|
HC DIETITIAN PHONE CONF 15 MINS
|
Facility
|
OP
|
$23.00
|
|
| Hospital Charge Code |
912900005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$19.55 |
| Rate for Payer: Adventist Health Commercial |
$4.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.12
|
| Rate for Payer: Cash Price |
$12.65
|
| Rate for Payer: Cigna of CA HMO |
$14.72
|
| Rate for Payer: Cigna of CA PPO |
$17.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.20
|
| Rate for Payer: EPIC Health Plan Senior |
$9.20
|
| Rate for Payer: Galaxy Health WC |
$19.55
|
| Rate for Payer: Global Benefits Group Commercial |
$13.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.10
|
| Rate for Payer: Multiplan Commercial |
$18.40
|
| Rate for Payer: Networks By Design Commercial |
$14.95
|
| Rate for Payer: Prime Health Services Commercial |
$19.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.50
|
| Rate for Payer: United Healthcare All Other HMO |
$11.50
|
| Rate for Payer: United Healthcare HMO Rider |
$11.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.55
|
| Rate for Payer: Vantage Medical Group Senior |
$19.55
|
|
|
HC DIFFERENTIAL LUNG SCAN
|
Facility
|
OP
|
$3,209.00
|
|
|
Service Code
|
CPT 78597
|
| Hospital Charge Code |
909301404
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$298.35 |
| Max. Negotiated Rate |
$2,727.65 |
| Rate for Payer: Adventist Health Commercial |
$641.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,104.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,326.68
|
| Rate for Payer: Blue Shield of California Commercial |
$1,963.91
|
| Rate for Payer: Blue Shield of California EPN |
$1,296.44
|
| Rate for Payer: Cash Price |
$1,764.95
|
| Rate for Payer: Cash Price |
$1,764.95
|
| Rate for Payer: Cigna of CA HMO |
$2,053.76
|
| Rate for Payer: Cigna of CA PPO |
$2,374.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$689.27
|
| Rate for Payer: EPIC Health Plan Senior |
$510.57
|
| Rate for Payer: Galaxy Health WC |
$2,727.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,925.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$837.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$298.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,140.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$337.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$510.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$770.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$684.16
|
| Rate for Payer: Multiplan Commercial |
$2,567.20
|
| Rate for Payer: Networks By Design Commercial |
$2,085.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,727.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,925.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,925.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$518.19
|
| Rate for Payer: United Healthcare All Other HMO |
$518.19
|
| Rate for Payer: United Healthcare HMO Rider |
$518.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$518.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$510.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC DIFFERENTIAL LUNG SCAN
|
Facility
|
IP
|
$3,209.00
|
|
|
Service Code
|
CPT 78597
|
| Hospital Charge Code |
909301404
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$641.80 |
| Max. Negotiated Rate |
$2,727.65 |
| Rate for Payer: Adventist Health Commercial |
$641.80
|
| Rate for Payer: Cash Price |
$1,764.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,283.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.60
|
| Rate for Payer: Galaxy Health WC |
$2,727.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,925.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,140.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,222.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,986.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$770.16
|
| Rate for Payer: Multiplan Commercial |
$2,567.20
|
| Rate for Payer: Networks By Design Commercial |
$2,085.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,727.65
|
|
|
HC DIGITAL-SCREENING MAMMO, BILAT
|
Facility
|
OP
|
$598.00
|
|
|
Service Code
|
CPT 77067
|
| Hospital Charge Code |
909002010
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$119.60 |
| Max. Negotiated Rate |
$508.30 |
| Rate for Payer: Adventist Health Commercial |
$119.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$392.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$508.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$328.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$367.23
|
| Rate for Payer: Blue Shield of California Commercial |
$365.98
|
| Rate for Payer: Blue Shield of California EPN |
$241.59
|
| Rate for Payer: Cash Price |
$328.90
|
| Rate for Payer: Cash Price |
$328.90
|
| Rate for Payer: Cigna of CA HMO |
$382.72
|
| Rate for Payer: Cigna of CA PPO |
$442.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$508.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$508.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$508.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$239.20
|
| Rate for Payer: EPIC Health Plan Senior |
$239.20
|
| Rate for Payer: Galaxy Health WC |
$508.30
|
| Rate for Payer: Global Benefits Group Commercial |
$358.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$200.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$398.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$226.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$418.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$418.60
|
| Rate for Payer: Multiplan Commercial |
$478.40
|
| Rate for Payer: Networks By Design Commercial |
$388.70
|
| Rate for Payer: Prime Health Services Commercial |
