|
HC GASTROESOPHAGEAL REFLUX
|
Facility
|
OP
|
$1,922.00
|
|
|
Service Code
|
CPT 78262
|
| Hospital Charge Code |
909301365
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$205.47 |
| Max. Negotiated Rate |
$1,729.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$515.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,191.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$885.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,135.52
|
| Rate for Payer: Blue Distinction Transplant |
$1,153.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,187.80
|
| Rate for Payer: Blue Shield of California EPN |
$934.09
|
| Rate for Payer: Caremore Medicare Advantage |
$515.32
|
| Rate for Payer: Cash Price |
$864.90
|
| Rate for Payer: Cash Price |
$864.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,537.60
|
| Rate for Payer: Cigna of CA HMO |
$1,230.08
|
| Rate for Payer: Cigna of CA PPO |
$1,422.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Media |
$515.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$695.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$515.32
|
| Rate for Payer: Galaxy Health WC |
$1,633.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,153.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,729.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,441.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$845.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$850.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$515.32
|
| Rate for Payer: InnovAge PACE Commercial |
$772.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,281.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$690.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$690.53
|
| Rate for Payer: Multiplan Commercial |
$1,441.50
|
| Rate for Payer: Networks By Design Commercial |
$1,249.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,633.70
|
| Rate for Payer: Prime Health Services Medicare |
$546.24
|
| Rate for Payer: Riverside University Health System MISP |
$566.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,153.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,153.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$623.82
|
| Rate for Payer: United Healthcare All Other HMO |
$623.82
|
| Rate for Payer: United Healthcare HMO Rider |
$623.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$623.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC GASTROESOPHAGEAL REFLUX
|
Facility
|
IP
|
$1,922.00
|
|
|
Service Code
|
CPT 78262
|
| Hospital Charge Code |
909301365
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$384.40 |
| Max. Negotiated Rate |
$1,729.80 |
| Rate for Payer: Cash Price |
$864.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,537.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$768.80
|
| Rate for Payer: Galaxy Health WC |
$1,633.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,153.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,729.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,281.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$732.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.40
|
| Rate for Payer: Multiplan Commercial |
$1,441.50
|
| Rate for Payer: Networks By Design Commercial |
$1,249.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,633.70
|
|
|
HC GASTROESOPHAGEAL REFLUX TEST
|
Facility
|
OP
|
$2,731.00
|
|
|
Service Code
|
CPT 91035
|
| Hospital Charge Code |
906791035
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$194.62 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Adventist Health Medi-Cal |
$669.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,440.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$736.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$669.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,884.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,613.47
|
| Rate for Payer: Blue Distinction Transplant |
$1,638.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$669.68
|
| Rate for Payer: Cash Price |
$1,228.95
|
| Rate for Payer: Cash Price |
$1,228.95
|
| Rate for Payer: Cash Price |
$1,228.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,184.80
|
| Rate for Payer: Cigna of CA PPO |
$2,020.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Dignity Health Media |
$669.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$736.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$904.07
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$669.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$669.68
|
| Rate for Payer: Galaxy Health WC |
$2,321.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,638.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,457.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,048.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,098.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,104.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$669.68
|
| Rate for Payer: InnovAge PACE Commercial |
$1,004.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,821.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$194.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$669.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$546.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$897.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$897.37
|
| Rate for Payer: Multiplan Commercial |
$2,048.25
|
| Rate for Payer: Networks By Design Commercial |
$1,775.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,321.35
|
| Rate for Payer: Prime Health Services Medicare |
$709.86
|
| Rate for Payer: Riverside University Health System MISP |
$736.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,638.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$803.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$736.65
|
| Rate for Payer: Vantage Medical Group Senior |
$669.68
|
|
|
HC GASTROESOPHAGEAL REFLUX TEST
|
Facility
|
IP
|
$4,302.00
|
|
|
Service Code
|
CPT 91035
|
| Hospital Charge Code |
906791035
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$860.40 |
| Max. Negotiated Rate |
$3,871.80 |
| Rate for Payer: Cash Price |
