|
HC UNLST PROC TONGUE FLOOR OF MOUTH
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
CPT 41599
|
| Hospital Charge Code |
900501220
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$344.25 |
| Rate for Payer: Adventist Health Commercial |
$81.00
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$283.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.00
|
| Rate for Payer: EPIC Health Plan Senior |
$162.00
|
| Rate for Payer: Galaxy Health WC |
$344.25
|
| Rate for Payer: Global Benefits Group Commercial |
$243.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$257.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$238.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.20
|
| Rate for Payer: Multiplan Commercial |
$324.00
|
| Rate for Payer: Networks By Design Commercial |
$263.25
|
| Rate for Payer: Prime Health Services Commercial |
$344.25
|
|
|
HC UNOS REGISTRATION HEART
|
Facility
|
IP
|
$1,140.00
|
|
| Hospital Charge Code |
902200120
|
|
Hospital Revenue Code
|
810
|
| Min. Negotiated Rate |
$228.00 |
| Max. Negotiated Rate |
$969.00 |
| Rate for Payer: Adventist Health Commercial |
$228.00
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$798.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$456.00
|
| Rate for Payer: EPIC Health Plan Senior |
$456.00
|
| Rate for Payer: Galaxy Health WC |
$969.00
|
| Rate for Payer: Global Benefits Group Commercial |
$684.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$723.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$672.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$273.60
|
| Rate for Payer: Multiplan Commercial |
$912.00
|
| Rate for Payer: Networks By Design Commercial |
$741.00
|
| Rate for Payer: Prime Health Services Commercial |
$969.00
|
|
|
HC UNOS REGISTRATION HEART
|
Facility
|
OP
|
$1,140.00
|
|
| Hospital Charge Code |
902200120
|
|
Hospital Revenue Code
|
810
|
| Min. Negotiated Rate |
$228.00 |
| Max. Negotiated Rate |
$969.00 |
| Rate for Payer: Adventist Health Commercial |
$228.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$747.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$969.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$627.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$855.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$731.54
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Cigna of CA HMO |
$729.60
|
| Rate for Payer: Cigna of CA PPO |
$843.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$969.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$969.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$969.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$798.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$456.00
|
| Rate for Payer: EPIC Health Plan Senior |
$456.00
|
| Rate for Payer: Galaxy Health WC |
$969.00
|
| Rate for Payer: Global Benefits Group Commercial |
$684.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$723.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$413.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$672.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$273.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$798.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$798.00
|
| Rate for Payer: Multiplan Commercial |
$912.00
|
| Rate for Payer: Networks By Design Commercial |
$741.00
|
| Rate for Payer: Prime Health Services Commercial |
$969.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$684.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$684.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$969.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$969.00
|
| Rate for Payer: Vantage Medical Group Senior |
$969.00
|
|
|
HC UNOS REGISTRATION KIDNEY
|
Facility
|
OP
|
$1,140.00
|
|
| Hospital Charge Code |
904700020
|
|
Hospital Revenue Code
|
810
|
| Min. Negotiated Rate |
$228.00 |
| Max. Negotiated Rate |
$969.00 |
| Rate for Payer: Adventist Health Commercial |
$228.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$747.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$969.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$627.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$855.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$731.54
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Cigna of CA HMO |
$729.60
|
| Rate for Payer: Cigna of CA PPO |
$843.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$969.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$969.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$969.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$798.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$456.00
|
| Rate for Payer: EPIC Health Plan Senior |
$456.00
|
| Rate for Payer: Galaxy Health WC |
$969.00
|
| Rate for Payer: Global Benefits Group Commercial |
$684.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$723.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$413.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$672.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$273.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$798.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$798.00
|
| Rate for Payer: Multiplan Commercial |
$912.00
|
| Rate for Payer: Networks By Design Commercial |
$741.00
|
| Rate for Payer: Prime Health Services Commercial |
$969.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$684.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$684.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$969.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$969.00
