|
HC REP INCARCERATED HERNIA REDUCT
|
Facility
|
IP
|
$9,921.00
|
|
|
Service Code
|
CPT 49507
|
| Hospital Charge Code |
900501638
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$1,984.20 |
| Max. Negotiated Rate |
$8,928.90 |
| Rate for Payer: Cash Price |
$4,464.45
|
| Rate for Payer: Central Health Plan Commercial |
$7,936.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,968.40
|
| Rate for Payer: Galaxy Health WC |
$8,432.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,952.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,928.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,617.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,779.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,984.20
|
| Rate for Payer: Multiplan Commercial |
$7,440.75
|
| Rate for Payer: Networks By Design Commercial |
$6,448.65
|
| Rate for Payer: Prime Health Services Commercial |
$8,432.85
|
|
|
HC REP INCARCERATED HERNIA REDUCT
|
Facility
|
IP
|
$9,921.00
|
|
|
Service Code
|
CPT 49507
|
| Hospital Charge Code |
900501638
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,984.20 |
| Max. Negotiated Rate |
$8,928.90 |
| Rate for Payer: Cash Price |
$4,464.45
|
| Rate for Payer: Central Health Plan Commercial |
$7,936.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,968.40
|
| Rate for Payer: Galaxy Health WC |
$8,432.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,952.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,928.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,617.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,779.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,984.20
|
| Rate for Payer: Multiplan Commercial |
$7,440.75
|
| Rate for Payer: Networks By Design Commercial |
$6,448.65
|
| Rate for Payer: Prime Health Services Commercial |
$8,432.85
|
|
|
HC REP INCARCERATED HERNIA REDUCT
|
Facility
|
OP
|
$9,921.00
|
|
|
Service Code
|
CPT 49507
|
| Hospital Charge Code |
900501638
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$157.74 |
| Max. Negotiated Rate |
$10,567.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,322.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,952.60
|
| Rate for Payer: Caremore Medicare Advantage |
$4,322.62
|
| Rate for Payer: Cash Price |
$4,464.45
|
| Rate for Payer: Cash Price |
$4,464.45
|
| Rate for Payer: Cash Price |
$4,464.45
|
| Rate for Payer: Cash Price |
$4,464.45
|
| Rate for Payer: Central Health Plan Commercial |
$7,936.80
|
| Rate for Payer: Cigna of CA PPO |
$7,341.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Dignity Health Media |
$4,322.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,754.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,835.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,322.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,322.62
|
| Rate for Payer: Galaxy Health WC |
$8,432.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,952.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,928.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,440.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,089.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,322.62
|
| Rate for Payer: InnovAge PACE Commercial |
$6,483.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,617.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,322.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,984.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,792.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,792.31
|
| Rate for Payer: Multiplan Commercial |
$7,440.75
|
| Rate for Payer: Networks By Design Commercial |
$6,448.65
|
| Rate for Payer: Prime Health Services Commercial |
$8,432.85
|
| Rate for Payer: Prime Health Services Medicare |
$4,581.98
|
| Rate for Payer: Riverside University Health System MISP |
$4,754.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,952.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,960.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,960.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,960.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,960.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: Vantage Medical Group Senior |
$4,322.62
|
|
|
HC REP INCARCERATED HERNIA REDUCT
|
Facility
|
OP
|
$9,921.00
|
|
|
Service Code
|
CPT 49507
|
| Hospital Charge Code |
900501638
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$157.74 |
| Max. Negotiated Rate |
$10,567.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,322.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,322.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,952.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6,240.31
|
| Rate for Payer: Blue Shield of California EPN |
$4,851.37
|
| Rate for Payer: Caremore Medicare Advantage |
$4,322.62
|
| Rate for Payer: Cash Price |
$4,464.45
|
| Rate for Payer: Cash Price |
$4,464.45
|
| Rate for Payer: Central Health Plan Commercial |
$7,936.80
|
| Rate for Payer: Cigna of CA HMO |
$6,349.44
|
| Rate for Payer: Cigna of CA PPO |
$7,341.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Dignity Health Media |
$4,322.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,754.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,835.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,322.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,322.62
|
| Rate for Payer: Galaxy Health WC |
$8,432.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,952.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,928.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,440.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,089.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,132.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,322.62
|
| Rate for Payer: InnovAge PACE Commercial |
$6,483.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,617.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,322.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,984.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,792.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,792.31
|
| Rate for Payer: Multiplan Commercial |
$7,440.75
|
| Rate for Payer: Networks By Design Commercial |
$6,448.65
|
| Rate for Payer: Prime Health Services Commercial |
$8,432.85
|
| Rate for Payer: Prime Health Services Medicare |
$4,581.98
|
| Rate for Payer: Riverside University Health System MISP |
$4,754.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,952.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,952.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,960.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,960.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,960.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,960.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: Vantage Medical Group Senior |
