|
HC REP INT WNDS FACE 7.6-12.5CM
|
Facility
|
OP
|
$3,632.00
|
|
|
Service Code
|
CPT 12054
|
| Hospital Charge Code |
900501038
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$296.38 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$726.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$808.84
|
| Rate for Payer: Cash Price |
$1,634.40
|
| Rate for Payer: Cash Price |
$1,634.40
|
| Rate for Payer: Cash Price |
$1,634.40
|
| Rate for Payer: Cash Price |
$1,634.40
|
| Rate for Payer: Central Health Plan Commercial |
$2,905.60
|
| Rate for Payer: Cigna of CA HMO |
$2,324.48
|
| Rate for Payer: Cigna of CA PPO |
$2,687.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,542.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$3,087.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,179.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,268.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$857.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,306.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$296.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$726.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$2,724.00
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$2,360.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$522.85
|
| Rate for Payer: Preferred Health Network WC |
$825.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,087.20
|
| Rate for Payer: Prime Health Services Medicare |
$554.22
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Riverside University Health System MISP |
$575.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,179.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,816.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,816.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,816.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,816.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$522.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
HC REP INT WNDS FACE 7.6-12.5CM
|
Facility
|
IP
|
$3,632.00
|
|
|
Service Code
|
CPT 12054
|
| Hospital Charge Code |
900501038
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$726.40 |
| Max. Negotiated Rate |
$3,268.80 |
| Rate for Payer: Adventist Health Commercial |
$726.40
|
| Rate for Payer: Cash Price |
$1,634.40
|
| Rate for Payer: Central Health Plan Commercial |
$2,905.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,542.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,452.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,452.80
|
| Rate for Payer: Galaxy Health WC |
$3,087.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,179.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,268.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,306.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,142.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$726.40
|
| Rate for Payer: Multiplan Commercial |
$2,724.00
|
| Rate for Payer: Networks By Design Commercial |
$2,360.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,087.20
|
|
|
HC REP INT WNDS FACE 7.6-12.5CM
|
Facility
|
IP
|
$3,632.00
|
|
|
Service Code
|
CPT 12054
|
| Hospital Charge Code |
900501038
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$726.40 |
| Max. Negotiated Rate |
$3,268.80 |
| Rate for Payer: Adventist Health Commercial |
$726.40
|
| Rate for Payer: Cash Price |
$1,634.40
|
| Rate for Payer: Central Health Plan Commercial |
$2,905.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,542.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,452.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,452.80
|
| Rate for Payer: Galaxy Health WC |
$3,087.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,179.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,268.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,306.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,142.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$726.40
|
| Rate for Payer: Multiplan Commercial |
$2,724.00
|
| Rate for Payer: Networks By Design Commercial |
$2,360.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,087.20
|
|
|
HC REPLACE DUODENAL/JEJUN TUBE
|
Facility
|
OP
|
$4,818.00
|
|
|
Service Code
|
CPT 49451
|
| Hospital Charge Code |
909020006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$963.60 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$963.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,166.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,898.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$2,168.10
|
| Rate for Payer: Cash Price |
$2,168.10
|
| Rate for Payer: Cash Price |
$2,168.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,854.40
|
| Rate for Payer: Cigna of CA HMO |
$3,083.52
|
| Rate for Payer: Cigna of CA PPO |
$3,565.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,372.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: Galaxy Health WC |
$4,095.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,890.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,336.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,166.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,059.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,288.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$963.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$3,613.50
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Networks By Design Commercial |