|
| Rate for Payer: Vantage Medical Group Senior |
$969.00
|
|
|
HC UNOS REGISTRATION KIDNEY
|
Facility
|
IP
|
$1,140.00
|
|
| Hospital Charge Code |
904700020
|
|
Hospital Revenue Code
|
810
|
| Min. Negotiated Rate |
$228.00 |
| Max. Negotiated Rate |
$969.00 |
| Rate for Payer: Adventist Health Commercial |
$228.00
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$798.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$456.00
|
| Rate for Payer: EPIC Health Plan Senior |
$456.00
|
| Rate for Payer: Galaxy Health WC |
$969.00
|
| Rate for Payer: Global Benefits Group Commercial |
$684.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$723.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$672.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$273.60
|
| Rate for Payer: Multiplan Commercial |
$912.00
|
| Rate for Payer: Networks By Design Commercial |
$741.00
|
| Rate for Payer: Prime Health Services Commercial |
$969.00
|
|
|
HC UNSCHED DIALYSIS ESRD PT OP
|
Facility
|
IP
|
$1,634.00
|
|
|
Service Code
|
CPT 90935
|
| Hospital Charge Code |
940100257
|
|
Hospital Revenue Code
|
829
|
| Min. Negotiated Rate |
$326.80 |
| Max. Negotiated Rate |
$1,388.90 |
| Rate for Payer: Adventist Health Commercial |
$326.80
|
| Rate for Payer: Cash Price |
$735.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,143.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$653.60
|
| Rate for Payer: EPIC Health Plan Senior |
$653.60
|
| Rate for Payer: Galaxy Health WC |
$1,388.90
|
| Rate for Payer: Global Benefits Group Commercial |
$980.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,037.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$964.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.16
|
| Rate for Payer: Multiplan Commercial |
$1,307.20
|
| Rate for Payer: Networks By Design Commercial |
$1,062.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,388.90
|
|
|
HC UNSCHED DIALYSIS ESRD PT OP
|
Facility
|
OP
|
$1,634.00
|
|
|
Service Code
|
CPT 90935
|
| Hospital Charge Code |
940100257
|
|
Hospital Revenue Code
|
829
|
| Min. Negotiated Rate |
$95.09 |
| Max. Negotiated Rate |
$1,610.00 |
| Rate for Payer: Adventist Health Commercial |
$326.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$488.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,324.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$970.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$882.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,048.54
|
| Rate for Payer: Cash Price |
$735.30
|
| Rate for Payer: Cash Price |
$735.30
|
| Rate for Payer: Cash Price |
$735.30
|
| Rate for Payer: Cigna of CA HMO |
$1,045.76
|
| Rate for Payer: Cigna of CA PPO |
$1,209.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,324.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$970.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$882.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,143.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,456.49
|
| Rate for Payer: EPIC Health Plan Senior |
$970.99
|
| Rate for Payer: Galaxy Health WC |
$1,388.90
|
| Rate for Payer: Global Benefits Group Commercial |
$980.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,447.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$95.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$882.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,037.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$107.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,235.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,112.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,182.84
|
| Rate for Payer: Multiplan Commercial |
$1,307.20
|
| Rate for Payer: Networks By Design Commercial |
$1,062.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,388.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$980.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$980.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,570.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,610.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,170.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,072.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$882.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,324.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$970.99
|
| Rate for Payer: Vantage Medical Group Senior |
$882.72
|
|
|
HC UPPER EXT ADD'L DISCNCT INSERT
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
CPT L6616
|
| Hospital Charge Code |
915356616
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$30.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$67.95
|
| Rate for Payer: Cash Price |
$67.95
|
| Rate for Payer: Cigna of CA HMO |
$105.70
|
| Rate for Payer: Cigna of CA PPO |
$105.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$105.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.40
|
| Rate for Payer: EPIC Health Plan Senior |
$60.40
|
| Rate for Payer: Galaxy Health WC |
$128.35
|
| Rate for Payer: Global Benefits Group Commercial |
$90.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$95.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$89.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.24
|
| Rate for Payer: Multiplan Commercial |
$120.80
|
| Rate for Payer: Networks By Design Commercial |
$98.15
|
| Rate for Payer: Prime Health Services Commercial |
$128.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.67
|
| Rate for Payer: United Healthcare All Other HMO |
$55.16
|
