|
HC BFLEX 3.8 BRONCHOSCOPE
|
Facility
|
IP
|
$3,900.00
|
|
| Hospital Charge Code |
900831703
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| Rate for Payer: Multiplan Commercial |
$3,120.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
|
|
HC BFLEX 3.8 BRONCHOSCOPE
|
Facility
|
OP
|
$3,900.00
|
|
| Hospital Charge Code |
900831703
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,558.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,394.99
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cigna of CA HMO |
$2,496.00
|
| Rate for Payer: Cigna of CA PPO |
$2,886.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$3,120.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,950.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,950.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,950.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,950.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC BFLEX 5.0 BRONCHOSCOPE
|
Facility
|
IP
|
$3,900.00
|
|
| Hospital Charge Code |
900831701
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| Rate for Payer: Multiplan Commercial |
$3,120.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
|
|
HC BFLEX 5.0 BRONCHOSCOPE
|
Facility
|
OP
|
$3,900.00
|
|
| Hospital Charge Code |
900831701
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,558.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,394.99
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cigna of CA HMO |
$2,496.00
|
| Rate for Payer: Cigna of CA PPO |
$2,886.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$3,120.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,950.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,950.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,950.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,950.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC BFLEX 5.8 BRONCHOSCOPE
|
Facility
|
IP
|
$1,564.00
|
|
| Hospital Charge Code |
900831702
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$312.80 |
| Max. Negotiated Rate |
$1,329.40 |
| Rate for Payer: Adventist Health Commercial |
$312.80
|
| Rate for Payer: Cash Price |
$703.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$625.60
|
| Rate for Payer: EPIC Health Plan Senior |
$625.60
|
| Rate for Payer: Galaxy Health WC |
$1,329.40
|
| Rate for Payer: Global Benefits Group Commercial |
$938.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,043.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$595.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$968.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$375.36
|
| Rate for Payer: Multiplan Commercial |
$1,251.20
|
| Rate for Payer: Networks By Design Commercial |
$1,016.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,329.40
|
|
|
HC BFLEX 5.8 BRONCHOSCOPE
|
Facility
|
OP
|
$1,564.00
|
|
| Hospital Charge Code |
900831702
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$312.80 |
| Max. Negotiated Rate |
$1,329.40 |
| Rate for Payer: Adventist Health Commercial |
$312.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,025.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,329.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$860.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,173.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$960.45
|
| Rate for Payer: Cash Price |
$703.80
|
| Rate for Payer: Cigna of CA HMO |
$1,000.96
|
| Rate for Payer: Cigna of CA PPO |
$1,157.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,329.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,329.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,329.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$625.60
|
| Rate for Payer: EPIC Health Plan Senior |
$625.60
|
| Rate for Payer: Galaxy Health WC |
$1,329.40
|
| Rate for Payer: Global Benefits Group Commercial |
$938.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,043.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$595.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$968.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$375.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,094.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,094.80
|
| Rate for Payer: Multiplan Commercial |
$1,251.20
|
| Rate for Payer: Networks By Design Commercial |
$1,016.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,329.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$938.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$938.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$782.00
|
| Rate for Payer: United Healthcare All Other HMO |
$782.00
|
| Rate for Payer: United Healthcare HMO Rider |
$782.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$782.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,329.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,329.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,329.40
|
|
|
HC BG ARTERIAL PUNCTURE
|
Facility
|
IP
|
$353.00
|
|
|
Service Code
|
CPT 36600
|
| Hospital Charge Code |
900801101
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$70.60 |
| Max. Negotiated Rate |
$300.05 |
| Rate for Payer: Adventist Health Commercial |
$70.60
|
| Rate for Payer: Cash Price |
$158.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$141.20
|
| Rate for Payer: EPIC Health Plan Senior |
$141.20
|
| Rate for Payer: Galaxy Health WC |
$300.05
|
| Rate for Payer: Global Benefits Group Commercial |
$211.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$235.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$218.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.72
|
| Rate for Payer: Multiplan Commercial |
$282.40
|
| Rate for Payer: Networks By Design Commercial |
$229.45
