|
HC DIALYSIS CRCT VASC EMBO OR OCC
|
Facility
|
OP
|
$6,886.00
|
|
|
Service Code
|
CPT 36909
|
| Hospital Charge Code |
909036909
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,000.00 |
| Max. Negotiated Rate |
$8,581.00 |
| Rate for Payer: Adventist Health Commercial |
$1,377.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,853.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,787.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,164.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,581.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,999.40
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: Cash Price |
$3,098.70
|
| Rate for Payer: Cash Price |
$3,098.70
|
| Rate for Payer: Cash Price |
$3,098.70
|
| Rate for Payer: Central Health Plan Commercial |
$5,508.80
|
| Rate for Payer: Cigna of CA HMO |
$4,407.04
|
| Rate for Payer: Cigna of CA PPO |
$5,095.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,853.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,853.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,853.10
|
| 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: Inland Empire Health Plan (IEHP) medi-cal |
$3,106.37
|
| Rate for Payer: InnovAge PACE Commercial |
$3,443.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,592.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,431.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,262.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,377.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,820.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,820.20
|
| 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
|
| Rate for Payer: Riverside University Health System MISP |
$2,754.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,131.60
|
| 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: Vantage Medical Group Commercial/Exchange |
$5,853.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,853.10
|
| Rate for Payer: Vantage Medical Group Senior |
$5,853.10
|
|
|
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 |
$58.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$87.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$64.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$990.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$93.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| 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 |
$87.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$58.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.15
|
| Rate for Payer: EPIC Health Plan Senior |
$58.63
|
| 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 |
$96.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$58.63
|
| Rate for Payer: InnovAge PACE Commercial |
$87.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$398.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$58.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78.56
|
| 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 |
$58.63
|
| 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 |
$62.15
|
| Rate for Payer: Prime Health Services WC |
$92.45
|
| Rate for Payer: Riverside University Health System MISP |
$64.49
|
| 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 |
$58.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$87.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.49
|
| Rate for Payer: Vantage Medical Group Senior |
$58.63
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$398.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$227.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.16
|
| 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 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: 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 Permanente of CA Commercial/Self Funded |
$1,089.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$622.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,010.83
|
| 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/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 |
$541.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$991.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$811.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$595.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$541.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$790.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$959.06
|
| Rate for Payer: Blue Shield of California Commercial |
$997.76
|
| 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 |
$811.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$595.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$541.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$730.42
|
| Rate for Payer: EPIC Health Plan Senior |
$541.05
|
| 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 |
$887.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$124.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$541.05
|
| Rate for Payer: InnovAge PACE Commercial |
$811.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,089.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$541.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$326.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$725.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$725.01
|
| 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 |
$541.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,388.05
|
| Rate for Payer: Prime Health Services Medicare |
$573.51
|
| Rate for Payer: Riverside University Health System MISP |
$595.15
|
| 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 |
$541.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$811.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$595.15
|
| Rate for Payer: Vantage Medical Group Senior |
$541.05
|
|
|
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 |
$463.50 |
| Rate for Payer: Adventist Health Commercial |
$103.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$312.76
|
| 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 |
$302.46
|
| Rate for Payer: Blue Shield of California Commercial |
$314.67
|
| 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: 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: InnovAge PACE Commercial |
$257.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$343.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$318.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$360.50
|
| Rate for Payer: Molina Healthcare of CA 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 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: 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 Permanente of CA Commercial/Self Funded |
$343.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$318.79
|
| 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 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: 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 Permanente of CA Commercial/Self Funded |
$1,931.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,103.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,792.62
|
| 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 DIFFERENTIAL LUNG SCAN
|
Facility
|
OP
|
$2,896.00
|
|
|
Service Code
|
CPT 78597
|
| Hospital Charge Code |
909301404
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$198.31 |
| Max. Negotiated Rate |
$2,606.40 |
| Rate for Payer: Adventist Health Commercial |
$579.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$510.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,758.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$977.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$198.31
|
| Rate for Payer: Blue Shield of California Commercial |
$1,757.87
|
| 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 |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$689.27
|
| Rate for Payer: EPIC Health Plan Senior |
$510.57
|
| 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 |
$837.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$305.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: InnovAge PACE Commercial |
