|
HC DIALYSIS CRCT VASC EMBO OR OCC
|
Facility
|
IP
|
$6,886.00
|
|
|
Service Code
|
CPT 36909
|
| Hospital Charge Code |
909036909
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,377.20 |
| Max. Negotiated Rate |
$6,197.40 |
| Rate for Payer: Adventist Health Commercial |
$1,377.20
|
| Rate for Payer: Cash Price |
$3,098.70
|
| Rate for Payer: Central Health Plan Commercial |
$5,508.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,820.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,754.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,754.40
|
| Rate for Payer: Galaxy Health WC |
$5,853.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,131.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,197.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,372.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,062.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,377.20
|
| Rate for Payer: Multiplan Commercial |
$5,164.50
|
| Rate for Payer: Networks By Design Commercial |
$4,475.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,853.10
|
|
|
HC DIALYSIS ONLY IV PUSH EA ADD NEW DRUG
|
Facility
|
IP
|
$598.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
946100112
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$119.60 |
| Max. Negotiated Rate |
$538.20 |
| Rate for Payer: Adventist Health Commercial |
$119.60
|
| Rate for Payer: Cash Price |
$269.10
|
| Rate for Payer: Central Health Plan Commercial |
$478.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$418.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$239.20
|
| Rate for Payer: EPIC Health Plan Senior |
$239.20
|
| Rate for Payer: Galaxy Health WC |
$508.30
|
| Rate for Payer: Global Benefits Group Commercial |
$358.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$538.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$379.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$352.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.60
|
| Rate for Payer: Multiplan Commercial |
$448.50
|
| Rate for Payer: Networks By Design Commercial |
$388.70
|
| Rate for Payer: Prime Health Services Commercial |
$508.30
|
|
|
HC DIALYSIS ONLY IV PUSH EA ADD NEW DRUG
|
Facility
|
OP
|
$598.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
946100112
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$36.62 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$119.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$60.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,029.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$93.40
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$269.10
|
| Rate for Payer: Cash Price |
$269.10
|
| Rate for Payer: Cash Price |
$269.10
|
| Rate for Payer: Central Health Plan Commercial |
$478.40
|
| Rate for Payer: Cigna of CA HMO |
$382.72
|
| Rate for Payer: Cigna of CA PPO |
$442.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$90.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$66.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$418.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.38
|
| Rate for Payer: EPIC Health Plan Senior |
$66.25
|
| Rate for Payer: Galaxy Health WC |
$508.30
|
| Rate for Payer: Global Benefits Group Commercial |
$358.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$538.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$98.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$60.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$379.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$80.71
|
| Rate for Payer: Multiplan Commercial |
$448.50
|
| Rate for Payer: Multiplan WC |
$93.40
|
| Rate for Payer: Networks By Design Commercial |
$388.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$60.23
|
| Rate for Payer: Preferred Health Network WC |
$95.31
|
| Rate for Payer: Prime Health Services Commercial |
$508.30
|
| Rate for Payer: Prime Health Services Medicare |
$63.84
|
| Rate for Payer: Prime Health Services WC |
$92.45
|
| Rate for Payer: Riverside University Health System MISP |
$66.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$358.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$299.00
|
| Rate for Payer: United Healthcare All Other HMO |
$299.00
|
| Rate for Payer: United Healthcare HMO Rider |
$299.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$299.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$60.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$90.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.25
|
| Rate for Payer: Vantage Medical Group Senior |
$60.23
|
|
|
HC DIALYSIS PERITONEAL/CCPD
|
Facility
|
OP
|
$1,633.00
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
944000100
|
|
Hospital Revenue Code
|
804
|
| Min. Negotiated Rate |
$124.12 |
| Max. Negotiated Rate |
$1,469.70 |
| Rate for Payer: Adventist Health Commercial |
$326.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$536.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$479.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$805.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$590.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$536.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$790.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$949.92
|
| Rate for Payer: Blue Shield of California Commercial |
$1,035.32
|
| Rate for Payer: Blue Shield of California EPN |
$651.57
|
| Rate for Payer: Cash Price |
$734.85
|
| Rate for Payer: Cash Price |
$734.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,306.40
|
| Rate for Payer: Cigna of CA HMO |
$1,045.12
|
| Rate for Payer: Cigna of CA PPO |
$1,208.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$805.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$590.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$536.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,143.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$885.51
|
| Rate for Payer: EPIC Health Plan Senior |
$590.34
|
| Rate for Payer: Galaxy Health WC |
$1,388.05
|
| Rate for Payer: Global Benefits Group Commercial |
$979.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,469.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$880.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$124.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$536.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,036.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$137.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$751.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$326.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$719.14