$3,131.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Preferred Health Network WC |
$1,936.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,095.30
|
| Rate for Payer: Prime Health Services Medicare |
$1,236.52
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Riverside University Health System MISP |
$1,283.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,890.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,409.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC REPLACE DUODENAL/JEJUN TUBE
|
Facility
|
IP
|
$4,818.00
|
|
|
Service Code
|
CPT 49451
|
| Hospital Charge Code |
909020006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$963.60 |
| Max. Negotiated Rate |
$4,336.20 |
| Rate for Payer: Adventist Health Commercial |
$963.60
|
| Rate for Payer: Cash Price |
$2,168.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,854.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,372.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,927.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,927.20
|
| Rate for Payer: Galaxy Health WC |
$4,095.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,890.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,336.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,059.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,842.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$963.60
|
| Rate for Payer: Multiplan Commercial |
$3,613.50
|
| Rate for Payer: Networks By Design Commercial |
$3,131.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,095.30
|
|
|
HC REPLACE FOOT DROP SPINT
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
CPT L4394
|
| Hospital Charge Code |
915354394
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.81 |
| Max. Negotiated Rate |
$29.70 |
| Rate for Payer: Adventist Health Commercial |
$13.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.20
|
| Rate for Payer: Blue Shield of California Commercial |
$26.47
|
| Rate for Payer: Blue Shield of California EPN |
$16.63
|
| Rate for Payer: Cash Price |
$14.85
|
| Rate for Payer: Central Health Plan Commercial |
$26.40
|
| Rate for Payer: Cigna of CA HMO |
$23.10
|
| Rate for Payer: Cigna of CA PPO |
$23.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.20
|
| Rate for Payer: EPIC Health Plan Senior |
$13.20
|
| Rate for Payer: Galaxy Health WC |
$28.05
|
| Rate for Payer: Global Benefits Group Commercial |
$19.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.10
|
| Rate for Payer: Multiplan Commercial |
$24.75
|
| Rate for Payer: Networks By Design Commercial |
$16.50
|
| Rate for Payer: Prime Health Services Commercial |
$28.05
|
| Rate for Payer: Riverside University Health System MISP |
$13.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.38
|
| Rate for Payer: United Healthcare All Other HMO |
$12.05
|
| Rate for Payer: United Healthcare HMO Rider |
$11.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.05
|
| Rate for Payer: Vantage Medical Group Senior |
$28.05
|
|
|
HC REPLACE FOOT DROP SPINT
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
CPT L4394
|
| Hospital Charge Code |
905354394
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.81 |
| Max. Negotiated Rate |
$29.70 |
| Rate for Payer: Adventist Health Commercial |
$13.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.20
|
| Rate for Payer: Blue Shield of California Commercial |
$26.47
|
| Rate for Payer: Blue Shield of California EPN |
$16.63
|
| Rate for Payer: Cash Price |
$14.85
|
| Rate for Payer: Central Health Plan Commercial |
$26.40
|
| Rate for Payer: Cigna of CA HMO |
$23.10
|
| Rate for Payer: Cigna of CA PPO |
$23.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.20
|
| Rate for Payer: EPIC Health Plan Senior |
$13.20
|
| Rate for Payer: Galaxy Health WC |
$28.05
|
| Rate for Payer: Global Benefits Group Commercial |
$19.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.10
|
| Rate for Payer: Multiplan Commercial |
$24.75
|
| Rate for Payer: Networks By Design Commercial |
$16.50
|
| Rate for Payer: Prime Health Services Commercial |
$28.05
|
| Rate for Payer: Riverside University Health System MISP |
$13.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.38
|
| Rate for Payer: United Healthcare All Other HMO |
$12.05
|
| Rate for Payer: United Healthcare HMO Rider |
$11.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.05
|
| Rate for Payer: Vantage Medical Group Senior |
$28.05
|
|
|
HC REPLACE FOOT DROP SPINT
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
CPT L4394
|
| Hospital Charge Code |
915354394
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$29.70 |
| Rate for Payer: Cash Price |
$14.85
|
| Rate for Payer: Central Health Plan Commercial |
$26.40
|
| Rate for Payer: Cigna of CA HMO |
$23.10
|
| Rate for Payer: Cigna of CA PPO |
$23.10
|
| Rate for Payer: Adventist Health Commercial |
$6.60
|
| Rate for Payer: Blue Shield of California Commercial |
$26.47
|
| Rate for Payer: Blue Shield of California EPN |
$16.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.20
|
| Rate for Payer: EPIC Health Plan Senior |
$13.20
|
| Rate for Payer: Galaxy Health WC |
$28.05
|
| Rate for Payer: Global Benefits Group Commercial |
$19.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.60
|
| Rate for Payer: Multiplan Commercial |
$24.75
|
