|
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 |
$269.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$418.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$379.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$352.82
|
| 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 |
$85.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$133.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$121.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$112.69
|
| 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: Adventist Health Commercial |
$10.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.92
|
| 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 Medi-Cal |
$14.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$137.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$137.03
|
| Rate for Payer: Blue Shield of California Commercial |
$23.51
|
| Rate for Payer: Blue Shield of California Commercial |
$133.13
|
| Rate for Payer: Blue Shield of California Commercial |
$35.55
|
| Rate for Payer: Blue Shield of California Commercial |
$88.05
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Cash Price |
$85.95
|
| Rate for Payer: Cash Price |
$85.95
|
| Rate for Payer: Cigna of CA HMO |
$32.64
|
| Rate for Payer: Cigna of CA HMO |
$122.24
|
| Rate for Payer: Cigna of CA PPO |
$141.34
|
| Rate for Payer: Cigna of CA PPO |
$37.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$133.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.91
|
| Rate for Payer: EPIC Health Plan Senior |
$14.61
|
| Rate for Payer: EPIC Health Plan Senior |
$14.61
|
| Rate for Payer: Galaxy Health WC |
$162.35
|
| Rate for Payer: Galaxy Health WC |
$43.35
|
| Rate for Payer: Global Benefits Group Commercial |
$114.60
|
| Rate for Payer: Global Benefits Group Commercial |
$30.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.78
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.82
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$121.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.80
|
| Rate for Payer: Multiplan Commercial |
$40.80
|
| Rate for Payer: Multiplan Commercial |
$152.80
|
| Rate for Payer: Networks By Design Commercial |
$33.15
|
| Rate for Payer: Networks By Design Commercial |
$124.15
|
| Rate for Payer: Prime Health Services Commercial |
$162.35
|
| Rate for Payer: Prime Health Services Commercial |
$43.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$114.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$114.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.76
|
| 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 All Other HMO |
$10.76
|
| Rate for Payer: United Healthcare HMO Rider |
$10.76
|
| Rate for Payer: United Healthcare HMO Rider |
$10.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.76
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.28
|
| 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 Commercial/Exchange |
$19.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.61
|
| Rate for Payer: Vantage Medical Group Senior |
$13.28
|
| Rate for Payer: Vantage Medical Group Senior |
$13.28
|
|
|
HC DILAPAN DILATOR 3X55MM
|
Facility
|
IP
|
$200.00
|
|
| Hospital Charge Code |
988169900
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$118.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
|
|
HC DILAPAN DILATOR 3X55MM
|
Facility
|
OP
|
$200.00
|
|
| Hospital Charge Code |
988169900
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$131.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$110.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$128.34
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna of CA HMO |
$128.00
|
| Rate for Payer: Cigna of CA PPO |
$148.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$170.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$170.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$118.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.00
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO |
$100.00
|
| Rate for Payer: United Healthcare HMO Rider |
$100.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$100.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$170.00
|
| Rate for Payer: Vantage Medical Group Senior |
$170.00
|
|
|
HC DILAPAN DILATOR 4X55MM
|
Facility
|
IP
|
$200.00
|
|
| Hospital Charge Code |
988169901
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$118.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
|
|
HC DILAPAN DILATOR 4X55MM
|
Facility
|
OP
|
$200.00
|
|
| Hospital Charge Code |
988169901
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$131.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$110.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$128.34
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna of CA HMO |
$128.00
|
| Rate for Payer: Cigna of CA PPO |
$148.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$170.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$170.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$118.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.00
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO |
$100.00
|
| Rate for Payer: United Healthcare HMO Rider |
$100.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$100.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$170.00
|
| Rate for Payer: Vantage Medical Group Senior |
$170.00
|
|
|
HC DILAPAN DILATOR 4X65MM
|
Facility
|
IP
|
$200.00
|
|
| Hospital Charge Code |
988169902
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$118.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
|
|
HC DILAPAN DILATOR 4X65MM
|
Facility
|
OP
|
$200.00
|
|
| Hospital Charge Code |
988169902
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$131.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$110.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$128.34
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna of CA HMO |
$128.00
|
| Rate for Payer: Cigna of CA PPO |
$148.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$170.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$170.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$118.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.00
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO |
$100.00
|
| Rate for Payer: United Healthcare HMO Rider |
$100.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$100.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$170.00
|
| Rate for Payer: Vantage Medical Group Senior |
$170.00
|
|
|
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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,940.20
|
| Rate for Payer: Adventist Health Commercial |
$2,597.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,692.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,692.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,539.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,539.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Cash Price |
$5,845.05
|
| Rate for Payer: Cash Price |
$4,365.45
|
| Rate for Payer: Cash Price |
$4,365.45
|
| Rate for Payer: Cash Price |
$5,845.05
|
| Rate for Payer: Cash Price |
$5,845.05
|
| Rate for Payer: Cash Price |
$4,365.45
|
| Rate for Payer: Cigna of CA HMO |
$6,208.64
|
| Rate for Payer: Cigna of CA HMO |
$8,312.96
|
| Rate for Payer: Cigna of CA PPO |
$9,611.86
|
| Rate for Payer: Cigna of CA PPO |
$7,178.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,692.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,692.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,539.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,539.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,790.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,092.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,539.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,539.48
|
| Rate for Payer: EPIC Health Plan Senior |