|
| Rate for Payer: Multiplan Commercial |
$1,224.75
|
| Rate for Payer: Networks By Design Commercial |
$1,061.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$536.67
|
| Rate for Payer: Prime Health Services Commercial |
$1,388.05
|
| Rate for Payer: Prime Health Services Medicare |
$568.87
|
| Rate for Payer: Riverside University Health System MISP |
$590.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$979.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$979.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$816.50
|
| Rate for Payer: United Healthcare All Other HMO |
$816.50
|
| Rate for Payer: United Healthcare HMO Rider |
$816.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$816.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$536.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$805.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$590.34
|
| Rate for Payer: Vantage Medical Group Senior |
$536.67
|
|
|
HC DIALYSIS PERITONEAL/CCPD
|
Facility
|
IP
|
$1,633.00
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
944000100
|
|
Hospital Revenue Code
|
804
|
| Min. Negotiated Rate |
$326.60 |
| Max. Negotiated Rate |
$1,469.70 |
| Rate for Payer: Adventist Health Commercial |
$326.60
|
| Rate for Payer: Cash Price |
$734.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,306.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,143.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$653.20
|
| Rate for Payer: EPIC Health Plan Senior |
$653.20
|
| Rate for Payer: Galaxy Health WC |
$1,388.05
|
| Rate for Payer: Global Benefits Group Commercial |
$979.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,469.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,036.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$963.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$326.60
|
| Rate for Payer: Multiplan Commercial |
$1,224.75
|
| Rate for Payer: Networks By Design Commercial |
$1,061.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,388.05
|
|
|
HC DIALYSIS PERITONEAL REPEAT
|
Facility
|
IP
|
$515.00
|
|
|
Service Code
|
CPT 90947
|
| Hospital Charge Code |
988190947
|
|
Hospital Revenue Code
|
804
|
| Min. Negotiated Rate |
$103.00 |
| Max. Negotiated Rate |
$463.50 |
| Rate for Payer: Adventist Health Commercial |
$103.00
|
| Rate for Payer: Cash Price |
$231.75
|
| Rate for Payer: Central Health Plan Commercial |
$412.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$360.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$206.00
|
| Rate for Payer: EPIC Health Plan Senior |
$206.00
|
| Rate for Payer: Galaxy Health WC |
$437.75
|
| Rate for Payer: Global Benefits Group Commercial |
$309.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$463.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$327.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$303.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.00
|
| Rate for Payer: Multiplan Commercial |
$386.25
|
| Rate for Payer: Networks By Design Commercial |
$334.75
|
| Rate for Payer: Prime Health Services Commercial |
$437.75
|
|
|
HC DIALYSIS PERITONEAL REPEAT
|
Facility
|
OP
|
$515.00
|
|
|
Service Code
|
CPT 90947
|
| Hospital Charge Code |
988190947
|
|
Hospital Revenue Code
|
804
|
| Min. Negotiated Rate |
$103.00 |
| Max. Negotiated Rate |
$718.00 |
| Rate for Payer: Adventist Health Commercial |
$103.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$718.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$437.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$386.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$249.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$299.58
|
| Rate for Payer: Blue Shield of California Commercial |
$326.51
|
| Rate for Payer: Blue Shield of California EPN |
$205.49
|
| Rate for Payer: Cash Price |
$231.75
|
| Rate for Payer: Cash Price |
$231.75
|
| Rate for Payer: Central Health Plan Commercial |
$412.00
|
| Rate for Payer: Cigna of CA HMO |
$329.60
|
| Rate for Payer: Cigna of CA PPO |
$381.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$437.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$437.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$437.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$360.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$206.00
|
| Rate for Payer: EPIC Health Plan Senior |
$206.00
|
| Rate for Payer: Galaxy Health WC |
$437.75
|
| Rate for Payer: Global Benefits Group Commercial |
$309.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$463.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$186.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$327.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$205.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$303.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$360.50
|
| Rate for Payer: Multiplan Commercial |
$386.25
|
| Rate for Payer: Networks By Design Commercial |
$334.75
|
| Rate for Payer: Prime Health Services Commercial |
$437.75
|
| Rate for Payer: Riverside University Health System MISP |
$206.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$309.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$309.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$257.50
|
| Rate for Payer: United Healthcare All Other HMO |
$257.50
|
| Rate for Payer: United Healthcare HMO Rider |
$257.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$257.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$437.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$437.75
|
| Rate for Payer: Vantage Medical Group Senior |
$437.75
|
|
|
HC DIFFERENTIAL LUNG SCAN
|
Facility
|
OP
|
$2,896.00
|
|
|
Service Code
|
CPT 78597
|
| Hospital Charge Code |
909301404
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$305.45 |
| Max. Negotiated Rate |
$2,606.40 |
| Rate for Payer: Adventist Health Commercial |
$579.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$514.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$975.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$514.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$977.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,358.46
|
| Rate for Payer: Blue Shield of California Commercial |
$1,824.48
|
| Rate for Payer: Blue Shield of California EPN |
$1,149.71
|
| Rate for Payer: Cash Price |
$1,303.20
|
| Rate for Payer: Cash Price |
$1,303.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,316.80
|