| Rate for Payer: Networks By Design Commercial |
$21.45
|
| Rate for Payer: Prime Health Services Commercial |
$28.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.38
|
| Rate for Payer: United Healthcare All Other HMO |
$12.05
|
| Rate for Payer: United Healthcare HMO Rider |
$11.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.81
|
|
|
HC REPLACE FOOT DROP SPINT
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
CPT L4394
|
| Hospital Charge Code |
905354394
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$29.70 |
| Rate for Payer: Adventist Health Commercial |
$6.60
|
| Rate for Payer: Blue Shield of California Commercial |
$26.47
|
| Rate for Payer: Blue Shield of California EPN |
$16.63
|
| Rate for Payer: Cash Price |
$14.85
|
| Rate for Payer: Central Health Plan Commercial |
$26.40
|
| Rate for Payer: Cigna of CA HMO |
$23.10
|
| Rate for Payer: Cigna of CA PPO |
$23.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.20
|
| Rate for Payer: EPIC Health Plan Senior |
$13.20
|
| Rate for Payer: Galaxy Health WC |
$28.05
|
| Rate for Payer: Global Benefits Group Commercial |
$19.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.60
|
| Rate for Payer: Multiplan Commercial |
$24.75
|
| Rate for Payer: Networks By Design Commercial |
$21.45
|
| Rate for Payer: Prime Health Services Commercial |
$28.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.38
|
| Rate for Payer: United Healthcare All Other HMO |
$12.05
|
| Rate for Payer: United Healthcare HMO Rider |
$11.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.81
|
|
|
HC REPLACE GAST/CECOSTOMY TUBE
|
Facility
|
OP
|
$5,808.00
|
|
|
Service Code
|
CPT 49450
|
| Hospital Charge Code |
906749450
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$1,161.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,898.06
|
| Rate for Payer: Cash Price |
$2,613.60
|
| Rate for Payer: Cash Price |
$2,613.60
|
| Rate for Payer: Cash Price |
$2,613.60
|
| Rate for Payer: Cash Price |
$2,613.60
|
| Rate for Payer: Central Health Plan Commercial |
$4,646.40
|
| Rate for Payer: Cigna of CA HMO |
$3,717.12
|
| Rate for Payer: Cigna of CA PPO |
$4,297.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,065.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: Galaxy Health WC |
$4,936.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,484.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,227.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,688.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,216.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,254.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,161.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$4,356.00
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Networks By Design Commercial |
$3,775.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Preferred Health Network WC |
$1,936.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,936.80
|
| Rate for Payer: Prime Health Services Medicare |
$1,236.52
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Riverside University Health System MISP |
$1,283.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,484.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,904.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,904.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,904.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,904.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC REPLACE GAST/CECOSTOMY TUBE
|
Facility
|
OP
|
$5,808.00
|
|
|
Service Code
|
CPT 49450
|
| Hospital Charge Code |
906749450
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,101.42 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,161.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,166.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,898.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$2,613.60
|
| Rate for Payer: Cash Price |
$2,613.60
|
| Rate for Payer: Cash Price |
$2,613.60
|
| Rate for Payer: Central Health Plan Commercial |
$4,646.40
|
| Rate for Payer: Cigna of CA HMO |
$3,717.12
|
| Rate for Payer: Cigna of CA PPO |
$4,297.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,065.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: Galaxy Health WC |
$4,936.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,484.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,227.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,101.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,688.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,216.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,161.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$4,356.00
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Networks By Design Commercial |
$3,775.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Preferred Health Network WC |
$1,936.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,936.80
|
| Rate for Payer: Prime Health Services Medicare |
$1,236.52
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Riverside University Health System MISP |
$1,283.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,484.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,904.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC REPLACE GAST/CECOSTOMY TUBE
|
Facility
|
IP
|
$5,808.00
|
|
|
Service Code
|
CPT 49450
|
| Hospital Charge Code |
906749450
