|
HC ROTABLATOR ADVANCER
|
Facility
|
IP
|
$2,201.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081507
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$440.20 |
| Max. Negotiated Rate |
$1,980.90 |
| Rate for Payer: Adventist Health Commercial |
$440.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,765.20
|
| Rate for Payer: Blue Shield of California EPN |
$1,109.30
|
| Rate for Payer: Cash Price |
$990.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,760.80
|
| Rate for Payer: Cigna of CA HMO |
$1,540.70
|
| Rate for Payer: Cigna of CA PPO |
$1,540.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,540.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$880.40
|
| Rate for Payer: EPIC Health Plan Senior |
$880.40
|
| Rate for Payer: Galaxy Health WC |
$1,870.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,320.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,980.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,397.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,298.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$440.20
|
| Rate for Payer: Multiplan Commercial |
$1,650.75
|
| Rate for Payer: Networks By Design Commercial |
$1,100.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,870.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$826.04
|
| Rate for Payer: United Healthcare All Other HMO |
$804.03
|
| Rate for Payer: United Healthcare HMO Rider |
$786.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$720.83
|
|
|
HC ROTABLATOR ADVANCER
|
Facility
|
OP
|
$2,201.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081507
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$440.20 |
| Max. Negotiated Rate |
$1,980.90 |
| Rate for Payer: Adventist Health Commercial |
$440.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,870.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,210.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,650.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,004.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,207.03
|
| Rate for Payer: Blue Shield of California Commercial |
$1,765.20
|
| Rate for Payer: Blue Shield of California EPN |
$1,109.30
|
| Rate for Payer: Cash Price |
$990.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,760.80
|
| Rate for Payer: Cigna of CA HMO |
$1,540.70
|
| Rate for Payer: Cigna of CA PPO |
$1,540.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,870.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,870.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,870.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,540.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$880.40
|
| Rate for Payer: EPIC Health Plan Senior |
$880.40
|
| Rate for Payer: Galaxy Health WC |
$1,870.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,320.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,980.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,397.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$798.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,298.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$440.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,540.70
|
| Rate for Payer: Multiplan Commercial |
$1,650.75
|
| Rate for Payer: Networks By Design Commercial |
$1,100.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,870.85
|
| Rate for Payer: Riverside University Health System MISP |
$880.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,320.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,320.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$826.04
|
| Rate for Payer: United Healthcare All Other HMO |
$804.03
|
| Rate for Payer: United Healthcare HMO Rider |
$786.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$720.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,870.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,870.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,870.85
|
|
|
HC ROTABLATOR GUIDE WIRE
|
Facility
|
IP
|
$535.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081508
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.00 |
| Max. Negotiated Rate |
$481.50 |
| Rate for Payer: Adventist Health Commercial |
$107.00
|
| Rate for Payer: Cash Price |
$240.75
|
| Rate for Payer: Central Health Plan Commercial |
$428.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$374.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$214.00
|
| Rate for Payer: EPIC Health Plan Senior |
$214.00
|
| Rate for Payer: Galaxy Health WC |
$454.75
|
| Rate for Payer: Global Benefits Group Commercial |
$321.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$481.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$339.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.00
|
| Rate for Payer: Multiplan Commercial |
$401.25
|
| Rate for Payer: Networks By Design Commercial |
$347.75
|
| Rate for Payer: Prime Health Services Commercial |
$454.75
|
|
|
HC ROTABLATOR GUIDE WIRE
|
Facility
|
OP
|
$535.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081508
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.00 |
| Max. Negotiated Rate |
$481.50 |
| Rate for Payer: Adventist Health Commercial |
$107.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$454.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$401.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$259.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$311.21
|
| Rate for Payer: Blue Shield of California Commercial |
$339.19
|
| Rate for Payer: Blue Shield of California EPN |
$213.47
|
| Rate for Payer: Cash Price |
$240.75
|
| Rate for Payer: Cash Price |
$240.75
|
| Rate for Payer: Central Health Plan Commercial |
$428.00
|
| Rate for Payer: Cigna of CA HMO |
$342.40
|
| Rate for Payer: Cigna of CA PPO |
$395.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$454.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$454.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$454.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$374.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$214.00
|
| Rate for Payer: EPIC Health Plan Senior |
$214.00
|
| Rate for Payer: Galaxy Health WC |
$454.75
|
| Rate for Payer: Global Benefits Group Commercial |
