|
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 |
$1,082.95
|
| Rate for Payer: Cash Price |
$1,082.95
|
| Rate for Payer: Cash Price |
$1,082.95
|
| 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 ESOPHAGUS
|
Facility
|
IP
|
$987.00
|
|
|
Service Code
|
CPT 43456
|
| Hospital Charge Code |
906743456
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$197.40 |
| Max. Negotiated Rate |
$888.30 |
| Rate for Payer: Adventist Health Commercial |
$197.40
|
| Rate for Payer: Cash Price |
$542.85
|
| Rate for Payer: Central Health Plan Commercial |
$789.60
|
| 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: 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: Multiplan Commercial |
$740.25
|
| Rate for Payer: Networks By Design Commercial |
$641.55
|
| Rate for Payer: Prime Health Services Commercial |
$838.95
|
|
|
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 |
$542.85
|
| Rate for Payer: Cash Price |
$542.85
|
| 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 |
$2,531.65
|
| Rate for Payer: Cash Price |
$2,531.65
|
| Rate for Payer: Cash Price |
$2,531.65
|
| 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
|
IP
|
$4,603.00
|
|
|
Service Code
|
CPT 43450
|
| Hospital Charge Code |
906743450
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$920.60 |
| Max. Negotiated Rate |
$4,142.70 |
| Rate for Payer: Adventist Health Commercial |
$920.60
|
| Rate for Payer: Cash Price |
$2,531.65
|
| Rate for Payer: Central Health Plan Commercial |
$3,682.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,841.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,841.20
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$3,070.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,753.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,849.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$920.60
|
| Rate for Payer: Multiplan Commercial |
$3,452.25
|
| Rate for Payer: Networks By Design Commercial |
$2,991.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,912.55
|
|
|
HC DILAT ESOPH BOUGIE/SNGL OR MUL
|
Facility
|
IP
|
$4,603.00
|
|
|
Service Code
|
CPT 43450
|
| Hospital Charge Code |
906743450
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$920.60 |
| Max. Negotiated Rate |
$4,142.70 |
| Rate for Payer: Adventist Health Commercial |
$920.60
|
| Rate for Payer: Cash Price |
$2,531.65
|
| Rate for Payer: Central Health Plan Commercial |
$3,682.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,841.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,841.20
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$3,070.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,753.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,849.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$920.60
|
| Rate for Payer: Multiplan Commercial |
$3,452.25
|
| Rate for Payer: Networks By Design Commercial |
$2,991.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,912.55
|
|
|
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 |
$2,531.65
|
| Rate for Payer: Cash Price |
$2,531.65
|
| Rate for Payer: Cash Price |
$2,531.65
|
| Rate for Payer: Cash Price |
$2,531.65
|
| 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 OVER GUIDE WIRE
|
Facility
|
OP
|
$4,595.00
|
|
|
Service Code
|
CPT 43453
|
| Hospital Charge Code |
906743453
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$172.89 |
| Max. Negotiated Rate |
$7,378.00 |
| Rate for Payer: Adventist Health Commercial |
$919.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,410.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,410.32
|
| Rate for Payer: Anthem Blue Cross of CA 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 |
$2,527.25
|
| Rate for Payer: Cash Price |
$2,527.25
|
| Rate for Payer: Cash Price |
$2,527.25
|
| Rate for Payer: Central Health Plan Commercial |
$3,676.00
|
| Rate for Payer: Cigna of CA HMO |
$2,940.80
|
| Rate for Payer: Cigna of CA PPO |
$3,400.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,651.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,410.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,253.93
|
| Rate for Payer: EPIC Health Plan Senior |
$2,410.32
|
| Rate for Payer: Galaxy Health WC |
$3,905.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,757.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,135.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$172.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: InnovAge PACE Commercial |
$3,615.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,064.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$190.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$919.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,229.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,229.83
|
| Rate for Payer: Multiplan Commercial |
$3,446.25
|
| Rate for Payer: Networks By Design Commercial |
$2,986.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Prime Health Services Commercial |
$3,905.75
|
| Rate for Payer: Prime Health Services Medicare |
$2,554.94
|
| Rate for Payer: Riverside University Health System MISP |
$2,651.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,757.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,892.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,410.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,410.32
|
|
|
HC DILAT ESOPH OVER GUIDE WIRE
|
Facility
|
IP
|
$4,595.00
|
|
|
Service Code
|
CPT 43453
|
| Hospital Charge Code |
906743453