$508.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$358.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$358.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$269.26
|
| Rate for Payer: United Healthcare All Other HMO |
$269.26
|
| Rate for Payer: United Healthcare HMO Rider |
$269.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$269.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$508.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$508.30
|
| Rate for Payer: Vantage Medical Group Senior |
$508.30
|
|
|
HC DIGITAL-SCREENING MAMMO, BILAT
|
Facility
|
IP
|
$598.00
|
|
|
Service Code
|
CPT 77067
|
| Hospital Charge Code |
909002010
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$119.60 |
| Max. Negotiated Rate |
$508.30 |
| Rate for Payer: Adventist Health Commercial |
$119.60
|
| Rate for Payer: Cash Price |
$328.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$239.20
|
| Rate for Payer: EPIC Health Plan Senior |
$239.20
|
| Rate for Payer: Galaxy Health WC |
$508.30
|
| Rate for Payer: Global Benefits Group Commercial |
$358.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$398.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$227.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.52
|
| Rate for Payer: Multiplan Commercial |
$478.40
|
| Rate for Payer: Networks By Design Commercial |
$388.70
|
| Rate for Payer: Prime Health Services Commercial |
$508.30
|
|
|
HC DIGOXIN
|
Facility
|
IP
|
$191.00
|
|
|
Service Code
|
CPT 80162
|
| Hospital Charge Code |
900910816
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.20 |
| Max. Negotiated Rate |
$162.35 |
| Rate for Payer: Adventist Health Commercial |
$38.20
|
| Rate for Payer: Cash Price |
$105.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.40
|
| Rate for Payer: EPIC Health Plan Senior |
$76.40
|
| Rate for Payer: Galaxy Health WC |
$162.35
|
| Rate for Payer: Global Benefits Group Commercial |
$114.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$127.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$118.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.84
|
| Rate for Payer: Multiplan Commercial |
$152.80
|
| Rate for Payer: Networks By Design Commercial |
$124.15
|
| Rate for Payer: Prime Health Services Commercial |
$162.35
|
|
|
HC DIGOXIN
|
Facility
|
OP
|
$191.00
|
|
|
Service Code
|
CPT 80162
|
| Hospital Charge Code |
900910816
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.76 |
| Max. Negotiated Rate |
$162.35 |
| Rate for Payer: Adventist Health Commercial |
$38.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$125.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$131.13
|
| Rate for Payer: Blue Shield of California Commercial |
$127.78
|
| Rate for Payer: Blue Shield of California EPN |
$84.42
|
| Rate for Payer: Cash Price |
$105.05
|
| Rate for Payer: Cash Price |
$105.05
|
| Rate for Payer: Cigna of CA HMO |
$122.24
|
| Rate for Payer: Cigna of CA PPO |
$141.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.93
|
| Rate for Payer: EPIC Health Plan Senior |
$13.28
|
| Rate for Payer: Galaxy Health WC |
$162.35
|
| Rate for Payer: Global Benefits Group Commercial |
$114.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$127.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.80
|
| Rate for Payer: Multiplan Commercial |
$152.80
|
| Rate for Payer: Networks By Design Commercial |
$124.15
|
| Rate for Payer: Prime Health Services Commercial |
$162.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$114.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$114.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.76
|
| Rate for Payer: United Healthcare All Other HMO |
$10.76
|
| Rate for Payer: United Healthcare HMO Rider |
$10.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.76
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.61
|
| Rate for Payer: Vantage Medical Group Senior |
$13.28
|
|
|
HC DILAT ANAL SPHINC UNDER ANES
|
Facility
|
OP
|
$12,989.00
|
|
|
Service Code
|
CPT 45905
|
| Hospital Charge Code |
906745905
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$253.31 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$2,597.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,498.14
|
| 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 |
$1,845.77
|
| Rate for Payer: Cash Price |
$7,143.95
|
| Rate for Payer: Cash Price |
$7,143.95
|
| Rate for Payer: Cash Price |
$7,143.95
|
| Rate for Payer: Cigna of CA HMO |
$8,312.96
|
| Rate for Payer: Cigna of CA PPO |
$9,611.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,647.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,498.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,022.49
|
| Rate for Payer: EPIC Health Plan Senior |
$1,498.14
|
| Rate for Payer: Galaxy Health WC |
$11,040.65
|
| Rate for Payer: Global Benefits Group Commercial |
$7,793.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,456.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$253.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,498.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,663.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$286.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,498.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,117.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,887.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,007.51
|
| Rate for Payer: Multiplan Commercial |
$10,391.20
|
| Rate for Payer: Networks By Design Commercial |
$8,442.85
|
| Rate for Payer: Prime Health Services Commercial |
$11,040.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,793.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,797.77
|