$765.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,931.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$337.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$510.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$579.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$684.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$684.16
|
| 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 |
$510.57
|
| Rate for Payer: Prime Health Services Commercial |
$2,461.60
|
| Rate for Payer: Prime Health Services Medicare |
$541.20
|
| Rate for Payer: Riverside University Health System MISP |
$561.63
|
| 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 |
$510.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
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 |
$484.02
|
| 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 |
$468.08
|
| Rate for Payer: Blue Shield of California Commercial |
$483.78
|
| 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: 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: InnovAge PACE Commercial |
$398.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$531.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$226.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$493.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$557.90
|
| Rate for Payer: Molina Healthcare of CA 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: 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 Permanente of CA Commercial/Self Funded |
$531.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$303.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$493.34
|
| 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
|
$51.00
|
|
|
Service Code
|
CPT 80162
|
| Hospital Charge Code |
900910816
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$96.58 |
| Rate for Payer: Adventist Health Commercial |
$10.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.97
|
| 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 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 HMO/PPO |
$19.60
|
| Rate for Payer: Blue Shield of California Commercial |
$30.96
|
| Rate for Payer: Blue Shield of California EPN |
$20.25
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Central Health Plan Commercial |
$40.80
|
| Rate for Payer: Cigna of CA HMO |
$32.64
|
| Rate for Payer: Cigna of CA PPO |
$37.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.93
|
| Rate for Payer: EPIC Health Plan Senior |
$13.28
|
| Rate for Payer: Galaxy Health WC |
$43.35
|
| Rate for Payer: Global Benefits Group Commercial |
$30.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.90
|
| 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) Medicare Advantage |
$13.28
|
| Rate for Payer: InnovAge PACE Commercial |
$19.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.80
|
| Rate for Payer: Multiplan Commercial |
$38.25
|
| Rate for Payer: Networks By Design Commercial |
$33.15
|
| 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 Medicare |
$14.08
|
| Rate for Payer: Riverside University Health System MISP |
$14.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.60
|
| 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 HMO Rider |
$10.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.76
|
| 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 Medi-Cal |
$14.61
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$127.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$118.23
|
| 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
|
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: 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 Permanente of CA Commercial/Self Funded |
$11,721.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,695.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,877.69
|
| 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
|
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 Medi-Cal |
$1,498.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,498.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,927.31
|
| Rate for Payer: Blue Shield of California EPN |
$3,870.70
|
| 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: Central Health Plan Commercial |
$7,760.80
|
| Rate for Payer: Cigna of CA HMO |
$6,208.64
|
| Rate for Payer: Cigna of CA PPO |
$7,178.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,647.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,498.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,022.49
|
| Rate for Payer: EPIC Health Plan Senior |
$1,498.14
|
| Rate for Payer: Galaxy Health WC |
$8,245.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,820.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,730.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,456.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$259.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,498.14
|
| Rate for Payer: InnovAge PACE Commercial |
$2,247.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,470.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$286.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,498.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,940.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,007.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,007.51
|
| Rate for Payer: Multiplan Commercial |
$7,275.75
|
| Rate for Payer: Networks By Design Commercial |
$6,305.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,498.14
|
| Rate for Payer: Prime Health Services Commercial |
$8,245.85
|
| Rate for Payer: Prime Health Services Medicare |
$1,588.03
|
| Rate for Payer: Riverside University Health System MISP |
$1,647.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,820.60
|
| 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 HMO |
$4,850.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,850.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,850.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,498.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,498.14
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$11,721.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,695.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,877.69
|
| 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
|
OP
|
$9,701.00
|
|
|
Service Code
|
CPT 45905
|
| Hospital Charge Code |
906745905
|
|
Hospital Revenue Code
|
750
|
| 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 Medi-Cal |
$1,498.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,498.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| 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 |
$4,365.45
|
| Rate for Payer: Central Health Plan Commercial |
$7,760.80
|
| Rate for Payer: Cigna of CA HMO |
$6,208.64
|
| Rate for Payer: Cigna of CA PPO |
$7,178.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,647.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,498.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,022.49
|
| Rate for Payer: EPIC Health Plan Senior |
$1,498.14
|
| Rate for Payer: Galaxy Health WC |
$8,245.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,820.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,730.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,456.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$259.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,498.14
|
| Rate for Payer: InnovAge PACE Commercial |
$2,247.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,470.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$286.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,498.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,940.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,007.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,007.51
|
| Rate for Payer: Multiplan Commercial |
$7,275.75
|
| Rate for Payer: Networks By Design Commercial |
$6,305.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,498.14
|
| Rate for Payer: Prime Health Services Commercial |
$8,245.85
|
| Rate for Payer: Prime Health Services Medicare |
$1,588.03
|
| Rate for Payer: Riverside University Health System MISP |
$1,647.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,820.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,797.77
|
| 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 |
$1,498.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,498.14