|
| Rate for Payer: Prime Health Services Commercial |
$300.05
|
|
|
HC BG ARTERIAL PUNCTURE
|
Facility
|
OP
|
$353.00
|
|
|
Service Code
|
CPT 36600
|
| Hospital Charge Code |
900801101
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$21.27 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$70.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$231.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$158.85
|
| Rate for Payer: Cash Price |
$158.85
|
| Rate for Payer: Cash Price |
$158.85
|
| Rate for Payer: Cigna of CA HMO |
$225.92
|
| Rate for Payer: Cigna of CA PPO |
$261.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$300.05
|
| Rate for Payer: Global Benefits Group Commercial |
$211.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$235.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$282.40
|
| Rate for Payer: Networks By Design Commercial |
$229.45
|
| Rate for Payer: Prime Health Services Commercial |
$300.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$211.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$211.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$176.50
|
| Rate for Payer: United Healthcare All Other HMO |
$176.50
|
| Rate for Payer: United Healthcare HMO Rider |
$176.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$176.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC BG IONIZED CALCIUM
|
Facility
|
IP
|
$455.00
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
900801120
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$386.75 |
| Rate for Payer: Adventist Health Commercial |
$91.00
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.00
|
| Rate for Payer: EPIC Health Plan Senior |
$182.00
|
| Rate for Payer: Galaxy Health WC |
$386.75
|
| Rate for Payer: Global Benefits Group Commercial |
$273.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$303.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$173.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$281.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.20
|
| Rate for Payer: Multiplan Commercial |
$364.00
|
| Rate for Payer: Networks By Design Commercial |
$295.75
|
| Rate for Payer: Prime Health Services Commercial |
$386.75
|
|
|
HC BG IONIZED CALCIUM
|
Facility
|
OP
|
$455.00
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
900801120
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$386.75 |
| Rate for Payer: Adventist Health Commercial |
$91.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$298.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$134.99
|
| Rate for Payer: Blue Shield of California Commercial |
$304.39
|
| Rate for Payer: Blue Shield of California EPN |
$201.11
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Cigna of CA HMO |
$291.20
|
| Rate for Payer: Cigna of CA PPO |
$336.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.47
|
| Rate for Payer: EPIC Health Plan Senior |
$13.68
|
| Rate for Payer: Galaxy Health WC |
$386.75
|
| Rate for Payer: Global Benefits Group Commercial |
$273.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$303.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.33
|
| Rate for Payer: Multiplan Commercial |
$364.00
|
| Rate for Payer: Networks By Design Commercial |
$295.75
|
| Rate for Payer: Prime Health Services Commercial |
$386.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$273.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$273.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.08
|
| Rate for Payer: United Healthcare All Other HMO |
$11.08
|
| Rate for Payer: United Healthcare HMO Rider |
$11.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.08
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.05
|
| Rate for Payer: Vantage Medical Group Senior |
$13.68
|
|
|
HC BILATERAL LSHO-CUSTOM FIT ABD
|
Facility
|
OP
|
$3,039.00
|
|
|
Service Code
|
CPT L1690
|
| Hospital Charge Code |
915351690
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$729.36 |
| Max. Negotiated Rate |
$2,583.15 |
| Rate for Payer: Adventist Health Commercial |
$1,245.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,583.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,671.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,279.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,760.19
|
| Rate for Payer: Blue Shield of California Commercial |
$2,242.78
|
| Rate for Payer: Blue Shield of California EPN |
$1,476.95
|
| Rate for Payer: Cash Price |
$1,367.55
|
| Rate for Payer: Cash Price |
$1,367.55
|
| Rate for Payer: Cigna of CA HMO |
$2,127.30
|
| Rate for Payer: Cigna of CA PPO |
$2,127.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,583.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,583.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,583.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,215.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,215.60
|
| Rate for Payer: Galaxy Health WC |
$2,583.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,823.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,641.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,027.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,856.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,881.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$729.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,127.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,127.30
|
| Rate for Payer: Multiplan Commercial |
$2,431.20
|
| Rate for Payer: Networks By Design Commercial |
$1,519.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,583.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,823.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,823.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,140.54
