|
HC ENDO SM INT ILEUM DIAG
|
Facility
|
IP
|
$6,410.00
|
|
|
Service Code
|
CPT 44376
|
| Hospital Charge Code |
906744376
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,282.00 |
| Max. Negotiated Rate |
$5,448.50 |
| Rate for Payer: Adventist Health Commercial |
$1,282.00
|
| Rate for Payer: Cash Price |
$3,525.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,564.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,564.00
|
| Rate for Payer: Galaxy Health WC |
$5,448.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,846.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,275.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,442.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,967.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,538.40
|
| Rate for Payer: Multiplan Commercial |
$5,128.00
|
| Rate for Payer: Networks By Design Commercial |
$4,166.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,448.50
|
|
|
HC ENDO SM INT ILEUM W BX
|
Facility
|
OP
|
$4,168.00
|
|
|
Service Code
|
CPT 44377
|
| Hospital Charge Code |
906744377
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$448.46 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$833.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| 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 |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$2,292.40
|
| Rate for Payer: Cash Price |
$2,292.40
|
| Rate for Payer: Cash Price |
$2,292.40
|
| Rate for Payer: Cigna of CA HMO |
$2,667.52
|
| Rate for Payer: Cigna of CA PPO |
$3,084.32
|
| 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 |
$3,542.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,500.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$448.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,780.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$507.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,000.32
|
| 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 |
$3,334.40
|
| Rate for Payer: Networks By Design Commercial |
$2,709.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,542.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,500.80
|
| 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 ENDO SM INT ILEUM W BX
|
Facility
|
IP
|
$4,168.00
|
|
|
Service Code
|
CPT 44377
|
| Hospital Charge Code |
906744377
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$833.60 |
| Max. Negotiated Rate |
$3,542.80 |
| Rate for Payer: Adventist Health Commercial |
$833.60
|
| Rate for Payer: Cash Price |
$2,292.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,667.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,667.20
|
| Rate for Payer: Galaxy Health WC |
$3,542.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,500.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,780.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,588.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,579.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,000.32
|
| Rate for Payer: Multiplan Commercial |
$3,334.40
|
| Rate for Payer: Networks By Design Commercial |
$2,709.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,542.80
|
|
|
HC ENDO SM INT ILEUM W CNTRL BLEEDING
|
Facility
|
IP
|
$4,168.00
|
|
|
Service Code
|
CPT 44378
|
| Hospital Charge Code |
906744378
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$833.60 |
| Max. Negotiated Rate |
$3,542.80 |
| Rate for Payer: Adventist Health Commercial |
$833.60
|
| Rate for Payer: Cash Price |
$2,292.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,667.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,667.20
|
| Rate for Payer: Galaxy Health WC |
$3,542.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,500.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,780.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,588.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,579.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,000.32
|
| Rate for Payer: Multiplan Commercial |
$3,334.40
|
| Rate for Payer: Networks By Design Commercial |
$2,709.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,542.80
|
|
|
HC ENDO SM INT ILEUM W CNTRL BLEEDING
|
Facility
|
OP
|
$4,168.00
|
|
|
Service Code
|
CPT 44378
|
| Hospital Charge Code |
906744378
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$584.81 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$833.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| 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 |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$2,292.40
|
| Rate for Payer: Cash Price |
$2,292.40
|
| Rate for Payer: Cash Price |
$2,292.40
|
| Rate for Payer: Cigna of CA HMO |
$2,667.52
|
| Rate for Payer: Cigna of CA PPO |
$3,084.32
|
| 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 |
$3,542.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,500.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$584.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,780.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$661.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,000.32
|
| 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 |
$3,334.40
|
| Rate for Payer: Networks By Design Commercial |
$2,709.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,542.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,500.80
|
| 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 ENDO SM INT ILEUM W STNT PLCMNT
|
Facility
|
OP
|
$9,147.00
|
|
|
Service Code
|
CPT 44379
|
| Hospital Charge Code |
906744379
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$540.41 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$1,829.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13,086.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,345.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,320.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,563.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| 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 |
