1,786.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,744.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,122.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,596.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,596.29
|
| Rate for Payer: Multiplan Commercial |
$4,210.50
|
| Rate for Payer: Networks By Design Commercial |
$3,649.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Prime Health Services Commercial |
$4,771.90
|
| Rate for Payer: Prime Health Services Medicare |
$1,262.74
|
| Rate for Payer: Riverside University Health System MISP |
$1,310.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,368.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,429.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,191.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC 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 |
$1,048.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,524.80
|
| 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 Permanente of CA Commercial/Self Funded |
$1,271.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$726.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,179.81
|
| 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
|
|
|
HC GASTRO UGI SMB W WO KUB
|
Facility
|
OP
|
$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: Aetna of CA HMO/PPO |
$1,157.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,620.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,048.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,429.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$922.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,119.39
|
| Rate for Payer: Blue Shield of California Commercial |
$1,156.94
|
| Rate for Payer: Blue Shield of California EPN |
$756.68
|
| Rate for Payer: Cash Price |
$1,048.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,524.80
|
| Rate for Payer: Cigna of CA HMO |
$1,219.84
|
| Rate for Payer: Cigna of CA PPO |
$1,410.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,620.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,620.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,620.10
|
| 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: InnovAge PACE Commercial |
$953.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,271.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$726.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,179.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$381.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,334.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,334.20
|
| 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
|
| Rate for Payer: Riverside University Health System MISP |
$762.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,143.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,143.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$953.00
|
| Rate for Payer: United Healthcare All Other HMO |
$953.00
|
| Rate for Payer: United Healthcare HMO Rider |
$953.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$953.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,620.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,620.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,620.10
|
|
|
HC GASTRO UGI SNGL CNTRST
|
Facility
|
OP
|
$1,115.00
|
|
|
Service Code
|
CPT 74240
|
| Hospital Charge Code |
909001873
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$61.92 |
| Max. Negotiated Rate |
$1,003.50 |
| Rate for Payer: Adventist Health Commercial |
$223.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$226.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$677.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$305.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.92
|
| Rate for Payer: Blue Shield of California Commercial |
$676.80
|
| Rate for Payer: Blue Shield of California EPN |
$442.65
|
| Rate for Payer: Cash Price |
$613.25
|
| Rate for Payer: Cash Price |
$613.25
|
| Rate for Payer: Central Health Plan Commercial |
$892.00
|
| Rate for Payer: Cigna of CA HMO |
$713.60
|
| Rate for Payer: Cigna of CA PPO |
$825.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.36
|
| Rate for Payer: EPIC Health Plan Senior |
$226.19
|
| Rate for Payer: Galaxy Health WC |
$947.75
|
| Rate for Payer: Global Benefits Group Commercial |
$669.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,003.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$175.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: InnovAge PACE Commercial |
$339.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$743.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$193.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$303.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.09
|
| Rate for Payer: Multiplan Commercial |
$836.25
|
| Rate for Payer: Networks By Design Commercial |
$724.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$226.19
|
| Rate for Payer: Prime Health Services Commercial |
$947.75
|
| Rate for Payer: Prime Health Services Medicare |
$239.76
|
| Rate for Payer: Riverside University Health System MISP |
$248.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$669.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$669.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.73
|
| Rate for Payer: United Healthcare All Other HMO |
$219.73
|
| Rate for Payer: United Healthcare HMO Rider |
$219.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$226.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC GASTRO UGI SNGL CNTRST
|
Facility
|
IP
|
$1,115.00
|
|
|
Service Code
|
CPT 74240
|
| Hospital Charge Code |
909001873
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$223.00 |
| Max. Negotiated Rate |
$1,003.50 |
| Rate for Payer: Adventist Health Commercial |
$223.00
|
| Rate for Payer: Cash Price |
$613.25
|
| Rate for Payer: Central Health Plan Commercial |
$892.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$446.00
|
| Rate for Payer: EPIC Health Plan Senior |
$446.00
|
| Rate for Payer: Galaxy Health WC |
$947.75
|
| Rate for Payer: Global Benefits Group Commercial |
$669.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,003.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$743.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$424.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$690.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.00
|
| Rate for Payer: Multiplan Commercial |
$836.25
|
| Rate for Payer: Networks By Design Commercial |
$724.75
|