| Rate for Payer: Cigna of CA HMO |
$1,853.44
|
| Rate for Payer: Cigna of CA PPO |
$2,143.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$771.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,027.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$848.38
|
| Rate for Payer: EPIC Health Plan Senior |
$565.59
|
| Rate for Payer: Galaxy Health WC |
$2,461.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,737.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,606.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$843.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$305.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$514.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,838.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$337.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$719.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$579.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$688.99
|
| Rate for Payer: Multiplan Commercial |
$2,172.00
|
| Rate for Payer: Networks By Design Commercial |
$1,882.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$514.17
|
| Rate for Payer: Prime Health Services Commercial |
$2,461.60
|
| Rate for Payer: Prime Health Services Medicare |
$545.02
|
| Rate for Payer: Riverside University Health System MISP |
$565.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,737.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,737.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$518.19
|
| Rate for Payer: United Healthcare All Other HMO |
$518.19
|
| Rate for Payer: United Healthcare HMO Rider |
$518.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$518.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$514.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Vantage Medical Group Senior |
$514.17
|
|
|
HC DIFFERENTIAL LUNG SCAN
|
Facility
|
IP
|
$2,896.00
|
|
|
Service Code
|
CPT 78597
|
| Hospital Charge Code |
909301404
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$579.20 |
| Max. Negotiated Rate |
$2,606.40 |
| Rate for Payer: Adventist Health Commercial |
$579.20
|
| Rate for Payer: Cash Price |
$1,303.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,316.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,027.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,158.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,158.40
|
| Rate for Payer: Galaxy Health WC |
$2,461.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,737.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,606.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,838.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,708.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$579.20
|
| Rate for Payer: Multiplan Commercial |
$2,172.00
|
| Rate for Payer: Networks By Design Commercial |
$1,882.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,461.60
|
|
|
HC DIGITAL-SCREENING MAMMO, BILAT
|
Facility
|
OP
|
$797.00
|
|
|
Service Code
|
CPT 77067
|
| Hospital Charge Code |
909002010
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$159.40 |
| Max. Negotiated Rate |
$717.30 |
| Rate for Payer: Adventist Health Commercial |
$159.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$611.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$677.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$438.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$597.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$590.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$463.61
|
| Rate for Payer: Blue Shield of California Commercial |
$502.11
|
| Rate for Payer: Blue Shield of California EPN |
$316.41
|
| Rate for Payer: Cash Price |
$358.65
|
| Rate for Payer: Cash Price |
$358.65
|
| Rate for Payer: Central Health Plan Commercial |
$637.60
|
| Rate for Payer: Cigna of CA HMO |
$510.08
|
| Rate for Payer: Cigna of CA PPO |
$589.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$677.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$677.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$677.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$557.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.80
|
| Rate for Payer: EPIC Health Plan Senior |
$318.80
|
| Rate for Payer: Galaxy Health WC |
$677.45
|
| Rate for Payer: Global Benefits Group Commercial |
$478.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$717.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$205.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$506.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$226.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$470.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$557.90
|
| Rate for Payer: Multiplan Commercial |
$597.75
|
| Rate for Payer: Networks By Design Commercial |
$518.05
|
| Rate for Payer: Prime Health Services Commercial |
$677.45
|
| Rate for Payer: Riverside University Health System MISP |
$318.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$478.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$478.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$269.26
|
| Rate for Payer: United Healthcare All Other HMO |
$269.26
|
| Rate for Payer: United Healthcare HMO Rider |
$269.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$269.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$677.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$677.45
|
| Rate for Payer: Vantage Medical Group Senior |
$677.45
|
|
|
HC DIGITAL-SCREENING MAMMO, BILAT
|
Facility
|
IP
|
$797.00
|
|
|
Service Code
|
CPT 77067
|
| Hospital Charge Code |
909002010
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$159.40 |
| Max. Negotiated Rate |
$717.30 |
| Rate for Payer: Adventist Health Commercial |
$159.40
|
| Rate for Payer: Cash Price |
$358.65
|
| Rate for Payer: Central Health Plan Commercial |
$637.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$557.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.80
|
| Rate for Payer: EPIC Health Plan Senior |
$318.80
|
| Rate for Payer: Galaxy Health WC |
$677.45
|
| Rate for Payer: Global Benefits Group Commercial |
$478.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$717.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$506.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$470.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.40
|
| Rate for Payer: Multiplan Commercial |
$597.75
|
| Rate for Payer: Networks By Design Commercial |
$518.05
|
| Rate for Payer: Prime Health Services Commercial |
$677.45
|
|
|
HC DIGOXIN
|
Facility
|
OP
|
$191.00