| 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 |
$1,498.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,498.14
|
|
|
HC DILAT ANAL SPHINC UNDER ANES
|
Facility
|
IP
|
$12,989.00
|
|
|
Service Code
|
CPT 45905
|
| Hospital Charge Code |
906745905
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,597.80 |
| Max. Negotiated Rate |
$11,040.65 |
| Rate for Payer: Adventist Health Commercial |
$2,597.80
|
| Rate for Payer: Cash Price |
$7,143.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,195.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5,195.60
|
| Rate for Payer: Galaxy Health WC |
$11,040.65
|
| Rate for Payer: Global Benefits Group Commercial |
$7,793.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,663.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,948.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,040.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,117.36
|
| Rate for Payer: Multiplan Commercial |
$10,391.20
|
| Rate for Payer: Networks By Design Commercial |
$8,442.85
|
| Rate for Payer: Prime Health Services Commercial |
$11,040.65
|
|
|
HC DILATE BILIARY OR AMPULLA PERC
|
Facility
|
IP
|
$993.00
|
|
|
Service Code
|
CPT 47542
|
| Hospital Charge Code |
909047542
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$198.60 |
| Max. Negotiated Rate |
$844.05 |
| Rate for Payer: Adventist Health Commercial |
$198.60
|
| Rate for Payer: Cash Price |
$546.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$397.20
|
| Rate for Payer: EPIC Health Plan Senior |
$397.20
|
| Rate for Payer: Galaxy Health WC |
$844.05
|
| Rate for Payer: Global Benefits Group Commercial |
$595.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$662.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$378.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$614.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.32
|
| Rate for Payer: Multiplan Commercial |
$794.40
|
| Rate for Payer: Networks By Design Commercial |
$645.45
|
| Rate for Payer: Prime Health Services Commercial |
$844.05
|
|
|
HC DILATE BILIARY OR AMPULLA PERC
|
Facility
|
OP
|
$993.00
|
|
|
Service Code
|
CPT 47542
|
| Hospital Charge Code |
909047542
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$198.60 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$198.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$844.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$546.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$744.75
|
| 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 |
$546.15
|
| Rate for Payer: Cash Price |
$546.15
|
| Rate for Payer: Cash Price |
$546.15
|
| Rate for Payer: Cigna of CA HMO |
$635.52
|
| Rate for Payer: Cigna of CA PPO |
$734.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$844.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$844.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$844.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$397.20
|
| Rate for Payer: EPIC Health Plan Senior |
$397.20
|
| Rate for Payer: Galaxy Health WC |
$844.05
|
| Rate for Payer: Global Benefits Group Commercial |
$595.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$788.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$662.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$891.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$614.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$695.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$695.10
|
| Rate for Payer: Multiplan Commercial |
$794.40
|
| Rate for Payer: Networks By Design Commercial |
$645.45
|
| Rate for Payer: Prime Health Services Commercial |
$844.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$595.80
|
| 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 |
$844.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$844.05
|
| Rate for Payer: Vantage Medical Group Senior |
$844.05
|
|
|
HC DILATE ESOPHAGUS
|
Facility
|
IP
|
$987.00
|
|
|
Service Code
|
CPT 43456
|
| Hospital Charge Code |
906743456
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$197.40 |
| Max. Negotiated Rate |
$838.95 |
| Rate for Payer: Adventist Health Commercial |
$197.40
|
| Rate for Payer: Cash Price |
$542.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$394.80
|
| Rate for Payer: EPIC Health Plan Senior |
$394.80
|
| Rate for Payer: Galaxy Health WC |
$838.95
|
| Rate for Payer: Global Benefits Group Commercial |
$592.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$658.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$376.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$610.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$236.88
|
| Rate for Payer: Multiplan Commercial |
$789.60
|
| Rate for Payer: Networks By Design Commercial |
$641.55
|
| Rate for Payer: Prime Health Services Commercial |
$838.95
|
|
|
HC DILATE ESOPHAGUS
|
Facility
|
OP
|
$987.00
|
|
|
Service Code
|
CPT 43456
|
| Hospital Charge Code |
906743456
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$197.40 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$197.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$838.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$542.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$740.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$606.12
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$542.85
|
| Rate for Payer: Cash Price |
$542.85
|
| Rate for Payer: Cigna of CA HMO |
$631.68
|
| Rate for Payer: Cigna of CA PPO |
$730.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$838.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$838.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$838.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$394.80
|