$321.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$481.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$339.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$194.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$374.50
|
| Rate for Payer: Multiplan Commercial |
$401.25
|
| Rate for Payer: Networks By Design Commercial |
$347.75
|
| Rate for Payer: Prime Health Services Commercial |
$454.75
|
| Rate for Payer: Riverside University Health System MISP |
$214.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$321.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$321.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$267.50
|
| Rate for Payer: United Healthcare All Other HMO |
$267.50
|
| Rate for Payer: United Healthcare HMO Rider |
$267.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$267.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$454.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$454.75
|
| Rate for Payer: Vantage Medical Group Senior |
$454.75
|
|
|
HC ROTATABLE OVAL SNARE
|
Facility
|
IP
|
$1,404.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
900803816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$280.80 |
| Max. Negotiated Rate |
$1,263.60 |
| Rate for Payer: Adventist Health Commercial |
$280.80
|
| Rate for Payer: Cash Price |
$631.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,123.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$982.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$561.60
|
| Rate for Payer: EPIC Health Plan Senior |
$561.60
|
| Rate for Payer: Galaxy Health WC |
$1,193.40
|
| Rate for Payer: Global Benefits Group Commercial |
$842.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,263.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$891.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$828.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.80
|
| Rate for Payer: Multiplan Commercial |
$1,053.00
|
| Rate for Payer: Networks By Design Commercial |
$912.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,193.40
|
|
|
HC ROTATABLE OVAL SNARE
|
Facility
|
OP
|
$1,404.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
900803816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$280.80 |
| Max. Negotiated Rate |
$2,522.20 |
| Rate for Payer: Adventist Health Commercial |
$280.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,522.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,193.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$772.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,053.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$679.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$816.71
|
| Rate for Payer: Blue Shield of California Commercial |
$890.14
|
| Rate for Payer: Blue Shield of California EPN |
$560.20
|
| Rate for Payer: Cash Price |
$631.80
|
| Rate for Payer: Cash Price |
$631.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,123.20
|
| Rate for Payer: Cigna of CA HMO |
$898.56
|
| Rate for Payer: Cigna of CA PPO |
$1,038.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,193.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,193.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,193.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$982.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$561.60
|
| Rate for Payer: EPIC Health Plan Senior |
$561.60
|
| Rate for Payer: Galaxy Health WC |
$1,193.40
|
| Rate for Payer: Global Benefits Group Commercial |
$842.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,263.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$891.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$509.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$828.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$982.80
|
| Rate for Payer: Multiplan Commercial |
$1,053.00
|
| Rate for Payer: Networks By Design Commercial |
$912.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,193.40
|
| Rate for Payer: Riverside University Health System MISP |
$561.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$842.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$842.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$702.00
|
| Rate for Payer: United Healthcare All Other HMO |
$702.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$702.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,193.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,193.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,193.40
|
|
|
HC ROTOVIRUS AG
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 87425
|
| Hospital Charge Code |
900910976
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$34.40 |
| Max. Negotiated Rate |
$154.80 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Central Health Plan Commercial |
$137.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$120.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.80
|
| Rate for Payer: EPIC Health Plan Senior |
$68.80
|
| Rate for Payer: Galaxy Health WC |
$146.20
|
| Rate for Payer: Global Benefits Group Commercial |
$103.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$154.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$109.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$101.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.40
|
| Rate for Payer: Multiplan Commercial |
$129.00
|
| Rate for Payer: Networks By Design Commercial |
$111.80
|
| Rate for Payer: Prime Health Services Commercial |
$146.20
|
|
|
HC ROTOVIRUS AG
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT 87425
|
| Hospital Charge Code |
900910976
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.70 |
| Max. Negotiated Rate |
$154.80 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.98
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$65.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$65.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.90
|
| Rate for Payer: Blue Shield of California Commercial |
$24.57
|
| Rate for Payer: Blue Shield of California Commercial |
$108.36
|
| Rate for Payer: Blue Shield of California EPN |
$15.48
|
| Rate for Payer: Blue Shield of California EPN |
$68.28
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Central Health Plan Commercial |