| Rate for Payer: Prime Health Services Commercial |
$947.75
|
|
|
HC GASTRO UGI WITH KUB
|
Facility
|
OP
|
$1,486.00
|
|
|
Service Code
|
CPT 74241
|
| Hospital Charge Code |
909001796
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$297.20 |
| Max. Negotiated Rate |
$1,337.40 |
| Rate for Payer: Adventist Health Commercial |
$297.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$902.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,263.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$817.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,114.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$719.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$872.73
|
| Rate for Payer: Blue Shield of California Commercial |
$902.00
|
| Rate for Payer: Blue Shield of California EPN |
$589.94
|
| Rate for Payer: Cash Price |
$817.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,188.80
|
| Rate for Payer: Cigna of CA HMO |
$951.04
|
| Rate for Payer: Cigna of CA PPO |
$1,099.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,263.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,263.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,263.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$594.40
|
| Rate for Payer: EPIC Health Plan Senior |
$594.40
|
| Rate for Payer: Galaxy Health WC |
$1,263.10
|
| Rate for Payer: Global Benefits Group Commercial |
$891.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,337.40
|
| Rate for Payer: InnovAge PACE Commercial |
$743.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$991.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$566.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$919.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,040.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,040.20
|
| Rate for Payer: Multiplan Commercial |
$1,114.50
|
| Rate for Payer: Networks By Design Commercial |
$965.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,263.10
|
| Rate for Payer: Riverside University Health System MISP |
$594.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$891.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$891.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$743.00
|
| Rate for Payer: United Healthcare All Other HMO |
$743.00
|
| Rate for Payer: United Healthcare HMO Rider |
$743.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$743.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,263.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,263.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,263.10
|
|
|
HC GASTRO UGI WITH KUB
|
Facility
|
IP
|
$1,486.00
|
|
|
Service Code
|
CPT 74241
|
| Hospital Charge Code |
909001796
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$297.20 |
| Max. Negotiated Rate |
$1,337.40 |
| Rate for Payer: Adventist Health Commercial |
$297.20
|
| Rate for Payer: Cash Price |
$817.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,188.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$594.40
|
| Rate for Payer: EPIC Health Plan Senior |
$594.40
|
| Rate for Payer: Galaxy Health WC |
$1,263.10
|
| Rate for Payer: Global Benefits Group Commercial |
$891.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,337.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$991.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$566.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$919.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.20
|
| Rate for Payer: Multiplan Commercial |
$1,114.50
|
| Rate for Payer: Networks By Design Commercial |
$965.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,263.10
|
|
|
HC GASTROVIEW PER ML
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT Q9960
|
| Hospital Charge Code |
909001017
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.77
|
| Rate for Payer: Blue Shield of California EPN |
$0.50
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: Central Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Senior |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
|
|
HC GASTROVIEW PER ML
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT Q9960
|
| Hospital Charge Code |
909001017
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.59
|
| Rate for Payer: Blue Shield of California Commercial |
$0.61
|
| Rate for Payer: Blue Shield of California EPN |
$0.40
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: Central Health Plan Commercial |
$0.80
|
| Rate for Payer: Cigna of CA HMO |
$0.64
|
| Rate for Payer: Cigna of CA PPO |
$0.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Senior |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.38
|
| Rate for Payer: InnovAge PACE Commercial |
$0.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
| Rate for Payer: Riverside University Health System MISP |
$0.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO |
$0.50
|
| Rate for Payer: United Healthcare HMO Rider |
$0.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Vantage Medical Group Senior |
$0.85
|
|
|
HC GATED BLOOD POOL- MUGA
|
Facility
|
IP
|
$3,304.00
|
|
|
Service Code
|
CPT 78472
|
| Hospital Charge Code |
908801550
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$660.80 |
| Max. Negotiated Rate |
$2,973.60 |
| Rate for Payer: Adventist Health Commercial |
$660.80
|
| Rate for Payer: Cash Price |
$1,817.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,643.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,321.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,321.60
|
| Rate for Payer: Galaxy Health WC |
$2,808.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,982.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,973.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,203.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,258.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,045.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$660.80
|
| Rate for Payer: Multiplan Commercial |
$2,478.00
|
| Rate for Payer: Networks By Design Commercial |
$2,147.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,808.40
|
|
|
HC GATED BLOOD POOL- MUGA
|
Facility
|
OP
|
$3,304.00
|
|
|
Service Code
|
CPT 78472
|
| Hospital Charge Code |
909301381
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$288.56 |
| Max. Negotiated Rate |
$2,973.60 |
| Rate for Payer: Adventist Health Commercial |
$660.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$510.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,006.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,000.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,940.44