$1,935.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,441.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,720.80
|
| Rate for Payer: Galaxy Health WC |
$3,656.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,581.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,871.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,869.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,639.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$860.40
|
| Rate for Payer: Multiplan Commercial |
$3,226.50
|
| Rate for Payer: Networks By Design Commercial |
$2,796.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,656.70
|
|
|
HC GASTROESOPHAGEAL REFLUX TEST
|
Facility
|
OP
|
$1,578.00
|
|
|
Service Code
|
CPT 91034
|
| Hospital Charge Code |
906791034
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$147.46 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Adventist Health Medi-Cal |
$669.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$888.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$736.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$669.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,370.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$932.28
|
| Rate for Payer: Blue Distinction Transplant |
$946.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$669.68
|
| Rate for Payer: Cash Price |
$710.10
|
| Rate for Payer: Cash Price |
$710.10
|
| Rate for Payer: Cash Price |
$710.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,262.40
|
| Rate for Payer: Cigna of CA PPO |
$1,167.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Dignity Health Media |
$669.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$736.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$904.07
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$669.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$669.68
|
| Rate for Payer: Galaxy Health WC |
$1,341.30
|
| Rate for Payer: Global Benefits Group Commercial |
$946.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,420.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,183.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,098.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,104.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$669.68
|
| Rate for Payer: InnovAge PACE Commercial |
$1,004.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,052.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$147.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$669.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$315.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$897.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$897.37
|
| Rate for Payer: Multiplan Commercial |
$1,183.50
|
| Rate for Payer: Networks By Design Commercial |
$1,025.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,341.30
|
| Rate for Payer: Prime Health Services Medicare |
$709.86
|
| Rate for Payer: Riverside University Health System MISP |
$736.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$946.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$803.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$736.65
|
| Rate for Payer: Vantage Medical Group Senior |
$669.68
|
|
|
HC GASTROESOPHAGEAL REFLUX TEST
|
Facility
|
IP
|
$3,575.00
|
|
|
Service Code
|
CPT 91034
|
| Hospital Charge Code |
906791034
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$715.00 |
| Max. Negotiated Rate |
$3,217.50 |
| Rate for Payer: Cash Price |
$1,608.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,860.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,430.00
|
| Rate for Payer: Galaxy Health WC |
$3,038.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,145.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,217.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,384.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,362.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$715.00
|
| Rate for Payer: Multiplan Commercial |
$2,681.25
|
| Rate for Payer: Networks By Design Commercial |
$2,323.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,038.75
|
|
|
HC GASTROJEJUNOSTOMY SET D/L
|
Facility
|
OP
|
$928.00
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
909001042
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$324.80 |
| Max. Negotiated Rate |
$835.20 |
| 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 |
$510.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$449.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$548.26
|
| Rate for Payer: Blue Distinction Transplant |
$556.80
|
| Rate for Payer: Blue Shield of California Commercial |
$696.00
|
| Rate for Payer: Blue Shield of California EPN |
$504.83
|
| 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 Media |
$788.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$788.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$371.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$696.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$324.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$618.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$353.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$380.48
|
| 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 |
$464.00
|
| Rate for Payer: United Healthcare All Other HMO |
$464.00
|
| Rate for Payer: United Healthcare HMO Rider |
$464.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$464.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$788.80
|
| Rate for Payer: Vantage Medical Group Senior |
$788.80
|
|
|
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: Blue Shield of California EPN |
$495.55
|
| 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: EPIC Health Plan Commercial |
$371.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$618.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$353.57
|
| 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 |
$464.00
|
| Rate for Payer: Prime Health Services Commercial |
$788.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$350.41
|
| Rate for Payer: United Healthcare All Other HMO |
$342.25
|
| Rate for Payer: United Healthcare HMO Rider |
$334.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$306.24
|
|
|
HC GASTROJEJUNOSTOMY SET SGL/LMN