$4,322.62
|
|
|
HC REP INT WNDS 7.6-12.5CM
|
Facility
|
OP
|
$1,879.00
|
|
|
Service Code
|
CPT 12044
|
| Hospital Charge Code |
900501231
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$205.14 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,127.40
|
| Rate for Payer: Caremore Medicare Advantage |
$784.71
|
| Rate for Payer: Cash Price |
$845.55
|
| Rate for Payer: Cash Price |
$845.55
|
| Rate for Payer: Cash Price |
$845.55
|
| Rate for Payer: Cash Price |
$845.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,503.20
|
| Rate for Payer: Cigna of CA PPO |
$1,390.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Dignity Health Media |
$784.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.71
|
| Rate for Payer: Galaxy Health WC |
$1,597.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,127.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,691.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,409.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,286.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.71
|
| Rate for Payer: InnovAge PACE Commercial |
$1,177.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,253.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$375.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,051.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.51
|
| Rate for Payer: Multiplan Commercial |
$1,409.25
|
| Rate for Payer: Networks By Design Commercial |
$1,221.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,597.15
|
| Rate for Payer: Prime Health Services Medicare |
$831.79
|
| Rate for Payer: Riverside University Health System MISP |
$863.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,127.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$939.50
|
| Rate for Payer: United Healthcare All Other HMO |
$939.50
|
| Rate for Payer: United Healthcare HMO Rider |
$939.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$939.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Vantage Medical Group Senior |
$784.71
|
|
|
HC REP INT WNDS 7.6-12.5CM
|
Facility
|
IP
|
$1,879.00
|
|
|
Service Code
|
CPT 12044
|
| Hospital Charge Code |
900501231
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$375.80 |
| Max. Negotiated Rate |
$1,691.10 |
| Rate for Payer: Cash Price |
$845.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,503.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$751.60
|
| Rate for Payer: Galaxy Health WC |
$1,597.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,127.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,691.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,253.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$715.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$375.80
|
| Rate for Payer: Multiplan Commercial |
$1,409.25
|
| Rate for Payer: Networks By Design Commercial |
$1,221.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,597.15
|
|
|
HC REP INT WNDS FACE 7.6-12.5CM
|
Facility
|
IP
|
$2,746.00
|
|
|
Service Code
|
CPT 12054
|
| Hospital Charge Code |
900501038
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$549.20 |
| Max. Negotiated Rate |
$2,471.40 |
| Rate for Payer: Cash Price |
$1,235.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,196.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,098.40
|
| Rate for Payer: Galaxy Health WC |
$2,334.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,647.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,471.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,831.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,046.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$549.20
|
| Rate for Payer: Multiplan Commercial |
$2,059.50
|
| Rate for Payer: Networks By Design Commercial |
$1,784.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,334.10
|
|
|
HC REP INT WNDS FACE 7.6-12.5CM
|
Facility
|
OP
|
$2,746.00
|
|
|
Service Code
|
CPT 12054
|
| Hospital Charge Code |
900501038
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$296.38 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,647.60
|
| Rate for Payer: Caremore Medicare Advantage |
$498.20
|
| Rate for Payer: Cash Price |
$1,235.70
|
| Rate for Payer: Cash Price |
$1,235.70
|
| Rate for Payer: Cash Price |
$1,235.70
|
| Rate for Payer: Cash Price |
$1,235.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,196.80
|
| Rate for Payer: Cigna of CA PPO |
$2,032.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Media |
$498.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Galaxy Health WC |
$2,334.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,647.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,471.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,059.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$817.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$498.20
|
| Rate for Payer: InnovAge PACE Commercial |
$747.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,831.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$296.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$549.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$667.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Multiplan Commercial |
$2,059.50
|
| Rate for Payer: Networks By Design Commercial |
$1,784.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,334.10
|
| Rate for Payer: Prime Health Services Medicare |
$528.09
|
| Rate for Payer: Riverside University Health System MISP |
$548.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,647.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,373.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,373.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,373.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,373.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC REP INT WNDS FACE 7.6-12.5CM
|
Facility
|
OP
|
$2,746.00
|
|
|
Service Code
|
CPT 12054
|
| Hospital Charge Code |
900501038
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$296.38 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$498.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,647.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,727.23
|
| Rate for Payer: Blue Shield of California EPN |
$1,342.79
|
| Rate for Payer: Caremore Medicare Advantage |
$498.20
|
| Rate for Payer: Cash Price |
$1,235.70
|
| Rate for Payer: Cash Price |
$1,235.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,196.80
|
| Rate for Payer: Cigna of CA HMO |
$1,757.44
|
| Rate for Payer: Cigna of CA PPO |