| Rate for Payer: EPIC Health Plan Senior |
$394.80
|
| Rate for Payer: Galaxy Health WC |
$838.95
|
| Rate for Payer: Global Benefits Group Commercial |
$592.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$658.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$376.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$610.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$236.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$690.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$690.90
|
| Rate for Payer: Multiplan Commercial |
$789.60
|
| Rate for Payer: Networks By Design Commercial |
$641.55
|
| Rate for Payer: Prime Health Services Commercial |
$838.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$592.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$592.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$493.50
|
| Rate for Payer: United Healthcare All Other HMO |
$493.50
|
| Rate for Payer: United Healthcare HMO Rider |
$493.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$493.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$838.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$838.95
|
| Rate for Payer: Vantage Medical Group Senior |
$838.95
|
|
|
HC DILAT ESOPH BOUGIE/SNGL OR MUL
|
Facility
|
OP
|
$6,527.00
|
|
|
Service Code
|
CPT 43450
|
| Hospital Charge Code |
906743450
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$78.19 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$1,305.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$3,589.85
|
| Rate for Payer: Cash Price |
$3,589.85
|
| Rate for Payer: Cash Price |
$3,589.85
|
| Rate for Payer: Cigna of CA HMO |
$4,177.28
|
| Rate for Payer: Cigna of CA PPO |
$4,829.98
|
| 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 |
$5,547.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,916.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$78.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,353.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,566.48
|
| 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 |
$5,221.60
|
| Rate for Payer: Networks By Design Commercial |
$4,242.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,547.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,916.20
|
| 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 DILAT ESOPH BOUGIE/SNGL OR MUL
|
Facility
|
IP
|
$6,527.00
|
|
|
Service Code
|
CPT 43450
|
| Hospital Charge Code |
906743450
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,305.40 |
| Max. Negotiated Rate |
$5,547.95 |
| Rate for Payer: Adventist Health Commercial |
$1,305.40
|
| Rate for Payer: Cash Price |
$3,589.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,610.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,610.80
|
| Rate for Payer: Galaxy Health WC |
$5,547.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,916.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,353.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,486.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,040.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,566.48
|
| Rate for Payer: Multiplan Commercial |
$5,221.60
|
| Rate for Payer: Networks By Design Commercial |
$4,242.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,547.95
|
|
|
HC DILAT ESOPH BOUGIE/SNGL OR MUL
|
Facility
|
IP
|
$6,527.00
|
|
|
Service Code
|
CPT 43450
|
| Hospital Charge Code |
906743450
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,305.40 |
| Max. Negotiated Rate |
$5,547.95 |
| Rate for Payer: Adventist Health Commercial |
$1,305.40
|
| Rate for Payer: Cash Price |
$3,589.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,610.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,610.80
|
| Rate for Payer: Galaxy Health WC |
$5,547.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,916.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,353.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,486.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,040.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,566.48
|
| Rate for Payer: Multiplan Commercial |
$5,221.60
|
| Rate for Payer: Networks By Design Commercial |
$4,242.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,547.95
|
|
|
HC DILAT ESOPH BOUGIE/SNGL OR MUL
|
Facility
|
OP
|
$6,527.00
|
|
|
Service Code
|
CPT 43450
|
| Hospital Charge Code |
906743450
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$88.43 |
| Max. Negotiated Rate |
$5,547.95 |
| Rate for Payer: EPIC Health Plan Senior |
$1,191.26
|
| Rate for Payer: Adventist Health Commercial |
$1,305.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$3,589.85
|
| Rate for Payer: Cash Price |
$3,589.85
|
| Rate for Payer: Cash Price |
$3,589.85
|
| Rate for Payer: Cigna of CA HMO |
$4,177.28
|
| Rate for Payer: Cigna of CA PPO |
$4,829.98
|
| 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: Galaxy Health WC |
$5,547.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,916.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,353.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,566.48
|
| 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 |
$5,221.60
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Networks By Design Commercial |
$4,242.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,547.95
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,916.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,263.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,263.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,263.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,263.50
|
| 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 DILAT ESOPH OVER GUIDE WIRE
|
Facility
|
OP
|
$5,214.00
