|
HC ERCP EA DUCT/AMPULLA DILATATION
|
Facility
|
OP
|
$6,862.00
|
|
|
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 |
$1,372.40
|
| 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 |
$3,087.90
|
| Rate for Payer: Cash Price |
$3,087.90
|
| Rate for Payer: Cash Price |
$3,087.90
|
| Rate for Payer: Cigna of CA HMO |
$4,391.68
|
| Rate for Payer: Cigna of CA PPO |
$5,077.88
|
| 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 |
$5,832.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,117.20
|
| 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 |
$4,576.95
|
| 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 |
$1,646.88
|
| 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 |
$5,489.60
|
| Rate for Payer: Networks By Design Commercial |
$4,460.30
|
| Rate for Payer: Prime Health Services Commercial |
$5,832.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,117.20
|
| 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 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 |
$4,620.15
|
| 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 LESION ABLAT W DILATION
|
Facility
|
OP
|
$4,303.00
|
|
|
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: Galaxy Health WC |
$3,657.55
|
| Rate for Payer: Adventist Health Commercial |
$860.60
|
| 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 |
$1,936.35
|
| Rate for Payer: Cash Price |
$1,936.35
|
| Rate for Payer: Cash Price |
$1,936.35
|
| Rate for Payer: Cigna of CA HMO |
$2,753.92
|
| Rate for Payer: Cigna of CA PPO |
$3,184.22
|
| 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: Global Benefits Group Commercial |
$2,581.80
|
| 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 |
$2,870.10
|
| 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 |
$1,032.72
|
| 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 |
$3,442.40
|
| Rate for Payer: Networks By Design Commercial |
$2,796.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,657.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,581.80
|
| 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 |
$2,454.75
|
| 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 |
$863.10
|
| Rate for Payer: Cash Price |
$863.10
|
| 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 |
$863.10
|
| 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
|
$3,731.00
|
|
|
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 |
$746.20
|
| 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 |
$1,678.95
|
| Rate for Payer: Cash Price |
$1,678.95
|
| Rate for Payer: Cash Price |
$1,678.95
|
| Rate for Payer: Cigna of CA HMO |
$2,387.84
|
| Rate for Payer: Cigna of CA PPO |
$2,760.94
|
| 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 |
$3,171.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,238.60
|
| 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 |
$2,488.58
|
| 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 |
$895.44
|
| 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 |
$2,984.80
|
| Rate for Payer: Networks By Design Commercial |
$2,425.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,171.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,238.60
|
| 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 |
$2,511.90
|
| 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
|
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 |
$3,188.70
|
| Rate for Payer: Cash Price |
$3,188.70
|
| 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 |
$4,310.10
|
| 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
|
$5,492.00
|
|
|
Service Code
|
CPT 43265
|
| Hospital Charge Code |
906743265
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,098.40 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$1,098.40
|
| 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 |
$2,471.40
|
| Rate for Payer: Cash Price |
$2,471.40
|
| Rate for Payer: Cash Price |
$2,471.40
|
| Rate for Payer: Cigna of CA HMO |
$3,514.88
|
| Rate for Payer: Cigna of CA PPO |
$4,064.08
|
| 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 |
$4,668.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,295.20
|
| 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 |
$3,663.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,092.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,563.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,318.08
|
| 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 |
$4,393.60
|
| Rate for Payer: Networks By Design Commercial |
$3,569.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,668.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,295.20
|
| 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
|
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 |
$2,594.70
|
| Rate for Payer: Cash Price |
$2,594.70
|
| 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
|
OP
|
$5,363.00
|
|
|
Service Code
|
CPT 43268
|
| Hospital Charge Code |
906743268
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,072.60 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,072.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,558.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,949.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,022.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,293.42
|
| 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 |
$2,413.35
|
| Rate for Payer: Cash Price |
$2,413.35
|
| Rate for Payer: Cigna of CA HMO |
$3,432.32
|
| Rate for Payer: Cigna of CA PPO |
$3,968.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,558.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,558.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,558.55
|
| 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: Molina Healthcare of CA Medi-Cal |
$3,754.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,754.10
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,217.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,217.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,681.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,681.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,681.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,681.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,558.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,558.55
|
| Rate for Payer: Vantage Medical Group Senior |
$4,558.55
|
|
|
HC ERCP W/ENDO RETRO RMVL CALCULU
|
Facility
|
OP
|
$6,778.00
|
|
|
Service Code
|
CPT 43264
|
| Hospital Charge Code |
906743264
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$644.85 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$1,355.60
|
| 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 |
$3,050.10
|
| Rate for Payer: Cash Price |
$3,050.10
|
| Rate for Payer: Cash Price |
