|
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 |
$2,949.65
|
| Rate for Payer: Cash Price |
$2,949.65
|
| 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
|
$10,124.00
|
|
|
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 |
$2,024.80
|
| 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 |
$5,568.20
|
| Rate for Payer: Cash Price |
$5,568.20
|
| Rate for Payer: Cash Price |
$5,568.20
|
| Rate for Payer: Cigna of CA HMO |
$6,479.36
|
| Rate for Payer: Cigna of CA PPO |
$7,491.76
|
| 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 |
$8,605.40
|
| Rate for Payer: Global Benefits Group Commercial |
$6,074.40
|
| 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 |
$6,752.71
|
| 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 |
$2,429.76
|
| 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 |
$8,099.20
|
| Rate for Payer: Networks By Design Commercial |
$6,580.60
|
| Rate for Payer: Prime Health Services Commercial |
$8,605.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,074.40
|
| 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 |
$5,568.20
|
| 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 |
$2,687.85
|
| Rate for Payer: Cash Price |
$2,687.85
|
| 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 ENDO RETRO RMVL FBTUBE
|
Facility
|
IP
|
$4,887.00
|
|
|
Service Code
|
CPT 43269
|
| Hospital Charge Code |
906743269
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$977.40 |
| Max. Negotiated Rate |
$4,153.95 |
| Rate for Payer: Adventist Health Commercial |
$977.40
|
| Rate for Payer: Cash Price |
$2,687.85
|
| 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: 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
|
|
|
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 |
$3,482.05
|
| 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
|
$6,331.00
|
|
|
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 |
$1,266.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,410.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$3,482.05
|
| Rate for Payer: Cash Price |
$3,482.05
|
| Rate for Payer: Cash Price |
$3,482.05
|
| Rate for Payer: Cigna of CA HMO |
$4,051.84
|
| Rate for Payer: Cigna of CA PPO |
$4,684.94
|
| 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 |
$5,381.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,798.60
|
| 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 |
$4,222.78
|
| 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 |
$1,519.44
|
| 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 |
$5,064.80
|
| Rate for Payer: Networks By Design Commercial |
$4,115.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,381.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,798.60
|
| 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
|
OP
|
$7,082.00
|
|
|
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 |
$1,416.40
|
| 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 |
$3,895.10
|
| Rate for Payer: Cash Price |
$3,895.10
|
| Rate for Payer: Cash Price |
$3,895.10
|
| Rate for Payer: Cigna of CA HMO |
$4,532.48
|
| Rate for Payer: Cigna of CA PPO |
$5,240.68
|
| 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 |
$6,019.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,249.20
|
| 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 |
$4,723.69
|
| 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 |
$1,699.68
|
| 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 |
$5,665.60
|
| Rate for Payer: Networks By Design Commercial |
$4,603.30
|
| Rate for Payer: Prime Health Services Commercial |
$6,019.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,249.20
|
| 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 |
$3,895.10
|
| 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 & 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 |
$4,274.05
|
| 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 RMVL & XCHNG OF STNT INCL SPINC EA STNT
|
Facility
|
OP
|
$7,771.00
|
|
|
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 |
$1,554.20
|
| 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 |
$4,274.05
|
| Rate for Payer: Cash Price |
$4,274.05
|
| Rate for Payer: Cash Price |
$4,274.05
|
| Rate for Payer: Cigna of CA HMO |
$4,973.44
|
| Rate for Payer: Cigna of CA PPO |
$5,750.54
|
| 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 |
$6,605.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,662.60
|
| 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 |
$5,183.26
|
| 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 |
$1,865.04
|
| 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 |
$6,216.80
|
| Rate for Payer: Networks By Design Commercial |
$5,051.15
|
| Rate for Payer: Prime Health Services Commercial |
$6,605.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,662.60
|
| 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 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 |
$2,964.50
|
| 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
|
$5,390.00
|
|
|
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 |
$1,078.00
|
| 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 |
$2,964.50
|
| Rate for Payer: Cash Price |
$2,964.50
|
| Rate for Payer: Cash Price |
$2,964.50
|
| Rate for Payer: Cigna of CA HMO |
$3,449.60
|
| Rate for Payer: Cigna of CA PPO |
$3,988.60
|
| 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 |
$4,581.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,234.00
|
| 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 |
$3,595.13
|
| 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 |
$1,293.60
|
| 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 |
$4,312.00
|
| Rate for Payer: Networks By Design Commercial |
$3,503.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,581.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,234.00
|
| 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 ESBL DISK CONFIRMATION
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT 87184
|
| Hospital Charge Code |
900912449
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.06 |
| Max. Negotiated Rate |
$178.50 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$137.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.03
|
| Rate for Payer: Blue Shield of California Commercial |
$140.49
|
| Rate for Payer: Blue Shield of California EPN |
$92.82
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna of CA HMO |
$134.40
|
| Rate for Payer: Cigna of CA PPO |
$155.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.10
|
| Rate for Payer: EPIC Health Plan Senior |
$7.48
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.02
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.06
|
| Rate for Payer: United Healthcare All Other HMO |
$6.06
|
| Rate for Payer: United Healthcare HMO Rider |
$6.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.06
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.23
|
| Rate for Payer: Vantage Medical Group Senior |
$7.48
|
|
|