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,161.60 |
| Max. Negotiated Rate |
$5,227.20 |
| Rate for Payer: Adventist Health Commercial |
$1,161.60
|
| Rate for Payer: Cash Price |
$2,613.60
|
| Rate for Payer: Central Health Plan Commercial |
$4,646.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,065.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,323.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,323.20
|
| Rate for Payer: Galaxy Health WC |
$4,936.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,484.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,227.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,688.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,426.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,161.60
|
| Rate for Payer: Multiplan Commercial |
$4,356.00
|
| Rate for Payer: Networks By Design Commercial |
$3,775.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,936.80
|
|
|
HC REPLACE GAST/CECOSTOMY TUBE
|
Facility
|
IP
|
$5,808.00
|
|
|
Service Code
|
CPT 49450
|
| Hospital Charge Code |
906749450
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,161.60 |
| Max. Negotiated Rate |
$5,227.20 |
| Rate for Payer: Adventist Health Commercial |
$1,161.60
|
| Rate for Payer: Cash Price |
$2,613.60
|
| Rate for Payer: Central Health Plan Commercial |
$4,646.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,065.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,323.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,323.20
|
| Rate for Payer: Galaxy Health WC |
$4,936.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,484.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,227.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,688.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,426.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,161.60
|
| Rate for Payer: Multiplan Commercial |
$4,356.00
|
| Rate for Payer: Networks By Design Commercial |
$3,775.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,936.80
|
|
|
HC REPLACE GIRDLE MILWAUKEE
|
Facility
|
IP
|
$1,971.00
|
|
|
Service Code
|
CPT L4000
|
| Hospital Charge Code |
915354000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$394.20 |
| Max. Negotiated Rate |
$1,773.90 |
| Rate for Payer: Adventist Health Commercial |
$394.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,580.74
|
| Rate for Payer: Blue Shield of California EPN |
$993.38
|
| Rate for Payer: Cash Price |
$886.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,576.80
|
| Rate for Payer: Cigna of CA HMO |
$1,379.70
|
| Rate for Payer: Cigna of CA PPO |
$1,379.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,379.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$788.40
|
| Rate for Payer: EPIC Health Plan Senior |
$788.40
|
| Rate for Payer: Galaxy Health WC |
$1,675.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,182.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,773.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,251.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,162.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$394.20
|
| Rate for Payer: Multiplan Commercial |
$1,478.25
|
| Rate for Payer: Networks By Design Commercial |
$1,281.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,675.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$739.72
|
| Rate for Payer: United Healthcare All Other HMO |
$720.01
|
| Rate for Payer: United Healthcare HMO Rider |
$704.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$645.50
|
|
|
HC REPLACE GIRDLE MILWAUKEE
|
Facility
|
IP
|
$1,971.00
|
|
|
Service Code
|
CPT L4000
|
| Hospital Charge Code |
905354000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$394.20 |
| Max. Negotiated Rate |
$1,773.90 |
| Rate for Payer: Adventist Health Commercial |
$394.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,580.74
|
| Rate for Payer: Blue Shield of California EPN |
$993.38
|
| Rate for Payer: Cash Price |
$886.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,576.80
|
| Rate for Payer: Cigna of CA HMO |
$1,379.70
|
| Rate for Payer: Cigna of CA PPO |
$1,379.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,379.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$788.40
|
| Rate for Payer: EPIC Health Plan Senior |
$788.40
|
| Rate for Payer: Galaxy Health WC |
$1,675.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,182.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,773.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,251.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,162.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$394.20
|
| Rate for Payer: Multiplan Commercial |
$1,478.25
|
| Rate for Payer: Networks By Design Commercial |
$1,281.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,675.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$739.72
|
| Rate for Payer: United Healthcare All Other HMO |
$720.01
|
| Rate for Payer: United Healthcare HMO Rider |
$704.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$645.50
|
|
|
HC REPLACE GIRDLE MILWAUKEE
|
Facility
|
OP
|
$1,971.00
|
|
|
Service Code
|
CPT L4000
|
| Hospital Charge Code |
905354000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$645.50 |
| Max. Negotiated Rate |
$1,773.90 |
| Rate for Payer: Adventist Health Commercial |