$2,032.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Media |
$498.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Galaxy Health WC |
$2,334.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,647.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,471.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,059.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$817.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$822.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$498.20
|
| Rate for Payer: InnovAge PACE Commercial |
$747.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,831.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$296.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$549.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$667.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Multiplan Commercial |
$2,059.50
|
| Rate for Payer: Networks By Design Commercial |
$1,784.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,334.10
|
| Rate for Payer: Prime Health Services Medicare |
$528.09
|
| Rate for Payer: Riverside University Health System MISP |
$548.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,647.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,647.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,373.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,373.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,373.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,373.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC REP INT WNDS FACE 7.6-12.5CM
|
Facility
|
IP
|
$2,746.00
|
|
|
Service Code
|
CPT 12054
|
| Hospital Charge Code |
900501038
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$549.20 |
| Max. Negotiated Rate |
$2,471.40 |
| Rate for Payer: Cash Price |
$1,235.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,196.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,098.40
|
| Rate for Payer: Galaxy Health WC |
$2,334.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,647.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,471.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,831.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,046.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$549.20
|
| Rate for Payer: Multiplan Commercial |
$2,059.50
|
| Rate for Payer: Networks By Design Commercial |
$1,784.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,334.10
|
|
|
HC REPLACE DUODENAL/JEJUN TUBE
|
Facility
|
OP
|
$4,411.00
|
|
|
Service Code
|
CPT 49451
|
| Hospital Charge Code |
909020006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$882.20 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,132.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,646.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$1,132.59
|
| Rate for Payer: Cash Price |
$1,984.95
|
| Rate for Payer: Cash Price |
$1,984.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,528.80
|
| Rate for Payer: Cigna of CA PPO |
$3,264.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$3,749.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,646.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,969.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,308.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,857.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,868.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: InnovAge PACE Commercial |
$1,698.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,942.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,288.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$882.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,517.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$3,308.25
|
| Rate for Payer: Networks By Design Commercial |
$2,867.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,749.35
|
| Rate for Payer: Prime Health Services Medicare |
$1,200.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,245.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,646.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC REPLACE DUODENAL/JEJUN TUBE
|
Facility
|
IP
|
$4,411.00
|
|
|
Service Code
|
CPT 49451
|
| Hospital Charge Code |
909020006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$882.20 |
| Max. Negotiated Rate |
$3,969.90 |
| Rate for Payer: Cash Price |
$1,984.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,528.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,764.40
|
| Rate for Payer: Galaxy Health WC |
$3,749.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,646.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,969.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,942.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,680.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$882.20
|
| Rate for Payer: Multiplan Commercial |
$3,308.25
|
| Rate for Payer: Networks By Design Commercial |
$2,867.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,749.35
|
|
|
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: Blue Shield of California EPN |
$17.62
|
| 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: EPIC Health Plan Commercial |
$13.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$22.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.57
|
| 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 |
$16.50
|
| Rate for Payer: Prime Health Services Commercial |
$28.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.46
|
| Rate for Payer: United Healthcare All Other HMO |
$12.17
|
| Rate for Payer: United Healthcare HMO Rider |
$11.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.89
|
|
|
HC REPLACE FOOT DROP SPINT
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
CPT L4394
|
| Hospital Charge Code |
905354394
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$29.70 |
| 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 |
$18.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.50
|
| Rate for Payer: Blue Distinction Transplant |
$19.80
|
| Rate for Payer: Blue Shield of California Commercial |
$24.75
|
| Rate for Payer: Blue Shield of California EPN |
$17.95
|
| 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 Media |
$28.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$24.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.53
|
| 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 |
$16.50
|
| Rate for Payer: United Healthcare All Other HMO |
$16.50
|
| Rate for Payer: United Healthcare HMO Rider |
$16.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.05
|
| Rate for Payer: Vantage Medical Group Senior |
$28.05
|
|
|
HC REPLACE GAST/CECOSTOMY TUBE
|
Facility
|
IP
|
$4,391.00
|
|
|
Service Code