| Rate for Payer: United Healthcare HMO Rider |
$53.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.45
|
|
|
HC UPPER EXT ADD'L DISCNCT INSERT
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
CPT L6616
|
| Hospital Charge Code |
915356616
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.24 |
| Max. Negotiated Rate |
$128.35 |
| Rate for Payer: Adventist Health Commercial |
$61.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$128.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$91.40
|
| Rate for Payer: Blue Shield of California Commercial |
$76.56
|
| Rate for Payer: Blue Shield of California Commercial |
$116.12
|
| Rate for Payer: Cash Price |
$67.95
|
| Rate for Payer: Cash Price |
$67.95
|
| Rate for Payer: Cigna of CA HMO |
$105.70
|
| Rate for Payer: Cigna of CA PPO |
$105.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$128.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$128.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$128.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$105.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.40
|
| Rate for Payer: EPIC Health Plan Senior |
$60.40
|
| Rate for Payer: Galaxy Health WC |
$128.35
|
| Rate for Payer: Global Benefits Group Commercial |
$90.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$47.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$95.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$53.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$89.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$105.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$105.70
|
| Rate for Payer: Multiplan Commercial |
$120.80
|
| Rate for Payer: Networks By Design Commercial |
$75.50
|
| Rate for Payer: Prime Health Services Commercial |
$128.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.67
|
| Rate for Payer: United Healthcare All Other HMO |
$55.16
|
| Rate for Payer: United Healthcare HMO Rider |
$53.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$128.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$128.35
|
| Rate for Payer: Vantage Medical Group Senior |
$128.35
|
|
|
HC UPPER EXT ADD'L DISCNCT INSERT
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
CPT L6616
|
| Hospital Charge Code |
905356616
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$30.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$67.95
|
| Rate for Payer: Cash Price |
$67.95
|
| Rate for Payer: Cigna of CA HMO |
$105.70
|
| Rate for Payer: Cigna of CA PPO |
$105.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$105.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.40
|
| Rate for Payer: EPIC Health Plan Senior |
$60.40
|
| Rate for Payer: Galaxy Health WC |
$128.35
|
| Rate for Payer: Global Benefits Group Commercial |
$90.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$95.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$89.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.24
|
| Rate for Payer: Multiplan Commercial |
$120.80
|
| Rate for Payer: Networks By Design Commercial |
$98.15
|
| Rate for Payer: Prime Health Services Commercial |
$128.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.67
|
| Rate for Payer: United Healthcare All Other HMO |
$55.16
|
| Rate for Payer: United Healthcare HMO Rider |
$53.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.45
|
|
|
HC UPPER EXT ADD'L DISCNCT INSERT
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
CPT L6616
|
| Hospital Charge Code |
905356616
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.24 |
| Max. Negotiated Rate |
$128.35 |
| Rate for Payer: Adventist Health Commercial |
$61.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$128.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$91.40
|
| Rate for Payer: Blue Shield of California Commercial |
$76.56
|
| Rate for Payer: Blue Shield of California Commercial |
$116.12
|
| Rate for Payer: Cash Price |
$67.95
|
| Rate for Payer: Cash Price |
$67.95
|
| Rate for Payer: Cigna of CA HMO |
$105.70
|
| Rate for Payer: Cigna of CA PPO |
$105.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$128.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$128.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$128.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$105.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.40
|
| Rate for Payer: EPIC Health Plan Senior |
$60.40
|
| Rate for Payer: Galaxy Health WC |
$128.35
|
| Rate for Payer: Global Benefits Group Commercial |
$90.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$47.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$95.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$53.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$89.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$105.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$105.70
|
| Rate for Payer: Multiplan Commercial |
$120.80
|
| Rate for Payer: Networks By Design Commercial |
$75.50
|
| Rate for Payer: Prime Health Services Commercial |
$128.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.67
|
| Rate for Payer: United Healthcare All Other HMO |
$55.16
|
| Rate for Payer: United Healthcare HMO Rider |
$53.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$128.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$128.35
|
| Rate for Payer: Vantage Medical Group Senior |
$128.35
|
|
|
HC UPPER GI ENDOSCOPY W OPTCL END
|
Facility
|
IP
|
$3,052.00
|
|
|
Service Code
|
CPT 43252
|
| Hospital Charge Code |
906743252
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$610.40 |