|
Facility
|
OP
|
$619.00
|
|
| Hospital Charge Code |
909001041
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$216.65 |
| Max. Negotiated Rate |
$557.10 |
| 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 |
$340.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$299.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$365.71
|
| Rate for Payer: Blue Distinction Transplant |
$371.40
|
| Rate for Payer: Blue Shield of California Commercial |
$464.25
|
| Rate for Payer: Blue Shield of California EPN |
$336.74
|
| 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 Media |
$526.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$526.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$247.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$464.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$216.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$412.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$235.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.79
|
| 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 |
$309.50
|
| Rate for Payer: United Healthcare All Other HMO |
$309.50
|
| Rate for Payer: United Healthcare HMO Rider |
$309.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$309.50
|
| 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: Blue Shield of California EPN |
$330.55
|
| 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: EPIC Health Plan Commercial |
$247.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$412.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$235.84
|
| 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 |
$309.50
|
| Rate for Payer: Prime Health Services Commercial |
$526.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$233.73
|
| Rate for Payer: United Healthcare All Other HMO |
$228.29
|
| Rate for Payer: United Healthcare HMO Rider |
$223.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$204.27
|
|
|
HC GASTRO PANEL NUCLEIC ACID
|
Facility
|
IP
|
$766.00
|
|
|
Service Code
|
CPT 87507
|
| Hospital Charge Code |
900913644
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$153.20 |
| Max. Negotiated Rate |
$689.40 |
| Rate for Payer: Cash Price |
$344.70
|
| Rate for Payer: Central Health Plan Commercial |
$612.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$306.40
|
| Rate for Payer: Galaxy Health WC |
$651.10
|
| Rate for Payer: Global Benefits Group Commercial |
$459.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$689.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$510.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$291.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.20
|
| Rate for Payer: Multiplan Commercial |
$574.50
|
| Rate for Payer: Networks By Design Commercial |
$497.90
|
| Rate for Payer: Prime Health Services Commercial |
$651.10
|
|
|
HC GASTRO PANEL NUCLEIC ACID
|
Facility
|
OP
|
$644.00
|
|
|
Service Code
|
CPT 87507
|
| Hospital Charge Code |
900913644
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$128.80 |
| Max. Negotiated Rate |
$2,958.02 |
| Rate for Payer: Adventist Health Medi-Cal |
$416.78
|
| 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 Medi-Cal |
$458.46
|
| 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 HMO/PPO |
$2,774.56
|
| Rate for Payer: Blue Distinction Transplant |
$386.40
|
| Rate for Payer: Blue Shield of California Commercial |
$397.99
|
| Rate for Payer: Blue Shield of California EPN |
$312.98
|
| Rate for Payer: Caremore Medicare Advantage |
$416.78
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: Central Health Plan Commercial |
$515.20
|
| Rate for Payer: Cigna of CA HMO |
$412.16
|
| Rate for Payer: Cigna of CA PPO |
$476.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$625.17
|
| Rate for Payer: Dignity Health Media |
$416.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$458.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$562.65
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$416.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$416.78
|
| Rate for Payer: Galaxy Health WC |
$547.40
|
| Rate for Payer: Global Benefits Group Commercial |
$386.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$579.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$483.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$683.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$687.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$416.78
|
| Rate for Payer: InnovAge PACE Commercial |
$625.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$429.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$703.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$416.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$558.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$558.49
|
| Rate for Payer: Multiplan Commercial |
$483.00
|
| Rate for Payer: Networks By Design Commercial |
$418.60
|
| Rate for Payer: Prime Health Services Commercial |
$547.40
|
| Rate for Payer: Prime Health Services Medicare |
$441.79
|
| Rate for Payer: Riverside University Health System MISP |
$458.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$386.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$386.40
|
| 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 HMO Rider |
$337.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$337.59
|
| 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 Senior |
$416.78
|
|
|
HC GASTROSTOMY TUBE PERCUT
|
Facility
|
IP
|
$5,767.00
|
|
|
Service Code
|
CPT 49440
|
| Hospital Charge Code |
906743750
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,153.40 |
| Max. Negotiated Rate |
$5,190.30 |
| Rate for Payer: Cash Price |
$2,595.15
|
| Rate for Payer: Central Health Plan Commercial |
$4,613.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,306.80
|
| Rate for Payer: Galaxy Health WC |
$4,901.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,460.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,190.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,846.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,197.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,153.40
|
| Rate for Payer: Multiplan Commercial |
$4,325.25
|