$5,030.85
|
| Rate for Payer: Cash Price |
$5,030.85
|
| Rate for Payer: Cash Price |
$5,030.85
|
| Rate for Payer: Cigna of CA HMO |
$5,854.08
|
| Rate for Payer: Cigna of CA PPO |
$6,768.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,345.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,320.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,563.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,210.91
|
| Rate for Payer: EPIC Health Plan Senior |
$7,563.64
|
| Rate for Payer: Galaxy Health WC |
$7,774.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,488.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,404.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$540.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,563.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,101.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$611.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,563.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,195.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,530.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,135.28
|
| Rate for Payer: Multiplan Commercial |
$7,317.60
|
| Rate for Payer: Networks By Design Commercial |
$5,945.55
|
| Rate for Payer: Prime Health Services Commercial |
$7,774.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,488.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,076.37
|
| 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 |
$7,563.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,345.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,320.00
|
| Rate for Payer: Vantage Medical Group Senior |
$7,563.64
|
|
|
HC ENDO SM INT ILEUM W STNT PLCMNT
|
Facility
|
IP
|
$9,147.00
|
|
|
Service Code
|
CPT 44379
|
| Hospital Charge Code |
906744379
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,829.40 |
| Max. Negotiated Rate |
$7,774.95 |
| Rate for Payer: Adventist Health Commercial |
$1,829.40
|
| Rate for Payer: Cash Price |
$5,030.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,658.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,658.80
|
| Rate for Payer: Galaxy Health WC |
$7,774.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,488.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,101.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,485.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,661.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,195.28
|
| Rate for Payer: Multiplan Commercial |
$7,317.60
|
| Rate for Payer: Networks By Design Commercial |
$5,945.55
|
| Rate for Payer: Prime Health Services Commercial |
$7,774.95
|
|
|
HC ENDO SM INT W/ABLATION
|
Facility
|
IP
|
$3,335.00
|
|
|
Service Code
|
CPT 44369
|
| Hospital Charge Code |
906744369
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$667.00 |
| Max. Negotiated Rate |
$2,834.75 |
| Rate for Payer: Adventist Health Commercial |
$667.00
|
| Rate for Payer: Cash Price |
$1,834.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,334.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,334.00
|
| Rate for Payer: Galaxy Health WC |
$2,834.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,001.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,224.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,270.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,064.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$800.40
|
| Rate for Payer: Multiplan Commercial |
$2,668.00
|
| Rate for Payer: Networks By Design Commercial |
$2,167.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,834.75
|
|
|
HC ENDO SM INT W/ABLATION
|
Facility
|
OP
|
$3,335.00
|
|
|
Service Code
|
CPT 44369
|
| Hospital Charge Code |
906744369
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$442.83 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$667.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| 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 |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$1,834.25
|
| Rate for Payer: Cash Price |
$1,834.25
|
| Rate for Payer: Cash Price |
$1,834.25
|
| Rate for Payer: Cigna of CA HMO |
$2,134.40
|
| Rate for Payer: Cigna of CA PPO |
$2,467.90
|
| 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 |
$2,834.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,001.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$442.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,224.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$500.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$800.40
|
| 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 |
$2,668.00
|
| Rate for Payer: Networks By Design Commercial |
$2,167.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,834.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,001.00
|
| 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 ENDO SM INT W/ CONVERSION
|
Facility
|
OP
|
$5,788.00
|
|
|
Service Code
|
CPT 44373
|
| Hospital Charge Code |
906744373
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$355.89 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$1,157.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| 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 |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$3,183.40
|
| Rate for Payer: Cash Price |
$3,183.40
|
| Rate for Payer: Cash Price |
$3,183.40
|
| Rate for Payer: Cigna of CA HMO |
$3,704.32
|
| Rate for Payer: Cigna of CA PPO |
$4,283.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,651.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,410.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,253.93
|
| Rate for Payer: EPIC Health Plan Senior |
$2,410.32
|
| Rate for Payer: Galaxy Health WC |