| Max. Negotiated Rate |
$2,594.20 |
| Rate for Payer: Adventist Health Commercial |
$610.40
|
| Rate for Payer: Cash Price |
$1,373.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,136.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,220.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,220.80
|
| Rate for Payer: Galaxy Health WC |
$2,594.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,831.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,938.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,800.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$732.48
|
| Rate for Payer: Multiplan Commercial |
$2,441.60
|
| Rate for Payer: Networks By Design Commercial |
$1,983.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,594.20
|
|
|
HC UPPER GI ENDOSCOPY W OPTCL END
|
Facility
|
OP
|
$3,052.00
|
|
|
Service Code
|
CPT 43252
|
| Hospital Charge Code |
906743252
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$610.40 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: Adventist Health Commercial |
$610.40
|
| Rate for Payer: Adventist Health Commercial |
$408.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Cash Price |
$1,373.40
|
| Rate for Payer: Cash Price |
$918.45
|
| Rate for Payer: Cash Price |
$1,373.40
|
| Rate for Payer: Cash Price |
$918.45
|
| Rate for Payer: Cash Price |
$918.45
|
| Rate for Payer: Cash Price |
$1,373.40
|
| Rate for Payer: Cigna of CA HMO |
$1,306.24
|
| Rate for Payer: Cigna of CA HMO |
$1,953.28
|
| Rate for Payer: Cigna of CA PPO |
$1,510.34
|
| Rate for Payer: Cigna of CA PPO |
$2,258.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,136.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,428.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: Galaxy Health WC |
$1,734.85
|
| Rate for Payer: Galaxy Health WC |
$2,594.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,224.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,831.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,296.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,938.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$489.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$732.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,109.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,109.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,307.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$2,441.60
|
| Rate for Payer: Multiplan Commercial |
$1,632.80
|
| Rate for Payer: Networks By Design Commercial |
$1,326.65
|
| Rate for Payer: Networks By Design Commercial |
$1,983.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,594.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,734.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,831.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,224.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,961.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,961.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,526.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,020.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
|
|
HC UPPER GI ENDOSCOPY W/RMVL FB
|
Facility
|
IP
|
$4,421.00
|
|
|
Service Code
|
CPT 43247
|
| Hospital Charge Code |
900501341
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$884.20 |
| Max. Negotiated Rate |
$3,757.85 |
| Rate for Payer: Adventist Health Commercial |
$884.20
|
| Rate for Payer: Cash Price |
$1,989.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,094.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,768.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,768.40
|
| Rate for Payer: Galaxy Health WC |
$3,757.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,652.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,807.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,608.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,061.04
|
| Rate for Payer: Multiplan Commercial |
$3,536.80
|
| Rate for Payer: Networks By Design Commercial |
$2,873.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,757.85
|
|
|
HC UPPER GI ENDOSCOPY W/RMVL FB
|
Facility
|
OP
|
$4,421.00
|
|
|
Service Code
|
CPT 43247
|
| Hospital Charge Code |
900501341
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$440.00 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$1,812.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,315.08
|
| 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 HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$1,989.45
|
| Rate for Payer: Cash Price |
$1,989.45
|
| Rate for Payer: Cash Price |
$1,989.45
|
| Rate for Payer: Cigna of CA HMO |
$2,829.44
|
| Rate for Payer: Cigna of CA PPO |
$3,271.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,094.70
|
| 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 |
$3,757.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,652.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,807.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$485.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,254.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,061.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,469.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$3,536.80
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Networks By Design Commercial |
$2,873.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,757.85
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,652.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,652.60
|
| 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 |