|
|
|
Service Code
|
CPT 80162
|
| Hospital Charge Code |
900910816
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.76 |
| Max. Negotiated Rate |
$171.90 |
| Rate for Payer: Adventist Health Commercial |
$38.20
|
| Rate for Payer: Adventist Health Commercial |
$10.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.28
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$97.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$97.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$96.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$96.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$134.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$134.27
|
| Rate for Payer: Blue Shield of California Commercial |
$32.13
|
| Rate for Payer: Blue Shield of California Commercial |
$120.33
|
| Rate for Payer: Blue Shield of California EPN |
$20.25
|
| Rate for Payer: Blue Shield of California EPN |
$75.83
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Cash Price |
$85.95
|
| Rate for Payer: Cash Price |
$85.95
|
| Rate for Payer: Central Health Plan Commercial |
$152.80
|
| Rate for Payer: Central Health Plan Commercial |
$40.80
|
| Rate for Payer: Cigna of CA HMO |
$32.64
|
| Rate for Payer: Cigna of CA HMO |
$122.24
|
| Rate for Payer: Cigna of CA PPO |
$37.74
|
| Rate for Payer: Cigna of CA PPO |
$141.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$133.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.91
|
| Rate for Payer: EPIC Health Plan Senior |
$14.61
|
| Rate for Payer: EPIC Health Plan Senior |
$14.61
|
| Rate for Payer: Galaxy Health WC |
$43.35
|
| Rate for Payer: Galaxy Health WC |
$162.35
|
| Rate for Payer: Global Benefits Group Commercial |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$114.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$171.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.78
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$121.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.80
|
| Rate for Payer: Multiplan Commercial |
$38.25
|
| Rate for Payer: Multiplan Commercial |
$143.25
|
| Rate for Payer: Networks By Design Commercial |
$124.15
|
| Rate for Payer: Networks By Design Commercial |
$33.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.28
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.28
|
| Rate for Payer: Prime Health Services Commercial |
$43.35
|
| Rate for Payer: Prime Health Services Commercial |
$162.35
|
| Rate for Payer: Prime Health Services Medicare |
$14.08
|
| Rate for Payer: Prime Health Services Medicare |
$14.08
|
| Rate for Payer: Riverside University Health System MISP |
$14.61
|
| Rate for Payer: Riverside University Health System MISP |
$14.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$114.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$114.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.76
|
| Rate for Payer: United Healthcare All Other HMO |
$10.76
|
| Rate for Payer: United Healthcare All Other HMO |
$10.76
|
| Rate for Payer: United Healthcare HMO Rider |
$10.76
|
| Rate for Payer: United Healthcare HMO Rider |
$10.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.76
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.28
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.61
|
| Rate for Payer: Vantage Medical Group Senior |
$13.28
|
| Rate for Payer: Vantage Medical Group Senior |
$13.28
|
|
|
HC DIGOXIN
|
Facility
|
IP
|
$191.00
|
|
|
Service Code
|
CPT 80162
|
| Hospital Charge Code |
900910816
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.20 |
| Max. Negotiated Rate |
$171.90 |
| Rate for Payer: Adventist Health Commercial |
$38.20
|
| Rate for Payer: Cash Price |
$85.95
|
| Rate for Payer: Central Health Plan Commercial |
$152.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$133.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.40
|
| Rate for Payer: EPIC Health Plan Senior |
$76.40
|
| Rate for Payer: Galaxy Health WC |
$162.35
|
| Rate for Payer: Global Benefits Group Commercial |
$114.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$171.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$121.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$112.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.20
|
| Rate for Payer: Multiplan Commercial |
$143.25
|
| Rate for Payer: Networks By Design Commercial |
$124.15
|
| Rate for Payer: Prime Health Services Commercial |
$162.35
|
|
|
HC DILAT ANAL SPHINC UNDER ANES
|
Facility
|
OP
|
$9,701.00
|
|
|
Service Code
|
CPT 45905
|
| Hospital Charge Code |
906745905
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$259.34 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,940.20
|
| Rate for Payer: Adventist Health Commercial |
$3,514.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,539.08
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,539.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,692.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,692.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,539.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,539.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$4,365.45
|
| Rate for Payer: Cash Price |
$4,365.45
|
| Rate for Payer: Cash Price |
$7,907.85
|
| Rate for Payer: Cash Price |
$4,365.45
|
| Rate for Payer: Cash Price |
$7,907.85
|
| Rate for Payer: Cash Price |
$7,907.85
|
| Rate for Payer: Central Health Plan Commercial |
$14,058.40
|
| Rate for Payer: Central Health Plan Commercial |
$7,760.80
|
| Rate for Payer: Cigna of CA HMO |
$11,246.72
|
| Rate for Payer: Cigna of CA HMO |
$6,208.64
|
| Rate for Payer: Cigna of CA PPO |
$7,178.74
|
| Rate for Payer: Cigna of CA PPO |
$13,004.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,692.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,692.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,539.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,539.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,301.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,790.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,539.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,539.48
|
| Rate for Payer: EPIC Health Plan Senior |
$1,692.99
|
| Rate for Payer: EPIC Health Plan Senior |
$1,692.99
|
| Rate for Payer: Galaxy Health WC |
$8,245.85
|
| Rate for Payer: Galaxy Health WC |
$14,937.05
|
| Rate for Payer: Global Benefits Group Commercial |