$808.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,675.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,084.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,478.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,146.53
|
| Rate for Payer: Blue Shield of California Commercial |
$1,580.74
|
| Rate for Payer: Blue Shield of California EPN |
$993.38
|
| Rate for Payer: Cash Price |
$886.95
|
| Rate for Payer: Cash Price |
$886.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,576.80
|
| Rate for Payer: Cigna of CA HMO |
$1,379.70
|
| Rate for Payer: Cigna of CA PPO |
$1,379.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,675.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,675.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,675.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,379.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$788.40
|
| Rate for Payer: EPIC Health Plan Senior |
$788.40
|
| Rate for Payer: Galaxy Health WC |
$1,675.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,182.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,773.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$678.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,251.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$748.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,162.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$808.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,379.70
|
| Rate for Payer: Multiplan Commercial |
$1,478.25
|
| Rate for Payer: Networks By Design Commercial |
$985.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,675.35
|
| Rate for Payer: Riverside University Health System MISP |
$788.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,182.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,182.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$739.72
|
| Rate for Payer: United Healthcare All Other HMO |
$720.01
|
| Rate for Payer: United Healthcare HMO Rider |
$704.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$645.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,675.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,675.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,675.35
|
|
|
HC REPLACE GIRDLE MILWAUKEE
|
Facility
|
OP
|
$1,971.00
|
|
|
Service Code
|
CPT L4000
|
| Hospital Charge Code |
915354000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$645.50 |
| Max. Negotiated Rate |
$1,773.90 |
| Rate for Payer: Dignity Health Medi-Cal |
$1,675.35
|
| Rate for Payer: Adventist Health Commercial |
$808.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,675.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,084.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,478.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,146.53
|
| Rate for Payer: Blue Shield of California Commercial |
$1,580.74
|
| Rate for Payer: Blue Shield of California EPN |
$993.38
|
| Rate for Payer: Cash Price |
$886.95
|
| Rate for Payer: Cash Price |
$886.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,576.80
|
| Rate for Payer: Cigna of CA HMO |
$1,379.70
|
| Rate for Payer: Cigna of CA PPO |
$1,379.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,675.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,675.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,379.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$788.40
|
| Rate for Payer: EPIC Health Plan Senior |
$788.40
|
| Rate for Payer: Galaxy Health WC |
$1,675.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,182.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,773.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$678.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,251.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$748.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,162.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$808.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,379.70
|
| Rate for Payer: Multiplan Commercial |
$1,478.25
|
| Rate for Payer: Networks By Design Commercial |
$985.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,675.35
|
| Rate for Payer: Riverside University Health System MISP |
$788.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,182.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,182.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$739.72
|
| Rate for Payer: United Healthcare All Other HMO |
$720.01
|
| Rate for Payer: United Healthcare HMO Rider |
$704.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$645.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,675.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,675.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,675.35
|
|
|
HC REPLACE G-J TUBE PERC
|
Facility
|
OP
|
$5,561.00
|
|
|
Service Code
|
CPT 49452
|
| Hospital Charge Code |
906749452
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$1,112.20
|
| Rate for Payer: Adventist Health Commercial |
$564.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,898.06
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,898.06
|
| Rate for Payer: Cash Price |
$1,270.80
|
| Rate for Payer: Cash Price |
$2,502.45
|
| Rate for Payer: Cash Price |
$2,502.45
|
| Rate for Payer: Cash Price |
$1,270.80
|
| Rate for Payer: Cash Price |
$1,270.80
|
| Rate for Payer: Cash Price |
$2,502.45
|
| Rate for Payer: Cash Price |
$1,270.80
|
| Rate for Payer: Cash Price |
$2,502.45
|
