|
HC EPS VENTRICULAR PACING
|
Facility
|
OP
|
$7,245.00
|
|
|
Service Code
|
CPT 93612
|
| Hospital Charge Code |
906811325
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$177.88 |
| Max. Negotiated Rate |
$15,811.96 |
| Rate for Payer: Adventist Health Commercial |
$1,449.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,752.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,462.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,605.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,641.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$3,984.75
|
| Rate for Payer: Cash Price |
$3,984.75
|
| Rate for Payer: Cash Price |
$3,984.75
|
| Rate for Payer: Cigna of CA HMO |
$4,636.80
|
| Rate for Payer: Cigna of CA PPO |
$5,361.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,462.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,605.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,641.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,015.94
|
| Rate for Payer: EPIC Health Plan Senior |
$9,641.44
|
| Rate for Payer: Galaxy Health WC |
$6,158.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,347.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,811.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$177.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,641.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,832.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$201.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,641.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,738.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,148.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,919.53
|
| Rate for Payer: Multiplan Commercial |
$5,796.00
|
| Rate for Payer: Networks By Design Commercial |
$4,709.25
|
| Rate for Payer: Prime Health Services Commercial |
$6,158.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,347.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,347.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,641.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14,462.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,605.58
|
| Rate for Payer: Vantage Medical Group Senior |
$9,641.44
|
|
|
HC EPS VENTRICULAR PACING
|
Facility
|
IP
|
$7,041.00
|
|
|
Service Code
|
CPT 93612
|
| Hospital Charge Code |
906820044
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,408.20 |
| Max. Negotiated Rate |
$5,984.85 |
| Rate for Payer: Adventist Health Commercial |
$1,408.20
|
| Rate for Payer: Cash Price |
$3,872.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,816.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,816.40
|
| Rate for Payer: Galaxy Health WC |
$5,984.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,224.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,696.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,682.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,358.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,689.84
|
| Rate for Payer: Multiplan Commercial |
$5,632.80
|
| Rate for Payer: Networks By Design Commercial |
$4,576.65
|
| Rate for Payer: Prime Health Services Commercial |
$5,984.85
|
|
|
HC ERCP BILIARY/SPHINCT
|
Facility
|
IP
|
$2,120.00
|
|
|
Service Code
|
CPT 74328
|
| Hospital Charge Code |
909001862
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$424.00 |
| Max. Negotiated Rate |
$1,802.00 |
| Rate for Payer: Adventist Health Commercial |
$424.00
|
| Rate for Payer: Cash Price |
$1,166.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$848.00
|
| Rate for Payer: EPIC Health Plan Senior |
$848.00
|
| Rate for Payer: Galaxy Health WC |
$1,802.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,272.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,414.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$807.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,312.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$508.80
|
| Rate for Payer: Multiplan Commercial |
$1,696.00
|
| Rate for Payer: Networks By Design Commercial |
$1,378.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,802.00
|
|
|
HC ERCP BILIARY/SPHINCT
|
Facility
|
OP
|
$2,120.00
|
|
|
Service Code
|
CPT 74328
|
| Hospital Charge Code |
909001862
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$193.42 |
| Max. Negotiated Rate |
$1,802.00 |
| Rate for Payer: Adventist Health Commercial |
$424.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,390.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,802.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,166.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,590.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$885.21
|
| Rate for Payer: Blue Shield of California Commercial |
$1,297.44
|
| Rate for Payer: Blue Shield of California EPN |
$856.48
|
| Rate for Payer: Cash Price |
$1,166.00
|
| Rate for Payer: Cash Price |
$1,166.00
|
| Rate for Payer: Cigna of CA HMO |
$1,356.80
|
| Rate for Payer: Cigna of CA PPO |
$1,568.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,802.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,802.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,802.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$848.00
|
| Rate for Payer: EPIC Health Plan Senior |
$848.00
|
| Rate for Payer: Galaxy Health WC |
$1,802.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,272.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$193.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,414.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,312.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$508.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,484.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,484.00
|
| Rate for Payer: Multiplan Commercial |
$1,696.00
|
| Rate for Payer: Networks By Design Commercial |
$1,378.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,802.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,272.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,272.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,060.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,060.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,060.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,060.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,802.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,802.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,802.00
