|
HC ERCP W/BX SNGL OR MULTI
|
Facility
OP
|
$4,620.00
|
|
|
Service Code
|
CPT 43261
|
| Hospital Charge Code |
906743261
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$647.96 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,177.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,263.53
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,785.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: BCBS Transplant Transplant |
$2,772.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,612.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,351.09
|
| Rate for Payer: Cash Price |
$2,079.00
|
| Rate for Payer: Cash Price |
$2,079.00
|
| Rate for Payer: Cigna of CA PPO |
$3,418.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,177.54
|
| Rate for Payer: Dignity Health Media |
$4,785.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,263.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,459.79
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,785.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,785.03
|
| Rate for Payer: Galaxy Health WC |
$3,927.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,772.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,465.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,847.45
|
| Rate for Payer: Heritage Provider Network Transplant |
$7,847.45
|
| Rate for Payer: IEHP Medi-Cal |
$7,751.75
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$7,751.75
|
| Rate for Payer: IEHP Medicare Advantage |
$4,785.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,081.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$647.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,785.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,108.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,029.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,411.94
|
| Rate for Payer: Multiplan Commercial |
$3,696.00
|
| Rate for Payer: Networks By Design Commercial |
$3,003.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,927.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5,263.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,772.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,742.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,177.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,263.53
|
| Rate for Payer: Vantage Medical Group Senior |
$4,785.03
|
|
|
HC ERCP W/BX SNGL OR MULTI
|
Facility
IP
|
$6,913.00
|
|
|
Service Code
|
CPT 43261
|
| Hospital Charge Code |
906743261
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,659.12 |
| Max. Negotiated Rate |
$5,876.05 |
| Rate for Payer: Cash Price |
$3,110.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,765.20
|
| Rate for Payer: Galaxy Health WC |
$5,876.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,147.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,610.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,633.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,659.12
|
| Rate for Payer: Multiplan Commercial |
$5,530.40
|
| Rate for Payer: Networks By Design Commercial |
$4,493.45
|
| Rate for Payer: Prime Health Services Commercial |
$5,876.05
|
|
|
HC ERCP W/ENDO RETRO DESTRUCTION
|
Facility
IP
|
$11,862.00
|
|
|
Service Code
|
CPT 43265
|
| Hospital Charge Code |
906743265
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,846.88 |
| Max. Negotiated Rate |
$10,082.70 |
| Rate for Payer: Cash Price |
$5,337.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,744.80
|
| Rate for Payer: Galaxy Health WC |
$10,082.70
|
| Rate for Payer: Global Benefits Group Commercial |
$7,117.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,911.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,519.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,846.88
|
| Rate for Payer: Multiplan Commercial |
$9,489.60
|
| Rate for Payer: Networks By Design Commercial |
$7,710.30
|
| Rate for Payer: Prime Health Services Commercial |
$10,082.70
|
|
|
HC ERCP W/ENDO RETRO DESTRUCTION
|
Facility
OP
|
$6,801.00
|
|
|
Service Code
|
CPT 43265
|
| Hospital Charge Code |
906743265
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,632.24 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,681.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,832.91
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,120.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: BCBS Transplant Transplant |
$4,080.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,612.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,351.09
|
| Rate for Payer: Cash Price |
$3,060.45
|
| Rate for Payer: Cash Price |
$3,060.45
|
| Rate for Payer: Cigna of CA PPO |
$5,032.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,681.24
|
| Rate for Payer: Dignity Health Media |
$7,120.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,832.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,613.12
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,120.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,120.83
|
| Rate for Payer: Galaxy Health WC |
$5,780.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,080.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5,100.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,678.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$11,678.16
|
| Rate for Payer: IEHP Medi-Cal |
$11,535.74
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$11,535.74
|
| Rate for Payer: IEHP Medicare Advantage |
$7,120.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,536.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,591.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,120.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,632.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,972.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,541.91
|
| Rate for Payer: Multiplan Commercial |
$5,440.80
|