$10,543.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,820.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,815.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,730.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,524.09
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,524.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$259.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$259.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,539.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,539.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,158.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,160.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$286.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$286.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,154.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,154.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,940.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,514.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,062.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,062.37
|
| Rate for Payer: Multiplan Commercial |
$7,275.75
|
| Rate for Payer: Multiplan Commercial |
$13,179.75
|
| Rate for Payer: Networks By Design Commercial |
$6,305.65
|
| Rate for Payer: Networks By Design Commercial |
$11,422.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,539.08
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,539.08
|
| Rate for Payer: Prime Health Services Commercial |
$14,937.05
|
| Rate for Payer: Prime Health Services Commercial |
$8,245.85
|
| Rate for Payer: Prime Health Services Medicare |
$1,631.42
|
| Rate for Payer: Prime Health Services Medicare |
$1,631.42
|
| Rate for Payer: Riverside University Health System MISP |
$1,692.99
|
| Rate for Payer: Riverside University Health System MISP |
$1,692.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,543.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,820.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,846.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,846.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,850.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,786.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,539.08
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,539.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,692.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,692.99
|
| Rate for Payer: Vantage Medical Group Senior |
$1,539.08
|
| Rate for Payer: Vantage Medical Group Senior |
$1,539.08
|
|
|
HC DILAT ANAL SPHINC UNDER ANES
|
Facility
|
OP
|
$9,701.00
|
|
|
Service Code
|
CPT 45905
|
| Hospital Charge Code |
906745905
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$259.34 |
| Max. Negotiated Rate |
$8,730.90 |
| Rate for Payer: Adventist Health Commercial |
$1,940.20
|
| Rate for Payer: Adventist Health Commercial |
$3,514.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,539.08
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,539.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$945.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$945.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,692.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,692.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,539.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,539.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,141.28
|
| Rate for Payer: Blue Shield of California Commercial |
$6,150.43
|
| Rate for Payer: Blue Shield of California EPN |
$3,870.70
|
| Rate for Payer: Blue Shield of California EPN |
$7,011.63
|
| Rate for Payer: Cash Price |
$7,907.85
|
| Rate for Payer: Cash Price |
$4,365.45
|
| Rate for Payer: Cash Price |
$4,365.45
|
| Rate for Payer: Cash Price |
$4,365.45
|
| Rate for Payer: Cash Price |
$7,907.85
|
| Rate for Payer: Cash Price |
$7,907.85
|
| Rate for Payer: Central Health Plan Commercial |
$7,760.80
|
| Rate for Payer: Central Health Plan Commercial |
$14,058.40
|
| Rate for Payer: Cigna of CA HMO |
$11,246.72
|
| Rate for Payer: Cigna of CA HMO |
$6,208.64
|
| Rate for Payer: Cigna of CA PPO |
$13,004.02
|
| Rate for Payer: Cigna of CA PPO |
$7,178.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,692.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,692.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,539.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,539.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,790.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,301.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,539.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,539.48
|
| Rate for Payer: EPIC Health Plan Senior |
$1,692.99
|
| Rate for Payer: EPIC Health Plan Senior |
$1,692.99
|
| Rate for Payer: Galaxy Health WC |
$14,937.05
|
| Rate for Payer: Galaxy Health WC |
$8,245.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,820.60
|
| Rate for Payer: Global Benefits Group Commercial |
$10,543.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,730.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,815.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,524.09
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,524.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$259.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$259.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,539.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,539.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,160.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,158.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$286.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$286.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,154.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,154.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,514.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,940.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,062.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,062.37
|
| Rate for Payer: Multiplan Commercial |
$13,179.75
|
| Rate for Payer: Multiplan Commercial |
$7,275.75
|
| Rate for Payer: Networks By Design Commercial |
$11,422.45
|
| Rate for Payer: Networks By Design Commercial |
$6,305.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,539.08
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,539.08
|
| Rate for Payer: Prime Health Services Commercial |
$14,937.05
|
| Rate for Payer: Prime Health Services Commercial |
$8,245.85
|
| Rate for Payer: Prime Health Services Medicare |
$1,631.42
|
| Rate for Payer: Prime Health Services Medicare |
$1,631.42