|
|
|
HC ERCP COMBINED SPHINCT
|
Facility
|
OP
|
$2,524.00
|
|
|
Service Code
|
CPT 74330
|
| Hospital Charge Code |
909001863
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$193.42 |
| Max. Negotiated Rate |
$2,145.40 |
| Rate for Payer: Adventist Health Commercial |
$504.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,655.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,145.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,388.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,893.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$885.21
|
| Rate for Payer: Blue Shield of California Commercial |
$1,544.69
|
| Rate for Payer: Blue Shield of California EPN |
$1,019.70
|
| Rate for Payer: Cash Price |
$1,388.20
|
| Rate for Payer: Cash Price |
$1,388.20
|
| Rate for Payer: Cigna of CA HMO |
$1,615.36
|
| Rate for Payer: Cigna of CA PPO |
$1,867.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,145.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,145.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,145.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,009.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,009.60
|
| Rate for Payer: Galaxy Health WC |
$2,145.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,514.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$193.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,683.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,562.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$605.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,766.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,766.80
|
| Rate for Payer: Multiplan Commercial |
$2,019.20
|
| Rate for Payer: Networks By Design Commercial |
$1,640.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,145.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,514.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,514.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,262.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,262.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,262.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,262.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,145.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,145.40
|
| Rate for Payer: Vantage Medical Group Senior |
$2,145.40
|
|
|
HC ERCP COMBINED SPHINCT
|
Facility
|
IP
|
$2,524.00
|
|
|
Service Code
|
CPT 74330
|
| Hospital Charge Code |
909001863
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$504.80 |
| Max. Negotiated Rate |
$2,145.40 |
| Rate for Payer: Adventist Health Commercial |
$504.80
|
| Rate for Payer: Cash Price |
$1,388.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,009.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,009.60
|
| Rate for Payer: Galaxy Health WC |
$2,145.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,514.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,683.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$961.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,562.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$605.76
|
| Rate for Payer: Multiplan Commercial |
$2,019.20
|
| Rate for Payer: Networks By Design Commercial |
$1,640.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,145.40
|
|
|
HC ERCP DIAG W/ OR W/O COLLECT SP
|
Facility
|
IP
|
$6,977.00
|
|
|
Service Code
|
CPT 43260
|
| Hospital Charge Code |
906743260
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,395.40 |
| Max. Negotiated Rate |
$5,930.45 |
| Rate for Payer: Adventist Health Commercial |
$1,395.40
|
| Rate for Payer: Cash Price |
$3,837.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,790.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,790.80
|
| Rate for Payer: Galaxy Health WC |
$5,930.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,186.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,653.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,658.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,318.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,674.48
|
| Rate for Payer: Multiplan Commercial |
$5,581.60
|
| Rate for Payer: Networks By Design Commercial |
$4,535.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,930.45
|
|
|
HC ERCP DIAG W/ OR W/O COLLECT SP
|
Facility
|
OP
|
$6,977.00
|
|
|
Service Code
|
CPT 43260
|
| Hospital Charge Code |
906743260
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$519.14 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$1,395.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,251.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,317.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,834.04
|
| 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 |
$3,837.35
|
| Rate for Payer: Cash Price |
$3,837.35
|
| Rate for Payer: Cash Price |
$3,837.35
|
| Rate for Payer: Cigna of CA HMO |
$4,465.28
|
| Rate for Payer: Cigna of CA PPO |
$5,162.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,251.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,317.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,834.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,525.95
|
| Rate for Payer: EPIC Health Plan Senior |
$4,834.04
|
| Rate for Payer: Galaxy Health WC |
$5,930.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,186.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,927.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$519.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,834.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,653.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$587.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,834.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,674.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,090.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,477.61
|
| Rate for Payer: Multiplan Commercial |
$5,581.60
|
| Rate for Payer: Networks By Design Commercial |