|
|
|
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 |
$7,764.00 |
| Rate for Payer: Adventist Health Commercial |
$393.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| 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 |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,764.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,851.77
|
| 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: 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: InnovAge PACE Commercial |
$984.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,313.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$891.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,218.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$393.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,378.30
|
| Rate for Payer: Molina Healthcare of CA 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 |
$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: 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: 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 Permanente of CA Commercial/Self Funded |
$1,313.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$750.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,218.81
|
| 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 DILATE ESOPHAGUS
|
Facility
|
OP
|
$987.00
|
|
|
Service Code
|
CPT 43456
|
| Hospital Charge Code |
906743456
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$197.40 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$197.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$838.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$542.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$740.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$477.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$579.67
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$444.15
|
| Rate for Payer: Cash Price |
$444.15
|
| Rate for Payer: Central Health Plan Commercial |
$789.60
|
| Rate for Payer: Cigna of CA HMO |
$631.68
|
| Rate for Payer: Cigna of CA PPO |
$730.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$838.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$838.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$838.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$394.80
|
| Rate for Payer: EPIC Health Plan Senior |
$394.80
|
| Rate for Payer: Galaxy Health WC |
$838.95
|
| Rate for Payer: Global Benefits Group Commercial |
$592.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$888.30
|
| Rate for Payer: InnovAge PACE Commercial |
$493.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$658.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$376.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$610.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$197.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$690.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$690.90
|
| Rate for Payer: Multiplan Commercial |
$740.25
|
| Rate for Payer: Networks By Design Commercial |
$641.55
|
| Rate for Payer: Prime Health Services Commercial |
$838.95
|
| Rate for Payer: Riverside University Health System MISP |
$394.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$592.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$592.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$493.50
|
| Rate for Payer: United Healthcare All Other HMO |
$493.50
|
| Rate for Payer: United Healthcare HMO Rider |
$493.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$493.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$838.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$838.95
|
| Rate for Payer: Vantage Medical Group Senior |
$838.95
|
|
|
HC DILAT ESOPH BOUGIE/SNGL OR MUL
|
Facility
|
OP
|
$4,603.00
|
|
|
Service Code
|
CPT 43450
|
| Hospital Charge Code |
906743450
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$80.05 |
| Max. Negotiated Rate |
$7,378.00 |
| Rate for Payer: Adventist Health Commercial |
$920.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,191.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$2,071.35
|
| 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: Cigna of CA HMO |
$2,945.92
|
| Rate for Payer: Cigna of CA PPO |
$3,406.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,608.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,191.26
|
| Rate for Payer: Galaxy Health WC |
$3,912.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,761.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,142.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$80.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: InnovAge PACE Commercial |
$1,786.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,070.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$920.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,596.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,596.29
|
| Rate for Payer: Multiplan Commercial |
$3,452.25
|
| Rate for Payer: Networks By Design Commercial |
$2,991.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Prime Health Services Commercial |
$3,912.55
|
| Rate for Payer: Prime Health Services Medicare |
$1,262.74
|
| Rate for Payer: Riverside University Health System MISP |
$1,310.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,761.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,429.51
|
| 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 |
$1,191.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC DILAT ESOPH BOUGIE/SNGL OR MUL
|
Facility
|
OP
|
$4,603.00
|
|
|
Service Code
|
CPT 43450
|
| Hospital Charge Code |
906743450
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$88.43 |
| Max. Negotiated Rate |
$4,142.70 |
| Rate for Payer: Adventist Health Commercial |
$920.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| 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 |
$2,071.35
|
| 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: Cigna of CA HMO |
$2,945.92
|
| Rate for Payer: Cigna of CA PPO |
$3,406.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,608.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,191.26
|
| Rate for Payer: Galaxy Health WC |
$3,912.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,761.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,142.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: InnovAge PACE Commercial |
$1,786.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,070.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$920.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,596.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,596.29
|
| Rate for Payer: Multiplan Commercial |
$3,452.25
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Networks By Design Commercial |
$2,991.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Preferred Health Network WC |
$1,936.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,912.55
|
| Rate for Payer: Prime Health Services Medicare |
$1,262.74
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Riverside University Health System MISP |
$1,310.39
|
| 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 HMO |
$2,301.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,301.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,301.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,191.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$5,890.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,364.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,467.01
|
| 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
|
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: 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 Permanente of CA Commercial/Self Funded |
$5,890.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,364.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,467.01
|
| 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
|
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: 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 Permanente of CA Commercial/Self Funded |
$4,705.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,687.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,366.43
|
| 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
|
|