|
| Rate for Payer: Riverside University Health System MISP |
$1,692.99
|
| Rate for Payer: Riverside University Health System MISP |
$1,692.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,820.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,543.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10,543.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,820.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,850.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,786.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,850.50
|
| Rate for Payer: United Healthcare All Other HMO |
$8,786.50
|
| Rate for Payer: United Healthcare HMO Rider |
$8,786.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,850.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,850.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,786.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,539.08
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,539.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,692.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,692.99
|
| Rate for Payer: Vantage Medical Group Senior |
$1,539.08
|
| Rate for Payer: Vantage Medical Group Senior |
$1,539.08
|
|
|
HC DILAT ANAL SPHINC UNDER ANES
|
Facility
|
IP
|
$17,573.00
|
|
|
Service Code
|
CPT 45905
|
| Hospital Charge Code |
906745905
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3,514.60 |
| Max. Negotiated Rate |
$15,815.70 |
| Rate for Payer: Adventist Health Commercial |
$3,514.60
|
| Rate for Payer: Cash Price |
$7,907.85
|
| Rate for Payer: Central Health Plan Commercial |
$14,058.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,301.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,029.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7,029.20
|
| Rate for Payer: Galaxy Health WC |
$14,937.05
|
| Rate for Payer: Global Benefits Group Commercial |
$10,543.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,815.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,158.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,368.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,514.60
|
| Rate for Payer: Multiplan Commercial |
$13,179.75
|
| Rate for Payer: Networks By Design Commercial |
$11,422.45
|
| Rate for Payer: Prime Health Services Commercial |
$14,937.05
|
|
|
HC DILAT ANAL SPHINC UNDER ANES
|
Facility
|
IP
|
$17,573.00
|
|
|
Service Code
|
CPT 45905
|
| Hospital Charge Code |
906745905
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$3,514.60 |
| Max. Negotiated Rate |
$15,815.70 |
| Rate for Payer: Adventist Health Commercial |
$3,514.60
|
| Rate for Payer: Cash Price |
$7,907.85
|
| Rate for Payer: Central Health Plan Commercial |
$14,058.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,301.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,029.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7,029.20
|
| Rate for Payer: Galaxy Health WC |
$14,937.05
|
| Rate for Payer: Global Benefits Group Commercial |
$10,543.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,815.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,158.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,368.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,514.60
|
| Rate for Payer: Multiplan Commercial |
$13,179.75
|
| Rate for Payer: Networks By Design Commercial |
$11,422.45
|
| Rate for Payer: Prime Health Services Commercial |
$14,937.05
|
|
|
HC DILATE BILIARY OR AMPULLA PERC
|
Facility
|
OP
|
$1,969.00
|
|
|
Service Code
|
CPT 47542
|
| Hospital Charge Code |
909047542
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$393.80 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$393.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,673.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,082.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,476.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$886.05
|
| Rate for Payer: Cash Price |
$886.05
|
| Rate for Payer: Cash Price |
$886.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,575.20
|
| Rate for Payer: Cigna of CA HMO |
$1,260.16
|
| Rate for Payer: Cigna of CA PPO |
$1,457.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,673.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,673.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,673.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,378.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$787.60
|
| Rate for Payer: EPIC Health Plan Senior |
$787.60
|
| Rate for Payer: Galaxy Health WC |
$1,673.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,181.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,772.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$807.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,250.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$891.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,161.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$393.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,378.30
|
| Rate for Payer: Multiplan Commercial |
$1,476.75
|
| Rate for Payer: Networks By Design Commercial |
$1,279.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,673.65
|
| Rate for Payer: Riverside University Health System MISP |
$787.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,181.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$984.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,673.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,673.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1,673.65
|
|
|
HC DILATE BILIARY OR AMPULLA PERC
|
Facility
|
IP
|
$1,969.00
|
|
|
Service Code
|
CPT 47542
|
| Hospital Charge Code |
909047542
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$393.80 |
| Max. Negotiated Rate |
$1,772.10 |
| Rate for Payer: Adventist Health Commercial |
$393.80
|
| Rate for Payer: Cash Price |
$886.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,575.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,378.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$787.60
|
| Rate for Payer: EPIC Health Plan Senior |
$787.60
|
| Rate for Payer: Galaxy Health WC |
$1,673.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,181.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,772.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,250.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,161.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$393.80
|
| Rate for Payer: Multiplan Commercial |
$1,476.75
|
| Rate for Payer: Networks By Design Commercial |