|
| Rate for Payer: Blue Shield of California Commercial |
$2,005.53
|
| Rate for Payer: Blue Shield of California EPN |
$1,311.69
|
| Rate for Payer: Cash Price |
$1,817.20
|
| Rate for Payer: Cash Price |
$1,817.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,643.20
|
| Rate for Payer: Cigna of CA HMO |
$2,114.56
|
| Rate for Payer: Cigna of CA PPO |
$2,444.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$689.27
|
| Rate for Payer: EPIC Health Plan Senior |
$510.57
|
| Rate for Payer: Galaxy Health WC |
$2,808.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,982.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,973.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$837.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$288.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: InnovAge PACE Commercial |
$765.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,203.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$318.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$510.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$660.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$684.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$684.16
|
| Rate for Payer: Multiplan Commercial |
$2,478.00
|
| Rate for Payer: Networks By Design Commercial |
$2,147.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$510.57
|
| Rate for Payer: Prime Health Services Commercial |
$2,808.40
|
| Rate for Payer: Prime Health Services Medicare |
$541.20
|
| Rate for Payer: Riverside University Health System MISP |
$561.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,982.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,982.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$761.81
|
| Rate for Payer: United Healthcare All Other HMO |
$761.81
|
| Rate for Payer: United Healthcare HMO Rider |
$761.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$761.81
|
| Rate for Payer: Upland Medical Group Pediatric |
$510.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC GATED BLOOD POOL- MUGA
|
Facility
|
IP
|
$3,304.00
|
|
|
Service Code
|
CPT 78472
|
| Hospital Charge Code |
909301381
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$660.80 |
| Max. Negotiated Rate |
$2,973.60 |
| Rate for Payer: Adventist Health Commercial |
$660.80
|
| Rate for Payer: Cash Price |
$1,817.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,643.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,321.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,321.60
|
| Rate for Payer: Galaxy Health WC |
$2,808.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,982.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,973.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,203.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,258.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,045.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$660.80
|
| Rate for Payer: Multiplan Commercial |
$2,478.00
|
| Rate for Payer: Networks By Design Commercial |
$2,147.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,808.40
|
|
|
HC GATED BLOOD POOL- MUGA
|
Facility
|
OP
|
$3,304.00
|
|
|
Service Code
|
CPT 78472
|
| Hospital Charge Code |
908801550
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$288.56 |
| Max. Negotiated Rate |
$2,973.60 |
| Rate for Payer: Adventist Health Commercial |
$660.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$510.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,006.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,000.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,940.44
|
| Rate for Payer: Blue Shield of California Commercial |
$2,005.53
|
| Rate for Payer: Blue Shield of California EPN |
$1,311.69
|
| Rate for Payer: Cash Price |
$1,817.20
|
| Rate for Payer: Cash Price |
$1,817.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,643.20
|
| Rate for Payer: Cigna of CA HMO |
$2,114.56
|
| Rate for Payer: Cigna of CA PPO |
$2,444.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$689.27
|
| Rate for Payer: EPIC Health Plan Senior |
$510.57
|
| Rate for Payer: Galaxy Health WC |
$2,808.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,982.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,973.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$837.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$288.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: InnovAge PACE Commercial |
$765.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,203.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$318.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$510.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$660.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$684.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$684.16
|
| Rate for Payer: Multiplan Commercial |
$2,478.00
|
| Rate for Payer: Networks By Design Commercial |
$2,147.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$510.57
|
| Rate for Payer: Prime Health Services Commercial |
$2,808.40
|
| Rate for Payer: Prime Health Services Medicare |
$541.20
|
| Rate for Payer: Riverside University Health System MISP |
$561.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,982.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,982.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$761.81
|
| Rate for Payer: United Healthcare All Other HMO |
$761.81
|
| Rate for Payer: United Healthcare HMO Rider |
$761.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$761.81
|
| Rate for Payer: Upland Medical Group Pediatric |
$510.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC GATED FIRST PASS
|
Facility
|
OP
|
$1,297.00
|
|
|
Service Code
|
CPT 78481
|
| Hospital Charge Code |
909301391
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$259.40 |
| Max. Negotiated Rate |
$1,167.30 |
| Rate for Payer: Adventist Health Commercial |
$259.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$683.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$787.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$683.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,079.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$761.73
|
| Rate for Payer: Blue Shield of California Commercial |
$787.28
|
| Rate for Payer: Blue Shield of California EPN |
$514.91
|
| Rate for Payer: Cash Price |
$713.35
|
| Rate for Payer: Cash Price |
$713.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,037.60
|
| Rate for Payer: Cigna of CA HMO |
$830.08