$4,919.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,472.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$355.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,860.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$402.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,389.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,037.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,229.83
|
| Rate for Payer: Multiplan Commercial |
$4,630.40
|
| Rate for Payer: Networks By Design Commercial |
$3,762.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,919.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,472.80
|
| 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 ENDO SM INT W/ CONVERSION
|
Facility
|
IP
|
$5,788.00
|
|
|
Service Code
|
CPT 44373
|
| Hospital Charge Code |
906744373
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,157.60 |
| Max. Negotiated Rate |
$4,919.80 |
| Rate for Payer: Adventist Health Commercial |
$1,157.60
|
| Rate for Payer: Cash Price |
$3,183.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,315.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,315.20
|
| Rate for Payer: Galaxy Health WC |
$4,919.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,472.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,860.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,205.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,582.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,389.12
|
| Rate for Payer: Multiplan Commercial |
$4,630.40
|
| Rate for Payer: Networks By Design Commercial |
$3,762.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,919.80
|
|
|
HC ENDO SM INT W/FORCEPS
|
Facility
|
IP
|
$3,335.00
|
|
|
Service Code
|
CPT 44365
|
| Hospital Charge Code |
906744365
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$667.00 |
| Max. Negotiated Rate |
$2,834.75 |
| Rate for Payer: Adventist Health Commercial |
$667.00
|
| Rate for Payer: Cash Price |
$1,834.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,334.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,334.00
|
| Rate for Payer: Galaxy Health WC |
$2,834.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,001.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,224.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,270.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,064.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$800.40
|
| Rate for Payer: Multiplan Commercial |
$2,668.00
|
| Rate for Payer: Networks By Design Commercial |
$2,167.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,834.75
|
|
|
HC ENDO SM INT W/FORCEPS
|
Facility
|
OP
|
$3,335.00
|
|
|
Service Code
|
CPT 44365
|
| Hospital Charge Code |
906744365
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$436.58 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$667.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| 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 |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$1,834.25
|
| Rate for Payer: Cash Price |
$1,834.25
|
| Rate for Payer: Cash Price |
$1,834.25
|
| Rate for Payer: Cigna of CA HMO |
$2,134.40
|
| Rate for Payer: Cigna of CA PPO |
$2,467.90
|
| 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 |
$2,834.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,001.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$436.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,224.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$493.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$800.40
|
| 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 |
$2,668.00
|
| Rate for Payer: Networks By Design Commercial |
$2,167.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,834.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,001.00
|
| 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 ENDO SM INT W/PLCMNT PERCUT
|
Facility
|
IP
|
$5,796.00
|
|
|
Service Code
|
CPT 44372
|
| Hospital Charge Code |
906744372
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,159.20 |
| Max. Negotiated Rate |
$4,926.60 |
| Rate for Payer: Adventist Health Commercial |
$1,159.20
|
| Rate for Payer: Cash Price |
$3,187.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,318.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,318.40
|
| Rate for Payer: Galaxy Health WC |
$4,926.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,477.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,865.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,208.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,587.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,391.04
|
| Rate for Payer: Multiplan Commercial |
$4,636.80
|
| Rate for Payer: Networks By Design Commercial |
$3,767.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,926.60
|
|
|
HC ENDO SM INT W/PLCMNT PERCUT
|
Facility
|
OP
|
$5,796.00
|
|
|
Service Code
|
CPT 44372
|
| Hospital Charge Code |
906744372
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$402.80 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$1,159.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| 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 |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$3,187.80
|
| Rate for Payer: Cash Price |
$3,187.80
|
| Rate for Payer: Cash Price |
$3,187.80
|
| Rate for Payer: Cigna of CA HMO |
$3,709.44
|
| Rate for Payer: Cigna of CA PPO |
$4,289.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,651.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,410.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,253.93
|
| Rate for Payer: EPIC Health Plan Senior |
$2,410.32
|
| Rate for Payer: Galaxy Health WC |
$4,926.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,477.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$402.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,865.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$455.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,391.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,037.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,229.83
