|
HC BILIARY DILATION W/O STENT
|
Facility
|
IP
|
$7,130.00
|
|
|
Service Code
|
CPT 47555
|
| Hospital Charge Code |
909000149
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,426.00 |
| Max. Negotiated Rate |
$6,060.50 |
| Rate for Payer: Adventist Health Commercial |
$1,426.00
|
| Rate for Payer: Cash Price |
$3,208.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,852.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,852.00
|
| Rate for Payer: Galaxy Health WC |
$6,060.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,278.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,755.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,716.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,413.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,711.20
|
| Rate for Payer: Multiplan Commercial |
$5,704.00
|
| Rate for Payer: Networks By Design Commercial |
$4,634.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,060.50
|
|
|
HC BILIARY DRAINAGE CATH CHANGE
|
Facility
|
OP
|
$6,620.00
|
|
|
Service Code
|
CPT 47536
|
| Hospital Charge Code |
909000147
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$973.00 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$1,324.00
|
| 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: Cash Price |
$2,979.00
|
| Rate for Payer: Cash Price |
$2,979.00
|
| Rate for Payer: Cash Price |
$2,979.00
|
| Rate for Payer: Cigna of CA HMO |
$4,236.80
|
| Rate for Payer: Cigna of CA PPO |
$4,898.80
|
| 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 |
$5,627.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,972.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,353.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,484.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,415.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,428.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,484.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,588.80
|
| 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 |
$5,296.00
|
| Rate for Payer: Multiplan WC |
$7,144.49
|
| Rate for Payer: Networks By Design Commercial |
$4,303.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,627.00
|
| Rate for Payer: Prime Health Services WC |
$7,071.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,972.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,310.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,310.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,310.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,310.00
|
| 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 DRAINAGE CATH CHANGE
|
Facility
|
IP
|
$6,620.00
|
|
|
Service Code
|
CPT 47536
|
| Hospital Charge Code |
909000147
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,324.00 |
| Max. Negotiated Rate |
$5,627.00 |
| Rate for Payer: Adventist Health Commercial |
$1,324.00
|
| Rate for Payer: Cash Price |
$2,979.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,648.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,648.00
|
| Rate for Payer: Galaxy Health WC |
$5,627.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,972.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,415.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,522.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,097.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,588.80
|
| Rate for Payer: Multiplan Commercial |
$5,296.00
|
| Rate for Payer: Networks By Design Commercial |
$4,303.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,627.00
|
|
|
HC BILIARY DRAINAGE CATH CHANGE
|
Facility
|
IP
|
$6,620.00
|
|
|
Service Code
|
CPT 47536
|
| Hospital Charge Code |
909000147
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,324.00 |
| Max. Negotiated Rate |
$5,627.00 |
| Rate for Payer: Adventist Health Commercial |
$1,324.00
|
| Rate for Payer: Cash Price |
$2,979.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,648.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,648.00
|
| Rate for Payer: Galaxy Health WC |
$5,627.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,972.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,415.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,522.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,097.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,588.80
|
| Rate for Payer: Multiplan Commercial |
$5,296.00
|
| Rate for Payer: Networks By Design Commercial |
$4,303.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,627.00
|
|
|
HC BILIARY DRAINAGE CATH CHANGE
|
Facility
|
OP
|
$6,620.00
|
|
|
Service Code
|
CPT 47536
|
| Hospital Charge Code |
909000147
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,263.44 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$1,324.00
|
| 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 |
$2,979.00
|
| Rate for Payer: Cash Price |
$2,979.00
|
| Rate for Payer: Cash Price |
$2,979.00
|
| Rate for Payer: Cigna of CA HMO |
$4,236.80
|
| Rate for Payer: Cigna of CA PPO |
$4,898.80
|
| 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 |
$5,627.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,972.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,353.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,263.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,484.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,415.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,428.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,484.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,588.80
|
| 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 |
$5,296.00
|
| Rate for Payer: Multiplan WC |
$7,144.49
|
| Rate for Payer: Networks By Design Commercial |
$4,303.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,627.00
|
| Rate for Payer: Prime Health Services WC |
$7,071.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,972.00
|
| 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
|
|
|
HC BILIARY ENDOPROSTHESIS
|
Facility
|
IP
|
$2,611.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909001046
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$522.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$522.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,174.95
|
| Rate for Payer: Cash Price |
$1,174.95
|
| Rate for Payer: Cigna of CA HMO |
$1,827.70
|
| Rate for Payer: Cigna of CA PPO |
$1,827.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,044.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,044.40
|
| Rate for Payer: Galaxy Health WC |