| Rate for Payer: Networks By Design Commercial |
$3,748.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,901.95
|
|
|
HC GASTROSTOMY TUBE PERCUT
|
Facility
|
OP
|
$2,547.00
|
|
|
Service Code
|
CPT 49440
|
| Hospital Charge Code |
906743750
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$509.40 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,377.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,528.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$2,377.45
|
| Rate for Payer: Cash Price |
$1,146.15
|
| Rate for Payer: Cash Price |
$1,146.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,037.60
|
| Rate for Payer: Cigna of CA PPO |
$1,884.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Media |
$2,377.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Galaxy Health WC |
$2,164.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,528.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,292.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,910.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,899.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,922.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,377.45
|
| Rate for Payer: InnovAge PACE Commercial |
$3,566.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,698.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,749.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$509.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,185.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Multiplan Commercial |
$1,910.25
|
| Rate for Payer: Networks By Design Commercial |
$1,655.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,164.95
|
| Rate for Payer: Prime Health Services Medicare |
$2,520.10
|
| Rate for Payer: Riverside University Health System MISP |
$2,615.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,528.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,852.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC GASTROSTOMY TUBE PERCUT
|
Facility
|
OP
|
$2,547.00
|
|
|
Service Code
|
CPT 49440
|
| Hospital Charge Code |
906743750
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$509.40 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,377.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,528.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$2,377.45
|
| Rate for Payer: Cash Price |
$1,146.15
|
| Rate for Payer: Cash Price |
$1,146.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,037.60
|
| Rate for Payer: Cigna of CA PPO |
$1,884.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Media |
$2,377.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Galaxy Health WC |
$2,164.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,528.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,292.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,910.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,899.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,922.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,377.45
|
| Rate for Payer: InnovAge PACE Commercial |
$3,566.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,698.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,749.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$509.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,185.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Multiplan Commercial |
$1,910.25
|
| Rate for Payer: Networks By Design Commercial |
$1,655.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,164.95
|
| Rate for Payer: Prime Health Services Medicare |
$2,520.10
|
| Rate for Payer: Riverside University Health System MISP |
$2,615.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,528.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC GASTROSTOMY TUBE PERCUT
|
Facility
|
IP
|
$5,767.00
|
|
|
Service Code
|
CPT 49440
|
| Hospital Charge Code |
906743750
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,153.40 |
| Max. Negotiated Rate |
$5,190.30 |
| Rate for Payer: Cash Price |
$2,595.15
|
| Rate for Payer: Central Health Plan Commercial |
$4,613.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,306.80
|
| Rate for Payer: Galaxy Health WC |
$4,901.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,460.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,190.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,846.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,197.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,153.40
|
| Rate for Payer: Multiplan Commercial |
$4,325.25
|
| Rate for Payer: Networks By Design Commercial |
$3,748.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,901.95
|
|
|
HC GASTROSTOMY TUBE REPOSITION
|
Facility
|
OP
|
$2,905.00
|
|
|
Service Code
|
CPT 43761
|
| Hospital Charge Code |
906743761
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$150.67 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$308.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$308.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,743.00
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Caremore Medicare Advantage |
$308.79
|
| Rate for Payer: Cash Price |
$1,307.25
|
| Rate for Payer: Cash Price |
$1,307.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,324.00
|
| Rate for Payer: Cigna of CA PPO |
$2,149.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.18
|
| Rate for Payer: Dignity Health Media |
$308.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$416.87
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$308.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$308.79
|
| Rate for Payer: Galaxy Health WC |
$2,469.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,743.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,614.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,178.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$506.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$509.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$308.79
|
| Rate for Payer: InnovAge PACE Commercial |
$463.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,937.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$150.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$308.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$581.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$413.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$413.78