|
| Rate for Payer: United Healthcare All Other HMO |
$1,110.15
|
| Rate for Payer: United Healthcare HMO Rider |
$1,086.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$995.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,583.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,583.15
|
| Rate for Payer: Vantage Medical Group Senior |
$2,583.15
|
|
|
HC BILATERAL LSHO-CUSTOM FIT ABD
|
Facility
|
IP
|
$3,039.00
|
|
|
Service Code
|
CPT L1690
|
| Hospital Charge Code |
905351690
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$607.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$607.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,367.55
|
| Rate for Payer: Cash Price |
$1,367.55
|
| Rate for Payer: Cigna of CA HMO |
$2,127.30
|
| Rate for Payer: Cigna of CA PPO |
$2,127.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,215.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,215.60
|
| Rate for Payer: Galaxy Health WC |
$2,583.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,823.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,027.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,157.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,881.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$729.36
|
| Rate for Payer: Multiplan Commercial |
$2,431.20
|
| Rate for Payer: Networks By Design Commercial |
$1,519.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,583.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,140.54
|
| Rate for Payer: United Healthcare All Other HMO |
$1,110.15
|
| Rate for Payer: United Healthcare HMO Rider |
$1,086.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$995.27
|
|
|
HC BILATERAL LSHO-CUSTOM FIT ABD
|
Facility
|
OP
|
$3,039.00
|
|
|
Service Code
|
CPT L1690
|
| Hospital Charge Code |
905351690
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$729.36 |
| Max. Negotiated Rate |
$2,583.15 |
| Rate for Payer: Adventist Health Commercial |
$1,245.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,583.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,671.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,279.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,760.19
|
| Rate for Payer: Blue Shield of California Commercial |
$2,242.78
|
| Rate for Payer: Blue Shield of California EPN |
$1,476.95
|
| Rate for Payer: Cash Price |
$1,367.55
|
| Rate for Payer: Cash Price |
$1,367.55
|
| Rate for Payer: Cigna of CA HMO |
$2,127.30
|
| Rate for Payer: Cigna of CA PPO |
$2,127.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,583.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,583.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,583.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,215.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,215.60
|
| Rate for Payer: Galaxy Health WC |
$2,583.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,823.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,641.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,027.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,856.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,881.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$729.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,127.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,127.30
|
| Rate for Payer: Multiplan Commercial |
$2,431.20
|
| Rate for Payer: Networks By Design Commercial |
$1,519.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,583.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,823.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,823.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,140.54
|
| Rate for Payer: United Healthcare All Other HMO |
$1,110.15
|
| Rate for Payer: United Healthcare HMO Rider |
$1,086.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$995.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,583.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,583.15
|
| Rate for Payer: Vantage Medical Group Senior |
$2,583.15
|
|
|
HC BILATERAL LSHO-CUSTOM FIT ABD
|
Facility
|
IP
|
$3,039.00
|
|
|
Service Code
|
CPT L1690
|
| Hospital Charge Code |
915351690
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$607.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$607.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,367.55
|
| Rate for Payer: Cash Price |
$1,367.55
|
| Rate for Payer: Cigna of CA HMO |
$2,127.30
|
| Rate for Payer: Cigna of CA PPO |
$2,127.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,215.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,215.60
|
| Rate for Payer: Galaxy Health WC |
$2,583.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,823.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,027.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,157.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,881.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$729.36
|
| Rate for Payer: Multiplan Commercial |
$2,431.20
|
| Rate for Payer: Networks By Design Commercial |
$1,519.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,583.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,140.54
|
| Rate for Payer: United Healthcare All Other HMO |
$1,110.15
|
| Rate for Payer: United Healthcare HMO Rider |
$1,086.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$995.27
|
|
|
HC BIL CATH CONV EXT TO INT/EXT
|
Facility
|
IP
|
$7,427.00
|
|
|
Service Code
|
CPT 47535
|
| Hospital Charge Code |
909047535
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,485.40 |
| Max. Negotiated Rate |
$6,312.95 |
| Rate for Payer: Adventist Health Commercial |
$1,485.40
|
| Rate for Payer: Cash Price |