| Rate for Payer: Networks By Design Commercial |
$4,420.65
|
| Rate for Payer: Prime Health Services Commercial |
$5,780.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7,832.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,080.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,545.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,681.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,832.91
|
| Rate for Payer: Vantage Medical Group Senior |
$7,120.83
|
|
|
HC ERCP W/ENDO RETRO RMVL CALCULU
|
Facility
IP
|
$12,560.00
|
|
|
Service Code
|
CPT 43264
|
| Hospital Charge Code |
906743264
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$3,014.40 |
| Max. Negotiated Rate |
$10,676.00 |
| Rate for Payer: Cash Price |
$5,652.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,024.00
|
| Rate for Payer: Galaxy Health WC |
$10,676.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,536.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,377.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,785.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,014.40
|
| Rate for Payer: Multiplan Commercial |
$10,048.00
|
| Rate for Payer: Networks By Design Commercial |
$8,164.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,676.00
|
|
|
HC ERCP W/ENDO RETRO RMVL CALCULU
|
Facility
OP
|
$8,394.00
|
|
|
Service Code
|
CPT 43264
|
| Hospital Charge Code |
906743264
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$729.30 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,177.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,263.53
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,785.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: BCBS Transplant Transplant |
$5,036.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,612.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,351.09
|
| Rate for Payer: Cash Price |
$3,777.30
|
| Rate for Payer: Cash Price |
$3,777.30
|
| Rate for Payer: Cigna of CA PPO |
$6,211.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,177.54
|
| Rate for Payer: Dignity Health Media |
$4,785.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,263.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,459.79
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,785.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,785.03
|
| Rate for Payer: Galaxy Health WC |
$7,134.90
|
| Rate for Payer: Global Benefits Group Commercial |
$5,036.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6,295.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,847.45
|
| Rate for Payer: Heritage Provider Network Transplant |
$7,847.45
|
| Rate for Payer: IEHP Medi-Cal |
$7,751.75
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$7,751.75
|
| Rate for Payer: IEHP Medicare Advantage |
$4,785.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,598.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$729.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,785.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,014.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,029.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,411.94
|
| Rate for Payer: Multiplan Commercial |
$6,715.20
|
| Rate for Payer: Networks By Design Commercial |
$5,456.10
|
| Rate for Payer: Prime Health Services Commercial |
$7,134.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5,263.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,036.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,742.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,177.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,263.53
|
| Rate for Payer: Vantage Medical Group Senior |
$4,785.03
|
|
|
HC ERCP W/PRESS MSRMNT
|
Facility
OP
|
$5,242.00
|
|
|
Service Code
|
CPT 43263
|
| Hospital Charge Code |
906743263
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$507.19 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: BCBS Transplant Transplant |
$3,145.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,612.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,351.09
|
| Rate for Payer: Cash Price |
$2,358.90
|
| Rate for Payer: Cash Price |
$2,358.90
|
| Rate for Payer: Cigna of CA PPO |
$3,879.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Media |
$2,377.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Galaxy Health WC |
$4,455.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,145.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,931.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,899.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,899.02
|
| Rate for Payer: IEHP Medi-Cal |
$3,851.47
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3,851.47
|
| Rate for Payer: IEHP Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,496.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$507.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,258.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Multiplan Commercial |
$4,193.60
|
| Rate for Payer: Networks By Design Commercial |
$3,407.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,455.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,615.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,145.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,852.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC ERCP W/PRESS MSRMNT
|
Facility
IP
|
$7,841.00
|
|
|
Service Code
|
CPT 43263
|
| Hospital Charge Code |
906743263
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,881.84 |
| Max. Negotiated Rate |
$6,664.85 |
| Rate for Payer: Cash Price |
$3,528.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,136.40
|
| Rate for Payer: Galaxy Health WC |
$6,664.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,704.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,229.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,987.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,881.84
|