$1,692.99
|
| Rate for Payer: EPIC Health Plan Senior |
$1,692.99
|
| Rate for Payer: Galaxy Health WC |
$8,245.85
|
| Rate for Payer: Galaxy Health WC |
$11,040.65
|
| Rate for Payer: Global Benefits Group Commercial |
$7,793.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,820.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,524.09
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,524.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$253.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$253.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,539.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,539.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,160.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,248.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$286.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$286.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,154.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,154.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,117.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,328.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,939.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,939.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,062.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,062.37
|
| Rate for Payer: Multiplan Commercial |
$10,391.20
|
| Rate for Payer: Multiplan Commercial |
$7,760.80
|
| Rate for Payer: Networks By Design Commercial |
$6,305.65
|
| Rate for Payer: Networks By Design Commercial |
$8,442.85
|
| Rate for Payer: Prime Health Services Commercial |
$8,245.85
|
| Rate for Payer: Prime Health Services Commercial |
$11,040.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,820.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,793.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,846.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,846.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,494.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,850.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| 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 HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,539.08
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,539.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,692.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,692.99
|
| Rate for Payer: Vantage Medical Group Senior |
$1,539.08
|
| Rate for Payer: Vantage Medical Group Senior |
$1,539.08
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,092.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$8,248.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,663.51
|
| 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 |
$446.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$695.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$630.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$585.87
|
| 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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$198.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| 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 |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,454.70
|
| Rate for Payer: Blue Shield of California Commercial |
$2,942.61
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$695.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$630.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$891.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$585.87
|
| 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 |
$496.50
|
| 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 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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,305.40
|
| Rate for Payer: Adventist Health Commercial |
$920.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Cash Price |
$2,071.35
|
| Rate for Payer: Cash Price |
$2,937.15
|
| Rate for Payer: Cash Price |
$2,937.15
|
| Rate for Payer: Cash Price |
$2,071.35
|
| Rate for Payer: Cash Price |
$2,071.35
|
| Rate for Payer: Cash Price |
$2,937.15
|
| Rate for Payer: Cigna of CA HMO |
$4,177.28
|
| Rate for Payer: Cigna of CA HMO |
$2,945.92
|
| Rate for Payer: Cigna of CA PPO |
$3,406.22
|
| Rate for Payer: Cigna of CA PPO |
$4,829.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,568.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,222.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: Galaxy Health WC |
$5,547.95
|
| Rate for Payer: Galaxy Health WC |
$3,912.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,761.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,916.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$78.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$78.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,144.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,922.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$88.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$88.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,104.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,566.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,469.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,469.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,563.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$3,682.40
|
| Rate for Payer: Multiplan Commercial |
$5,221.60
|
| Rate for Payer: Networks By Design Commercial |
$4,242.55
|
| Rate for Payer: Networks By Design Commercial |
$2,991.95
|
| Rate for Payer: Prime Health Services Commercial |
$5,547.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,912.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,916.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,761.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,399.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,399.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,301.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,263.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| 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 HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,568.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$4,144.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,850.93
|
| 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 |
$2,937.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,568.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$4,144.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,850.93
|
| 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 |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$920.60
|
| Rate for Payer: Adventist Health Commercial |
$1,305.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$2,071.35
|
| Rate for Payer: Cash Price |
$2,071.35
|
| Rate for Payer: Cash Price |
$2,937.15
|
| Rate for Payer: Cash Price |
$2,937.15
|
| Rate for Payer: Cash Price |
$2,071.35
|
| Rate for Payer: Cash Price |
$2,937.15
|
| Rate for Payer: Cigna of CA HMO |
$4,177.28
|
| Rate for Payer: Cigna of CA HMO |
$2,945.92
|
| Rate for Payer: Cigna of CA PPO |
$3,406.22
|
| Rate for Payer: Cigna of CA PPO |
$4,829.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,568.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,222.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: Galaxy Health WC |
$3,912.55
|
| Rate for Payer: Galaxy Health WC |
$5,547.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,916.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,761.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,922.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,144.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$88.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$88.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,254.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,254.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,104.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,566.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,469.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,469.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,563.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$5,221.60