$3,342.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,970.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,970.80
|
| Rate for Payer: Galaxy Health WC |
$6,312.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,456.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,953.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,829.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,597.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,782.48
|
| Rate for Payer: Multiplan Commercial |
$5,941.60
|
| Rate for Payer: Networks By Design Commercial |
$4,827.55
|
| Rate for Payer: Prime Health Services Commercial |
$6,312.95
|
|
|
HC BIL CATH CONV EXT TO INT/EXT
|
Facility
|
OP
|
$7,427.00
|
|
|
Service Code
|
CPT 47535
|
| Hospital Charge Code |
909047535
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,485.40 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$1,485.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,726.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,932.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,484.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,822.94
|
| Rate for Payer: Cash Price |
$3,342.15
|
| Rate for Payer: Cash Price |
$3,342.15
|
| Rate for Payer: Cash Price |
$3,342.15
|
| Rate for Payer: Cigna of CA HMO |
$4,753.28
|
| Rate for Payer: Cigna of CA PPO |
$5,495.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,726.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,932.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,484.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,053.43
|
| Rate for Payer: EPIC Health Plan Senior |
$4,484.02
|
| Rate for Payer: Galaxy Health WC |
$6,312.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,456.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,353.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,704.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,484.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,953.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,927.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,484.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,782.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,649.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,008.59
|
| Rate for Payer: Multiplan Commercial |
$5,941.60
|
| Rate for Payer: Multiplan WC |
$7,144.49
|
| Rate for Payer: Networks By Design Commercial |
$4,827.55
|
| Rate for Payer: Prime Health Services Commercial |
$6,312.95
|
| Rate for Payer: Prime Health Services WC |
$7,071.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,456.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| 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 |
$4,484.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,726.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,932.42
|
| Rate for Payer: Vantage Medical Group Senior |
$4,484.02
|
|
|
HC BILIARY BRUSH/BIOPSY
|
Facility
|
OP
|
$6,773.00
|
|
|
Service Code
|
CPT 47553
|
| Hospital Charge Code |
909000148
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$406.56 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$1,354.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,892.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,721.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,928.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,822.94
|
| Rate for Payer: Cash Price |
$3,047.85
|
| Rate for Payer: Cash Price |
$3,047.85
|
| Rate for Payer: Cash Price |
$3,047.85
|
| Rate for Payer: Cigna of CA HMO |
$4,334.72
|
| Rate for Payer: Cigna of CA PPO |
$5,012.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,892.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,721.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,928.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,703.11
|
| Rate for Payer: EPIC Health Plan Senior |
$7,928.23
|
| Rate for Payer: Galaxy Health WC |
$5,757.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,063.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,002.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$406.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,928.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,517.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$459.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,928.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,625.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,989.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,623.83
|
| Rate for Payer: Multiplan Commercial |
$5,418.40
|
| Rate for Payer: Multiplan WC |
$12,632.22
|
| Rate for Payer: Networks By Design Commercial |
$4,402.45
|
| Rate for Payer: Prime Health Services Commercial |
$5,757.05
|
| Rate for Payer: Prime Health Services WC |
$12,503.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,063.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,928.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,892.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,721.05
|
| Rate for Payer: Vantage Medical Group Senior |
$7,928.23
|
|
|
HC BILIARY BRUSH/BIOPSY
|
Facility
|
IP
|
$6,773.00
|
|
|
Service Code
|
CPT 47553
|
| Hospital Charge Code |
909000148
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,354.60 |
| Max. Negotiated Rate |
$5,757.05 |
| Rate for Payer: Adventist Health Commercial |
$1,354.60
|
| Rate for Payer: Cash Price |
$3,047.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,709.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,709.20
|
| Rate for Payer: Galaxy Health WC |
$5,757.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,063.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,517.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,580.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,192.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,625.52