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 |
$115.50
|
| 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
|
|
|
HC ESOPH ACID REFLX TEST
|
Facility
|
IP
|
$3,494.00
|
|
|
Service Code
|
CPT 91034
|
| Hospital Charge Code |
906791033
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$698.80 |
| Max. Negotiated Rate |
$2,969.90 |
| Rate for Payer: Adventist Health Commercial |
$698.80
|
| Rate for Payer: Cash Price |
$1,921.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,397.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,397.60
|
| Rate for Payer: Galaxy Health WC |
$2,969.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,096.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,330.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,331.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,162.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$838.56
|
| Rate for Payer: Multiplan Commercial |
$2,795.20
|
| Rate for Payer: Networks By Design Commercial |
$2,271.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,969.90
|
|
|
HC ESOPH ACID REFLX TEST
|
Facility
|
OP
|
$3,494.00
|
|
|
Service Code
|
CPT 91034
|
| Hospital Charge Code |
906791033
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$130.38 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$698.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$741.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$674.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,145.67
|
| 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 |
$1,921.70
|
| Rate for Payer: Cash Price |
$1,921.70
|
| Rate for Payer: Cash Price |
$1,921.70
|
| Rate for Payer: Cigna of CA HMO |
$2,236.16
|
| Rate for Payer: Cigna of CA PPO |
$2,585.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$741.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$674.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$910.14
|
| Rate for Payer: EPIC Health Plan Senior |
$674.18
|
| Rate for Payer: Galaxy Health WC |
$2,969.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,096.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,105.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$130.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$674.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,330.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$147.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$674.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$838.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$849.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$903.40
|
| Rate for Payer: Multiplan Commercial |
$2,795.20
|
| Rate for Payer: Networks By Design Commercial |
$2,271.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,969.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,096.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$809.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$674.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$741.60
|
| Rate for Payer: Vantage Medical Group Senior |
$674.18
|
|
|
HC ESOPHAG DIAG W BALLOON DILATION
|
Facility
|
IP
|
$4,573.00
|
|
|
Service Code
|
CPT 43220
|
| Hospital Charge Code |
909000188
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$914.60 |
| Max. Negotiated Rate |
$3,887.05 |
| Rate for Payer: Adventist Health Commercial |
$914.60
|
| Rate for Payer: Cash Price |
$2,515.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,829.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,829.20
|
| Rate for Payer: Galaxy Health WC |
$3,887.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,743.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,050.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,742.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,830.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,097.52
|
| Rate for Payer: Multiplan Commercial |
$3,658.40
|
| Rate for Payer: Networks By Design Commercial |
$2,972.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,887.05
|
|
|
HC ESOPHAG DIAG W BALLOON DILATION
|
Facility
|
OP
|
$4,573.00
|
|
|
Service Code
|
CPT 43220
|
| Hospital Charge Code |
909000188
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$300.22 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$914.60
|
| 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 |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$2,515.15
|
| Rate for Payer: Cash Price |
$2,515.15
|
| Rate for Payer: Cash Price |
$2,515.15
|
| Rate for Payer: Cigna of CA HMO |
$2,926.72
|
| Rate for Payer: Cigna of CA PPO |
$3,384.02
|
| 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 |
$3,887.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,743.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$300.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,050.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$339.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,097.52
|
| 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 |
$3,658.40
|
| Rate for Payer: Networks By Design Commercial |
$2,972.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,887.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,743.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,892.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,410.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,410.32
|
|
|
HC ESOPHAG DIAG W BALLOON DILATION
|
Facility
|
IP
|
$4,573.00
|
|
|
Service Code
|
CPT 43220
|
| Hospital Charge Code |
909000188
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$914.60 |
| Max. Negotiated Rate |
$3,887.05 |
| Rate for Payer: Adventist Health Commercial |
$914.60
|
| Rate for Payer: Cash Price |
$2,515.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,829.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,829.20
|
| Rate for Payer: Galaxy Health WC |
$3,887.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,743.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,050.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,742.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,830.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,097.52
|
| Rate for Payer: Multiplan Commercial |
$3,658.40
|
| Rate for Payer: Networks By Design Commercial |
$2,972.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,887.05
|
|
|
HC ESOPHAG DIAG W BALLOON DILATION
|
Facility
|
OP
|
$4,573.00
|
|
|
Service Code
|
CPT 43220
|
| Hospital Charge Code |
909000188
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$300.22 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$914.60
|
| 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 |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$2,515.15
|
| Rate for Payer: Cash Price |
$2,515.15
|
| Rate for Payer: Cash Price |
$2,515.15
|
| Rate for Payer: Cigna of CA HMO |
$2,926.72
|
| Rate for Payer: Cigna of CA PPO |
$3,384.02
|
| 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 |