| Rate for Payer: Central Health Plan Commercial |
$4,448.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,259.20
|
| Rate for Payer: Cigna of CA HMO |
$1,807.36
|
| Rate for Payer: Cigna of CA HMO |
$3,559.04
|
| Rate for Payer: Cigna of CA PPO |
$4,115.14
|
| Rate for Payer: Cigna of CA PPO |
$2,089.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,892.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,976.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: Galaxy Health WC |
$2,400.40
|
| Rate for Payer: Galaxy Health WC |
$4,726.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,694.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,336.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,004.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,541.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,793.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,531.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,573.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,573.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,254.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,254.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$564.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,112.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$2,118.00
|
| Rate for Payer: Multiplan Commercial |
$4,170.75
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Networks By Design Commercial |
$1,835.60
|
| Rate for Payer: Networks By Design Commercial |
$3,614.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,166.53
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Preferred Health Network WC |
$1,936.80
|
| Rate for Payer: Preferred Health Network WC |
$1,936.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,726.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,400.40
|
| Rate for Payer: Prime Health Services Medicare |
$1,236.52
|
| Rate for Payer: Prime Health Services Medicare |
$1,236.52
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Riverside University Health System MISP |
$1,283.18
|
| Rate for Payer: Riverside University Health System MISP |
$1,283.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,336.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,694.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,412.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,780.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,780.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,412.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,412.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,780.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,780.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,412.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC REPLACE G-J TUBE PERC
|
Facility
|
IP
|
$5,561.00
|
|
|
Service Code
|
CPT 49452
|
| Hospital Charge Code |
906749452
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,112.20 |
| Max. Negotiated Rate |
$5,004.90 |
| Rate for Payer: Adventist Health Commercial |
$1,112.20
|
| Rate for Payer: Cash Price |
$2,502.45
|
| Rate for Payer: Central Health Plan Commercial |
$4,448.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,892.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,224.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,224.40
|
| Rate for Payer: Galaxy Health WC |
$4,726.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,336.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,004.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,531.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,280.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,112.20
|
| Rate for Payer: Multiplan Commercial |
$4,170.75
|
| Rate for Payer: Networks By Design Commercial |
$3,614.65
|
| Rate for Payer: Prime Health Services Commercial |
$4,726.85
|
|
|
HC REPLACE G-J TUBE PERC
|
Facility
|
IP
|
$5,561.00
|
|
|
Service Code
|
CPT 49452
|
| Hospital Charge Code |
906749452
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,112.20 |
| Max. Negotiated Rate |
$5,004.90 |
| Rate for Payer: Adventist Health Commercial |
$1,112.20
|
| Rate for Payer: Cash Price |
$2,502.45
|
| Rate for Payer: Central Health Plan Commercial |
$4,448.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,892.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,224.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,224.40
|
| Rate for Payer: Galaxy Health WC |
$4,726.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,336.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,004.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,531.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,280.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,112.20
|
| Rate for Payer: Multiplan Commercial |
$4,170.75
|
| Rate for Payer: Networks By Design Commercial |
$3,614.65
|
| Rate for Payer: Prime Health Services Commercial |
$4,726.85
|
|
|
HC REPLACE G-J TUBE PERC
|
Facility
|
OP
|
$5,561.00
|
|
|
Service Code
|
CPT 49452
|
| Hospital Charge Code |
906749452
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,112.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,112.20
|
| Rate for Payer: Adventist Health Commercial |
$564.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,166.53
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,166.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$2,502.45