$2,219.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,566.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,741.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$994.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,616.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$626.64
|
| Rate for Payer: Multiplan Commercial |
$2,088.80
|
| Rate for Payer: Networks By Design Commercial |
$1,305.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,219.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$979.91
|
| Rate for Payer: United Healthcare All Other HMO |
$953.80
|
| Rate for Payer: United Healthcare HMO Rider |
$933.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$855.10
|
|
|
HC BILIARY ENDOPROSTHESIS
|
Facility
|
OP
|
$2,611.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909001046
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$522.20 |
| Max. Negotiated Rate |
$2,219.35 |
| Rate for Payer: Adventist Health Commercial |
$522.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,219.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,436.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,958.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,512.29
|
| Rate for Payer: Blue Shield of California Commercial |
$1,926.92
|
| Rate for Payer: Blue Shield of California EPN |
$1,268.95
|
| Rate for Payer: Cash Price |
$1,174.95
|
| Rate for Payer: Cigna of CA HMO |
$1,827.70
|
| Rate for Payer: Cigna of CA PPO |
$1,827.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,219.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,219.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,219.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,044.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,044.40
|
| Rate for Payer: Galaxy Health WC |
$2,219.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,566.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,741.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,616.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$626.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,827.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,827.70
|
| Rate for Payer: Multiplan Commercial |
$2,088.80
|
| Rate for Payer: Networks By Design Commercial |
$1,305.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,219.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,566.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,566.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$979.91
|
| Rate for Payer: United Healthcare All Other HMO |
$953.80
|
| Rate for Payer: United Healthcare HMO Rider |
$933.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$855.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,219.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,219.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,219.35
|
|
|
HC BILIARY ENDOPROTHESIS
|
Facility
|
IP
|
$455.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909001066
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$91.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Cigna of CA HMO |
$318.50
|
| Rate for Payer: Cigna of CA PPO |
$318.50
|
| 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 |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$386.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$170.76
|
| Rate for Payer: United Healthcare All Other HMO |
$166.21
|
| Rate for Payer: United Healthcare HMO Rider |
$162.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$149.01
|
|
|
HC BILIARY ENDOPROTHESIS
|
Facility
|
OP
|
$455.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909001066
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$386.75 |
| Rate for Payer: Adventist Health Commercial |
$91.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$386.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$250.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$341.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$263.54
|
| Rate for Payer: Blue Shield of California Commercial |
$335.79
|
| Rate for Payer: Blue Shield of California EPN |
$221.13
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Cigna of CA HMO |
$318.50
|
| Rate for Payer: Cigna of CA PPO |
$318.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$386.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$386.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$386.75
|
| 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 Medicare Advantage |
$281.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$318.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$318.50
|
| Rate for Payer: Multiplan Commercial |
$364.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| 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 |
$170.76
|
| Rate for Payer: United Healthcare All Other HMO |
$166.21
|
| Rate for Payer: United Healthcare HMO Rider |
$162.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$149.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$386.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$386.75
|
| Rate for Payer: Vantage Medical Group Senior |
$386.75
|
|
|
HC BILIARY ENDSCPY, INTRAOP
|
Facility
|
IP
|
$8,603.00
|
|
|
Service Code
|
CPT 47550
|
| Hospital Charge Code |
909047550
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,720.60 |
| Max. Negotiated Rate |
$7,312.55 |
| Rate for Payer: Adventist Health Commercial |
$1,720.60
|
| Rate for Payer: Cash Price |
$3,871.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,441.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,441.20
|
| Rate for Payer: Galaxy Health WC |
$7,312.55
|
| Rate for Payer: Global Benefits Group Commercial |
$5,161.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,738.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,277.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,325.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,064.72
|
| Rate for Payer: Multiplan Commercial |
$6,882.40
|
| Rate for Payer: Networks By Design Commercial |
$5,591.95
|
| Rate for Payer: Prime Health Services Commercial |
$7,312.55
|
|
|
HC BILIARY ENDSCPY, INTRAOP
|
Facility
|
OP
|
$8,603.00
|
|
|
Service Code
|
CPT 47550
|
| Hospital Charge Code |
909047550
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$185.76 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,720.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,312.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,731.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,452.25
|
| 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 |