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$919.00 |
| Max. Negotiated Rate |
$4,135.50 |
| Rate for Payer: Adventist Health Commercial |
$919.00
|
| Rate for Payer: Cash Price |
$2,527.25
|
| Rate for Payer: Central Health Plan Commercial |
$3,676.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,838.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,838.00
|
| Rate for Payer: Galaxy Health WC |
$3,905.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,757.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,135.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,064.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,750.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,844.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$919.00
|
| Rate for Payer: Multiplan Commercial |
$3,446.25
|
| Rate for Payer: Networks By Design Commercial |
$2,986.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,905.75
|
|
|
HC DILAT ESOPH W BLLN FOR ACHALAS
|
Facility
|
IP
|
$2,634.00
|
|
|
Service Code
|
CPT 43458
|
| Hospital Charge Code |
906743458
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$526.80 |
| Max. Negotiated Rate |
$2,370.60 |
| Rate for Payer: Adventist Health Commercial |
$526.80
|
| Rate for Payer: Cash Price |
$1,448.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,107.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,053.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,053.60
|
| Rate for Payer: Galaxy Health WC |
$2,238.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,580.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,370.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,756.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,003.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,630.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$526.80
|
| Rate for Payer: Multiplan Commercial |
$1,975.50
|
| Rate for Payer: Networks By Design Commercial |
$1,712.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,238.90
|
|
|
HC DILAT ESOPH W BLLN FOR ACHALAS
|
Facility
|
IP
|
$2,634.00
|
|
|
Service Code
|
CPT 43458
|
| Hospital Charge Code |
906743458
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$526.80 |
| Max. Negotiated Rate |
$2,370.60 |
| Rate for Payer: Adventist Health Commercial |
$526.80
|
| Rate for Payer: Cash Price |
$1,448.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,107.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,053.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,053.60
|
| Rate for Payer: Galaxy Health WC |
$2,238.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,580.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,370.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,756.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,003.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,630.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$526.80
|
| Rate for Payer: Multiplan Commercial |
$1,975.50
|
| Rate for Payer: Networks By Design Commercial |
$1,712.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,238.90
|
|
|
HC DILAT ESOPH W BLLN FOR ACHALAS
|
Facility
|
OP
|
$2,634.00
|
|
|
Service Code
|
CPT 43458
|
| Hospital Charge Code |
906743458
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$526.80 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$526.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,238.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,448.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,975.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,275.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,546.95
|
| 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 |
$1,448.70
|
| Rate for Payer: Cash Price |
$1,448.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,107.20
|
| Rate for Payer: Cigna of CA HMO |
$1,685.76
|
| Rate for Payer: Cigna of CA PPO |
$1,949.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,238.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,238.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,238.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,053.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,053.60
|
| Rate for Payer: Galaxy Health WC |
$2,238.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,580.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,370.60
|
| Rate for Payer: InnovAge PACE Commercial |
$1,317.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,756.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,003.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,630.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$526.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,843.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,843.80
|
| Rate for Payer: Multiplan Commercial |
$1,975.50
|
| Rate for Payer: Networks By Design Commercial |
$1,712.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,238.90
|
| Rate for Payer: Riverside University Health System MISP |
$1,053.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,580.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,317.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,317.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,317.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,317.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,238.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,238.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,238.90
|
|
|
