|
HC ERCP W/ENDO RETRO RMVL CALCULU
|
Facility
|
IP
|
$10,142.00
|
|
|
Service Code
|
CPT 43264
|
| Hospital Charge Code |
906743264
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,028.40 |
| Max. Negotiated Rate |
$9,127.80 |
| Rate for Payer: Adventist Health Commercial |
$2,028.40
|
| Rate for Payer: Cash Price |
$4,563.90
|
| Rate for Payer: Central Health Plan Commercial |
$8,113.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,099.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,056.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,056.80
|
| Rate for Payer: Galaxy Health WC |
$8,620.70
|
| Rate for Payer: Global Benefits Group Commercial |
$6,085.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,127.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,440.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,983.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,028.40
|
| Rate for Payer: Multiplan Commercial |
$7,606.50
|
| Rate for Payer: Networks By Design Commercial |
$6,592.30
|
| Rate for Payer: Prime Health Services Commercial |
$8,620.70
|
|
|
HC ERCP W/PRESS MSRMNT
|
Facility
|
OP
|
$6,332.00
|
|
|
Service Code
|
CPT 43263
|
| Hospital Charge Code |
906743263
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$459.14 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,266.40
|
| Rate for Payer: Adventist Health Commercial |
$846.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,468.04
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,468.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$2,849.40
|
| Rate for Payer: Cash Price |
$2,849.40
|
| Rate for Payer: Cash Price |
$1,904.85
|
| Rate for Payer: Cash Price |
$2,849.40
|
| Rate for Payer: Cash Price |
$1,904.85
|
| Rate for Payer: Cash Price |
$1,904.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,386.40
|
| Rate for Payer: Central Health Plan Commercial |
$5,065.60
|
| Rate for Payer: Cigna of CA HMO |
$2,709.12
|
| Rate for Payer: Cigna of CA HMO |
$4,052.48
|
| Rate for Payer: Cigna of CA PPO |
$4,685.68
|
| Rate for Payer: Cigna of CA PPO |
$3,132.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,963.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,432.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: Galaxy Health WC |
$5,382.20
|
| Rate for Payer: Galaxy Health WC |
$3,598.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,539.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,799.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,809.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,698.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$459.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$459.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,687.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,020.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$507.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$507.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,266.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$846.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$4,749.00
|
| Rate for Payer: Multiplan Commercial |
$3,174.75
|
| Rate for Payer: Networks By Design Commercial |
$4,115.80
|
| Rate for Payer: Networks By Design Commercial |
$2,751.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,468.04
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Prime Health Services Commercial |
$3,598.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,382.20
|
| Rate for Payer: Prime Health Services Medicare |
$2,616.12
|
| Rate for Payer: Prime Health Services Medicare |
$2,616.12
|
| Rate for Payer: Riverside University Health System MISP |
$2,714.84
|
| Rate for Payer: Riverside University Health System MISP |
$2,714.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,539.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,799.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,961.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,961.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,166.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,116.50
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| 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 HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
|
|
HC ERCP W/PRESS MSRMNT
|
Facility
|
IP
|
$6,332.00
|
|
|
Service Code
|
CPT 43263
|
| Hospital Charge Code |
906743263
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,266.40 |
| Max. Negotiated Rate |
$5,698.80 |
| Rate for Payer: Adventist Health Commercial |
$1,266.40
|
| Rate for Payer: Cash Price |
$2,849.40
|
| Rate for Payer: Central Health Plan Commercial |
$5,065.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,432.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,532.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,532.80
|
| Rate for Payer: Galaxy Health WC |
$5,382.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,799.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,698.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,020.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,735.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,266.40
|
| Rate for Payer: Multiplan Commercial |
$4,749.00
|
| Rate for Payer: Networks By Design Commercial |
$4,115.80
|
| Rate for Payer: Prime Health Services Commercial |
$5,382.20
|
|
|
HC ERCP W RMVL FB STNT
|
Facility
|
IP
|
$7,082.00
|
|
|
Service Code
|
CPT 43275
|
| Hospital Charge Code |
906743275
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,416.40 |
| Max. Negotiated Rate |
$6,373.80 |
| Rate for Payer: Adventist Health Commercial |
$1,416.40
|
| Rate for Payer: Cash Price |
$3,186.90
|
| Rate for Payer: Central Health Plan Commercial |
$5,665.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,957.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,832.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,832.80
|
| Rate for Payer: Galaxy Health WC |
$6,019.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,249.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,373.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,497.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,178.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,416.40
|
| Rate for Payer: Multiplan Commercial |
$5,311.50
|
| Rate for Payer: Networks By Design Commercial |
$4,603.30
|
| Rate for Payer: Prime Health Services Commercial |
$6,019.70
|
|
|
HC ERCP W RMVL FB STNT
|
Facility
|
OP
|
$7,082.00
|
|
|
Service Code
|
CPT 43275
|
| Hospital Charge Code |
906743275
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$588.48 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,416.40