$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 UPPER GI ENDOSCOPY W/RMVL FB
|
Facility
|
IP
|
$4,421.00
|
|
|
Service Code
|
CPT 43247
|
| Hospital Charge Code |
900501341
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$884.20 |
| Max. Negotiated Rate |
$3,757.85 |
| Rate for Payer: Adventist Health Commercial |
$884.20
|
| Rate for Payer: Cash Price |
$1,989.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,094.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,768.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,768.40
|
| Rate for Payer: Galaxy Health WC |
$3,757.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,652.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,807.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,608.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,061.04
|
| Rate for Payer: Multiplan Commercial |
$3,536.80
|
| Rate for Payer: Networks By Design Commercial |
$2,873.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,757.85
|
|
|
HC UPPER GI ENDOSCOPY W/RMVL FB
|
Facility
|
OP
|
$4,421.00
|
|
|
Service Code
|
CPT 43247
|
| Hospital Charge Code |
900501341
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$485.26 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$884.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| 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 HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$1,989.45
|
| Rate for Payer: Cash Price |
$1,989.45
|
| Rate for Payer: Cash Price |
$1,989.45
|
| Rate for Payer: Cigna of CA HMO |
$2,829.44
|
| Rate for Payer: Cigna of CA PPO |
$3,271.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,094.70
|
| 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 |
$3,757.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,652.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,807.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$485.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,254.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,061.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,469.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$3,536.80
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Networks By Design Commercial |
$2,873.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,757.85
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,652.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,210.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,210.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,210.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,210.50
|
| 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 UPPER GI SCOPE W/THRMAL ENERGY
|
Facility
|
IP
|
$7,318.00
|
|
|
Service Code
|
CPT 43257
|
| Hospital Charge Code |
906743257
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,463.60 |
| Max. Negotiated Rate |
$6,220.30 |
| Rate for Payer: Adventist Health Commercial |
$1,463.60
|
| Rate for Payer: Cash Price |
$3,293.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,122.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,927.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,927.20
|
| Rate for Payer: Galaxy Health WC |
$6,220.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,390.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,646.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,317.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,756.32
|
| Rate for Payer: Multiplan Commercial |
$5,854.40
|
| Rate for Payer: Networks By Design Commercial |
$4,756.70
|
| Rate for Payer: Prime Health Services Commercial |
$6,220.30
|
|
|
HC UPPER GI SCOPE W/THRMAL ENERGY
|
Facility
|
OP
|
$7,318.00
|
|
|
Service Code
|
CPT 43257
|
| Hospital Charge Code |
906743257
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$60.66 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,463.60
|
| Rate for Payer: Adventist Health Commercial |
$978.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,454.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,454.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,958.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,958.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,638.65
|
| Rate for Payer: Blue Shield of California Commercial |
$5,508.41
|
| Rate for Payer: Blue Shield of California Commercial |
$5,508.41
|
| Rate for Payer: Blue Shield of California Commercial |
$3,638.65
|
| Rate for Payer: Cash Price |
$2,200.95
|
| Rate for Payer: Cash Price |
$3,293.10
|
| Rate for Payer: Cash Price |
$3,293.10
|
| Rate for Payer: Cash Price |
$2,200.95
|
| Rate for Payer: Cash Price |
$2,200.95
|
| Rate for Payer: Cash Price |
$3,293.10
|
| Rate for Payer: Cigna of CA HMO |
$4,683.52
|
| Rate for Payer: Cigna of CA HMO |
$3,130.24
|
| Rate for Payer: Cigna of CA PPO |
$3,619.34
|
| Rate for Payer: Cigna of CA PPO |
$5,415.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,454.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,454.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,958.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,958.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,122.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,423.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,181.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,181.99
|
| Rate for Payer: EPIC Health Plan Senior |
$5,454.66
|
| Rate for Payer: EPIC Health Plan Senior |
$5,454.66
|
| Rate for Payer: Galaxy Health WC |
$6,220.30
|
| Rate for Payer: Galaxy Health WC |