$137.60
|
| Rate for Payer: Central Health Plan Commercial |
$31.20
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA HMO |
$110.08
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Cigna of CA PPO |
$127.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$120.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$27.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.77
|
| Rate for Payer: EPIC Health Plan Senior |
$13.18
|
| Rate for Payer: EPIC Health Plan Senior |
$13.18
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Galaxy Health WC |
$146.20
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Global Benefits Group Commercial |
$103.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$154.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.65
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$109.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.05
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: Multiplan Commercial |
$129.00
|
| Rate for Payer: Networks By Design Commercial |
$111.80
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.98
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.98
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Commercial |
$146.20
|
| Rate for Payer: Prime Health Services Medicare |
$12.70
|
| Rate for Payer: Prime Health Services Medicare |
$12.70
|
| Rate for Payer: Riverside University Health System MISP |
$13.18
|
| Rate for Payer: Riverside University Health System MISP |
$13.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$103.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$103.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.70
|
| Rate for Payer: United Healthcare All Other HMO |
$9.70
|
| Rate for Payer: United Healthcare All Other HMO |
$9.70
|
| Rate for Payer: United Healthcare HMO Rider |
$9.70
|
| Rate for Payer: United Healthcare HMO Rider |
$9.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.98
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC ROUND CALIPER AND PLATE ADDITION LE
|
Facility
|
OP
|
$401.00
|
|
|
Service Code
|
CPT L2240
|
| Hospital Charge Code |
915352240
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$87.46 |
| Max. Negotiated Rate |
$360.90 |
| Rate for Payer: Adventist Health Commercial |
$164.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$340.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$220.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$300.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$233.26
|
| Rate for Payer: Blue Shield of California Commercial |
$321.60
|
| Rate for Payer: Blue Shield of California EPN |
$202.10
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Central Health Plan Commercial |
$320.80
|
| Rate for Payer: Cigna of CA HMO |
$280.70
|
| Rate for Payer: Cigna of CA PPO |
$280.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$340.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$340.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$340.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$280.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.40
|
| Rate for Payer: EPIC Health Plan Senior |
$160.40
|
| Rate for Payer: Galaxy Health WC |
$340.85
|
| Rate for Payer: Global Benefits Group Commercial |
$240.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$360.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$87.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$254.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$96.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$236.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$280.70
|
| Rate for Payer: Multiplan Commercial |
$300.75
|
| Rate for Payer: Networks By Design Commercial |
$200.50
|
| Rate for Payer: Prime Health Services Commercial |
$340.85
|
| Rate for Payer: Riverside University Health System MISP |
$160.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$240.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$240.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.50
|
| Rate for Payer: United Healthcare All Other HMO |
$146.49
|
| Rate for Payer: United Healthcare HMO Rider |
$143.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$131.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$340.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$340.85
|
| Rate for Payer: Vantage Medical Group Senior |
$340.85
|
|
|
HC ROUND CALIPER AND PLATE ADDITION LE
|
Facility
|
IP
|
$401.00
|
|
|
Service Code
|
CPT L2240
|
| Hospital Charge Code |
915352240
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$80.20 |
| Max. Negotiated Rate |
$360.90 |
| Rate for Payer: Adventist Health Commercial |
$80.20
|
| Rate for Payer: Blue Shield of California Commercial |
$321.60
|
| Rate for Payer: Blue Shield of California EPN |
$202.10
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Central Health Plan Commercial |
$320.80
|
| Rate for Payer: Cigna of CA HMO |
$280.70
|
| Rate for Payer: Cigna of CA PPO |
$280.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$280.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.40
|
| Rate for Payer: EPIC Health Plan Senior |
$160.40
|
| Rate for Payer: Galaxy Health WC |
$340.85
|
| Rate for Payer: Global Benefits Group Commercial |
$240.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$360.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$254.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$236.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.20
|
| Rate for Payer: Multiplan Commercial |
$300.75
|
| Rate for Payer: Networks By Design Commercial |
$260.65
|
| Rate for Payer: Prime Health Services Commercial |
$340.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.50
|
| Rate for Payer: United Healthcare All Other HMO |
$146.49
|
| Rate for Payer: United Healthcare HMO Rider |
$143.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$131.33
|
|
|
HC ROUND CALIPER AND PLATE ADDITION LE
|
Facility
|
IP
|
$401.00
|
|
|
Service Code
|
CPT L2240
|
| Hospital Charge Code |
905352240
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$80.20 |
| Max. Negotiated Rate |
$360.90 |
| Rate for Payer: Adventist Health Commercial |
$80.20
|
| Rate for Payer: Blue Shield of California Commercial |