|
| Rate for Payer: Adventist Health Commercial |
$946.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,468.04
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,468.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$3,186.90
|
| Rate for Payer: Cash Price |
$3,186.90
|
| Rate for Payer: Cash Price |
$2,130.30
|
| Rate for Payer: Cash Price |
$3,186.90
|
| Rate for Payer: Cash Price |
$2,130.30
|
| Rate for Payer: Cash Price |
$2,130.30
|
| Rate for Payer: Central Health Plan Commercial |
$3,787.20
|
| Rate for Payer: Central Health Plan Commercial |
$5,665.60
|
| Rate for Payer: Cigna of CA HMO |
$3,029.76
|
| Rate for Payer: Cigna of CA HMO |
$4,532.48
|
| Rate for Payer: Cigna of CA PPO |
$5,240.68
|
| Rate for Payer: Cigna of CA PPO |
$3,503.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,313.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,957.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: Galaxy Health WC |
$6,019.70
|
| Rate for Payer: Galaxy Health WC |
$4,023.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,840.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,249.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,260.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,373.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$588.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$588.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,006.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,497.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$650.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$650.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,416.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$946.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$5,311.50
|
| Rate for Payer: Multiplan Commercial |
$3,550.50
|
| Rate for Payer: Networks By Design Commercial |
$4,603.30
|
| Rate for Payer: Networks By Design Commercial |
$3,077.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,468.04
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Prime Health Services Commercial |
$4,023.90
|
| Rate for Payer: Prime Health Services Commercial |
$6,019.70
|
| Rate for Payer: Prime Health Services Medicare |
$2,616.12
|
| Rate for Payer: Prime Health Services Medicare |
$2,616.12
|
| Rate for Payer: Riverside University Health System MISP |
$2,714.84
|
| Rate for Payer: Riverside University Health System MISP |
$2,714.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,840.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,249.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,961.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,961.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,541.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,367.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| 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 HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
|
|
HC ERCP W RMVL & XCHNG OF STNT INCL SPINC EA STNT
|
Facility
|
IP
|
$7,772.00
|
|
|
Service Code
|
CPT 43276
|
| Hospital Charge Code |
906743276
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,554.40 |
| Max. Negotiated Rate |
$6,994.80 |
| Rate for Payer: Adventist Health Commercial |
$1,554.40
|
| Rate for Payer: Cash Price |
$3,497.40
|
| Rate for Payer: Central Health Plan Commercial |
$6,217.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,440.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,108.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,108.80
|
| Rate for Payer: Galaxy Health WC |
$6,606.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,663.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,994.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,935.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,585.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,554.40
|
| Rate for Payer: Multiplan Commercial |
$5,829.00
|
| Rate for Payer: Networks By Design Commercial |
$5,051.80
|
| Rate for Payer: Prime Health Services Commercial |
$6,606.20
|
|
|
HC ERCP W RMVL & XCHNG OF STNT INCL SPINC EA STNT
|
Facility
|
OP
|
$7,772.00
|
|
|
Service Code
|
CPT 43276
|
| Hospital Charge Code |
906743276
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$742.18 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,554.40
|
| Rate for Payer: Adventist Health Commercial |
$1,038.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$7,808.19
|
| Rate for Payer: Adventist Health Medi-Cal |
$7,808.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,589.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,589.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,808.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,808.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$3,497.40
|
| Rate for Payer: Cash Price |
$3,497.40
|
| Rate for Payer: Cash Price |
$2,337.30
|
| Rate for Payer: Cash Price |
$3,497.40
|
| Rate for Payer: Cash Price |
$2,337.30
|
| Rate for Payer: Cash Price |
$2,337.30
|
| Rate for Payer: Central Health Plan Commercial |
$4,155.20
|
| Rate for Payer: Central Health Plan Commercial |
$6,217.60
|
| Rate for Payer: Cigna of CA HMO |
$3,324.16
|
| Rate for Payer: Cigna of CA HMO |
$4,974.08
|
| Rate for Payer: Cigna of CA PPO |
$5,751.28
|
| Rate for Payer: Cigna of CA PPO |
$3,843.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,589.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,589.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,808.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,808.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,635.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,440.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,883.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,883.51
|
| Rate for Payer: EPIC Health Plan Senior |
$8,589.01
|
| Rate for Payer: EPIC Health Plan Senior |
$8,589.01
|
| Rate for Payer: Galaxy Health WC |
$6,606.20
|
| Rate for Payer: Galaxy Health WC |
$4,414.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,116.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,663.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,674.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,994.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,805.43