HC DILAT ESOPH W BLLN FOR ACHALAS
|
Facility
|
OP
|
$2,634.00
|
|
|
Service Code
|
CPT 43458
|
| Hospital Charge Code |
906743458
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$526.80 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$526.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,238.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,448.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,975.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,275.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,546.95
|
| 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 |
$1,448.70
|
| Rate for Payer: Cash Price |
$1,448.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,107.20
|
| Rate for Payer: Cigna of CA HMO |
$1,685.76
|
| Rate for Payer: Cigna of CA PPO |
$1,949.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,238.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,238.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,238.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,053.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,053.60
|
| Rate for Payer: Galaxy Health WC |
$2,238.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,580.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,370.60
|
| Rate for Payer: InnovAge PACE Commercial |
$1,317.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,756.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,003.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,630.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$526.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,843.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,843.80
|
| Rate for Payer: Multiplan Commercial |
$1,975.50
|
| Rate for Payer: Networks By Design Commercial |
$1,712.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,238.90
|
| Rate for Payer: Riverside University Health System MISP |
$1,053.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,580.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,580.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,317.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,317.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,317.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,317.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,238.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,238.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,238.90
|
|
|
HC DILATE TEAR DUCT OPENING
|
Facility
|
OP
|
$372.00
|
|
|
Service Code
|
CPT 68801
|
| Hospital Charge Code |
900501698
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$74.40 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Commercial |
$74.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.02
|
| 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 |
$807.84
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Central Health Plan Commercial |
$297.60
|
| Rate for Payer: Cigna of CA HMO |
$238.08
|
| Rate for Payer: Cigna of CA PPO |
$275.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$760.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$557.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$684.48
|
| Rate for Payer: EPIC Health Plan Senior |
$507.02
|
| Rate for Payer: Galaxy Health WC |
$316.20
|
| Rate for Payer: Global Benefits Group Commercial |
$223.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$334.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$831.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.02
|
| Rate for Payer: InnovAge PACE Commercial |
$760.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$248.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$259.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$679.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$679.41
|
| Rate for Payer: Multiplan Commercial |
$279.00
|
| Rate for Payer: Multiplan WC |
$807.84
|
| Rate for Payer: Networks By Design Commercial |
$241.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$507.02
|
| Rate for Payer: Preferred Health Network WC |
$824.33
|
| Rate for Payer: Prime Health Services Commercial |
$316.20
|
| Rate for Payer: Prime Health Services Medicare |
$537.44
|
| Rate for Payer: Prime Health Services WC |
$799.60
|
| Rate for Payer: Riverside University Health System MISP |
$557.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$223.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$186.00
|
| Rate for Payer: United Healthcare All Other HMO |
$186.00
|
| Rate for Payer: United Healthcare HMO Rider |
$186.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$186.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$507.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Vantage Medical Group Senior |
$507.02
|
|
|
HC DILATE TEAR DUCT OPENING
|
Facility
|
IP
|
$372.00
|
|
|
Service Code
|
CPT 68801
|
| Hospital Charge Code |
900501698
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$74.40 |
| Max. Negotiated Rate |
$334.80 |
| Rate for Payer: Adventist Health Commercial |
$74.40
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Central Health Plan Commercial |
$297.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.80
|
| Rate for Payer: EPIC Health Plan Senior |
$148.80
|
| Rate for Payer: Galaxy Health WC |
$316.20
|
| Rate for Payer: Global Benefits Group Commercial |
$223.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$334.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$248.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$141.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$230.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.40