$3,050.10
|
| Rate for Payer: Cigna of CA HMO |
$4,337.92
|
| Rate for Payer: Cigna of CA PPO |
$5,015.72
|
| 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 |
$5,761.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,066.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,927.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$644.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,834.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,520.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$729.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,834.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,626.72
|
| 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 |
$5,422.40
|
| Rate for Payer: Networks By Design Commercial |
$4,405.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,761.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,066.80
|
| 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/ENDO RETRO RMVL CALCULU
|
Facility
|
IP
|
$10,124.00
|
|
|
Service Code
|
CPT 43264
|
| Hospital Charge Code |
906743264
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,024.80 |
| Max. Negotiated Rate |
$8,605.40 |
| Rate for Payer: Adventist Health Commercial |
$2,024.80
|
| Rate for Payer: Cash Price |
$4,555.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,049.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,049.60
|
| Rate for Payer: Galaxy Health WC |
$8,605.40
|
| Rate for Payer: Global Benefits Group Commercial |
$6,074.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,752.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,857.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,266.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,429.76
|
| Rate for Payer: Multiplan Commercial |
$8,099.20
|
| Rate for Payer: Networks By Design Commercial |
$6,580.60
|
| Rate for Payer: Prime Health Services Commercial |
$8,605.40
|
|
|
HC ERCP W ENDO RETRO RMVL FBTUBE
|
Facility
|
OP
|
$4,887.00
|
|
|
Service Code
|
CPT 43269
|
| Hospital Charge Code |
906743269
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$977.40 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$977.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,153.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,687.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,665.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,001.11
|
| 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 |
$2,199.15
|
| Rate for Payer: Cash Price |
$2,199.15
|
| Rate for Payer: Cigna of CA HMO |
$3,127.68
|
| Rate for Payer: Cigna of CA PPO |
$3,616.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,153.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,153.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,153.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,954.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,954.80
|
| Rate for Payer: Galaxy Health WC |
$4,153.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,932.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,259.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,861.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,025.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,172.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,420.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,420.90
|
| Rate for Payer: Multiplan Commercial |
$3,909.60
|
| Rate for Payer: Networks By Design Commercial |
$3,176.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,153.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,932.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,932.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,443.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,443.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,443.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,443.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,153.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,153.95
|
| Rate for Payer: Vantage Medical Group Senior |
$4,153.95
|
|
|
HC ERCP W/PRESS MSRMNT
|
Facility
|
IP
|
$6,331.00
|
|
|
Service Code
|
CPT 43263
|
| Hospital Charge Code |
906743263
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,266.20 |
| Max. Negotiated Rate |
$5,381.35 |
| Rate for Payer: Adventist Health Commercial |
$1,266.20
|
| Rate for Payer: Cash Price |
$2,848.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,532.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,532.40
|
| Rate for Payer: Galaxy Health WC |
$5,381.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,798.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,222.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,412.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,918.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,519.44
|
| Rate for Payer: Multiplan Commercial |
$5,064.80
|
| Rate for Payer: Networks By Design Commercial |
$4,115.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,381.35
|
|
|
HC ERCP W/PRESS MSRMNT
|
Facility
|
OP
|
$4,233.00
|
|
|
Service Code
|
CPT 43263
|
| Hospital Charge Code |
906743263
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$448.46 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$846.60
|
| 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 |
$1,904.85
|
| Rate for Payer: Cash Price |
$1,904.85
|
| Rate for Payer: Cash Price |
$1,904.85
|
| Rate for Payer: Cigna of CA HMO |
$2,709.12
|
| Rate for Payer: Cigna of CA PPO |
$3,132.42
|
| 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 |
$3,598.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,539.80
|
| 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 |
$2,823.41
|
| 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 |
$1,015.92
|
| 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 |
$3,386.40
|
| Rate for Payer: Networks By Design Commercial |
$2,751.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,598.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,539.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,892.38
|
| 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 |
$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 ERCP W RMVL FB STNT
|
Facility
|
IP
|
$7,082.00
|
|
|
Service Code
|
CPT 43275
|
| Hospital Charge Code |
906743275
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,416.40 |
| Max. Negotiated Rate |
$6,019.70 |
| Rate for Payer: Adventist Health Commercial |
$1,416.40
|
| Rate for Payer: Cash Price |
$3,186.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,832.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,832.80
|
| Rate for Payer: Galaxy Health WC |