$3,871.35
|
| Rate for Payer: Cash Price |
$3,871.35
|
| Rate for Payer: Cash Price |
$3,871.35
|
| Rate for Payer: Cigna of CA HMO |
$5,505.92
|
| Rate for Payer: Cigna of CA PPO |
$6,366.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,312.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,312.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,312.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,441.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,441.20
|
| Rate for Payer: Galaxy Health WC |
$7,312.55
|
| Rate for Payer: Global Benefits Group Commercial |
$5,161.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$185.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,738.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$210.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,325.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,064.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,022.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,022.10
|
| Rate for Payer: Multiplan Commercial |
$6,882.40
|
| Rate for Payer: Networks By Design Commercial |
$5,591.95
|
| Rate for Payer: Prime Health Services Commercial |
$7,312.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,161.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,312.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,312.55
|
| Rate for Payer: Vantage Medical Group Senior |
$7,312.55
|
|
|
HC BILIARY ENDSCPY, PERC; W RMVL OF CLCLS
|
Facility
|
OP
|
$14,910.00
|
|
|
Service Code
|
CPT 47554
|
| Hospital Charge Code |
909047554
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$509.75 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$2,982.00
|
| 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 |
$2,822.94
|
| Rate for Payer: Cash Price |
$6,709.50
|
| Rate for Payer: Cash Price |
$6,709.50
|
| Rate for Payer: Cash Price |
$6,709.50
|
| Rate for Payer: Cigna of CA HMO |
$9,542.40
|
| Rate for Payer: Cigna of CA PPO |
$11,033.40
|
| 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 |
$12,673.50
|
| Rate for Payer: Global Benefits Group Commercial |
$8,946.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$21,694.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$509.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,228.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,944.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$576.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,228.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,578.40
|
| 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 |
$11,928.00
|
| Rate for Payer: Multiplan WC |
$21,077.25
|
| Rate for Payer: Networks By Design Commercial |
$9,691.50
|
| Rate for Payer: Prime Health Services Commercial |
$12,673.50
|
| Rate for Payer: Prime Health Services WC |
$20,862.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,946.00
|
| 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 ENDSCPY, PERC; W RMVL OF CLCLS
|
Facility
|
IP
|
$14,910.00
|
|
|
Service Code
|
CPT 47554
|
| Hospital Charge Code |
909047554
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,982.00 |
| Max. Negotiated Rate |
$12,673.50 |
| Rate for Payer: Adventist Health Commercial |
$2,982.00
|
| Rate for Payer: Cash Price |
$6,709.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,964.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,964.00
|
| Rate for Payer: Galaxy Health WC |
$12,673.50
|
| Rate for Payer: Global Benefits Group Commercial |
$8,946.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,944.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,680.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,229.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,578.40
|
| Rate for Payer: Multiplan Commercial |
$11,928.00
|
| Rate for Payer: Networks By Design Commercial |
$9,691.50
|
| Rate for Payer: Prime Health Services Commercial |
$12,673.50
|
|
|
HC BILIARY STNT PLCMNT EXT ACCESS
|
Facility
|
OP
|
$20,587.00
|
|
|
Service Code
|
CPT 47538
|
| Hospital Charge Code |
909047538
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,822.94 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$4,117.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,119.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,154.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,413.14
|
| 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 |
$9,264.15
|
| Rate for Payer: Cash Price |
$9,264.15
|
| Rate for Payer: Cash Price |
$9,264.15
|
| Rate for Payer: Cigna of CA HMO |
$13,175.68
|
| Rate for Payer: Cigna of CA PPO |
$15,234.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,119.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,154.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,413.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,007.74
|
| Rate for Payer: EPIC Health Plan Senior |
$7,413.14
|
| Rate for Payer: Galaxy Health WC |
$17,498.95
|
| Rate for Payer: Global Benefits Group Commercial |
$12,352.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,157.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,038.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,413.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,731.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,960.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,413.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,940.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,340.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,933.61
|
| Rate for Payer: Multiplan Commercial |
$16,469.60
|
| Rate for Payer: Multiplan WC |
$11,811.52
|
| Rate for Payer: Networks By Design Commercial |
$13,381.55
|
| Rate for Payer: Prime Health Services Commercial |
$17,498.95
|
| Rate for Payer: Prime Health Services WC |
$11,690.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,352.20
|
| 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 |
$7,413.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,119.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,154.45
|
| Rate for Payer: Vantage Medical Group Senior |
$7,413.14
|
|
|
HC BILIARY STNT PLCMNT EXT ACCESS
|
Facility
|
IP
|
$20,587.00
|
|
|
Service Code
|
CPT 47538
|
| Hospital Charge Code |
909047538
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,117.40 |
| Max. Negotiated Rate |
$17,498.95 |
| Rate for Payer: Adventist Health Commercial |
$4,117.40
|
| Rate for Payer: Cash Price |
$9,264.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,234.80
|
| Rate for Payer: EPIC Health Plan Senior |