| Rate for Payer: Multiplan Commercial |
$6,272.80
|
| Rate for Payer: Networks By Design Commercial |
$5,096.65
|
| Rate for Payer: Prime Health Services Commercial |
$6,664.85
|
|
|
HC ERCP W RMVL FB STNT
|
Facility
OP
|
$5,862.00
|
|
|
Service Code
|
CPT 43275
|
| Hospital Charge Code |
906743275
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$650.07 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: BCBS Transplant Transplant |
$3,517.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,612.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,351.09
|
| Rate for Payer: Cash Price |
$2,637.90
|
| Rate for Payer: Cash Price |
$2,637.90
|
| Rate for Payer: Cigna of CA PPO |
$4,337.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Media |
$2,377.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Galaxy Health WC |
$4,982.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,517.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,396.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,899.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,899.02
|
| Rate for Payer: IEHP Medi-Cal |
$3,851.47
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3,851.47
|
| Rate for Payer: IEHP Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,909.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$650.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,406.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Multiplan Commercial |
$4,689.60
|
| Rate for Payer: Networks By Design Commercial |
$3,810.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,982.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,615.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,517.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,852.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC ERCP W RMVL FB STNT
|
Facility
IP
|
$8,771.00
|
|
|
Service Code
|
CPT 43275
|
| Hospital Charge Code |
906743275
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,105.04 |
| Max. Negotiated Rate |
$7,455.35 |
| Rate for Payer: Cash Price |
$3,946.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,508.40
|
| Rate for Payer: Galaxy Health WC |
$7,455.35
|
| Rate for Payer: Global Benefits Group Commercial |
$5,262.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,850.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,341.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,105.04
|
| Rate for Payer: Multiplan Commercial |
$7,016.80
|
| Rate for Payer: Networks By Design Commercial |
$5,701.15
|
| Rate for Payer: Prime Health Services Commercial |
$7,455.35
|
|
|
HC ERCP W RMVL & XCHNG OF STNT INCL SPINC EA STNT
|
Facility
IP
|
$9,624.00
|
|
|
Service Code
|
CPT 43276
|
| Hospital Charge Code |
906743276
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,309.76 |
| Max. Negotiated Rate |
$8,180.40 |
| Rate for Payer: Cash Price |
$4,330.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,849.60
|
| Rate for Payer: Galaxy Health WC |
$8,180.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,774.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,419.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,666.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,309.76
|
| Rate for Payer: Multiplan Commercial |
$7,699.20
|
| Rate for Payer: Networks By Design Commercial |
$6,255.60
|
| Rate for Payer: Prime Health Services Commercial |
$8,180.40
|
|
|
HC ERCP W RMVL & XCHNG OF STNT INCL SPINC EA STNT
|
Facility
OP
|
$6,432.00
|
|
|
Service Code
|
CPT 43276
|
| Hospital Charge Code |
906743276
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$819.85 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,681.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,832.91
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,120.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: BCBS Transplant Transplant |
$3,859.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,612.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,351.09
|
| Rate for Payer: Cash Price |
$2,894.40
|
| Rate for Payer: Cash Price |
$2,894.40
|
| Rate for Payer: Cigna of CA PPO |
$4,759.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,681.24
|
| Rate for Payer: Dignity Health Media |
$7,120.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,832.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,613.12
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,120.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,120.83
|
| Rate for Payer: Galaxy Health WC |
$5,467.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,859.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,824.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,678.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$11,678.16
|
| Rate for Payer: IEHP Medi-Cal |
$11,535.74
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$11,535.74
|
| Rate for Payer: IEHP Medicare Advantage |
$7,120.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,290.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$819.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,120.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,543.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,972.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,541.91
|
| Rate for Payer: Multiplan Commercial |
$5,145.60
|
| Rate for Payer: Networks By Design Commercial |
$4,180.80
|
| Rate for Payer: Prime Health Services Commercial |
$5,467.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7,832.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,859.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,545.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,681.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,832.91
|
| Rate for Payer: Vantage Medical Group Senior |
$7,120.83
|
|
|
HC ERCP W/SPHINCTERTMY
|
Facility
IP
|
$6,675.00
|
|
|
Service Code
|
CPT 43262
|
| Hospital Charge Code |