|
| Rate for Payer: Multiplan Commercial |
$4,636.80
|
| Rate for Payer: Networks By Design Commercial |
$3,767.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,926.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,477.60
|
| 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 ENDO SM INT W/RMVL FB
|
Facility
|
IP
|
$4,168.00
|
|
|
Service Code
|
CPT 44363
|
| Hospital Charge Code |
906744363
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$833.60 |
| Max. Negotiated Rate |
$3,542.80 |
| Rate for Payer: Adventist Health Commercial |
$833.60
|
| Rate for Payer: Cash Price |
$2,292.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,667.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,667.20
|
| Rate for Payer: Galaxy Health WC |
$3,542.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,500.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,780.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,588.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,579.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,000.32
|
| Rate for Payer: Multiplan Commercial |
$3,334.40
|
| Rate for Payer: Networks By Design Commercial |
$2,709.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,542.80
|
|
|
HC ENDO SM INT W/RMVL FB
|
Facility
|
OP
|
$4,168.00
|
|
|
Service Code
|
CPT 44363
|
| Hospital Charge Code |
906744363
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$283.95 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$833.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| 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 |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$2,292.40
|
| Rate for Payer: Cash Price |
$2,292.40
|
| Rate for Payer: Cash Price |
$2,292.40
|
| Rate for Payer: Cigna of CA HMO |
$2,667.52
|
| Rate for Payer: Cigna of CA PPO |
$3,084.32
|
| 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 |
$3,542.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,500.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$283.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,780.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,000.32
|
| 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 |
$3,334.40
|
| Rate for Payer: Networks By Design Commercial |
$2,709.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,542.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,500.80
|
| 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 ENDO SM INT W/SNARE
|
Facility
|
IP
|
$3,335.00
|
|
|
Service Code
|
CPT 44364
|
| Hospital Charge Code |
906744364
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$667.00 |
| Max. Negotiated Rate |
$2,834.75 |
| Rate for Payer: Adventist Health Commercial |
$667.00
|
| Rate for Payer: Cash Price |
$1,834.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,334.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,334.00
|
| Rate for Payer: Galaxy Health WC |
$2,834.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,001.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,224.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,270.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,064.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$800.40
|
| Rate for Payer: Multiplan Commercial |
$2,668.00
|
| Rate for Payer: Networks By Design Commercial |
$2,167.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,834.75
|
|
|
HC ENDO SM INT W/SNARE
|
Facility
|
OP
|
$3,335.00
|
|
|
Service Code
|
CPT 44364
|
| Hospital Charge Code |
906744364
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$340.87 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$667.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| 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 |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$1,834.25
|
| Rate for Payer: Cash Price |
$1,834.25
|
| Rate for Payer: Cash Price |
$1,834.25
|
| Rate for Payer: Cigna of CA HMO |
$2,134.40
|
| Rate for Payer: Cigna of CA PPO |
$2,467.90
|
| 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 |
$2,834.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,001.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$340.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,224.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$385.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$800.40
|
| 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 |
$2,668.00
|
| Rate for Payer: Networks By Design Commercial |
$2,167.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,834.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,001.00
|
| 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 ENDO SM INT W STENT PLCMNT
|
Facility
|
OP
|
$9,147.00
|
|
|
Service Code
|
CPT 44370
|
| Hospital Charge Code |
906744370
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$331.50 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: EPIC Health Plan Senior |
$7,563.64
|
| Rate for Payer: Adventist Health Commercial |
$1,829.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13,086.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,345.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,320.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,563.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| 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 |
$5,030.85
|
| Rate for Payer: Cash Price |
$5,030.85
|
| Rate for Payer: Cash Price |
$5,030.85
|
| Rate for Payer: Cigna of CA HMO |
$5,854.08
|
| Rate for Payer: Cigna of CA PPO |
$6,768.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,345.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,320.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,563.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,210.91
|