$6,019.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,249.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,723.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,698.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,383.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,699.68
|
| Rate for Payer: Multiplan Commercial |
$5,665.60
|
| Rate for Payer: Networks By Design Commercial |
$4,603.30
|
| Rate for Payer: Prime Health Services Commercial |
$6,019.70
|
|
|
HC ERCP W RMVL FB STNT
|
Facility
|
OP
|
$4,734.00
|
|
|
Service Code
|
CPT 43275
|
| Hospital Charge Code |
906743275
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$574.80 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$946.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| 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 |
$2,130.30
|
| Rate for Payer: Cash Price |
$2,130.30
|
| Rate for Payer: Cash Price |
$2,130.30
|
| Rate for Payer: Cigna of CA HMO |
$3,029.76
|
| Rate for Payer: Cigna of CA PPO |
$3,503.16
|
| 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 |
$4,023.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,840.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$574.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,157.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$650.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,136.16
|
| 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 |
$3,787.20
|
| Rate for Payer: Networks By Design Commercial |
$3,077.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,023.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,840.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,892.38
|
| 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 |
$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 ERCP W RMVL & XCHNG OF STNT INCL SPINC EA STNT
|
Facility
|
OP
|
$5,194.00
|
|
|
Service Code
|
CPT 43276
|
| Hospital Charge Code |
906743276
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$724.92 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$1,038.80
|
| 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 |
$2,337.30
|
| Rate for Payer: Cash Price |
$2,337.30
|
| Rate for Payer: Cash Price |
$2,337.30
|
| Rate for Payer: Cigna of CA HMO |
$3,324.16
|
| Rate for Payer: Cigna of CA PPO |
$3,843.56
|
| 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 |
$4,414.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,116.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,404.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$724.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,563.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,464.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$819.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,563.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,246.56
|
| 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 |
$4,155.20
|
| Rate for Payer: Networks By Design Commercial |
$3,376.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,414.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,116.40
|
| 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 RMVL & XCHNG OF STNT INCL SPINC EA STNT
|
Facility
|
IP
|
$7,771.00
|
|
|
Service Code
|
CPT 43276
|
| Hospital Charge Code |
906743276
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,554.20 |
| Max. Negotiated Rate |
$6,605.35 |
| Rate for Payer: Adventist Health Commercial |
$1,554.20
|
| Rate for Payer: Cash Price |
$3,496.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,108.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,108.40
|
| Rate for Payer: Galaxy Health WC |
$6,605.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,662.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,183.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,960.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,810.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,865.04
|
| Rate for Payer: Multiplan Commercial |
$6,216.80
|
| Rate for Payer: Networks By Design Commercial |
$5,051.15
|
| Rate for Payer: Prime Health Services Commercial |
$6,605.35
|
|
|
HC ERCP W/SPHINCTERTMY
|
Facility
|
IP
|
$5,390.00
|
|
|
Service Code
|
CPT 43262
|
| Hospital Charge Code |
906743262
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,078.00 |
| Max. Negotiated Rate |
$4,581.50 |
| Rate for Payer: Adventist Health Commercial |
$1,078.00
|
| Rate for Payer: Cash Price |
$2,425.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,156.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,156.00
|
| Rate for Payer: Galaxy Health WC |
$4,581.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,234.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,595.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,053.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,336.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,293.60
|
| Rate for Payer: Multiplan Commercial |
$4,312.00
|
| Rate for Payer: Networks By Design Commercial |
$3,503.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,581.50
|
|
|
HC ERCP W/SPHINCTERTMY
|
Facility
|
OP
|
$3,601.00
|
|
|
Service Code
|
CPT 43262
|
| Hospital Charge Code |
906743262
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$622.34 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$720.20
|
| 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 |
$1,620.45
|
| Rate for Payer: Cash Price |
$1,620.45
|
| Rate for Payer: Cash Price |
$1,620.45
|
| Rate for Payer: Cigna of CA HMO |
$2,304.64
|
| Rate for Payer: Cigna of CA PPO |
$2,664.74
|
| 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 |
$3,060.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,160.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,927.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$622.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,834.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,401.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$703.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,834.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$864.24
|
| 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 |
$2,880.80
|
| Rate for Payer: Networks By Design Commercial |
$2,340.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,060.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,160.60
|
| 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 ESBL DISK CONFIRMATION
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT 87184
|
| Hospital Charge Code |
900912449
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$178.50 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$129.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.40
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: Networks By Design Commercial |
$136.50
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
|