906743262
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,602.00 |
| Max. Negotiated Rate |
$5,673.75 |
| Rate for Payer: Cash Price |
$3,003.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,670.00
|
| Rate for Payer: Galaxy Health WC |
$5,673.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,005.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,452.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,543.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,602.00
|
| Rate for Payer: Multiplan Commercial |
$5,340.00
|
| Rate for Payer: Networks By Design Commercial |
$4,338.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,673.75
|
|
|
HC ERCP W/SPHINCTERTMY
|
Facility
OP
|
$4,460.00
|
|
|
Service Code
|
CPT 43262
|
| Hospital Charge Code |
906743262
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$703.84 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,177.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,263.53
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,785.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: BCBS Transplant Transplant |
$2,676.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,612.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,351.09
|
| Rate for Payer: Cash Price |
$2,007.00
|
| Rate for Payer: Cash Price |
$2,007.00
|
| Rate for Payer: Cigna of CA PPO |
$3,300.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,177.54
|
| Rate for Payer: Dignity Health Media |
$4,785.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,263.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,459.79
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,785.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,785.03
|
| Rate for Payer: Galaxy Health WC |
$3,791.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,676.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,345.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,847.45
|
| Rate for Payer: Heritage Provider Network Transplant |
$7,847.45
|
| Rate for Payer: IEHP Medi-Cal |
$7,751.75
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$7,751.75
|
| Rate for Payer: IEHP Medicare Advantage |
$4,785.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,974.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$703.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,785.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,070.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,029.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,411.94
|
| Rate for Payer: Multiplan Commercial |
$3,568.00
|
| Rate for Payer: Networks By Design Commercial |
$2,899.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,791.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5,263.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,676.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,742.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,177.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,263.53
|
| Rate for Payer: Vantage Medical Group Senior |
$4,785.03
|
|
|
HC ESBL DISK CONFIRMATION
|
Facility
OP
|
$13.00
|
|
|
Service Code
|
CPT 87184
|
| Hospital Charge Code |
900912449
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$62.84 |
| Rate for Payer: Aetna of CA HMO/PPO |
$57.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.84
|
| Rate for Payer: BCBS Transplant Transplant |
$7.80
|
| Rate for Payer: Blue Shield of California Commercial |
$8.40
|
| Rate for Payer: Blue Shield of California EPN |
$6.66
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Cigna of CA HMO |
$8.32
|
| Rate for Payer: Cigna of CA PPO |
$9.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: Dignity Health Media |
$7.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.48
|
| Rate for Payer: Galaxy Health WC |
$11.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$12.27
|
| Rate for Payer: IEHP Medi-Cal |
$12.12
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$12.12
|
| Rate for Payer: IEHP Medicare Advantage |
$7.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.02
|
| Rate for Payer: Multiplan Commercial |
$10.40
|
| Rate for Payer: Networks By Design Commercial |
$8.45
|
| Rate for Payer: Prime Health Services Commercial |
$11.05
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.06
|
| Rate for Payer: United Healthcare All Other HMO |
$6.06
|
| Rate for Payer: United Healthcare HMO Rider |
$6.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.23
|
| Rate for Payer: Vantage Medical Group Senior |
$7.48
|
|
|
HC ESOPH ACID REFLX TEST
|
Facility
OP
|
$1,578.00
|
|
|
Service Code
|
CPT 91034
|
| Hospital Charge Code |
906791033
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$147.46 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,006.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,004.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$736.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$669.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$940.17
|
| Rate for Payer: BCBS Transplant Transplant |
$946.80
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$710.10
|
| Rate for Payer: Cash Price |
$710.10
|
| Rate for Payer: Cash Price |
$710.10
|
| Rate for Payer: Cigna of CA PPO |
$1,167.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Dignity Health Media |
$669.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$736.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$904.07
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$669.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$669.68
|
| Rate for Payer: Galaxy Health WC |
$1,341.30
|
| Rate for Payer: Global Benefits Group Commercial |
$946.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,183.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,098.28
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,098.28
|
| Rate for Payer: IEHP Medi-Cal |
$1,084.88