$8,234.80
|
| Rate for Payer: Galaxy Health WC |
$17,498.95
|
| Rate for Payer: Global Benefits Group Commercial |
$12,352.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,731.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,843.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,743.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,940.88
|
| Rate for Payer: Multiplan Commercial |
$16,469.60
|
| Rate for Payer: Networks By Design Commercial |
$13,381.55
|
| Rate for Payer: Prime Health Services Commercial |
$17,498.95
|
|
|
HC BILIARY STONE REMVL T-TUBE
|
Facility
|
OP
|
$10,736.00
|
|
|
Service Code
|
CPT 47544
|
| Hospital Charge Code |
909000151
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,000.00 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$2,147.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,125.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,904.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,052.00
|
| 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 |
$4,831.20
|
| Rate for Payer: Cash Price |
$4,831.20
|
| Rate for Payer: Cash Price |
$4,831.20
|
| Rate for Payer: Cigna of CA HMO |
$6,871.04
|
| Rate for Payer: Cigna of CA PPO |
$7,944.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,125.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,125.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,125.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,294.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,294.40
|
| Rate for Payer: Galaxy Health WC |
$9,125.60
|
| Rate for Payer: Global Benefits Group Commercial |
$6,441.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,250.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,160.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,414.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,645.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,576.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,515.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,515.20
|
| Rate for Payer: Multiplan Commercial |
$8,588.80
|
| Rate for Payer: Networks By Design Commercial |
$6,978.40
|
| Rate for Payer: Prime Health Services Commercial |
$9,125.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,441.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| 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 |
$9,125.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,125.60
|
| Rate for Payer: Vantage Medical Group Senior |
$9,125.60
|
|
|
HC BILIARY STONE REMVL T-TUBE
|
Facility
|
IP
|
$10,736.00
|
|
|
Service Code
|
CPT 47544
|
| Hospital Charge Code |
909000151
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,147.20 |
| Max. Negotiated Rate |
$9,125.60 |
| Rate for Payer: Adventist Health Commercial |
$2,147.20
|
| Rate for Payer: Cash Price |
$4,831.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,294.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,294.40
|
| Rate for Payer: Galaxy Health WC |
$9,125.60
|
| Rate for Payer: Global Benefits Group Commercial |
$6,441.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,160.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,090.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,645.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,576.64
|
| Rate for Payer: Multiplan Commercial |
$8,588.80
|
| Rate for Payer: Networks By Design Commercial |
$6,978.40
|
| Rate for Payer: Prime Health Services Commercial |
$9,125.60
|
|
|
HC BILIARY TRACT CELLVIZIO
|
Facility
|
OP
|
$7,965.00
|
|
|
Service Code
|
CPT 47999
|
| Hospital Charge Code |
906747999
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,191.26 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,593.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| 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 |
$4,891.31
|
| 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 |
$3,584.25
|
| Rate for Payer: Cash Price |
$3,584.25
|
| Rate for Payer: Cash Price |
$3,584.25
|
| Rate for Payer: Cigna of CA HMO |
$5,097.60
|
| Rate for Payer: Cigna of CA PPO |
$5,894.10
|
| 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 |
$6,770.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,779.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,312.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,911.60
|
| 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 |
$6,372.00
|
| Rate for Payer: Networks By Design Commercial |
$5,177.25
|
| Rate for Payer: Prime Health Services Commercial |
$6,770.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,779.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,429.51
|
| 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 TRACT CELLVIZIO
|
Facility
|
IP
|
$6,066.00
|
|
|
Service Code
|
CPT 47999
|
| Hospital Charge Code |
906747999
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,213.20 |
| Max. Negotiated Rate |
$5,156.10 |
| Rate for Payer: Adventist Health Commercial |
$1,213.20
|
| Rate for Payer: Cash Price |
$2,729.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,426.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,426.40
|
| Rate for Payer: Galaxy Health WC |
$5,156.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,639.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,046.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,311.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,754.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,455.84
|
| Rate for Payer: Multiplan Commercial |
$4,852.80
|
| Rate for Payer: Networks By Design Commercial |
$3,942.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,156.10
|
|
|
HC BILIARY TUBE CK-CHOLANGIO
|
Facility
|
OP
|
$6,466.00
|
|
|
Service Code
|
CPT 47532
|
| Hospital Charge Code |
909000144
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,258.44 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$1,293.20
|
| 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 |
$2,909.70
|
| Rate for Payer: Cash Price |
$2,909.70
|
| Rate for Payer: Cash Price |
$2,909.70
|
| Rate for Payer: Cigna of CA HMO |
$4,138.24
|
| Rate for Payer: Cigna of CA PPO |
$4,784.84
|
| 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 |
$5,496.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,879.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,353.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,258.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,484.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,312.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,423.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,484.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,551.84