$1,279.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,673.65
|
|
|
HC DILAT ESOPH BOUGIE/SNGL OR MUL
|
Facility
|
OP
|
$8,832.00
|
|
|
Service Code
|
CPT 43450
|
| Hospital Charge Code |
906743450
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$80.05 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,766.40
|
| Rate for Payer: Adventist Health Commercial |
$920.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,166.53
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,166.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$3,974.40
|
| Rate for Payer: Cash Price |
$3,974.40
|
| Rate for Payer: Cash Price |
$2,071.35
|
| Rate for Payer: Cash Price |
$3,974.40
|
| Rate for Payer: Cash Price |
$2,071.35
|
| Rate for Payer: Cash Price |
$2,071.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,682.40
|
| Rate for Payer: Central Health Plan Commercial |
$7,065.60
|
| Rate for Payer: Cigna of CA HMO |
$2,945.92
|
| Rate for Payer: Cigna of CA HMO |
$5,652.48
|
| Rate for Payer: Cigna of CA PPO |
$6,535.68
|
| Rate for Payer: Cigna of CA PPO |
$3,406.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,222.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,182.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: Galaxy Health WC |
$7,507.20
|
| Rate for Payer: Galaxy Health WC |
$3,912.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,761.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,299.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,142.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,948.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$80.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$80.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,922.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,608.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$88.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$88.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,766.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$920.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$6,624.00
|
| Rate for Payer: Multiplan Commercial |
$3,452.25
|
| Rate for Payer: Networks By Design Commercial |
$5,740.80
|
| Rate for Payer: Networks By Design Commercial |
$2,991.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,166.53
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Prime Health Services Commercial |
$3,912.55
|
| Rate for Payer: Prime Health Services Commercial |
$7,507.20
|
| Rate for Payer: Prime Health Services Medicare |
$1,236.52
|
| Rate for Payer: Prime Health Services Medicare |
$1,236.52
|
| Rate for Payer: Riverside University Health System MISP |
$1,283.18
|
| Rate for Payer: Riverside University Health System MISP |
$1,283.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,761.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,299.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,399.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,399.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,416.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,301.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC DILAT ESOPH BOUGIE/SNGL OR MUL
|
Facility
|
IP
|
$8,832.00
|
|
|
Service Code
|
CPT 43450
|
| Hospital Charge Code |
906743450
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,766.40 |
| Max. Negotiated Rate |
$7,948.80 |
| Rate for Payer: Adventist Health Commercial |
$1,766.40
|
| Rate for Payer: Cash Price |
$3,974.40
|
| Rate for Payer: Central Health Plan Commercial |
$7,065.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,182.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,532.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,532.80
|
| Rate for Payer: Galaxy Health WC |
$7,507.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,299.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,948.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,608.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,210.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,766.40
|
| Rate for Payer: Multiplan Commercial |
$6,624.00
|
| Rate for Payer: Networks By Design Commercial |
$5,740.80
|
| Rate for Payer: Prime Health Services Commercial |
$7,507.20
|
|
|
HC DILAT ESOPH BOUGIE/SNGL OR MUL
|
Facility
|
OP
|
$8,832.00
|
|
|
Service Code
|
CPT 43450
|
| Hospital Charge Code |
906743450
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$88.43 |
| Max. Negotiated Rate |
$7,948.80 |
| Rate for Payer: Adventist Health Commercial |
$1,766.40
|
| Rate for Payer: Adventist Health Commercial |
$920.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,898.06
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,898.06
|
| Rate for Payer: Cash Price |
$2,071.35
|
| Rate for Payer: Cash Price |
$3,974.40
|
| Rate for Payer: Cash Price |
$3,974.40
|
| Rate for Payer: Cash Price |
$2,071.35
|
| Rate for Payer: Cash Price |
$2,071.35
|
| Rate for Payer: Cash Price |
$3,974.40
|
| Rate for Payer: Cash Price |
$2,071.35
|
| Rate for Payer: Cash Price |
$3,974.40
|
| Rate for Payer: Central Health Plan Commercial |
$7,065.60
|
| Rate for Payer: Central Health Plan Commercial |
$3,682.40
|
| Rate for Payer: Cigna of CA HMO |
$2,945.92
|
| Rate for Payer: Cigna of CA HMO |
$5,652.48
|
| Rate for Payer: Cigna of CA PPO |
$6,535.68
|
| Rate for Payer: Cigna of CA PPO |
$3,406.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,182.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,222.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: Galaxy Health WC |
$3,912.55
|
| Rate for Payer: Galaxy Health WC |
$7,507.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,761.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,299.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,948.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,142.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,922.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,608.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$88.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$88.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,254.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,254.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$920.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,766.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$3,452.25
|
| Rate for Payer: Multiplan Commercial |
$6,624.00
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Networks By Design Commercial |
$2,991.95
|
| Rate for Payer: Networks By Design Commercial |