|
| Rate for Payer: Multiplan Commercial |
$2,178.75
|
| Rate for Payer: Networks By Design Commercial |
$1,888.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,469.25
|
| Rate for Payer: Prime Health Services Medicare |
$327.32
|
| Rate for Payer: Riverside University Health System MISP |
$339.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,743.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$370.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Vantage Medical Group Senior |
$308.79
|
|
|
HC GASTROSTOMY TUBE REPOSITION
|
Facility
|
IP
|
$2,905.00
|
|
|
Service Code
|
CPT 43761
|
| Hospital Charge Code |
906743761
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$581.00 |
| Max. Negotiated Rate |
$2,614.50 |
| Rate for Payer: Cash Price |
$1,307.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,324.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,162.00
|
| Rate for Payer: Galaxy Health WC |
$2,469.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,743.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,614.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,937.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,106.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$581.00
|
| Rate for Payer: Multiplan Commercial |
$2,178.75
|
| Rate for Payer: Networks By Design Commercial |
$1,888.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,469.25
|
|
|
HC GASTROSTOMY TUBE REPOSITION
|
Facility
|
OP
|
$2,905.00
|
|
|
Service Code
|
CPT 43761
|
| Hospital Charge Code |
906743761
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$150.67 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$308.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$308.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,743.00
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Caremore Medicare Advantage |
$308.79
|
| Rate for Payer: Cash Price |
$1,307.25
|
| Rate for Payer: Cash Price |
$1,307.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,324.00
|
| Rate for Payer: Cigna of CA PPO |
$2,149.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.18
|
| Rate for Payer: Dignity Health Media |
$308.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$416.87
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$308.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$308.79
|
| Rate for Payer: Galaxy Health WC |
$2,469.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,743.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,614.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,178.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$506.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$509.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$308.79
|
| Rate for Payer: InnovAge PACE Commercial |
$463.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,937.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$150.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$308.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$581.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$413.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$413.78
|
| Rate for Payer: Multiplan Commercial |
$2,178.75
|
| Rate for Payer: Networks By Design Commercial |
$1,888.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,469.25
|
| Rate for Payer: Prime Health Services Medicare |
$327.32
|
| Rate for Payer: Riverside University Health System MISP |
$339.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,743.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Vantage Medical Group Senior |
$308.79
|
|
|
HC GASTROSTOMY TUBE REPOSITION
|
Facility
|
OP
|
$2,905.00
|
|
|
Service Code
|
CPT 43761
|
| Hospital Charge Code |
906743761
|
|
Hospital Revenue Code
|
949
|
| Min. Negotiated Rate |
$150.67 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$308.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$308.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,743.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,827.24
|
| Rate for Payer: Blue Shield of California EPN |
$1,420.54
|
| Rate for Payer: Caremore Medicare Advantage |
$308.79
|
| Rate for Payer: Cash Price |
$1,307.25
|
| Rate for Payer: Cash Price |
$1,307.25
|
| Rate for Payer: Cash Price |
$1,307.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,324.00
|
| Rate for Payer: Cigna of CA HMO |
$1,859.20
|
| Rate for Payer: Cigna of CA PPO |
$2,149.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.18
|
| Rate for Payer: Dignity Health Media |
$308.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$416.87
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$308.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$308.79
|
| Rate for Payer: Galaxy Health WC |
$2,469.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,743.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,614.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,178.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$506.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$509.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$308.79
|
| Rate for Payer: InnovAge PACE Commercial |
$463.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,937.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$150.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$308.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$581.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$413.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$413.78
|
| Rate for Payer: Multiplan Commercial |
$2,178.75
|
| Rate for Payer: Networks By Design Commercial |
$1,888.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,469.25
|
| Rate for Payer: Prime Health Services Medicare |
$327.32
|
| Rate for Payer: Riverside University Health System MISP |
$339.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,743.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,743.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$762.00
|
| Rate for Payer: United Healthcare All Other HMO |
$515.00
|
