|
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 |
$5,845.05
|
| 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 DILAT ANAL SPHINC UNDER ANES
|
Facility
|
OP
|
$9,701.00
|
|
|
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 |
$1,940.20
|
| 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 |
$4,365.45
|
| Rate for Payer: Cash Price |
$4,365.45
|
| Rate for Payer: Cash Price |
$4,365.45
|
| Rate for Payer: Cigna of CA HMO |
$6,208.64
|
| Rate for Payer: Cigna of CA PPO |
$7,178.74
|
| 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 |
$8,245.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,820.60
|
| 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 |
$6,470.57
|
| 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 |
$2,328.24
|
| 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 |
$7,760.80
|
| Rate for Payer: Networks By Design Commercial |
$6,305.65
|
| Rate for Payer: Prime Health Services Commercial |
$8,245.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,820.60
|
| 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 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 |
$446.85
|
| Rate for Payer: Cash Price |
$446.85
|
| Rate for Payer: Cash Price |
$446.85
|
| 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 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 |
$446.85
|
| 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 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 |
$444.15
|
| Rate for Payer: Cash Price |
$444.15
|
| 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
|
$4,603.00
|
|
|
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 |
$920.60
|
| 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 |
$2,071.35
|
| Rate for Payer: Cash Price |
$2,071.35
|
| Rate for Payer: Cash Price |
$2,071.35
|
| Rate for Payer: Cigna of CA HMO |
$2,945.92
|
| Rate for Payer: Cigna of CA PPO |
$3,406.22
|
| 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 |
$3,912.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,761.80
|
| 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 |
$3,070.20
|
| 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 |
$1,104.72
|
| 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 |
$3,682.40
|
| Rate for Payer: Networks By Design Commercial |
$2,991.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,912.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,761.80
|
| 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
|
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 |
$2,937.15
|
| 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
|
$4,603.00
|
|
|
Service Code
|
CPT 43450
|
| Hospital Charge Code |
906743450
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$88.43 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$920.60
|
| 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 |
$2,071.35
|
| Rate for Payer: Cash Price |
$2,071.35
|
| Rate for Payer: Cash Price |
$2,071.35
|
| Rate for Payer: Cigna of CA HMO |
$2,945.92
|
| Rate for Payer: Cigna of CA PPO |
$3,406.22
|
| 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 |
$3,912.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,761.80
|
| 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 |
$3,070.20
|
| 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 |
$1,104.72
|
| 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 |
$3,682.40
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Networks By Design Commercial |
$2,991.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,912.55
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,761.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,301.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,301.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,301.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,301.50
|
| 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 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 |
$2,937.15
|
| 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 OVER GUIDE WIRE
|
Facility
|
OP
|
$4,595.00
|
|
|
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 |
$919.00
|
| 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 |
$2,067.75
|
| Rate for Payer: Cash Price |
$2,067.75
|
| Rate for Payer: Cash Price |
$2,067.75
|
| Rate for Payer: Cigna of CA HMO |
$2,940.80
|
| Rate for Payer: Cigna of CA PPO |
$3,400.30
|
| 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 |
$3,905.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,757.00
|
| 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 |
$3,064.86
|
| 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 |
$1,102.80
|
| 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 |
$3,676.00
|
| Rate for Payer: Networks By Design Commercial |
$2,986.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,905.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,757.00
|
| 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 |
$2,346.30
|
| 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 |
$106.20
|
| 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 |
$106.20
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cash Price |
$106.20
|
| 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 |
$6,495.75
|
| Rate for Payer: Cash Price |
$6,495.75
|
| Rate for Payer: Cash Price |
$6,495.75
|
| 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 |
$6,495.75
|
| 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
|
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 |
$2,642.40
|
| Rate for Payer: Cash Price |
$2,642.40
|
| Rate for Payer: Cash Price |
$2,642.40
|
| 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
|
|
|
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 |
$2,642.40
|
| 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 DILATOR VESSEL 5-13 FR 20 CM
|
Facility
|
OP
|
$31.00
|
|
| Hospital Charge Code |
909001071
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$26.35 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.04
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cigna of CA HMO |
$19.84
|
| Rate for Payer: Cigna of CA PPO |
$22.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.40
|
| Rate for Payer: EPIC Health Plan Senior |
$12.40
|
| Rate for Payer: Galaxy Health WC |
$26.35
|
| Rate for Payer: Global Benefits Group Commercial |
$18.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.70
|
| Rate for Payer: Multiplan Commercial |
$24.80
|
| Rate for Payer: Networks By Design Commercial |
$20.15
|
| Rate for Payer: Prime Health Services Commercial |
$26.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.50
|
| Rate for Payer: United Healthcare All Other HMO |
$15.50
|
| Rate for Payer: United Healthcare HMO Rider |
$15.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.35
|
| Rate for Payer: Vantage Medical Group Senior |
$26.35
|
|
|
HC DILATOR VESSEL 5-13 FR 20 CM
|
Facility
|
IP
|
$31.00
|
|
| Hospital Charge Code |
909001071
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$26.35 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.40
|
| Rate for Payer: EPIC Health Plan Senior |
$12.40
|
| Rate for Payer: Galaxy Health WC |
$26.35
|
| Rate for Payer: Global Benefits Group Commercial |
$18.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.44
|
| Rate for Payer: Multiplan Commercial |
$24.80
|
| Rate for Payer: Networks By Design Commercial |
$20.15
|
| Rate for Payer: Prime Health Services Commercial |
$26.35
|
|
|
HC DILAT RECTAL STRICTURE W ANESTH
|
Facility
|
OP
|
$9,953.00
|
|
|
Service Code
|
CPT 45910
|
| Hospital Charge Code |
906745910
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$177.63 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$1,990.60
|