$4,535.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,930.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,186.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,800.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,834.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,251.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,317.44
|
| Rate for Payer: Vantage Medical Group Senior |
$4,834.04
|
|
|
HC ERCP DUCT STENT PLACEMENT
|
Facility
|
IP
|
$8,356.00
|
|
|
Service Code
|
CPT 43274
|
| Hospital Charge Code |
900100019
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,671.20 |
| Max. Negotiated Rate |
$7,102.60 |
| Rate for Payer: Adventist Health Commercial |
$1,671.20
|
| Rate for Payer: Cash Price |
$4,595.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,342.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,342.40
|
| Rate for Payer: Galaxy Health WC |
$7,102.60
|
| Rate for Payer: Global Benefits Group Commercial |
$5,013.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,573.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,183.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,172.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,005.44
|
| Rate for Payer: Multiplan Commercial |
$6,684.80
|
| Rate for Payer: Networks By Design Commercial |
$5,431.40
|
| Rate for Payer: Prime Health Services Commercial |
$7,102.60
|
|
|
HC ERCP DUCT STENT PLACEMENT
|
Facility
|
OP
|
$8,356.00
|
|
|
Service Code
|
CPT 43274
|
| Hospital Charge Code |
900100019
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$696.76 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$1,671.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| 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 |
$2,470.08
|
| Rate for Payer: Cash Price |
$4,595.80
|
| Rate for Payer: Cash Price |
$4,595.80
|
| Rate for Payer: Cash Price |
$4,595.80
|
| Rate for Payer: Cigna of CA HMO |
$5,347.84
|
| Rate for Payer: Cigna of CA PPO |
$6,183.44
|
| 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 |
$7,102.60
|
| Rate for Payer: Global Benefits Group Commercial |
$5,013.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,404.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$696.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,563.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,573.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$788.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,563.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,005.44
|
| 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 |
$6,684.80
|
| Rate for Payer: Networks By Design Commercial |
$5,431.40
|
| Rate for Payer: Prime Health Services Commercial |
$7,102.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,013.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,076.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 ERCP EA DUCT/AMPULLA DILATATION
|
Facility
|
IP
|
$10,267.00
|
|
|
Service Code
|
CPT 43277
|
| Hospital Charge Code |
900100020
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,053.40 |
| Max. Negotiated Rate |
$8,726.95 |
| Rate for Payer: Adventist Health Commercial |
$2,053.40
|
| Rate for Payer: Cash Price |
$5,646.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,106.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,106.80
|
| Rate for Payer: Galaxy Health WC |
$8,726.95
|
| Rate for Payer: Global Benefits Group Commercial |
$6,160.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,848.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,911.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,355.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,464.08
|
| Rate for Payer: Multiplan Commercial |
$8,213.60
|
| Rate for Payer: Networks By Design Commercial |
$6,673.55
|
| Rate for Payer: Prime Health Services Commercial |
$8,726.95
|
|
|
HC ERCP EA DUCT/AMPULLA DILATATION
|
Facility
|
OP
|
$10,267.00
|
|
|
Service Code
|
CPT 43277
|
| Hospital Charge Code |
900100020
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$577.94 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$2,053.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,251.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,317.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,834.04
|
| 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 |
$5,646.85
|
| Rate for Payer: Cash Price |
$5,646.85
|
| Rate for Payer: Cash Price |
$5,646.85
|
| Rate for Payer: Cigna of CA HMO |
$6,570.88
|
| Rate for Payer: Cigna of CA PPO |
$7,597.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,251.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,317.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,834.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,525.95
|
| Rate for Payer: EPIC Health Plan Senior |
$4,834.04
|
| Rate for Payer: Galaxy Health WC |
$8,726.95
|
| Rate for Payer: Global Benefits Group Commercial |
$6,160.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,927.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$577.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,834.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,848.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$653.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,834.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,464.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,090.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,477.61
|
| Rate for Payer: Multiplan Commercial |
$8,213.60
|
| Rate for Payer: Networks By Design Commercial |
$6,673.55
|
| Rate for Payer: Prime Health Services Commercial |
$8,726.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,160.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,800.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,834.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,251.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,317.44
|
| Rate for Payer: Vantage Medical Group Senior |
$4,834.04
|
|
|
HC ERCP LESION ABLAT W DILATION
|
Facility
|
OP
|
$5,455.00
|
|
|
Service Code
|
CPT 43278
|
| Hospital Charge Code |
906743278
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$657.37 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$1,091.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,251.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,317.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,834.04