|
| 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 |
$5,172.80
|
| Rate for Payer: Multiplan WC |
$7,144.49
|
| Rate for Payer: Networks By Design Commercial |
$4,202.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,496.10
|
| Rate for Payer: Prime Health Services WC |
$7,071.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,879.60
|
| 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 TUBE CK-CHOLANGIO
|
Facility
|
IP
|
$6,466.00
|
|
|
Service Code
|
CPT 47532
|
| Hospital Charge Code |
909000144
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,293.20 |
| Max. Negotiated Rate |
$5,496.10 |
| Rate for Payer: Adventist Health Commercial |
$1,293.20
|
| Rate for Payer: Cash Price |
$2,909.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,586.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,586.40
|
| Rate for Payer: Galaxy Health WC |
$5,496.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,879.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,312.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,463.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,002.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,551.84
|
| Rate for Payer: Multiplan Commercial |
$5,172.80
|
| Rate for Payer: Networks By Design Commercial |
$4,202.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,496.10
|
|
|
HC BILI DUCT DILITATION PERC
|
Facility
|
IP
|
$2,432.00
|
|
|
Service Code
|
CPT 74363
|
| Hospital Charge Code |
909001856
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$486.40 |
| Max. Negotiated Rate |
$2,067.20 |
| Rate for Payer: Adventist Health Commercial |
$486.40
|
| Rate for Payer: Cash Price |
$1,094.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$972.80
|
| Rate for Payer: EPIC Health Plan Senior |
$972.80
|
| Rate for Payer: Galaxy Health WC |
$2,067.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,459.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,622.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$926.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,505.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$583.68
|
| Rate for Payer: Multiplan Commercial |
$1,945.60
|
| Rate for Payer: Networks By Design Commercial |
$1,580.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,067.20
|
|
|
HC BILI DUCT DILITATION PERC
|
Facility
|
OP
|
$2,432.00
|
|
|
Service Code
|
CPT 74363
|
| Hospital Charge Code |
909001856
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$222.05 |
| Max. Negotiated Rate |
$2,067.20 |
| Rate for Payer: Adventist Health Commercial |
$486.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,595.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,067.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,337.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,824.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,714.82
|
| Rate for Payer: Blue Shield of California Commercial |
$1,488.38
|
| Rate for Payer: Blue Shield of California EPN |
$982.53
|
| Rate for Payer: Cash Price |
$1,094.40
|
| Rate for Payer: Cash Price |
$1,094.40
|
| Rate for Payer: Cigna of CA HMO |
$1,556.48
|
| Rate for Payer: Cigna of CA PPO |
$1,799.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,067.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,067.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,067.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$972.80
|
| Rate for Payer: EPIC Health Plan Senior |
$972.80
|
| Rate for Payer: Galaxy Health WC |
$2,067.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,459.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$222.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,622.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$251.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,505.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$583.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,702.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,702.40
|
| Rate for Payer: Multiplan Commercial |
$1,945.60
|
| Rate for Payer: Networks By Design Commercial |
$1,580.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,067.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,459.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,459.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,216.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,216.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,216.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,216.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,067.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,067.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,067.20
|
|
|
HC BILIRUBIN DIRECT
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 82248
|
| Hospital Charge Code |
900910504
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.07 |
| Max. Negotiated Rate |
$49.41 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.41
|
| Rate for Payer: Blue Shield of California Commercial |
$22.75
|
| Rate for Payer: Blue Shield of California EPN |
$15.03
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna of CA HMO |
$21.76
|
| Rate for Payer: Cigna of CA PPO |
$25.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.78
|
| Rate for Payer: EPIC Health Plan Senior |
$5.02
|
| Rate for Payer: Galaxy Health WC |
$28.90
|
| Rate for Payer: Global Benefits Group Commercial |
$20.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.73
|
| Rate for Payer: Multiplan Commercial |
$27.20
|
| Rate for Payer: Networks By Design Commercial |
$22.10
|
| Rate for Payer: Prime Health Services Commercial |
$28.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.07
|
| Rate for Payer: United Healthcare All Other HMO |
$4.07
|
| Rate for Payer: United Healthcare HMO Rider |
$4.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.07
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: Vantage Medical Group Senior |
$5.02
|
|
|
HC BILIRUBIN DIRECT
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 82248
|
| Hospital Charge Code |
900910504
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$83.30 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.20
|
| Rate for Payer: EPIC Health Plan Senior |
$39.20
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$60.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.52
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
|