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$1,084.88
|
| Rate for Payer: IEHP Medicare Advantage |
$669.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,052.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$147.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$669.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$378.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$843.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$897.37
|
| Rate for Payer: Multiplan Commercial |
$1,262.40
|
| Rate for Payer: Networks By Design Commercial |
$1,025.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,341.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$736.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$946.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$803.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$736.65
|
| Rate for Payer: Vantage Medical Group Senior |
$669.68
|
|
|
HC ESOPH ACID REFLX TEST
|
Facility
IP
|
$3,575.00
|
|
|
Service Code
|
CPT 91034
|
| Hospital Charge Code |
906791033
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$858.00 |
| Max. Negotiated Rate |
$3,038.75 |
| Rate for Payer: Cash Price |
$1,608.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,430.00
|
| Rate for Payer: Galaxy Health WC |
$3,038.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,145.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,384.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,362.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$858.00
|
| Rate for Payer: Multiplan Commercial |
$2,860.00
|
| Rate for Payer: Networks By Design Commercial |
$2,323.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,038.75
|
|
|
HC ESOPHAG DIAG W BALLOON DILATION
|
Facility
IP
|
$5,664.00
|
|
|
Service Code
|
CPT 43220
|
| Hospital Charge Code |
909000188
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,359.36 |
| Max. Negotiated Rate |
$4,814.40 |
| Rate for Payer: Cash Price |
$2,548.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,265.60
|
| Rate for Payer: Galaxy Health WC |
$4,814.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,398.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,777.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,157.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,359.36
|
| Rate for Payer: Multiplan Commercial |
$4,531.20
|
| Rate for Payer: Networks By Design Commercial |
$3,681.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,814.40
|
|
|
HC ESOPHAG DIAG W BALLOON DILATION
|
Facility
OP
|
$3,785.00
|
|
|
Service Code
|
CPT 43220
|
| Hospital Charge Code |
909000188
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$339.53 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$2,271.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$1,703.25
|
| Rate for Payer: Cash Price |
$1,703.25
|
| Rate for Payer: Cigna of CA PPO |
$2,800.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Media |
$2,377.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Galaxy Health WC |
$3,217.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,271.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,838.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,899.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,899.02
|
| Rate for Payer: IEHP Medi-Cal |
$3,851.47
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3,851.47
|
| Rate for Payer: IEHP Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,524.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$339.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$908.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Multiplan Commercial |
$3,028.00
|
| Rate for Payer: Networks By Design Commercial |
$2,460.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,217.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,615.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,271.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,852.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC ESOPHAG DIAG W BALLOON DILATION
|
Facility
OP
|
$3,785.00
|
|
|
Service Code
|
CPT 43220
|
| Hospital Charge Code |
909000188
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$339.53 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$2,271.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$1,703.25
|
| Rate for Payer: Cash Price |
$1,703.25
|
| Rate for Payer: Cigna of CA PPO |
$2,800.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Media |
$2,377.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Galaxy Health WC |
$3,217.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,271.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,838.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,899.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,899.02
|
| Rate for Payer: IEHP Medi-Cal |
$3,851.47
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3,851.47
|
| Rate for Payer: IEHP Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,524.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$339.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$908.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Multiplan Commercial |
$3,028.00
|
| Rate for Payer: Networks By Design Commercial |
$2,460.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,217.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,271.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,271.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC ESOPHAG DIAG W BALLOON DILATION
|
Facility
IP
|
$5,664.00
|
|
|
Service Code
|
CPT 43220
|
| Hospital Charge Code |
909000188
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,359.36 |
| Max. Negotiated Rate |
$4,814.40 |
| Rate for Payer: Cash Price |
$2,548.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,265.60
|
| Rate for Payer: Galaxy Health WC |