|
| Rate for Payer: Multiplan Commercial |
$5,418.40
|
| Rate for Payer: Networks By Design Commercial |
$4,402.45
|
| Rate for Payer: Prime Health Services Commercial |
$5,757.05
|
|
|
HC BILIARY CATH RMVL W FLUORO
|
Facility
|
OP
|
$1,647.00
|
|
|
Service Code
|
CPT 47537
|
| Hospital Charge Code |
909047537
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$329.40 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$329.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$741.15
|
| Rate for Payer: Cash Price |
$741.15
|
| Rate for Payer: Cash Price |
$741.15
|
| Rate for Payer: Cigna of CA HMO |
$1,054.08
|
| Rate for Payer: Cigna of CA PPO |
$1,218.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,608.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,191.26
|
| Rate for Payer: Galaxy Health WC |
$1,399.95
|
| Rate for Payer: Global Benefits Group Commercial |
$988.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$569.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,098.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$644.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$395.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,500.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,596.29
|
| Rate for Payer: Multiplan Commercial |
$1,317.60
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Networks By Design Commercial |
$1,070.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,399.95
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$988.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,191.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC BILIARY CATH RMVL W FLUORO
|
Facility
|
IP
|
$1,647.00
|
|
|
Service Code
|
CPT 47537
|
| Hospital Charge Code |
909047537
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$329.40 |
| Max. Negotiated Rate |
$1,399.95 |
| Rate for Payer: Adventist Health Commercial |
$329.40
|
| Rate for Payer: Cash Price |
$741.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$658.80
|
| Rate for Payer: EPIC Health Plan Senior |
$658.80
|
| Rate for Payer: Galaxy Health WC |
$1,399.95
|
| Rate for Payer: Global Benefits Group Commercial |
$988.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,098.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$627.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,019.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$395.28
|
| Rate for Payer: Multiplan Commercial |
$1,317.60
|
| Rate for Payer: Networks By Design Commercial |
$1,070.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,399.95
|
|
|
HC BILIARY COPE LOOP CATH
|
Facility
|
IP
|
$418.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
909001069
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$83.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$83.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$188.10
|
| Rate for Payer: Cash Price |
$188.10
|
| Rate for Payer: Cigna of CA HMO |
$292.60
|
| Rate for Payer: Cigna of CA PPO |
$292.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$167.20
|
| Rate for Payer: EPIC Health Plan Senior |
$167.20
|
| Rate for Payer: Galaxy Health WC |
$355.30
|
| Rate for Payer: Global Benefits Group Commercial |
$250.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$278.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$258.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.32
|
| Rate for Payer: Multiplan Commercial |
$334.40
|
| Rate for Payer: Networks By Design Commercial |
$209.00
|
| Rate for Payer: Prime Health Services Commercial |
$355.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$156.88
|
| Rate for Payer: United Healthcare All Other HMO |
$152.70
|
| Rate for Payer: United Healthcare HMO Rider |
$149.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$136.90
|
|
|
HC BILIARY COPE LOOP CATH
|
Facility
|
OP
|
$418.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
909001069
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$83.60 |
| Max. Negotiated Rate |
$355.30 |
| Rate for Payer: Adventist Health Commercial |
$83.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$355.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$229.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$313.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$242.11
|
| Rate for Payer: Blue Shield of California Commercial |
$308.48
|
| Rate for Payer: Blue Shield of California EPN |
$203.15
|
| Rate for Payer: Cash Price |
$188.10
|
| Rate for Payer: Cigna of CA HMO |
$292.60
|
| Rate for Payer: Cigna of CA PPO |
$292.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$355.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$355.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$355.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$167.20
|
| Rate for Payer: EPIC Health Plan Senior |
$167.20
|
| Rate for Payer: Galaxy Health WC |
$355.30
|
| Rate for Payer: Global Benefits Group Commercial |
$250.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$278.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$258.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$292.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$292.60
|
| Rate for Payer: Multiplan Commercial |
$334.40
|
| Rate for Payer: Networks By Design Commercial |
$209.00
|
| Rate for Payer: Prime Health Services Commercial |
$355.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$250.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$250.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$156.88
|
| Rate for Payer: United Healthcare All Other HMO |
$152.70
|