$321.60
|
| Rate for Payer: Blue Shield of California EPN |
$202.10
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Central Health Plan Commercial |
$320.80
|
| Rate for Payer: Cigna of CA HMO |
$280.70
|
| Rate for Payer: Cigna of CA PPO |
$280.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$280.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.40
|
| Rate for Payer: EPIC Health Plan Senior |
$160.40
|
| Rate for Payer: Galaxy Health WC |
$340.85
|
| Rate for Payer: Global Benefits Group Commercial |
$240.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$360.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$254.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$236.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.20
|
| Rate for Payer: Multiplan Commercial |
$300.75
|
| Rate for Payer: Networks By Design Commercial |
$260.65
|
| Rate for Payer: Prime Health Services Commercial |
$340.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.50
|
| Rate for Payer: United Healthcare All Other HMO |
$146.49
|
| Rate for Payer: United Healthcare HMO Rider |
$143.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$131.33
|
|
|
HC ROUND CALIPER AND PLATE ADDITION LE
|
Facility
|
OP
|
$401.00
|
|
|
Service Code
|
CPT L2240
|
| Hospital Charge Code |
905352240
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$87.46 |
| Max. Negotiated Rate |
$360.90 |
| Rate for Payer: Adventist Health Commercial |
$164.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$340.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$220.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$300.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$233.26
|
| Rate for Payer: Blue Shield of California Commercial |
$321.60
|
| Rate for Payer: Blue Shield of California EPN |
$202.10
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Central Health Plan Commercial |
$320.80
|
| Rate for Payer: Cigna of CA HMO |
$280.70
|
| Rate for Payer: Cigna of CA PPO |
$280.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$340.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$340.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$340.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$280.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.40
|
| Rate for Payer: EPIC Health Plan Senior |
$160.40
|
| Rate for Payer: Galaxy Health WC |
$340.85
|
| Rate for Payer: Global Benefits Group Commercial |
$240.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$360.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$87.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$254.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$96.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$236.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$280.70
|
| Rate for Payer: Multiplan Commercial |
$300.75
|
| Rate for Payer: Networks By Design Commercial |
$200.50
|
| Rate for Payer: Prime Health Services Commercial |
$340.85
|
| Rate for Payer: Riverside University Health System MISP |
$160.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$240.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$240.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.50
|
| Rate for Payer: United Healthcare All Other HMO |
$146.49
|
| Rate for Payer: United Healthcare HMO Rider |
$143.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$131.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$340.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$340.85
|
| Rate for Payer: Vantage Medical Group Senior |
$340.85
|
|
|
HC ROUTINE URINALYSIS
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT 81001
|
| Hospital Charge Code |
900910167
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Central Health Plan Commercial |
$108.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$94.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.00
|
| Rate for Payer: EPIC Health Plan Senior |
$54.00
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$121.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$85.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.00
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
| Rate for Payer: Networks By Design Commercial |
$87.75
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
|
|
HC ROUTINE URINALYSIS
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
CPT 81001
|
| Hospital Charge Code |
900910167
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Adventist Health Commercial |
$6.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$3.17
|
| Rate for Payer: Adventist Health Medi-Cal |
$3.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.91
|
| Rate for Payer: Blue Shield of California Commercial |
$20.79
|
| Rate for Payer: Blue Shield of California Commercial |
$85.05
|
| Rate for Payer: Blue Shield of California EPN |
$13.10
|
| Rate for Payer: Blue Shield of California EPN |
$53.59
|
| Rate for Payer: Cash Price |
$14.85
|
| Rate for Payer: Cash Price |
$14.85
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Central Health Plan Commercial |
$108.00
|
| Rate for Payer: Central Health Plan Commercial |
$26.40
|
| Rate for Payer: Cigna of CA HMO |
$21.12
|
| Rate for Payer: Cigna of CA HMO |
$86.40
|
| Rate for Payer: Cigna of CA PPO |
$24.42
|
| Rate for Payer: Cigna of CA PPO |
$99.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$94.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.23
|
| Rate for Payer: EPIC Health Plan Senior |
$3.49
|
| Rate for Payer: EPIC Health Plan Senior |
$3.49
|
| Rate for Payer: Galaxy Health WC |
$28.05
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$19.80
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$121.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$85.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.25
|
| Rate for Payer: Multiplan Commercial |
$24.75
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
| Rate for Payer: Networks By Design Commercial |
$87.75
|
| Rate for Payer: Networks By Design Commercial |
$21.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3.17
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3.17
|
| Rate for Payer: Prime Health Services Commercial |
$28.05