|
| Rate for Payer: Cigna of CA PPO |
$959.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$752.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$683.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$923.31
|
| Rate for Payer: EPIC Health Plan Senior |
$683.93
|
| Rate for Payer: Galaxy Health WC |
$1,102.45
|
| Rate for Payer: Global Benefits Group Commercial |
$778.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,167.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,121.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$271.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$683.93
|
| Rate for Payer: InnovAge PACE Commercial |
$1,025.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$865.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$300.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$683.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$916.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$916.47
|
| Rate for Payer: Multiplan Commercial |
$972.75
|
| Rate for Payer: Networks By Design Commercial |
$843.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$683.93
|
| Rate for Payer: Prime Health Services Commercial |
$1,102.45
|
| Rate for Payer: Prime Health Services Medicare |
$724.97
|
| Rate for Payer: Riverside University Health System MISP |
$752.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$778.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$778.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$761.81
|
| Rate for Payer: United Healthcare All Other HMO |
$761.81
|
| Rate for Payer: United Healthcare HMO Rider |
$761.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$761.81
|
| Rate for Payer: Upland Medical Group Pediatric |
$683.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Vantage Medical Group Senior |
$683.93
|
|
|
HC GATED FIRST PASS
|
Facility
|
IP
|
$1,297.00
|
|
|
Service Code
|
CPT 78481
|
| Hospital Charge Code |
909301391
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$259.40 |
| Max. Negotiated Rate |
$1,167.30 |
| Rate for Payer: Adventist Health Commercial |
$259.40
|
| Rate for Payer: Cash Price |
$713.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,037.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$518.80
|
| Rate for Payer: EPIC Health Plan Senior |
$518.80
|
| Rate for Payer: Galaxy Health WC |
$1,102.45
|
| Rate for Payer: Global Benefits Group Commercial |
$778.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,167.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$865.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$494.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$802.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.40
|
| Rate for Payer: Multiplan Commercial |
$972.75
|
| Rate for Payer: Networks By Design Commercial |
$843.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,102.45
|
|
|
HC GAUZE SPONGE 4 X 4 5-PACK STE
|
Facility
|
OP
|
$0.57
|
|
| Hospital Charge Code |
901601679
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.33
|
| Rate for Payer: Blue Shield of California Commercial |
$0.35
|
| Rate for Payer: Blue Shield of California EPN |
$0.23
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: Central Health Plan Commercial |
$0.46
|
| Rate for Payer: Cigna of CA HMO |
$0.36
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Senior |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.48
|
| Rate for Payer: Global Benefits Group Commercial |
$0.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.51
|
| Rate for Payer: InnovAge PACE Commercial |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$0.43
|
| Rate for Payer: Networks By Design Commercial |
$0.37
|
| Rate for Payer: Prime Health Services Commercial |
$0.48
|
| Rate for Payer: Riverside University Health System MISP |
$0.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.29
|
| Rate for Payer: United Healthcare All Other HMO |
$0.29
|
| Rate for Payer: United Healthcare HMO Rider |
$0.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Vantage Medical Group Senior |
$0.48
|
|
|
HC GAUZE SPONGE 4 X 4 5-PACK STE
|
Facility
|
IP
|
$0.57
|
|
| Hospital Charge Code |
901601679
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: Central Health Plan Commercial |
$0.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Senior |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.48
|
| Rate for Payer: Global Benefits Group Commercial |
$0.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.43
|
| Rate for Payer: Networks By Design Commercial |
$0.37
|
| Rate for Payer: Prime Health Services Commercial |
$0.48
|
|
|
HC GAUZE SPONGE 4 X 4 STERILE
|
Facility
|
IP
|
$0.25
|
|
| Hospital Charge Code |
901602193
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Central Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.21
|
| Rate for Payer: Global Benefits Group Commercial |
$0.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.21
|
|
|
HC GAUZE SPONGE 4 X 4 STERILE
|
Facility
|
OP
|
$0.25
|
|
| Hospital Charge Code |
901602193
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.15
|
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Central Health Plan Commercial |
$0.20
|
| Rate for Payer: Cigna of CA HMO |
$0.16
|
| Rate for Payer: Cigna of CA PPO |
$0.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.21
|
| Rate for Payer: Global Benefits Group Commercial |
$0.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.23
|
| Rate for Payer: InnovAge PACE Commercial |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.21
|
| Rate for Payer: Riverside University Health System MISP |
$0.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO |
$0.13
|
| Rate for Payer: United Healthcare HMO Rider |
$0.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: Vantage Medical Group Senior |
$0.21
|
|
|
HC GAUZE SPONGE 6X6 STERILE
|
Facility
|
IP
|
$2.13
|
|
|
Service Code
|
CPT A6403
|
| Hospital Charge Code |
901698841
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$1.92 |
| Rate for Payer: Adventist Health Commercial |
$0.43
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Central Health Plan Commercial |
$1.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.85
|
| Rate for Payer: EPIC Health Plan Senior |
$0.85
|
| Rate for Payer: Galaxy Health WC |
$1.81
|
| Rate for Payer: Global Benefits Group Commercial |
$1.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: Networks By Design Commercial |
$1.38
|
| Rate for Payer: Prime Health Services Commercial |
$1.81
|
|