|
| Rate for Payer: Cash Price |
$2,502.45
|
| Rate for Payer: Cash Price |
$1,270.80
|
| Rate for Payer: Cash Price |
$2,502.45
|
| Rate for Payer: Cash Price |
$1,270.80
|
| Rate for Payer: Cash Price |
$1,270.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,259.20
|
| Rate for Payer: Central Health Plan Commercial |
$4,448.80
|
| Rate for Payer: Cigna of CA HMO |
$1,807.36
|
| Rate for Payer: Cigna of CA HMO |
$3,559.04
|
| Rate for Payer: Cigna of CA PPO |
$4,115.14
|
| Rate for Payer: Cigna of CA PPO |
$2,089.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,976.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,892.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: Galaxy Health WC |
$4,726.85
|
| Rate for Payer: Galaxy Health WC |
$2,400.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,694.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,336.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,541.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,004.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,424.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,424.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,793.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,531.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,573.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,573.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,112.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$564.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$4,170.75
|
| Rate for Payer: Multiplan Commercial |
$2,118.00
|
| Rate for Payer: Networks By Design Commercial |
$3,614.65
|
| Rate for Payer: Networks By Design Commercial |
$1,835.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,166.53
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Prime Health Services Commercial |
$2,400.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,726.85
|
| Rate for Payer: Prime Health Services Medicare |
$1,236.52
|
| Rate for Payer: Prime Health Services Medicare |
$1,236.52
|
| Rate for Payer: Riverside University Health System MISP |
$1,283.18
|
| Rate for Payer: Riverside University Health System MISP |
$1,283.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,694.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,336.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,399.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,399.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,780.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,412.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC REPLACE G-J TUBE PERC
|
Facility
|
IP
|
$5,561.00
|
|
|
Service Code
|
CPT 49452
|
| Hospital Charge Code |
906749452
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,112.20 |
| Max. Negotiated Rate |
$5,004.90 |
| Rate for Payer: Adventist Health Commercial |
$1,112.20
|
| Rate for Payer: Cash Price |
$2,502.45
|
| Rate for Payer: Central Health Plan Commercial |
$4,448.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,892.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,224.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,224.40
|
| Rate for Payer: Galaxy Health WC |
$4,726.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,336.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,004.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,531.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,280.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,112.20
|
| Rate for Payer: Multiplan Commercial |
$4,170.75
|
| Rate for Payer: Networks By Design Commercial |
$3,614.65
|
| Rate for Payer: Prime Health Services Commercial |
$4,726.85
|
|
|
HC REPLACE G-J TUBE PERC
|
Facility
|
OP
|
$5,561.00
|
|
|
Service Code
|
CPT 49452
|
| Hospital Charge Code |
906749452
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,112.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,112.20
|
| Rate for Payer: Adventist Health Commercial |
$564.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,166.53
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,166.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,898.06
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,898.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$1,270.80
|
| Rate for Payer: Cash Price |
$1,270.80
|
| Rate for Payer: Cash Price |
$1,270.80
|
| Rate for Payer: Cash Price |
$2,502.45
|
| Rate for Payer: Cash Price |
$2,502.45
|
| Rate for Payer: Cash Price |
$2,502.45
|
| Rate for Payer: Central Health Plan Commercial |
$4,448.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,259.20
|
| Rate for Payer: Cigna of CA HMO |
$1,807.36
|
| Rate for Payer: Cigna of CA HMO |
$3,559.04
|
| Rate for Payer: Cigna of CA PPO |
$4,115.14
|
| Rate for Payer: Cigna of CA PPO |
$2,089.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,976.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,892.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: Galaxy Health WC |
$4,726.85
|
| Rate for Payer: Galaxy Health WC |