$4,157.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,934.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,390.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8,132.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8,132.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$60.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$60.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,958.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,958.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,646.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,105.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$68.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$68.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,942.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,942.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,173.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,756.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,248.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,248.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,644.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,644.77
|
| Rate for Payer: Multiplan Commercial |
$3,912.80
|
| Rate for Payer: Multiplan Commercial |
$5,854.40
|
| Rate for Payer: Networks By Design Commercial |
$4,756.70
|
| Rate for Payer: Networks By Design Commercial |
$3,179.15
|
| Rate for Payer: Prime Health Services Commercial |
$6,220.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,157.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,390.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,934.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,950.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,950.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,445.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,958.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,958.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,454.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,454.66
|
| Rate for Payer: Vantage Medical Group Senior |
$4,958.78
|
| Rate for Payer: Vantage Medical Group Senior |
$4,958.78
|
|
|
HC UREA NITROGEN, UR
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
900910460
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.00 |
| Max. Negotiated Rate |
$182.75 |
| Rate for Payer: Adventist Health Commercial |
$43.00
|
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$150.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.00
|
| Rate for Payer: EPIC Health Plan Senior |
$86.00
|
| Rate for Payer: Galaxy Health WC |
$182.75
|
| Rate for Payer: Global Benefits Group Commercial |
$129.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$136.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$126.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.60
|
| Rate for Payer: Multiplan Commercial |
$172.00
|
| Rate for Payer: Networks By Design Commercial |
$139.75
|
| Rate for Payer: Prime Health Services Commercial |
$182.75
|
|
|
HC UREA NITROGEN, UR
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
900910460
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$182.75 |
| Rate for Payer: Dignity Health Medi-Cal |
$6.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.12
|
| Rate for Payer: Adventist Health Commercial |
$43.00
|
| Rate for Payer: Adventist Health Commercial |
$5.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.99
|
| Rate for Payer: Blue Shield of California Commercial |
$11.99
|
| Rate for Payer: Blue Shield of California Commercial |
$149.85
|
| Rate for Payer: Blue Shield of California Commercial |
$18.12
|
| Rate for Payer: Blue Shield of California Commercial |
$99.11
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: Cigna of CA HMO |
$16.64
|
| Rate for Payer: Cigna of CA HMO |
$137.60
|
| Rate for Payer: Cigna of CA PPO |
$159.10
|
| Rate for Payer: Cigna of CA PPO |
$19.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$150.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.17
|
| Rate for Payer: EPIC Health Plan Senior |
$6.12
|
| Rate for Payer: EPIC Health Plan Senior |
$6.12
|
| Rate for Payer: Galaxy Health WC |
$182.75
|
| Rate for Payer: Galaxy Health WC |
$22.10
|
| Rate for Payer: Global Benefits Group Commercial |
$129.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.12
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$136.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.45
|
| Rate for Payer: Multiplan Commercial |
$20.80
|
| Rate for Payer: Multiplan Commercial |
$172.00
|
| Rate for Payer: Networks By Design Commercial |
$16.90
|
| Rate for Payer: Networks By Design Commercial |
$139.75
|
| Rate for Payer: Prime Health Services Commercial |
$182.75
|
| Rate for Payer: Prime Health Services Commercial |
$22.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$129.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$129.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Vantage Medical Group Senior |
$5.56
|
| Rate for Payer: Vantage Medical Group Senior |
$5.56
|
|
|
HC URE EMBOLIZATION OR OCCLUSION
|
Facility
|
IP
|
$3,260.00
|
|
|
Service Code
|
CPT 50705
|
| Hospital Charge Code |
909050705
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$652.00 |
| Max. Negotiated Rate |
$2,771.00 |
| Rate for Payer: Adventist Health Commercial |
$652.00
|
| Rate for Payer: Cash Price |
$1,467.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,282.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,304.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,304.00