| Rate for Payer: United Healthcare HMO Rider |
$312.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$285.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Vantage Medical Group Senior |
$308.79
|
|
|
HC GASTROSTOMY TUBE REPOSITION
|
Facility
|
IP
|
$2,905.00
|
|
|
Service Code
|
CPT 43761
|
| Hospital Charge Code |
906743761
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$581.00 |
| Max. Negotiated Rate |
$2,614.50 |
| Rate for Payer: Cash Price |
$1,307.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,324.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,162.00
|
| Rate for Payer: Galaxy Health WC |
$2,469.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,743.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,614.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,937.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,106.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$581.00
|
| Rate for Payer: Multiplan Commercial |
$2,178.75
|
| Rate for Payer: Networks By Design Commercial |
$1,888.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,469.25
|
|
|
HC GASTROSTOMY TUBE REPOSITION
|
Facility
|
IP
|
$2,905.00
|
|
|
Service Code
|
CPT 43761
|
| Hospital Charge Code |
906743761
|
|
Hospital Revenue Code
|
949
|
| Min. Negotiated Rate |
$581.00 |
| Max. Negotiated Rate |
$2,614.50 |
| Rate for Payer: Cash Price |
$1,307.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,324.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,162.00
|
| Rate for Payer: Galaxy Health WC |
$2,469.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,743.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,614.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,937.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,106.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$581.00
|
| Rate for Payer: Multiplan Commercial |
$2,178.75
|
| Rate for Payer: Networks By Design Commercial |
$1,888.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,469.25
|
|
|
HC GASTRO TUBE PLACEMENT
|
Facility
|
OP
|
$2,287.00
|
|
|
Service Code
|
CPT 44500
|
| Hospital Charge Code |
906744500
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$36.78 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,132.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$130.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,372.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$1,132.59
|
| Rate for Payer: Cash Price |
$1,029.15
|
| Rate for Payer: Cash Price |
$1,029.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,829.60
|
| Rate for Payer: Cigna of CA PPO |
$1,692.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$1,943.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,372.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,058.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,715.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,857.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,868.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: InnovAge PACE Commercial |
$1,698.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,525.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$457.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,517.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$1,715.25
|
| Rate for Payer: Networks By Design Commercial |
$1,486.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,943.95
|
| Rate for Payer: Prime Health Services Medicare |
$1,200.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,245.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,372.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,359.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC GASTRO TUBE PLACEMENT
|
Facility
|
IP
|
$2,287.00
|
|
|
Service Code
|
CPT 44500
|
| Hospital Charge Code |
906744500
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$457.40 |
| Max. Negotiated Rate |
$2,058.30 |
| Rate for Payer: Cash Price |
$1,029.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,829.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$914.80
|
| Rate for Payer: Galaxy Health WC |
$1,943.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,372.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,058.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,525.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$871.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$457.40
|
| Rate for Payer: Multiplan Commercial |
$1,715.25
|
| Rate for Payer: Networks By Design Commercial |
$1,486.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,943.95
|
|
|
HC GASTRO TUBE PLACEMENT
|
Facility
|
OP
|
$2,287.00
|
|
|
Service Code
|
CPT 44500
|
| Hospital Charge Code |
906744500
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$36.78 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,132.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$130.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,372.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$1,132.59
|
| Rate for Payer: Cash Price |
$1,029.15
|
| Rate for Payer: Cash Price |
$1,029.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,829.60
|
| Rate for Payer: Cigna of CA PPO |
$1,692.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$1,943.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,372.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,058.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,715.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,857.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,868.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: InnovAge PACE Commercial |
$1,698.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,525.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$457.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,517.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$1,715.25
|
| Rate for Payer: Networks By Design Commercial |
$1,486.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,943.95
|
| Rate for Payer: Prime Health Services Medicare |
$1,200.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,245.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,372.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