$5,740.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,166.53
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Preferred Health Network WC |
$1,936.80
|
| Rate for Payer: Preferred Health Network WC |
$1,936.80
|
| Rate for Payer: Prime Health Services Commercial |
$7,507.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,912.55
|
| Rate for Payer: Prime Health Services Medicare |
$1,236.52
|
| Rate for Payer: Prime Health Services Medicare |
$1,236.52
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Riverside University Health System MISP |
$1,283.18
|
| Rate for Payer: Riverside University Health System MISP |
$1,283.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,299.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,761.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,301.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,416.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,416.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,301.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,301.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,416.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,416.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,301.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC DILAT ESOPH BOUGIE/SNGL OR MUL
|
Facility
|
IP
|
$8,832.00
|
|
|
Service Code
|
CPT 43450
|
| Hospital Charge Code |
906743450
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,766.40 |
| Max. Negotiated Rate |
$7,948.80 |
| Rate for Payer: Adventist Health Commercial |
$1,766.40
|
| Rate for Payer: Cash Price |
$3,974.40
|
| Rate for Payer: Central Health Plan Commercial |
$7,065.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,182.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,532.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,532.80
|
| Rate for Payer: Galaxy Health WC |
$7,507.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,299.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,948.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,608.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,210.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,766.40
|
| Rate for Payer: Multiplan Commercial |
$6,624.00
|
| Rate for Payer: Networks By Design Commercial |
$5,740.80
|
| Rate for Payer: Prime Health Services Commercial |
$7,507.20
|
|
|
HC DILAT ESOPH OVER GUIDE WIRE
|
Facility
|
OP
|
$7,054.00
|
|
|
Service Code
|
CPT 43453
|
| Hospital Charge Code |
906743453
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$172.89 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,410.80
|
| Rate for Payer: Adventist Health Commercial |
$919.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,468.04
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,468.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$3,174.30
|
| Rate for Payer: Cash Price |
$3,174.30
|
| Rate for Payer: Cash Price |
$2,067.75
|
| Rate for Payer: Cash Price |
$3,174.30
|
| Rate for Payer: Cash Price |
$2,067.75
|
| Rate for Payer: Cash Price |
$2,067.75
|
| Rate for Payer: Central Health Plan Commercial |
$3,676.00
|
| Rate for Payer: Central Health Plan Commercial |
$5,643.20
|
| Rate for Payer: Cigna of CA HMO |
$2,940.80
|
| Rate for Payer: Cigna of CA HMO |
$4,514.56
|
| Rate for Payer: Cigna of CA PPO |
$5,219.96
|
| Rate for Payer: Cigna of CA PPO |
$3,400.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,216.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,937.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: Galaxy Health WC |
$5,995.90
|
| Rate for Payer: Galaxy Health WC |
$3,905.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,757.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,232.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,135.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,348.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$172.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$172.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,917.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,479.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$190.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$190.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,410.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$919.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$5,290.50
|
| Rate for Payer: Multiplan Commercial |
$3,446.25
|
| Rate for Payer: Networks By Design Commercial |
$4,585.10
|
| Rate for Payer: Networks By Design Commercial |
$2,986.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,468.04
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Prime Health Services Commercial |
$3,905.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,995.90
|
| Rate for Payer: Prime Health Services Medicare |
$2,616.12
|
| Rate for Payer: Prime Health Services Medicare |
$2,616.12
|
| Rate for Payer: Riverside University Health System MISP |
$2,714.84
|
| Rate for Payer: Riverside University Health System MISP |
$2,714.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,757.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,232.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,961.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,961.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,527.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,297.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
|
|
HC DILAT ESOPH OVER GUIDE WIRE
|
Facility
|
IP
|
$7,054.00
|
|
|
Service Code
|
CPT 43453
|
| Hospital Charge Code |
906743453
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,410.80 |
| Max. Negotiated Rate |
$6,348.60 |
| Rate for Payer: Adventist Health Commercial |
$1,410.80
|
| Rate for Payer: Cash Price |
$3,174.30
|
| Rate for Payer: Central Health Plan Commercial |
$5,643.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,937.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,821.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,821.60
|
| Rate for Payer: Galaxy Health WC |
$5,995.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,232.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,348.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,479.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,161.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,410.80
|
| Rate for Payer: Multiplan Commercial |
$5,290.50
|
| Rate for Payer: Networks By Design Commercial |
$4,585.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,995.90
|
|