$3,887.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,743.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$300.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,050.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$339.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,097.52
|
| 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 |
$3,658.40
|
| Rate for Payer: Multiplan WC |
$3,840.40
|
| Rate for Payer: Networks By Design Commercial |
$2,972.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,887.05
|
| Rate for Payer: Prime Health Services WC |
$3,801.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,743.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,410.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,410.32
|
|
|
HC ESOPHAGEAL DILATATION
|
Facility
|
OP
|
$1,158.00
|
|
|
Service Code
|
CPT 74360
|
| Hospital Charge Code |
909001829
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$183.09 |
| Max. Negotiated Rate |
$984.30 |
| Rate for Payer: Adventist Health Commercial |
$231.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$759.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$984.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$636.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$868.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$885.14
|
| Rate for Payer: Blue Shield of California Commercial |
$708.70
|
| Rate for Payer: Blue Shield of California EPN |
$467.83
|
| Rate for Payer: Cash Price |
$636.90
|
| Rate for Payer: Cash Price |
$636.90
|
| Rate for Payer: Cigna of CA HMO |
$741.12
|
| Rate for Payer: Cigna of CA PPO |
$856.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$984.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$984.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$984.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$463.20
|
| Rate for Payer: EPIC Health Plan Senior |
$463.20
|
| Rate for Payer: Galaxy Health WC |
$984.30
|
| Rate for Payer: Global Benefits Group Commercial |
$694.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$183.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$772.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$207.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$716.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$277.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$810.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$810.60
|
| Rate for Payer: Multiplan Commercial |
$926.40
|
| Rate for Payer: Networks By Design Commercial |
$752.70
|
| Rate for Payer: Prime Health Services Commercial |
$984.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$694.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$694.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$579.00
|
| Rate for Payer: United Healthcare All Other HMO |
$579.00
|
| Rate for Payer: United Healthcare HMO Rider |
$579.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$579.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$984.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$984.30
|
| Rate for Payer: Vantage Medical Group Senior |
$984.30
|
|
|
HC ESOPHAGEAL DILATATION
|
Facility
|
IP
|
$1,158.00
|
|
|
Service Code
|
CPT 74360
|
| Hospital Charge Code |
909001829
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$231.60 |
| Max. Negotiated Rate |
$984.30 |
| Rate for Payer: Adventist Health Commercial |
$231.60
|
| Rate for Payer: Cash Price |
$636.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$463.20
|
| Rate for Payer: EPIC Health Plan Senior |
$463.20
|
| Rate for Payer: Galaxy Health WC |
$984.30
|
| Rate for Payer: Global Benefits Group Commercial |
$694.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$772.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$441.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$716.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$277.92
|
| Rate for Payer: Multiplan Commercial |
$926.40
|
| Rate for Payer: Networks By Design Commercial |
$752.70
|
| Rate for Payer: Prime Health Services Commercial |
$984.30
|
|
|
HC ESOPHAGOGASTRIC TMPONAD W/BLLN
|
Facility
|
IP
|
$3,313.00
|
|
|
Service Code
|
CPT 43460
|
| Hospital Charge Code |
906743460
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$662.60 |
| Max. Negotiated Rate |
$2,816.05 |
| Rate for Payer: Adventist Health Commercial |
$662.60
|
| Rate for Payer: Cash Price |
$1,822.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,325.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,325.20
|
| Rate for Payer: Galaxy Health WC |
$2,816.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,987.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,209.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,262.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,050.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$795.12
|
| Rate for Payer: Multiplan Commercial |
$2,650.40
|
| Rate for Payer: Networks By Design Commercial |
$2,153.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,816.05
|
|
|
HC ESOPHAGOGASTRIC TMPONAD W/BLLN
|
Facility
|
OP
|
$3,313.00
|
|
|
Service Code
|
CPT 43460
|
| Hospital Charge Code |
906743460
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$154.49 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$662.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,816.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,822.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,484.75
|
| 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 |
$1,845.77
|
| Rate for Payer: Cash Price |
$1,822.15
|
| Rate for Payer: Cash Price |
$1,822.15
|
| Rate for Payer: Cash Price |
$1,822.15
|
| Rate for Payer: Cigna of CA HMO |
$2,120.32
|
| Rate for Payer: Cigna of CA PPO |
$2,451.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,816.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,816.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,816.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,325.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,325.20
|
| Rate for Payer: Galaxy Health WC |
$2,816.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,987.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$154.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,209.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$174.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,050.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$795.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,319.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,319.10
|
| Rate for Payer: Multiplan Commercial |
$2,650.40
|
| Rate for Payer: Networks By Design Commercial |
$2,153.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,816.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,987.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,987.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,816.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,816.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,816.05
|
|