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
| Rate for Payer: Prime Health Services Medicare |
$3.36
|
| Rate for Payer: Prime Health Services Medicare |
$3.36
|
| Rate for Payer: Riverside University Health System MISP |
$3.49
|
| Rate for Payer: Riverside University Health System MISP |
$3.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.56
|
| Rate for Payer: United Healthcare All Other HMO |
$2.56
|
| Rate for Payer: United Healthcare All Other HMO |
$2.56
|
| Rate for Payer: United Healthcare HMO Rider |
$2.56
|
| Rate for Payer: United Healthcare HMO Rider |
$2.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.17
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.49
|
| Rate for Payer: Vantage Medical Group Senior |
$3.17
|
| Rate for Payer: Vantage Medical Group Senior |
$3.17
|
|
|
HC RPLCMNT GJ TUBE WO FLUORO MOUTH
|
Facility
|
OP
|
$3,678.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906744800
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$735.60 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$735.60
|
| 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 |
$1,780.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,139.49
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,655.10
|
| Rate for Payer: Cash Price |
$1,655.10
|
| Rate for Payer: Cash Price |
$1,655.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,942.40
|
| Rate for Payer: Cigna of CA HMO |
$2,353.92
|
| Rate for Payer: Cigna of CA PPO |
$2,721.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,574.60
|
| 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 |
$3,126.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,206.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,310.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,335.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$735.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$2,758.50
|
| Rate for Payer: Networks By Design Commercial |
$2,390.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Prime Health Services Commercial |
$3,126.30
|
| Rate for Payer: Prime Health Services Medicare |
$1,236.52
|
| Rate for Payer: Riverside University Health System MISP |
$1,283.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,206.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,399.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,839.00
|
| 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 RPLCMNT GJ TUBE WO FLUORO MOUTH
|
Facility
|
IP
|
$3,678.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906744800
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$735.60 |
| Max. Negotiated Rate |
$3,310.20 |
| Rate for Payer: Adventist Health Commercial |
$735.60
|
| Rate for Payer: Cash Price |
$1,655.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,942.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,574.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,471.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,471.20
|
| Rate for Payer: Galaxy Health WC |
$3,126.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,206.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,310.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,335.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,170.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$735.60
|
| Rate for Payer: Multiplan Commercial |
$2,758.50
|
| Rate for Payer: Networks By Design Commercial |
$2,390.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,126.30
|
|
|
HC RPL GTUBE NOT RQ RV GSTRST TRC
|
Facility
|
OP
|
$2,947.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
906743760
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$321.35 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$589.40
|
| 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 |
$482.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$321.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$492.37
|
| Rate for Payer: Cash Price |
$1,326.15
|
| Rate for Payer: Cash Price |
$1,326.15
|
| Rate for Payer: Cash Price |
$1,326.15
|
| Rate for Payer: Cash Price |
$1,326.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,357.60
|
| Rate for Payer: Cigna of CA HMO |
$1,886.08
|
| Rate for Payer: Cigna of CA PPO |
$2,180.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$482.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$353.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$321.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,062.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$530.23
|
| Rate for Payer: EPIC Health Plan Senior |
$353.49
|
| Rate for Payer: Galaxy Health WC |
$2,504.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,768.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,652.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$527.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$321.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,871.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$389.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$345.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$589.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$430.61
|
| Rate for Payer: Multiplan Commercial |
$2,210.25
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: Networks By Design Commercial |
$1,915.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$321.35
|
| Rate for Payer: Preferred Health Network WC |
$502.42
|
| Rate for Payer: Prime Health Services Commercial |
$2,504.95
|
| Rate for Payer: Prime Health Services Medicare |
$340.63
|
| Rate for Payer: Prime Health Services WC |
$487.35
|
| Rate for Payer: Riverside University Health System MISP |
$353.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,768.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,473.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,473.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,473.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,473.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$321.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Vantage Medical Group Senior |
$321.35
|
|
|
HC RPL GTUBE NOT RQ RV GSTRST TRC
|
Facility
|
IP
|
$2,947.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