|
| Rate for Payer: Multiplan Commercial |
$279.00
|
| Rate for Payer: Networks By Design Commercial |
$241.80
|
| Rate for Payer: Prime Health Services Commercial |
$316.20
|
|
|
HC DILATION OF CERVICAL CANAL
|
Facility
|
OP
|
$22,458.00
|
|
|
Service Code
|
CPT 57800
|
| Hospital Charge Code |
900501483
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$123.43 |
| Max. Negotiated Rate |
$20,212.20 |
| Rate for Payer: Adventist Health Commercial |
$4,491.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,039.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,039.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Blue Shield of California Commercial |
$13,721.84
|
| Rate for Payer: Blue Shield of California EPN |
$8,960.74
|
| Rate for Payer: Cash Price |
$12,351.90
|
| Rate for Payer: Cash Price |
$12,351.90
|
| Rate for Payer: Cash Price |
$12,351.90
|
| Rate for Payer: Central Health Plan Commercial |
$17,966.40
|
| Rate for Payer: Cigna of CA HMO |
$14,373.12
|
| Rate for Payer: Cigna of CA PPO |
$16,618.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,443.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,039.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,453.88
|
| Rate for Payer: EPIC Health Plan Senior |
$4,039.91
|
| Rate for Payer: Galaxy Health WC |
$19,089.30
|
| Rate for Payer: Global Benefits Group Commercial |
$13,474.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$20,212.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,625.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$123.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,039.91
|
| Rate for Payer: InnovAge PACE Commercial |
$6,059.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,979.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,039.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,491.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,413.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,413.48
|
| Rate for Payer: Multiplan Commercial |
$16,843.50
|
| Rate for Payer: Networks By Design Commercial |
$14,597.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,039.91
|
| Rate for Payer: Prime Health Services Commercial |
$19,089.30
|
| Rate for Payer: Prime Health Services Medicare |
$4,282.30
|
| Rate for Payer: Riverside University Health System MISP |
$4,443.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,474.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13,474.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,229.00
|
| Rate for Payer: United Healthcare All Other HMO |
$11,229.00
|
| Rate for Payer: United Healthcare HMO Rider |
$11,229.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,229.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,039.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Vantage Medical Group Senior |
$4,039.91
|
|
|
HC DILATION OF CERVICAL CANAL
|
Facility
|
IP
|
$22,458.00
|
|
|
Service Code
|
CPT 57800
|
| Hospital Charge Code |
900501483
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$4,491.60 |
| Max. Negotiated Rate |
$20,212.20 |
| Rate for Payer: Adventist Health Commercial |
$4,491.60
|
| Rate for Payer: Cash Price |
$12,351.90
|
| Rate for Payer: Central Health Plan Commercial |
$17,966.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,983.20
|
| Rate for Payer: EPIC Health Plan Senior |
$8,983.20
|
| Rate for Payer: Galaxy Health WC |
$19,089.30
|
| Rate for Payer: Global Benefits Group Commercial |
$13,474.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$20,212.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,979.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,556.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,901.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,491.60
|
| Rate for Payer: Multiplan Commercial |
$16,843.50
|
| Rate for Payer: Networks By Design Commercial |
$14,597.70
|
| Rate for Payer: Prime Health Services Commercial |
$19,089.30
|
|
|
HC DILATION OF CERVICAL CANAL
|
Facility
|
IP
|
$22,458.00
|
|
|
Service Code
|
CPT 57800
|
| Hospital Charge Code |
900501483
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4,491.60 |
| Max. Negotiated Rate |
$20,212.20 |
| Rate for Payer: Adventist Health Commercial |
$4,491.60
|
| Rate for Payer: Cash Price |
$12,351.90
|
| Rate for Payer: Central Health Plan Commercial |
$17,966.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,983.20
|
| Rate for Payer: EPIC Health Plan Senior |
$8,983.20
|
| Rate for Payer: Galaxy Health WC |
$19,089.30
|
| Rate for Payer: Global Benefits Group Commercial |
$13,474.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$20,212.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,979.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,556.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,901.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,491.60
|
| Rate for Payer: Multiplan Commercial |
$16,843.50
|
| Rate for Payer: Networks By Design Commercial |
$14,597.70
|
| Rate for Payer: Prime Health Services Commercial |
$19,089.30
|
|
|
HC DILATION OF CERVICAL CANAL
|
Facility
|
OP
|
$22,458.00
|
|
|
Service Code
|
CPT 57800
|
| Hospital Charge Code |
900501483
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$136.34 |
| Max. Negotiated Rate |
$20,212.20 |
| Rate for Payer: Adventist Health Commercial |
$4,491.60
|