|
| Rate for Payer: Multiplan Commercial |
$3,682.40
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Networks By Design Commercial |
$4,242.55
|
| 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 Commercial |
$5,547.95
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| 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: 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 Commercial |
$3,263.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,263.50
|
| 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 HMO Rider |
$3,263.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,301.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,263.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,042.80
|
| Rate for Payer: Adventist Health Commercial |
$919.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Cash Price |
$2,067.75
|
| Rate for Payer: Cash Price |
$2,346.30
|
| Rate for Payer: Cash Price |
$2,346.30
|
| Rate for Payer: Cash Price |
$2,067.75
|
| Rate for Payer: Cash Price |
$2,067.75
|
| Rate for Payer: Cash Price |
$2,346.30
|
| Rate for Payer: Cigna of CA HMO |
$3,336.96
|
| Rate for Payer: Cigna of CA HMO |
$2,940.80
|
| Rate for Payer: Cigna of CA PPO |
$3,400.30
|
| Rate for Payer: Cigna of CA PPO |
$3,858.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,649.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,216.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: Galaxy Health WC |
$4,431.90
|
| Rate for Payer: Galaxy Health WC |
$3,905.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,757.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,128.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$168.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$168.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,310.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,917.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$190.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$190.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,102.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,251.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,109.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,109.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,307.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$3,676.00
|
| Rate for Payer: Multiplan Commercial |
$4,171.20
|
| Rate for Payer: Networks By Design Commercial |
$3,389.10
|
| Rate for Payer: Networks By Design Commercial |
$2,986.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,431.90
|
| Rate for Payer: Prime Health Services Commercial |
$3,905.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,128.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,757.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,961.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,961.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,297.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,607.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| 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 HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,649.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3,310.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,076.26
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$165.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$149.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$139.24
|
| 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 |
$5,641.00 |
| Rate for Payer: EPIC Health Plan Commercial |
$948.02
|
| Rate for Payer: EPIC Health Plan Senior |
$632.02
|
| Rate for Payer: Galaxy Health WC |
$200.60
|
| 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 |
$861.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$574.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$861.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$632.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$574.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$165.20
|
| Rate for Payer: Global Benefits Group Commercial |
$141.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$942.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$574.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$149.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$259.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$617.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$723.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$769.91
|
| 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 |
$574.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Vantage Medical Group Senior |
$574.56
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,104.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$9,166.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,516.65
|
| 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 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 |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,163.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$6,245.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,579.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,163.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,104.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,869.74
|
| Rate for Payer: EPIC Health Plan Senior |
$4,579.83
|
| 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/Senior |
$6,828.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,166.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$136.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,475.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,464.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,245.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,579.06
|
| 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 |
$4,163.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Vantage Medical Group Senior |
$4,163.48
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,110.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3,728.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,464.48
|
| 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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,174.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,987.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,533.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| 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 |
$6,800.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,987.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,533.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,110.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,480.62
|
| Rate for Payer: EPIC Health Plan Senior |
$4,987.08
|
| 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/Senior |
$7,435.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$220.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,533.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,728.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$249.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,347.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,409.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,712.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,075.17
|
| 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 |
$2,936.00
|
| 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 |
$4,533.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,987.08
|
| Rate for Payer: Vantage Medical Group Senior |
$4,533.71
|
|