$2,400.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,336.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,694.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,541.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,004.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,424.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,424.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,531.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,793.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,573.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,573.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$564.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,112.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$4,170.75
|
| Rate for Payer: Multiplan Commercial |
$2,118.00
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Networks By Design Commercial |
$1,835.60
|
| Rate for Payer: Networks By Design Commercial |
$3,614.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,166.53
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Preferred Health Network WC |
$1,936.80
|
| Rate for Payer: Preferred Health Network WC |
$1,936.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,726.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,400.40
|
| Rate for Payer: Prime Health Services Medicare |
$1,236.52
|
| Rate for Payer: Prime Health Services Medicare |
$1,236.52
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Riverside University Health System MISP |
$1,283.18
|
| Rate for Payer: Riverside University Health System MISP |
$1,283.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,336.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,694.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,412.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,780.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC REPLACE HIGH ROLL CUFF
|
Facility
|
IP
|
$503.00
|
|
|
Service Code
|
CPT L4060
|
| Hospital Charge Code |
915354060
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$100.60 |
| Max. Negotiated Rate |
$452.70 |
| Rate for Payer: United Healthcare HMO Rider |
$179.77
|
| Rate for Payer: Adventist Health Commercial |
$100.60
|
| Rate for Payer: Blue Shield of California Commercial |
$403.41
|
| Rate for Payer: Blue Shield of California EPN |
$253.51
|
| Rate for Payer: Cash Price |
$226.35
|
| Rate for Payer: Central Health Plan Commercial |
$402.40
|
| Rate for Payer: Cigna of CA HMO |
$352.10
|
| Rate for Payer: Cigna of CA PPO |
$352.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$352.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.20
|
| Rate for Payer: EPIC Health Plan Senior |
$201.20
|
| Rate for Payer: Galaxy Health WC |
$427.55
|
| Rate for Payer: Global Benefits Group Commercial |
$301.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$452.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$319.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.60
|
| Rate for Payer: Multiplan Commercial |
$377.25
|
| Rate for Payer: Networks By Design Commercial |
$326.95
|
| Rate for Payer: Prime Health Services Commercial |
$427.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$188.78
|
| Rate for Payer: United Healthcare All Other HMO |
$183.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$164.73
|
|
|
HC REPLACE HIGH ROLL CUFF
|
Facility
|
OP
|
$503.00
|
|
|
Service Code
|
CPT L4060
|
| Hospital Charge Code |
905354060
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$164.73 |
| Max. Negotiated Rate |
$452.70 |
| Rate for Payer: Adventist Health Commercial |
$206.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$427.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$276.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$377.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$292.60
|
| Rate for Payer: Blue Shield of California Commercial |
$403.41
|
| Rate for Payer: Blue Shield of California EPN |
$253.51
|
| Rate for Payer: Cash Price |
$226.35
|
| Rate for Payer: Cash Price |
$226.35
|
| Rate for Payer: Central Health Plan Commercial |
$402.40
|
| Rate for Payer: Cigna of CA HMO |
$352.10
|
| Rate for Payer: Cigna of CA PPO |
$352.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$427.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$427.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$427.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$352.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.20
|
| Rate for Payer: EPIC Health Plan Senior |
$201.20
|
| Rate for Payer: Galaxy Health WC |
$427.55
|
| Rate for Payer: Global Benefits Group Commercial |
$301.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$452.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$404.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$319.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$446.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$352.10
|
| Rate for Payer: Multiplan Commercial |
$377.25
|
| Rate for Payer: Networks By Design Commercial |
$251.50
|
| Rate for Payer: Prime Health Services Commercial |
$427.55
|
| Rate for Payer: Riverside University Health System MISP |
$201.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$301.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$301.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$188.78
|
| Rate for Payer: United Healthcare All Other HMO |
$183.75
|
| Rate for Payer: United Healthcare HMO Rider |
$179.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$164.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$427.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$427.55
|
| Rate for Payer: Vantage Medical Group Senior |
$427.55
|
|