| 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 |
$6,059.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,039.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,436.87
|
| Rate for Payer: Cash Price |
$12,351.90
|
| Rate for Payer: Cash Price |
$12,351.90
|
| Rate for Payer: Cash Price |
$12,351.90
|
| Rate for Payer: Cash Price |
$12,351.90
|
| Rate for Payer: Central Health Plan Commercial |
$17,966.40
|
| Rate for Payer: Cigna of CA HMO |
$14,373.12
|
| Rate for Payer: Cigna of CA PPO |
$16,618.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,443.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,039.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,453.88
|
| Rate for Payer: EPIC Health Plan Senior |
$4,039.91
|
| Rate for Payer: Galaxy Health WC |
$19,089.30
|
| Rate for Payer: Global Benefits Group Commercial |
$13,474.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$20,212.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,625.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,039.91
|
| Rate for Payer: InnovAge PACE Commercial |
$6,059.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,979.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,039.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,491.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,413.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,413.48
|
| Rate for Payer: Multiplan Commercial |
$16,843.50
|
| Rate for Payer: Multiplan WC |
$6,436.87
|
| Rate for Payer: Networks By Design Commercial |
$14,597.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,039.91
|
| Rate for Payer: Preferred Health Network WC |
$6,568.23
|
| Rate for Payer: Prime Health Services Commercial |
$19,089.30
|
| Rate for Payer: Prime Health Services Medicare |
$4,282.30
|
| Rate for Payer: Prime Health Services WC |
$6,371.18
|
| Rate for Payer: Riverside University Health System MISP |
$4,443.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,474.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,229.00
|
| Rate for Payer: United Healthcare All Other HMO |
$11,229.00
|
| Rate for Payer: United Healthcare HMO Rider |
$11,229.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,229.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,039.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Vantage Medical Group Senior |
$4,039.91
|
|
|
HC DILATION OF NEPHROSTOMY
|
Facility
|
IP
|
$11,641.00
|
|
|
Service Code
|
CPT 50436
|
| Hospital Charge Code |
909000168
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,328.20 |
| Max. Negotiated Rate |
$10,476.90 |
| Rate for Payer: Adventist Health Commercial |
$2,328.20
|
| Rate for Payer: Cash Price |
$6,402.55
|
| Rate for Payer: Central Health Plan Commercial |
$9,312.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,656.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,656.40
|
| Rate for Payer: Galaxy Health WC |
$9,894.85
|
| Rate for Payer: Global Benefits Group Commercial |
$6,984.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,476.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,764.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,435.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,205.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,328.20
|
| Rate for Payer: Multiplan Commercial |
$8,730.75
|
| Rate for Payer: Networks By Design Commercial |
$7,566.65
|
| Rate for Payer: Prime Health Services Commercial |
$9,894.85
|
|
|
HC DILATION OF NEPHROSTOMY
|
Facility
|
OP
|
$11,641.00
|
|
|
Service Code
|
CPT 50436
|
| Hospital Charge Code |
909000168
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$226.04 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$2,328.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,382.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,573.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,820.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,382.26
|
| 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: Anthem Blue Cross of CA Workers' Comp |
$6,982.34
|
| 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 |
$6,402.55
|
| Rate for Payer: Cash Price |
$6,402.55
|
| Rate for Payer: Cash Price |
$6,402.55
|
| Rate for Payer: Central Health Plan Commercial |
$9,312.80
|
| Rate for Payer: Cigna of CA HMO |
$7,450.24
|
| Rate for Payer: Cigna of CA PPO |
$8,614.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,573.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,820.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,382.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,916.05
|
| Rate for Payer: EPIC Health Plan Senior |
$4,382.26
|
| Rate for Payer: Galaxy Health WC |
$9,894.85
|
| Rate for Payer: Global Benefits Group Commercial |
$6,984.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,476.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,186.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$226.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,382.26
|
| Rate for Payer: InnovAge PACE Commercial |
$6,573.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,764.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$249.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,382.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,328.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,872.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,872.23
|
| Rate for Payer: Multiplan Commercial |
$8,730.75
|
| Rate for Payer: Multiplan WC |