|
|
|
Service Code
|
CPT 43453
|
| Hospital Charge Code |
906743453
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$168.87 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$1,042.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,410.32
|
| 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 |
$2,867.70
|
| Rate for Payer: Cash Price |
$2,867.70
|
| Rate for Payer: Cash Price |
$2,867.70
|
| Rate for Payer: Cigna of CA HMO |
$3,336.96
|
| Rate for Payer: Cigna of CA PPO |
$3,858.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,651.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,410.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,253.93
|
| Rate for Payer: EPIC Health Plan Senior |
$2,410.32
|
| Rate for Payer: Galaxy Health WC |
$4,431.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,128.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$168.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,477.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$190.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,251.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,037.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,229.83
|
| Rate for Payer: Multiplan Commercial |
$4,171.20
|
| Rate for Payer: Networks By Design Commercial |
$3,389.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,431.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,128.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,892.38
|
| 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 |
$2,410.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,410.32
|
|
|
HC DILAT ESOPH OVER GUIDE WIRE
|
Facility
|
IP
|
$5,214.00
|
|
|
Service Code
|
CPT 43453
|
| Hospital Charge Code |
906743453
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,042.80 |
| Max. Negotiated Rate |
$4,431.90 |
| Rate for Payer: Adventist Health Commercial |
$1,042.80
|
| Rate for Payer: Cash Price |
$2,867.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,085.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,085.60
|
| Rate for Payer: Galaxy Health WC |
$4,431.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,128.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,477.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,986.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,227.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,251.36
|
| Rate for Payer: Multiplan Commercial |
$4,171.20
|
| Rate for Payer: Networks By Design Commercial |
$3,389.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,431.90
|
|
|
HC DILATE TEAR DUCT OPENING
|
Facility
|
IP
|
$236.00
|
|
|
Service Code
|
CPT 68801
|
| Hospital Charge Code |
900501698
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$47.20 |
| Max. Negotiated Rate |
$200.60 |
| Rate for Payer: Adventist Health Commercial |
$47.20
|
| Rate for Payer: Cash Price |
$129.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.40
|
| Rate for Payer: EPIC Health Plan Senior |
$94.40
|
| Rate for Payer: Galaxy Health WC |
$200.60
|
| Rate for Payer: Global Benefits Group Commercial |
$141.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$157.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$146.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.64
|
| Rate for Payer: Multiplan Commercial |
$188.80
|
| Rate for Payer: Networks By Design Commercial |
$153.40
|
| Rate for Payer: Prime Health Services Commercial |
$200.60
|
|
|
HC DILATE TEAR DUCT OPENING
|
Facility
|
OP
|
$236.00
|
|
|
Service Code
|
CPT 68801
|
| Hospital Charge Code |
900501698
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$47.20 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$47.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$129.80
|
| Rate for Payer: Cash Price |
$129.80
|
| Rate for Payer: Cash Price |
$129.80
|
| Rate for Payer: Cigna of CA HMO |
$151.04
|
| Rate for Payer: Cigna of CA PPO |
$174.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$760.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$557.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$684.48
|
| Rate for Payer: EPIC Health Plan Senior |
$507.02
|
| Rate for Payer: Galaxy Health WC |
$200.60
|
| Rate for Payer: Global Benefits Group Commercial |
$141.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$831.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$157.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$259.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$638.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$679.41
|
| Rate for Payer: Multiplan Commercial |
$188.80
|
| Rate for Payer: Multiplan WC |
$807.84
|
| Rate for Payer: Networks By Design Commercial |
$153.40
|
| Rate for Payer: Prime Health Services Commercial |
$200.60
|
| Rate for Payer: Prime Health Services WC |
$799.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$141.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$118.00
|
| Rate for Payer: United Healthcare All Other HMO |
$118.00
|
| Rate for Payer: United Healthcare HMO Rider |
$118.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$118.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$507.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Vantage Medical Group Senior |
$507.02
|
|
|
HC DILATION OF CERVICAL CANAL
|
Facility
|
OP
|
$14,435.00
|
|
|
Service Code
|
CPT 57800
|
| Hospital Charge Code |
900501483
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$136.34 |
| Max. Negotiated Rate |
$12,269.75 |
| Rate for Payer: Adventist Health Commercial |
$2,887.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,039.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$7,939.25
|
| Rate for Payer: Cash Price |