| 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 |
$4,478.85
|
| Rate for Payer: Cash Price |
$4,478.85
|
| Rate for Payer: Cash Price |
$4,478.85
|
| Rate for Payer: Cigna of CA HMO |
$6,369.92
|
| Rate for Payer: Cigna of CA PPO |
$7,365.22
|
| 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 |
$8,460.05
|
| Rate for Payer: Global Benefits Group Commercial |
$5,971.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,456.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$177.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,498.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,638.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,498.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,388.72
|
| 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 |
$7,962.40
|
| Rate for Payer: Networks By Design Commercial |
$6,469.45
|
| Rate for Payer: Prime Health Services Commercial |
$8,460.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,971.80
|
| 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 RECTAL STRICTURE W ANESTH
|
Facility
|
IP
|
$13,325.00
|
|
|
Service Code
|
CPT 45910
|
| Hospital Charge Code |
906745910
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,665.00 |
| Max. Negotiated Rate |
$11,326.25 |
| Rate for Payer: Adventist Health Commercial |
$2,665.00
|
| Rate for Payer: Cash Price |
$5,996.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,330.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,330.00
|
| Rate for Payer: Galaxy Health WC |
$11,326.25
|
| Rate for Payer: Global Benefits Group Commercial |
$7,995.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,887.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,076.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,248.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,198.00
|
| Rate for Payer: Multiplan Commercial |
$10,660.00
|
| Rate for Payer: Networks By Design Commercial |
$8,661.25
|
| Rate for Payer: Prime Health Services Commercial |
$11,326.25
|
|
|
HC DILAT XST TRC NEW ACCESS RCS
|
Facility
|
IP
|
$7,230.00
|
|
|
Service Code
|
CPT 50437
|
| Hospital Charge Code |
909050437
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,446.00 |
| Max. Negotiated Rate |
$6,145.50 |
| Rate for Payer: Adventist Health Commercial |
$1,446.00
|
| Rate for Payer: Cash Price |
$3,253.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,892.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,892.00
|
| Rate for Payer: Galaxy Health WC |
$6,145.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,338.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,822.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,754.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,475.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,735.20
|
| Rate for Payer: Multiplan Commercial |
$5,784.00
|
| Rate for Payer: Networks By Design Commercial |
$4,699.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,145.50
|
|
|
HC DILAT XST TRC NEW ACCESS RCS
|
Facility
|
OP
|
$7,230.00
|
|
|
Service Code
|
CPT 50437
|
| Hospital Charge Code |
909050437
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$367.77 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$1,446.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| 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 |
$7,415.66
|
| Rate for Payer: Cash Price |
$3,253.50
|
| Rate for Payer: Cash Price |
$3,253.50
|
| Rate for Payer: Cash Price |
$3,253.50
|
| Rate for Payer: Cigna of CA HMO |
$4,627.20
|
| Rate for Payer: Cigna of CA PPO |
$5,350.20
|
| 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 |
$6,145.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,338.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,186.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$367.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,382.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,822.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$415.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,382.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,735.20
|
| 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 |
$5,784.00
|
| Rate for Payer: Multiplan WC |
$6,982.34
|
| Rate for Payer: Networks By Design Commercial |
$4,699.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,145.50
|
| Rate for Payer: Prime Health Services WC |
$6,911.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,338.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,382.26
|
| 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
|
|
|
HC DIRECT ADMIT OBS A/D SAME DT HIGH COMPLEX
|
Facility
|
IP
|
$882.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902100072
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$176.40 |
| Max. Negotiated Rate |
$749.70 |
| Rate for Payer: Adventist Health Commercial |
$176.40
|
| Rate for Payer: Cash Price |
$396.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.80
|
| Rate for Payer: EPIC Health Plan Senior |
$352.80
|
| Rate for Payer: Galaxy Health WC |
$749.70
|
| Rate for Payer: Global Benefits Group Commercial |
$529.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$588.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$336.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$545.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.68
|
| Rate for Payer: Multiplan Commercial |
$705.60
|
| Rate for Payer: Networks By Design Commercial |
$573.30
|
| Rate for Payer: Prime Health Services Commercial |
$749.70
|
|
|
HC DIRECT ADMIT OBS A/D SAME DT HIGH COMPLEX
|
Facility
|
OP
|
$882.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902100072
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$176.40 |
| Max. Negotiated Rate |
$9,601.00 |
| Rate for Payer: Adventist Health Commercial |
$176.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,437.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,168.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$856.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$779.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,689.00
|
| Rate for Payer: Cash Price |
$396.90
|
| Rate for Payer: Cash Price |
$396.90
|
| Rate for Payer: Cash Price |
$396.90
|
| Rate for Payer: Cigna of CA HMO |
$564.48
|
| Rate for Payer: Cigna of CA PPO |
$652.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,168.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$856.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$779.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,051.65
|
| Rate for Payer: EPIC Health Plan Senior |
$779.00
|
| Rate for Payer: Galaxy Health WC |
$749.70
|
| Rate for Payer: Global Benefits Group Commercial |
$529.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,277.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$779.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$588.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$336.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$779.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$981.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,043.86
|
| Rate for Payer: Multiplan Commercial |
$705.60
|
| Rate for Payer: Networks By Design Commercial |
$573.30
|
| Rate for Payer: Prime Health Services Commercial |
$749.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$529.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,601.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,518.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,779.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$779.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,168.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$856.90
|
| Rate for Payer: Vantage Medical Group Senior |
$779.00
|
|