|
| 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 |
$3,000.25
|
| Rate for Payer: Cash Price |
$3,000.25
|
| Rate for Payer: Cash Price |
$3,000.25
|
| Rate for Payer: Cigna of CA HMO |
$3,491.20
|
| Rate for Payer: Cigna of CA PPO |
$4,036.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,251.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,317.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,834.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,525.95
|
| Rate for Payer: EPIC Health Plan Senior |
$4,834.04
|
| Rate for Payer: Galaxy Health WC |
$4,636.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,273.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,927.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$657.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,834.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,638.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$743.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,834.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,309.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,090.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,477.61
|
| Rate for Payer: Multiplan Commercial |
$4,364.00
|
| Rate for Payer: Networks By Design Commercial |
$3,545.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,636.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,273.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,800.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,834.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,251.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,317.44
|
| Rate for Payer: Vantage Medical Group Senior |
$4,834.04
|
|
|
HC ERCP LESION ABLAT W DILATION
|
Facility
|
IP
|
$5,455.00
|
|
|
Service Code
|
CPT 43278
|
| Hospital Charge Code |
906743278
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,091.00 |
| Max. Negotiated Rate |
$4,636.75 |
| Rate for Payer: Adventist Health Commercial |
$1,091.00
|
| Rate for Payer: Cash Price |
$3,000.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,182.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,182.00
|
| Rate for Payer: Galaxy Health WC |
$4,636.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,273.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,638.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,078.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,376.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,309.20
|
| Rate for Payer: Multiplan Commercial |
$4,364.00
|
| Rate for Payer: Networks By Design Commercial |
$3,545.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,636.75
|
|
|
HC ERCP PANCREATIC/SPHINCT
|
Facility
|
OP
|
$1,918.00
|
|
|
Service Code
|
CPT 74329
|
| Hospital Charge Code |
909001830
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$193.42 |
| Max. Negotiated Rate |
$1,630.30 |
| Rate for Payer: Adventist Health Commercial |
$383.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,258.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,630.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,054.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,438.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$885.21
|
| Rate for Payer: Blue Shield of California Commercial |
$1,173.82
|
| Rate for Payer: Blue Shield of California EPN |
$774.87
|
| Rate for Payer: Cash Price |
$1,054.90
|
| Rate for Payer: Cash Price |
$1,054.90
|
| Rate for Payer: Cigna of CA HMO |
$1,227.52
|
| Rate for Payer: Cigna of CA PPO |
$1,419.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,630.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,630.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,630.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$767.20
|
| Rate for Payer: EPIC Health Plan Senior |
$767.20
|
| Rate for Payer: Galaxy Health WC |
$1,630.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,150.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$193.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,279.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,187.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$460.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,342.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,342.60
|
| Rate for Payer: Multiplan Commercial |
$1,534.40
|
| Rate for Payer: Networks By Design Commercial |
$1,246.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,630.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,150.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,150.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$959.00
|
| Rate for Payer: United Healthcare All Other HMO |
$959.00
|
| Rate for Payer: United Healthcare HMO Rider |
$959.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$959.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,630.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,630.30
|
| Rate for Payer: Vantage Medical Group Senior |
$1,630.30
|
|
|
HC ERCP PANCREATIC/SPHINCT
|
Facility
|
IP
|
$1,918.00
|
|
|
Service Code
|
CPT 74329
|
| Hospital Charge Code |
909001830
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$383.60 |
| Max. Negotiated Rate |
$1,630.30 |
| Rate for Payer: Adventist Health Commercial |
$383.60
|
| Rate for Payer: Cash Price |
$1,054.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$767.20
|
| Rate for Payer: EPIC Health Plan Senior |
$767.20
|
| Rate for Payer: Galaxy Health WC |
$1,630.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,150.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,279.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$730.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,187.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$460.32
|
| Rate for Payer: Multiplan Commercial |
$1,534.40
|
| Rate for Payer: Networks By Design Commercial |
$1,246.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,630.30
|
|
|
HC ERCP W/BX SNGL OR MULTI
|
Facility
|
OP
|
$5,582.00
|
|
|
Service Code
|
CPT 43261
|
| Hospital Charge Code |
906743261