$7,939.25
|
| Rate for Payer: Cash Price |
$7,939.25
|
| Rate for Payer: Cigna of CA HMO |
$9,238.40
|
| Rate for Payer: Cigna of CA PPO |
$10,681.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,443.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,039.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,453.88
|
| Rate for Payer: EPIC Health Plan Senior |
$4,039.91
|
| Rate for Payer: Galaxy Health WC |
$12,269.75
|
| Rate for Payer: Global Benefits Group Commercial |
$8,661.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,625.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,039.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,628.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,039.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,464.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,090.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,413.48
|
| Rate for Payer: Multiplan Commercial |
$11,548.00
|
| Rate for Payer: Multiplan WC |
$6,436.87
|
| Rate for Payer: Networks By Design Commercial |
$9,382.75
|
| Rate for Payer: Prime Health Services Commercial |
$12,269.75
|
| Rate for Payer: Prime Health Services WC |
$6,371.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,661.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,217.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,217.50
|
| Rate for Payer: United Healthcare HMO Rider |
$7,217.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,217.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,039.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Vantage Medical Group Senior |
$4,039.91
|
|
|
HC DILATION OF CERVICAL CANAL
|
Facility
|
IP
|
$14,435.00
|
|
|
Service Code
|
CPT 57800
|
| Hospital Charge Code |
900501483
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,887.00 |
| Max. Negotiated Rate |
$12,269.75 |
| Rate for Payer: Adventist Health Commercial |
$2,887.00
|
| Rate for Payer: Cash Price |
$7,939.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,774.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,774.00
|
| Rate for Payer: Galaxy Health WC |
$12,269.75
|
| Rate for Payer: Global Benefits Group Commercial |
$8,661.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,628.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,499.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,935.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,464.40
|
| Rate for Payer: Multiplan Commercial |
$11,548.00
|
| Rate for Payer: Networks By Design Commercial |
$9,382.75
|
| Rate for Payer: Prime Health Services Commercial |
$12,269.75
|
|
|
HC DILATION OF NEPHROSTOMY
|
Facility
|
IP
|
$5,872.00
|
|
|
Service Code
|
CPT 50436
|
| Hospital Charge Code |
909000168
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,174.40 |
| Max. Negotiated Rate |
$4,991.20 |
| Rate for Payer: Adventist Health Commercial |
$1,174.40
|
| Rate for Payer: Cash Price |
$3,229.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,348.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,348.80
|
| Rate for Payer: Galaxy Health WC |
$4,991.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,523.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,916.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,237.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,634.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,409.28
|
| Rate for Payer: Multiplan Commercial |
$4,697.60
|
| Rate for Payer: Networks By Design Commercial |
$3,816.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,991.20
|
|
|
HC DILATION OF NEPHROSTOMY
|
Facility
|
OP
|
$5,872.00
|
|
|
Service Code
|
CPT 50436
|
| Hospital Charge Code |
909000168
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$220.79 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$1,174.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,573.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,820.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,382.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$3,229.60
|
| Rate for Payer: Cash Price |
$3,229.60
|
| Rate for Payer: Cash Price |
$3,229.60
|
| Rate for Payer: Cigna of CA HMO |
$3,758.08
|
| Rate for Payer: Cigna of CA PPO |
$4,345.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,573.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,820.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,382.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,916.05
|
| Rate for Payer: EPIC Health Plan Senior |
$4,382.26
|
| Rate for Payer: Galaxy Health WC |
$4,991.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,523.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,186.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$220.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,382.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,916.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$249.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,382.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,409.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,521.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,872.23
|
| Rate for Payer: Multiplan Commercial |
$4,697.60
|
| Rate for Payer: Multiplan WC |
$6,982.34
|
| Rate for Payer: Networks By Design Commercial |
$3,816.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,991.20
|
| Rate for Payer: Prime Health Services WC |
$6,911.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,523.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,382.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,573.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,820.49
|
| Rate for Payer: Vantage Medical Group Senior |
$4,382.26
|
|