$4,814.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,398.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,777.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,157.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,359.36
|
| Rate for Payer: Multiplan Commercial |
$4,531.20
|
| Rate for Payer: Networks By Design Commercial |
$3,681.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,814.40
|
|
|
HC ESOPHAGEAL DILATATION
|
Facility
OP
|
$1,232.00
|
|
|
Service Code
|
CPT 74360
|
| Hospital Charge Code |
909001829
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$207.06 |
| Max. Negotiated Rate |
$1,047.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$573.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,047.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$677.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$677.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$817.61
|
| Rate for Payer: BCBS Transplant Transplant |
$739.20
|
| Rate for Payer: Blue Shield of California Commercial |
$728.11
|
| Rate for Payer: Blue Shield of California EPN |
$577.81
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cigna of CA HMO |
$788.48
|
| Rate for Payer: Cigna of CA PPO |
$911.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,047.20
|
| Rate for Payer: Dignity Health Media |
$1,047.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,047.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$492.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$492.80
|
| Rate for Payer: Galaxy Health WC |
$1,047.20
|
| Rate for Payer: Global Benefits Group Commercial |
$739.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$924.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$821.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$207.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$295.68
|
| Rate for Payer: Multiplan Commercial |
$985.60
|
| Rate for Payer: Networks By Design Commercial |
$800.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,047.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$739.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$739.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$739.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$616.00
|
| Rate for Payer: United Healthcare All Other HMO |
$616.00
|
| Rate for Payer: United Healthcare HMO Rider |
$616.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$616.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,047.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,047.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,047.20
|
|
|
HC ESOPHAGEAL DILATATION
|
Facility
IP
|
$1,232.00
|
|
|
Service Code
|
CPT 74360
|
| Hospital Charge Code |
909001829
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$295.68 |
| Max. Negotiated Rate |
$1,047.20 |
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$492.80
|
| Rate for Payer: Galaxy Health WC |
$1,047.20
|
| Rate for Payer: Global Benefits Group Commercial |
$739.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$821.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$469.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$295.68
|
| Rate for Payer: Multiplan Commercial |
$985.60
|
| Rate for Payer: Networks By Design Commercial |
$800.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,047.20
|
|
|
HC ESOPHAGOGASTRIC TMPONAD W/BLLN
|
Facility
IP
|
$4,104.00
|
|
|
Service Code
|
CPT 43460
|
| Hospital Charge Code |
906743460
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$984.96 |
| Max. Negotiated Rate |
$3,488.40 |
| Rate for Payer: Cash Price |
$1,846.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,641.60
|
| Rate for Payer: Galaxy Health WC |
$3,488.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,462.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,737.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,563.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$984.96
|
| Rate for Payer: Multiplan Commercial |
$3,283.20
|
| Rate for Payer: Networks By Design Commercial |
$2,667.60
|
| Rate for Payer: Prime Health Services Commercial |
$3,488.40
|
|
|
HC ESOPHAGOGASTRIC TMPONAD W/BLLN
|
Facility
OP
|
$3,291.00
|
|
|
Service Code
|
CPT 43460
|
| Hospital Charge Code |
906743460
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$174.72 |
| Max. Negotiated Rate |
$5,938.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,332.32
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,797.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,810.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,810.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,974.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$1,480.95
|
| Rate for Payer: Cash Price |
$1,480.95
|
| Rate for Payer: Cigna of CA PPO |
$2,435.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,797.35
|
| Rate for Payer: Dignity Health Media |
$2,797.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,797.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,316.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,316.40
|
| Rate for Payer: Galaxy Health WC |
$2,797.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,974.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,468.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,195.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$174.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$789.84
|
| Rate for Payer: Multiplan Commercial |
$2,632.80
|
| Rate for Payer: Networks By Design Commercial |
$2,139.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,797.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,974.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,974.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,974.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,797.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,797.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,797.35
|
|