|
CPT 49450
|
| Hospital Charge Code |
906749450
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$878.20 |
| Max. Negotiated Rate |
$3,951.90 |
| Rate for Payer: Cash Price |
$1,975.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,512.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,756.40
|
| Rate for Payer: Galaxy Health WC |
$3,732.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,634.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,951.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,928.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,672.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$878.20
|
| Rate for Payer: Multiplan Commercial |
$3,293.25
|
| Rate for Payer: Networks By Design Commercial |
$2,854.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,732.35
|
|
|
HC REPLACE GAST/CECOSTOMY TUBE
|
Facility
|
IP
|
$4,391.00
|
|
|
Service Code
|
CPT 49450
|
| Hospital Charge Code |
906749450
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$878.20 |
| Max. Negotiated Rate |
$3,951.90 |
| Rate for Payer: Cash Price |
$1,975.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,512.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,756.40
|
| Rate for Payer: Galaxy Health WC |
$3,732.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,634.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,951.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,928.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,672.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$878.20
|
| Rate for Payer: Multiplan Commercial |
$3,293.25
|
| Rate for Payer: Networks By Design Commercial |
$2,854.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,732.35
|
|
|
HC REPLACE GAST/CECOSTOMY TUBE
|
Facility
|
OP
|
$4,391.00
|
|
|
Service Code
|
CPT 49450
|
| Hospital Charge Code |
906749450
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$878.20 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,132.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,634.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$1,132.59
|
| Rate for Payer: Cash Price |
$1,975.95
|
| Rate for Payer: Cash Price |
$1,975.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,512.80
|
| Rate for Payer: Cigna of CA PPO |
$3,249.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$3,732.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,634.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,951.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,293.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,857.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,868.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: InnovAge PACE Commercial |
$1,698.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,928.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,216.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$878.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,517.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$3,293.25
|
| Rate for Payer: Networks By Design Commercial |
$2,854.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,732.35
|
| Rate for Payer: Prime Health Services Medicare |
$1,200.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,245.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,634.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC REPLACE GAST/CECOSTOMY TUBE
|
Facility
|
OP
|
$4,391.00
|
|
|
Service Code
|
CPT 49450
|
| Hospital Charge Code |
906749450
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$5,779.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,634.60
|
| Rate for Payer: Caremore Medicare Advantage |
$1,132.59
|
| Rate for Payer: Cash Price |
$1,975.95
|
| Rate for Payer: Cash Price |
$1,975.95
|
| Rate for Payer: Cash Price |
$1,975.95
|
| Rate for Payer: Cash Price |
$1,975.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,512.80
|
| Rate for Payer: Cigna of CA PPO |
$3,249.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$3,732.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,634.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,951.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,293.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,857.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: InnovAge PACE Commercial |
$1,698.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,928.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,216.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$878.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,517.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$3,293.25
|
| Rate for Payer: Networks By Design Commercial |
$2,854.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,732.35
|
| Rate for Payer: Prime Health Services Medicare |
$1,200.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,245.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,634.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,195.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,195.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,195.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,195.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC 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: Blue Shield of California EPN |
$1,052.51
|
| 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: EPIC Health Plan Commercial |
$788.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$1,314.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$750.95
|
| 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 |
$985.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,675.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$744.25
|
| Rate for Payer: United Healthcare All Other HMO |
$726.90
|
| Rate for Payer: United Healthcare HMO Rider |
$711.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$650.43
|
|
|
HC REPLACE GIRDLE MILWAUKEE
|
Facility
|
OP
|
$1,971.00
|
|
|
Service Code
|
CPT L4000
|
| Hospital Charge Code |
905354000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$689.85 |
| Max. Negotiated Rate |
$1,773.90 |
| 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 |
$1,084.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$954.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,164.47
|
| Rate for Payer: Blue Distinction Transplant |
$1,182.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,478.25
|
| Rate for Payer: Blue Shield of California EPN |
$1,072.22
|
| 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 Media |