| Rate for Payer: United Healthcare HMO Rider |
$149.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$136.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$355.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$355.30
|
| Rate for Payer: Vantage Medical Group Senior |
$355.30
|
|
|
HC BILIARY DILATION WITH STENT
|
Facility
|
OP
|
$13,073.00
|
|
|
Service Code
|
CPT 47556
|
| Hospital Charge Code |
909000150
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$577.94 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$2,614.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,842.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,551.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,228.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$7,415.66
|
| Rate for Payer: Cash Price |
$5,882.85
|
| Rate for Payer: Cash Price |
$5,882.85
|
| Rate for Payer: Cash Price |
$5,882.85
|
| Rate for Payer: Cigna of CA HMO |
$8,366.72
|
| Rate for Payer: Cigna of CA PPO |
$9,674.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,842.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,551.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,228.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,858.47
|
| Rate for Payer: EPIC Health Plan Senior |
$13,228.50
|
| Rate for Payer: Galaxy Health WC |
$11,112.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7,843.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$21,694.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$577.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,228.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,719.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$653.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,228.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,137.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,667.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,726.19
|
| Rate for Payer: Multiplan Commercial |
$10,458.40
|
| Rate for Payer: Multiplan WC |
$21,077.25
|
| Rate for Payer: Networks By Design Commercial |
$8,497.45
|
| Rate for Payer: Prime Health Services Commercial |
$11,112.05
|
| Rate for Payer: Prime Health Services WC |
$20,862.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,843.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$13,228.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19,842.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,551.35
|
| Rate for Payer: Vantage Medical Group Senior |
$13,228.50
|
|
|
HC BILIARY DILATION WITH STENT
|
Facility
|
IP
|
$13,073.00
|
|
|
Service Code
|
CPT 47556
|
| Hospital Charge Code |
909000150
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,614.60 |
| Max. Negotiated Rate |
$11,112.05 |
| Rate for Payer: Adventist Health Commercial |
$2,614.60
|
| Rate for Payer: Cash Price |
$5,882.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,229.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,229.20
|
| Rate for Payer: Galaxy Health WC |
$11,112.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7,843.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,719.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,980.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,092.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,137.52
|
| Rate for Payer: Multiplan Commercial |
$10,458.40
|
| Rate for Payer: Networks By Design Commercial |
$8,497.45
|
| Rate for Payer: Prime Health Services Commercial |
$11,112.05
|
|
|
HC BILIARY DILATION W/O STENT
|
Facility
|
OP
|
$7,130.00
|
|
|
Service Code
|
CPT 47555
|
| Hospital Charge Code |
909000149
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$387.79 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$1,426.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,726.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,932.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,484.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,822.94
|
| Rate for Payer: Cash Price |
$3,208.50
|
| Rate for Payer: Cash Price |
$3,208.50
|
| Rate for Payer: Cash Price |
$3,208.50
|
| Rate for Payer: Cigna of CA HMO |
$4,563.20
|
| Rate for Payer: Cigna of CA PPO |
$5,276.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,726.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,932.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,484.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,053.43
|
| Rate for Payer: EPIC Health Plan Senior |
$4,484.02
|
| Rate for Payer: Galaxy Health WC |
$6,060.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,278.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,353.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$387.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,484.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,755.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$438.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,484.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,711.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,649.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,008.59
|
| Rate for Payer: Multiplan Commercial |
$5,704.00
|
| Rate for Payer: Multiplan WC |
$7,144.49
|
| Rate for Payer: Networks By Design Commercial |
$4,634.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,060.50
|
| Rate for Payer: Prime Health Services WC |
$7,071.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,278.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| 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 |
$4,484.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,726.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,932.42
|
| Rate for Payer: Vantage Medical Group Senior |
$4,484.02
|
|