| Rate for Payer: Galaxy Health WC |
$7,774.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,488.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,404.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$331.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,563.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,101.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$374.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,563.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,195.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,530.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,135.28
|
| Rate for Payer: Multiplan Commercial |
$7,317.60
|
| Rate for Payer: Networks By Design Commercial |
$5,945.55
|
| Rate for Payer: Prime Health Services Commercial |
$7,774.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,488.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,076.37
|
| 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 |
$7,563.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,345.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,320.00
|
| Rate for Payer: Vantage Medical Group Senior |
$7,563.64
|
|
|
HC ENDO SM INT W STENT PLCMNT
|
Facility
|
IP
|
$9,147.00
|
|
|
Service Code
|
CPT 44370
|
| Hospital Charge Code |
906744370
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,829.40 |
| Max. Negotiated Rate |
$7,774.95 |
| Rate for Payer: Adventist Health Commercial |
$1,829.40
|
| Rate for Payer: Cash Price |
$5,030.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,658.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,658.80
|
| Rate for Payer: Galaxy Health WC |
$7,774.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,488.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,101.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,485.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,661.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,195.28
|
| Rate for Payer: Multiplan Commercial |
$7,317.60
|
| Rate for Payer: Networks By Design Commercial |
$5,945.55
|
| Rate for Payer: Prime Health Services Commercial |
$7,774.95
|
|
|
HC ENDOTRACH 5.0MM W/CUFF PEDS
|
Facility
|
IP
|
$45.26
|
|
| Hospital Charge Code |
901698775
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$38.47 |
| Rate for Payer: Adventist Health Commercial |
$9.05
|
| Rate for Payer: Cash Price |
$24.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.10
|
| Rate for Payer: EPIC Health Plan Senior |
$18.10
|
| Rate for Payer: Galaxy Health WC |
$38.47
|
| Rate for Payer: Global Benefits Group Commercial |
$27.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.86
|
| Rate for Payer: Multiplan Commercial |
$36.21
|
| Rate for Payer: Networks By Design Commercial |
$29.42
|
| Rate for Payer: Prime Health Services Commercial |
$38.47
|
|
|
HC ENDOTRACH 5.0MM W/CUFF PEDS
|
Facility
|
OP
|
$45.26
|
|
| Hospital Charge Code |
901698775
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$38.47 |
| Rate for Payer: Adventist Health Commercial |
$9.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.79
|
| Rate for Payer: Cash Price |
$24.89
|
| Rate for Payer: Cigna of CA HMO |
$28.97
|
| Rate for Payer: Cigna of CA PPO |
$33.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$38.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.10
|
| Rate for Payer: EPIC Health Plan Senior |
$18.10
|
| Rate for Payer: Galaxy Health WC |
$38.47
|
| Rate for Payer: Global Benefits Group Commercial |
$27.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.68
|
| Rate for Payer: Multiplan Commercial |
$36.21
|
| Rate for Payer: Networks By Design Commercial |
$29.42
|
| Rate for Payer: Prime Health Services Commercial |
$38.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.63
|
| Rate for Payer: United Healthcare All Other HMO |
$22.63
|
| Rate for Payer: United Healthcare HMO Rider |
$22.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.47
|
| Rate for Payer: Vantage Medical Group Senior |
$38.47
|
|
|
HC ENDOTRACH 5.5MM W/CUFF PEDS
|
Facility
|
IP
|
$45.26
|
|
| Hospital Charge Code |
901698774
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$38.47 |
| Rate for Payer: Adventist Health Commercial |
$9.05
|
| Rate for Payer: Cash Price |
$24.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.10
|
| Rate for Payer: EPIC Health Plan Senior |
$18.10
|
| Rate for Payer: Galaxy Health WC |
$38.47
|
| Rate for Payer: Global Benefits Group Commercial |
$27.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.86
|
| Rate for Payer: Multiplan Commercial |
$36.21
|
| Rate for Payer: Networks By Design Commercial |
$29.42
|
| Rate for Payer: Prime Health Services Commercial |
$38.47
|
|
|
HC ENDOTRACH 5.5MM W/CUFF PEDS
|
Facility
|
OP
|
$45.26
|
|
| Hospital Charge Code |
901698774
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$38.47 |
| Rate for Payer: Adventist Health Commercial |
$9.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.79
|
| Rate for Payer: Cash Price |
$24.89
|
| Rate for Payer: Cigna of CA HMO |
$28.97
|
| Rate for Payer: Cigna of CA PPO |
$33.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$38.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.10
|
| Rate for Payer: EPIC Health Plan Senior |
$18.10
|
| Rate for Payer: Galaxy Health WC |
$38.47
|
| Rate for Payer: Global Benefits Group Commercial |
$27.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.68
|
| Rate for Payer: Multiplan Commercial |
$36.21
|
| Rate for Payer: Networks By Design Commercial |
$29.42
|
| Rate for Payer: Prime Health Services Commercial |
$38.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.63
|
| Rate for Payer: United Healthcare All Other HMO |
$22.63
|
| Rate for Payer: United Healthcare HMO Rider |
$22.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.47
|
| Rate for Payer: Vantage Medical Group Senior |
$38.47
|
|