$1,675.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,675.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$788.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$1,478.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$689.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,314.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$748.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$808.11
|
| 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 |
$985.50
|
| Rate for Payer: United Healthcare All Other HMO |
$985.50
|
| Rate for Payer: United Healthcare HMO Rider |
$985.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$985.50
|
| 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
|
$2,585.00
|
|
|
Service Code
|
CPT 49452
|
| Hospital Charge Code |
906749452
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$517.00 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,132.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,551.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$1,132.59
|
| Rate for Payer: Cash Price |
$1,163.25
|
| Rate for Payer: Cash Price |
$1,163.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,068.00
|
| Rate for Payer: Cigna of CA PPO |
$1,912.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$2,197.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,551.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,326.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,938.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,857.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,868.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: InnovAge PACE Commercial |
$1,698.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,724.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,573.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$517.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,517.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$1,938.75
|
| Rate for Payer: Networks By Design Commercial |
$1,680.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,197.25
|
| Rate for Payer: Prime Health Services Medicare |
$1,200.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,245.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,551.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC REPLACE G-J TUBE PERC
|
Facility
|
IP
|
$5,090.00
|
|
|
Service Code
|
CPT 49452
|
| Hospital Charge Code |
906749452
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,018.00 |
| Max. Negotiated Rate |
$4,581.00 |
| Rate for Payer: Cash Price |
$2,290.50
|
| Rate for Payer: Central Health Plan Commercial |
$4,072.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,036.00
|
| Rate for Payer: Galaxy Health WC |
$4,326.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,054.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,581.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,395.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,939.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,018.00
|
| Rate for Payer: Multiplan Commercial |
$3,817.50
|
| Rate for Payer: Networks By Design Commercial |
$3,308.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,326.50
|
|
|
HC REPLACE G-J TUBE PERC
|
Facility
|
OP
|
$2,585.00
|
|
|
Service Code
|
CPT 49452
|
| Hospital Charge Code |
906749452
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$5,779.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,551.00
|
| Rate for Payer: Caremore Medicare Advantage |
$1,132.59
|
| Rate for Payer: Cash Price |
$1,163.25
|
| Rate for Payer: Cash Price |
$1,163.25
|
| Rate for Payer: Cash Price |
$1,163.25
|
| Rate for Payer: Cash Price |
$1,163.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,068.00
|
| Rate for Payer: Cigna of CA PPO |
$1,912.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$2,197.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,551.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,326.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,938.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,857.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: InnovAge PACE Commercial |
$1,698.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,724.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,573.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$517.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,517.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$1,938.75
|
| Rate for Payer: Networks By Design Commercial |
$1,680.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,197.25
|
| Rate for Payer: Prime Health Services Medicare |
$1,200.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,245.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,551.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,292.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,292.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,292.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,292.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC REPLACE G-J TUBE PERC
|
Facility
|
IP
|
$5,090.00
|
|
|
Service Code
|
CPT 49452
|
| Hospital Charge Code |
906749452
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,018.00 |
| Max. Negotiated Rate |
$4,581.00 |
| Rate for Payer: Cash Price |
$2,290.50
|
| Rate for Payer: Central Health Plan Commercial |
$4,072.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,036.00
|
| Rate for Payer: Galaxy Health WC |
$4,326.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,054.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,581.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,395.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,939.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,018.00
|
| Rate for Payer: Multiplan Commercial |
$3,817.50
|
| Rate for Payer: Networks By Design Commercial |
$3,308.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,326.50
|
|
|
HC REPLACE G-J TUBE PERC
|
Facility
|
IP
|
$5,090.00
|
|
|
Service Code
|
CPT 49452
|
| Hospital Charge Code |
906749452
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,018.00 |
| Max. Negotiated Rate |
$4,581.00 |
| Rate for Payer: Cash Price |
$2,290.50
|
| Rate for Payer: Central Health Plan Commercial |
$4,072.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,036.00
|
| Rate for Payer: Galaxy Health WC |
$4,326.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,054.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,581.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,395.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,939.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,018.00
|
| Rate for Payer: Multiplan Commercial |
$3,817.50
|
| Rate for Payer: Networks By Design Commercial |
$3,308.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,326.50
|
|