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$572.93 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$1,116.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,251.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,317.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,834.04
|
| 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 |
$3,070.10
|
| Rate for Payer: Cash Price |
$3,070.10
|
| Rate for Payer: Cash Price |
$3,070.10
|
| Rate for Payer: Cigna of CA HMO |
$3,572.48
|
| Rate for Payer: Cigna of CA PPO |
$4,130.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,251.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,317.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,834.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,525.95
|
| Rate for Payer: EPIC Health Plan Senior |
$4,834.04
|
| Rate for Payer: Galaxy Health WC |
$4,744.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,349.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,927.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$572.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,834.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,723.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$647.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,834.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,339.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,090.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,477.61
|
| Rate for Payer: Multiplan Commercial |
$4,465.60
|
| Rate for Payer: Networks By Design Commercial |
$3,628.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,744.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,349.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,800.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,834.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,251.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,317.44
|
| Rate for Payer: Vantage Medical Group Senior |
$4,834.04
|
|
|
HC ERCP W/BX SNGL OR MULTI
|
Facility
|
IP
|
$5,582.00
|
|
|
Service Code
|
CPT 43261
|
| Hospital Charge Code |
906743261
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,116.40 |
| Max. Negotiated Rate |
$4,744.70 |
| Rate for Payer: Adventist Health Commercial |
$1,116.40
|
| Rate for Payer: Cash Price |
$3,070.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,232.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,232.80
|
| Rate for Payer: Galaxy Health WC |
$4,744.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,349.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,723.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,126.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,455.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,339.68
|
| Rate for Payer: Multiplan Commercial |
$4,465.60
|
| Rate for Payer: Networks By Design Commercial |
$3,628.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,744.70
|
|
|
HC ERCP W/ENDO RETRO BLLN DIAL AM
|
Facility
|
IP
|
$7,086.00
|
|
|
Service Code
|
CPT 43271
|
| Hospital Charge Code |
906743271
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,417.20 |
| Max. Negotiated Rate |
$6,023.10 |
| Rate for Payer: Adventist Health Commercial |
$1,417.20
|
| Rate for Payer: Cash Price |
$3,897.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,834.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,834.40
|
| Rate for Payer: Galaxy Health WC |
$6,023.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,251.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,726.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,699.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,386.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,700.64
|
| Rate for Payer: Multiplan Commercial |
$5,668.80
|
| Rate for Payer: Networks By Design Commercial |
$4,605.90
|
| Rate for Payer: Prime Health Services Commercial |
$6,023.10
|
|
|
HC ERCP W/ENDO RETRO BLLN DIAL AM
|
Facility
|
OP
|
$7,086.00
|
|
|
Service Code
|
CPT 43271
|
| Hospital Charge Code |
906743271
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,417.20 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,417.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,023.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,897.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,314.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,351.51
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$3,897.30
|
| Rate for Payer: Cash Price |
$3,897.30
|
| Rate for Payer: Cigna of CA HMO |
$4,535.04
|
| Rate for Payer: Cigna of CA PPO |
$5,243.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,023.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,023.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,023.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,834.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,834.40
|
| Rate for Payer: Galaxy Health WC |
$6,023.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,251.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,726.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,699.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,386.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,700.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,960.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,960.20
|
| Rate for Payer: Multiplan Commercial |
$5,668.80
|
| Rate for Payer: Networks By Design Commercial |
$4,605.90
|
| Rate for Payer: Prime Health Services Commercial |
$6,023.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,251.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,251.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,543.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,543.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,543.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,543.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,023.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,023.10
|
| Rate for Payer: Vantage Medical Group Senior |
$6,023.10
|
|
|
HC ERCP W/ENDO RETRO DESTRUCTION
|
Facility
|
IP
|
$9,578.00
|
|
|
Service Code
|
CPT 43265
|
| Hospital Charge Code |
906743265
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,915.60 |
| Max. Negotiated Rate |
$8,141.30 |