|
| Rate for Payer: Galaxy Health WC |
$2,771.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,956.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,070.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,923.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$782.40
|
| Rate for Payer: Multiplan Commercial |
$2,608.00
|
| Rate for Payer: Networks By Design Commercial |
$2,119.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,771.00
|
|
|
HC URE EMBOLIZATION OR OCCLUSION
|
Facility
|
OP
|
$3,260.00
|
|
|
Service Code
|
CPT 50705
|
| Hospital Charge Code |
909050705
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$652.00 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$652.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,771.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,793.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,445.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$1,467.00
|
| Rate for Payer: Cash Price |
$1,467.00
|
| Rate for Payer: Cash Price |
$1,467.00
|
| Rate for Payer: Cigna of CA HMO |
$2,086.40
|
| Rate for Payer: Cigna of CA PPO |
$2,412.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,771.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,771.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,771.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,282.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,304.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,304.00
|
| Rate for Payer: Galaxy Health WC |
$2,771.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,956.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,650.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,070.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,997.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,923.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$782.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,282.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,282.00
|
| Rate for Payer: Multiplan Commercial |
$2,608.00
|
| Rate for Payer: Networks By Design Commercial |
$2,119.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,771.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,956.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,630.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$2,771.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,771.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,771.00
|
|
|
HC URE STNT PLCMNT W NEPH CATH
|
Facility
|
IP
|
$16,022.00
|
|
|
Service Code
|
CPT 50695
|
| Hospital Charge Code |
909050695
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,204.40 |
| Max. Negotiated Rate |
$13,618.70 |
| Rate for Payer: Adventist Health Commercial |
$3,204.40
|
| Rate for Payer: Cash Price |
$7,209.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,215.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,408.80
|
| Rate for Payer: EPIC Health Plan Senior |
$6,408.80
|
| Rate for Payer: Galaxy Health WC |
$13,618.70
|
| Rate for Payer: Global Benefits Group Commercial |
$9,613.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,173.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,452.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,845.28
|
| Rate for Payer: Multiplan Commercial |
$12,817.60
|
| Rate for Payer: Networks By Design Commercial |
$10,414.30
|
| Rate for Payer: Prime Health Services Commercial |
$13,618.70
|
|
|
HC URE STNT PLCMNT W NEPH CATH
|
Facility
|
OP
|
$16,022.00
|
|
|
Service Code
|
CPT 50695
|
| Hospital Charge Code |
909050695
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,924.01 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$3,204.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,987.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,533.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$7,209.90
|
| Rate for Payer: Cash Price |
$7,209.90
|
| Rate for Payer: Cash Price |
$7,209.90
|
| Rate for Payer: Cigna of CA HMO |
$10,254.08
|
| Rate for Payer: Cigna of CA PPO |
$11,856.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,987.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,533.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,215.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,480.62
|
| Rate for Payer: EPIC Health Plan Senior |
$4,987.08
|
| Rate for Payer: Galaxy Health WC |
$13,618.70
|
| Rate for Payer: Global Benefits Group Commercial |
$9,613.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,435.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,187.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,533.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,173.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,473.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,347.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,845.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,712.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,075.17
|
| Rate for Payer: Multiplan Commercial |
$12,817.60
|
| Rate for Payer: Multiplan WC |
$6,982.34
|
| Rate for Payer: Networks By Design Commercial |
$10,414.30
|
| Rate for Payer: Prime Health Services Commercial |
$13,618.70
|
| Rate for Payer: Prime Health Services WC |
$6,911.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,613.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,011.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,533.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,987.08
|
| Rate for Payer: Vantage Medical Group Senior |
$4,533.71
|
|