906743760
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$589.40 |
| Max. Negotiated Rate |
$2,652.30 |
| Rate for Payer: Adventist Health Commercial |
$589.40
|
| Rate for Payer: Cash Price |
$1,326.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,357.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,062.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,178.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,178.80
|
| Rate for Payer: Galaxy Health WC |
$2,504.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,768.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,652.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,871.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,738.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$589.40
|
| Rate for Payer: Multiplan Commercial |
$2,210.25
|
| Rate for Payer: Networks By Design Commercial |
$1,915.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,504.95
|
|
|
HC RPL GTUBE NOT RQ RV GSTRST TRC
|
Facility
|
IP
|
$2,947.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
906743760
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$589.40 |
| Max. Negotiated Rate |
$2,652.30 |
| Rate for Payer: Adventist Health Commercial |
$589.40
|
| Rate for Payer: Cash Price |
$1,326.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,357.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,062.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,178.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,178.80
|
| Rate for Payer: Galaxy Health WC |
$2,504.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,768.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,652.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,871.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,738.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$589.40
|
| Rate for Payer: Multiplan Commercial |
$2,210.25
|
| Rate for Payer: Networks By Design Commercial |
$1,915.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,504.95
|
|
|
HC RPL GTUBE NOT RQ RV GSTRST TRC
|
Facility
|
OP
|
$2,947.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
906743760
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$215.18 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$1,208.27
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$215.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$321.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$492.37
|
| Rate for Payer: Cash Price |
$1,326.15
|
| Rate for Payer: Cash Price |
$1,326.15
|
| Rate for Payer: Cash Price |
$1,326.15
|
| Rate for Payer: Cash Price |
$1,326.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,357.60
|
| Rate for Payer: Cigna of CA HMO |
$1,886.08
|
| Rate for Payer: Cigna of CA PPO |
$2,180.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$482.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$353.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$321.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,062.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$530.23
|
| Rate for Payer: EPIC Health Plan Senior |
$353.49
|
| Rate for Payer: Galaxy Health WC |
$2,504.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,768.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,652.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$527.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$321.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,871.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$389.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$345.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$589.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$430.61
|
| Rate for Payer: Multiplan Commercial |
$2,210.25
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: Networks By Design Commercial |
$1,915.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$321.35
|
| Rate for Payer: Preferred Health Network WC |
$502.42
|
| Rate for Payer: Prime Health Services Commercial |
$2,504.95
|
| Rate for Payer: Prime Health Services Medicare |
$340.63
|
| Rate for Payer: Prime Health Services WC |
$487.35
|
| Rate for Payer: Riverside University Health System MISP |
$353.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,768.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,768.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$321.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Vantage Medical Group Senior |
$321.35
|
|
|
HC RPL GTUBE NOT RQ RV GSTRST TRC
|
Facility
|
IP
|
$2,947.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
906743760
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$589.40 |
| Max. Negotiated Rate |
$2,652.30 |
| Rate for Payer: Adventist Health Commercial |
$589.40
|
| Rate for Payer: Cash Price |
$1,326.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,357.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,062.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,178.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,178.80
|
| Rate for Payer: Galaxy Health WC |
$2,504.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,768.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,652.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,871.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,738.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$589.40
|
| Rate for Payer: Multiplan Commercial |
$2,210.25
|
| Rate for Payer: Networks By Design Commercial |
$1,915.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,504.95
|
|
|
HC RPL GTUBE NOT RQ RV GSTRST TRC
|
Facility
|
OP
|
$2,947.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
906743760
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$321.35 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$589.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$321.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$321.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,326.15
|
| Rate for Payer: Cash Price |
$1,326.15
|
| Rate for Payer: Cash Price |
$1,326.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,357.60
|
| Rate for Payer: Cigna of CA HMO |
$1,886.08
|
| Rate for Payer: Cigna of CA PPO |