| Rate for Payer: Adventist Health Commercial |
$1,915.60
|
| Rate for Payer: Cash Price |
$5,267.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,831.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,831.20
|
| Rate for Payer: Galaxy Health WC |
$8,141.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,746.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,388.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,649.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,928.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,298.72
|
| Rate for Payer: Multiplan Commercial |
$7,662.40
|
| Rate for Payer: Networks By Design Commercial |
$6,225.70
|
| Rate for Payer: Prime Health Services Commercial |
$8,141.30
|
|
|
HC ERCP W/ENDO RETRO DESTRUCTION
|
Facility
|
OP
|
$9,578.00
|
|
|
Service Code
|
CPT 43265
|
| Hospital Charge Code |
906743265
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,915.60 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$1,915.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| 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 |
$2,470.08
|
| Rate for Payer: Cash Price |
$5,267.90
|
| Rate for Payer: Cash Price |
$5,267.90
|
| Rate for Payer: Cash Price |
$5,267.90
|
| Rate for Payer: Cigna of CA HMO |
$6,129.92
|
| Rate for Payer: Cigna of CA PPO |
$7,087.72
|
| 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 |
$8,141.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,746.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,404.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,563.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,388.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,649.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,563.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,298.72
|
| 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 |
$7,662.40
|
| Rate for Payer: Networks By Design Commercial |
$6,225.70
|
| Rate for Payer: Prime Health Services Commercial |
$8,141.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,746.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,076.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 ERCP W/ENDO RETRO INSERT NASOB
|
Facility
|
IP
|
$5,766.00
|
|
|
Service Code
|
CPT 43267
|
| Hospital Charge Code |
906743267
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,153.20 |
| Max. Negotiated Rate |
$4,901.10 |
| Rate for Payer: Adventist Health Commercial |
$1,153.20
|
| Rate for Payer: Cash Price |
$3,171.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,306.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,306.40
|
| Rate for Payer: Galaxy Health WC |
$4,901.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,459.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,845.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,196.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,569.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,383.84
|
| Rate for Payer: Multiplan Commercial |
$4,612.80
|
| Rate for Payer: Networks By Design Commercial |
$3,747.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,901.10
|
|
|
HC ERCP W/ENDO RETRO INSERT NASOB
|
Facility
|
OP
|
$5,766.00
|
|
|
Service Code
|
CPT 43267
|
| Hospital Charge Code |
906743267
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,153.20 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,153.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,901.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,171.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,324.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,540.90
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$3,171.30
|
| Rate for Payer: Cash Price |
$3,171.30
|
| Rate for Payer: Cigna of CA HMO |
$3,690.24
|
| Rate for Payer: Cigna of CA PPO |
$4,266.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,901.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,901.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,901.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,306.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,306.40
|
| Rate for Payer: Galaxy Health WC |
$4,901.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,459.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,845.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,196.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,569.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,383.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,036.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,036.20
|
| Rate for Payer: Multiplan Commercial |
$4,612.80
|
| Rate for Payer: Networks By Design Commercial |
$3,747.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,901.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,459.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,459.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,883.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,883.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,883.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,883.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,901.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,901.10
|
| Rate for Payer: Vantage Medical Group Senior |
$4,901.10
|
|
|
HC ERCP W/ENDO RETRO INSERT TUBE
|
Facility
|
IP
|
$5,363.00
|
|
|
Service Code
|
CPT 43268
|
| Hospital Charge Code |
906743268
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,072.60 |
| Max. Negotiated Rate |
$4,558.55 |
| Rate for Payer: Adventist Health Commercial |
$1,072.60
|
| Rate for Payer: Cash Price |
$2,949.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,145.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,145.20
|
| Rate for Payer: Galaxy Health WC |
$4,558.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,217.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,577.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,043.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,319.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,287.12
|
| Rate for Payer: Multiplan Commercial |
$4,290.40
|
| Rate for Payer: Networks By Design Commercial |
$3,485.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,558.55
|
|