$6,982.34
|
| Rate for Payer: Networks By Design Commercial |
$7,566.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,382.26
|
| Rate for Payer: Preferred Health Network WC |
$7,124.84
|
| Rate for Payer: Prime Health Services Commercial |
$9,894.85
|
| Rate for Payer: Prime Health Services Medicare |
$4,645.20
|
| Rate for Payer: Prime Health Services WC |
$6,911.09
|
| Rate for Payer: Riverside University Health System MISP |
$4,820.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,984.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,382.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,573.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,820.49
|
| Rate for Payer: Vantage Medical Group Senior |
$4,382.26
|
|
|
HC DILATOR VESSEL 5-13 FR 20 CM
|
Facility
|
OP
|
$31.00
|
|
| Hospital Charge Code |
909001071
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$27.90 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.21
|
| Rate for Payer: Blue Shield of California Commercial |
$18.94
|
| Rate for Payer: Blue Shield of California EPN |
$12.37
|
| Rate for Payer: Cash Price |
$17.05
|
| Rate for Payer: Central Health Plan Commercial |
$24.80
|
| Rate for Payer: Cigna of CA HMO |
$19.84
|
| Rate for Payer: Cigna of CA PPO |
$22.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.40
|
| Rate for Payer: EPIC Health Plan Senior |
$12.40
|
| Rate for Payer: Galaxy Health WC |
$26.35
|
| Rate for Payer: Global Benefits Group Commercial |
$18.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.90
|
| Rate for Payer: InnovAge PACE Commercial |
$15.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.70
|
| Rate for Payer: Multiplan Commercial |
$23.25
|
| Rate for Payer: Networks By Design Commercial |
$20.15
|
| Rate for Payer: Prime Health Services Commercial |
$26.35
|
| Rate for Payer: Riverside University Health System MISP |
$12.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.50
|
| Rate for Payer: United Healthcare All Other HMO |
$15.50
|
| Rate for Payer: United Healthcare HMO Rider |
$15.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.35
|
| Rate for Payer: Vantage Medical Group Senior |
$26.35
|
|
|
HC DILATOR VESSEL 5-13 FR 20 CM
|
Facility
|
IP
|
$31.00
|
|
| Hospital Charge Code |
909001071
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$27.90 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Cash Price |
$17.05
|
| Rate for Payer: Central Health Plan Commercial |
$24.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.40
|
| Rate for Payer: EPIC Health Plan Senior |
$12.40
|
| Rate for Payer: Galaxy Health WC |
$26.35
|
| Rate for Payer: Global Benefits Group Commercial |
$18.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.20
|
| Rate for Payer: Multiplan Commercial |
$23.25
|
| Rate for Payer: Networks By Design Commercial |
$20.15
|
| Rate for Payer: Prime Health Services Commercial |
$26.35
|
|
|
HC DILAT RECTAL STRICTURE W ANESTH
|
Facility
|
IP
|
$9,953.00
|
|
|
Service Code
|
CPT 45910
|
| Hospital Charge Code |
906745910
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,990.60 |
| Max. Negotiated Rate |
$8,957.70 |
| Rate for Payer: Adventist Health Commercial |
$1,990.60
|
| Rate for Payer: Cash Price |
$5,474.15
|
| Rate for Payer: Central Health Plan Commercial |
$7,962.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,981.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,981.20
|
| Rate for Payer: Galaxy Health WC |
$8,460.05
|
| Rate for Payer: Global Benefits Group Commercial |
$5,971.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,957.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,638.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,792.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,160.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,990.60
|
| Rate for Payer: Multiplan Commercial |
$7,464.75
|
| Rate for Payer: Networks By Design Commercial |
$6,469.45
|
| Rate for Payer: Prime Health Services Commercial |
$8,460.05
|
|
|
HC DILAT RECTAL STRICTURE W ANESTH
|
Facility
|
OP
|
$9,953.00
|
|
|
Service Code
|
CPT 45910
|
| Hospital Charge Code |
906745910
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$181.86 |
| Max. Negotiated Rate |
$8,957.70 |
| Rate for Payer: Adventist Health Commercial |
$1,990.60
|
| 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 |
$5,474.15
|
| Rate for Payer: Cash Price |
$5,474.15
|
| Rate for Payer: Cash Price |
$5,474.15
|
| Rate for Payer: Central Health Plan Commercial |
$7,962.40
|
| Rate for Payer: Cigna of CA HMO |
$6,369.92
|
| Rate for Payer: Cigna of CA PPO |
$7,365.22
|
| 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 |
$8,460.05
|
| Rate for Payer: Global Benefits Group Commercial |
$5,971.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,957.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,456.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$181.86
|
| 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 |
$6,638.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,498.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,990.60
|
| 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 |
$7,464.75
|
| Rate for Payer: Networks By Design Commercial |
$6,469.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,498.14
|
| Rate for Payer: Prime Health Services Commercial |
$8,460.05
|
| 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 |
$5,971.80
|
| 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
|
|