$2,180.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$482.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$353.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$321.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,062.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$530.23
|
| Rate for Payer: EPIC Health Plan Senior |
$353.49
|
| Rate for Payer: Galaxy Health WC |
$2,504.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,768.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,652.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$527.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$352.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$321.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,871.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$389.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$449.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$589.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$430.61
|
| Rate for Payer: Multiplan Commercial |
$2,210.25
|
| Rate for Payer: Networks By Design Commercial |
$1,915.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$321.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,504.95
|
| Rate for Payer: Prime Health Services Medicare |
$340.63
|
| Rate for Payer: Riverside University Health System MISP |
$353.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,768.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$385.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,473.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$321.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Vantage Medical Group Senior |
$321.35
|
|
|
HC RPL GTUBE NOT RQ RV GSTRST TRC
|
Facility
|
IP
|
$2,947.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
906743760
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$589.40 |
| Max. Negotiated Rate |
$2,652.30 |
| Rate for Payer: Adventist Health Commercial |
$589.40
|
| Rate for Payer: Cash Price |
$1,326.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,357.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,062.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,178.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,178.80
|
| Rate for Payer: Galaxy Health WC |
$2,504.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,768.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,652.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,871.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,738.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$589.40
|
| Rate for Payer: Multiplan Commercial |
$2,210.25
|
| Rate for Payer: Networks By Design Commercial |
$1,915.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,504.95
|
|
|
HC RPL GTUBE NOT RQ RV GSTRST TRC
|
Facility
|
OP
|
$2,947.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
906743760
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$321.35 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$589.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$321.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$321.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$492.37
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,326.15
|
| Rate for Payer: Cash Price |
$1,326.15
|
| Rate for Payer: Cash Price |
$1,326.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,357.60
|
| Rate for Payer: Cigna of CA HMO |
$1,886.08
|
| Rate for Payer: Cigna of CA PPO |
$2,180.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$482.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$353.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$321.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,062.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$530.23
|
| Rate for Payer: EPIC Health Plan Senior |
$353.49
|
| Rate for Payer: Galaxy Health WC |
$2,504.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,768.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,652.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$527.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$352.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$321.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,871.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$389.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$449.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$589.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$430.61
|
| Rate for Payer: Multiplan Commercial |
$2,210.25
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: Networks By Design Commercial |
$1,915.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$321.35
|
| Rate for Payer: Preferred Health Network WC |
$502.42
|
| Rate for Payer: Prime Health Services Commercial |
$2,504.95
|
| Rate for Payer: Prime Health Services Medicare |
$340.63
|
| Rate for Payer: Prime Health Services WC |
$487.35
|
| Rate for Payer: Riverside University Health System MISP |
$353.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,768.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,473.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$321.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Vantage Medical Group Senior |
$321.35
|
|
|
HC RPL GTUBE REQ REV GSTRST TRC
|
Facility
|
IP
|
$1,134.00
|
|
|
Service Code
|
CPT 43763
|
| Hospital Charge Code |
906043763
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$226.80 |
| Max. Negotiated Rate |
$1,020.60 |
| Rate for Payer: Adventist Health Commercial |
$226.80
|
| Rate for Payer: Cash Price |
$510.30
|
| Rate for Payer: Central Health Plan Commercial |
$907.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$793.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$453.60
|
| Rate for Payer: EPIC Health Plan Senior |
$453.60
|
| Rate for Payer: Galaxy Health WC |
$963.90
|
| Rate for Payer: Global Benefits Group Commercial |
$680.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,020.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$720.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$669.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.80
|
| Rate for Payer: Multiplan Commercial |
$850.50
|
| Rate for Payer: Networks By Design Commercial |
$737.10
|
| Rate for Payer: Prime Health Services Commercial |
$963.90
|
|