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,805.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$742.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$742.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,808.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,808.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,298.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,935.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$819.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$819.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,931.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,931.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,554.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,038.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,462.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,462.97
|
| Rate for Payer: Multiplan Commercial |
$5,829.00
|
| Rate for Payer: Multiplan Commercial |
$3,895.50
|
| Rate for Payer: Networks By Design Commercial |
$5,051.80
|
| Rate for Payer: Networks By Design Commercial |
$3,376.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,808.19
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,808.19
|
| Rate for Payer: Prime Health Services Commercial |
$4,414.90
|
| Rate for Payer: Prime Health Services Commercial |
$6,606.20
|
| Rate for Payer: Prime Health Services Medicare |
$8,276.68
|
| Rate for Payer: Prime Health Services Medicare |
$8,276.68
|
| Rate for Payer: Riverside University Health System MISP |
$8,589.01
|
| Rate for Payer: Riverside University Health System MISP |
$8,589.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,116.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,663.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,369.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,369.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,886.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,597.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| 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 HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,808.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,808.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,589.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,589.01
|
| Rate for Payer: Vantage Medical Group Senior |
$7,808.19
|
| Rate for Payer: Vantage Medical Group Senior |
$7,808.19
|
|
|
HC ERCP W/SPHINCTERTMY
|
Facility
|
OP
|
$5,390.00
|
|
|
Service Code
|
CPT 43262
|
| Hospital Charge Code |
906743262
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$637.16 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,078.00
|
| Rate for Payer: Adventist Health Commercial |
$720.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,958.78
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,958.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,454.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,454.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,958.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,958.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$2,425.50
|
| Rate for Payer: Cash Price |
$2,425.50
|
| Rate for Payer: Cash Price |
$1,620.45
|
| Rate for Payer: Cash Price |
$2,425.50
|
| Rate for Payer: Cash Price |
$1,620.45
|
| Rate for Payer: Cash Price |
$1,620.45
|
| Rate for Payer: Central Health Plan Commercial |
$2,880.80
|
| Rate for Payer: Central Health Plan Commercial |
$4,312.00
|
| Rate for Payer: Cigna of CA HMO |
$2,304.64
|
| Rate for Payer: Cigna of CA HMO |
$3,449.60
|
| Rate for Payer: Cigna of CA PPO |
$3,988.60
|
| Rate for Payer: Cigna of CA PPO |
$2,664.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,454.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,454.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,958.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,958.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,520.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,773.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,181.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,181.99
|
| Rate for Payer: EPIC Health Plan Senior |
$5,454.66
|
| Rate for Payer: EPIC Health Plan Senior |
$5,454.66
|
| Rate for Payer: Galaxy Health WC |
$4,581.50
|
| Rate for Payer: Galaxy Health WC |
$3,060.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,160.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,234.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,240.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,851.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8,132.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8,132.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$637.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$637.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,958.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,958.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,286.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,422.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$703.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$703.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,942.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,942.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,078.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$720.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,644.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,644.77
|
| Rate for Payer: Multiplan Commercial |
$4,042.50
|
| Rate for Payer: Multiplan Commercial |
$2,700.75
|
| Rate for Payer: Networks By Design Commercial |
$3,503.50
|
| Rate for Payer: Networks By Design Commercial |
$2,340.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,958.78
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,958.78
|
| Rate for Payer: Prime Health Services Commercial |
$3,060.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,581.50
|
| Rate for Payer: Prime Health Services Medicare |
$5,256.31
|
| Rate for Payer: Prime Health Services Medicare |
$5,256.31
|
| Rate for Payer: Riverside University Health System MISP |
$5,454.66
|
| Rate for Payer: Riverside University Health System MISP |
$5,454.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,160.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,234.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,950.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,950.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,695.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,800.50
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| 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 HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,958.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,958.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,454.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,454.66
|
| Rate for Payer: Vantage Medical Group Senior |
$4,958.78
|
| Rate for Payer: Vantage Medical Group Senior |
$4,958.78
|
|
|
HC ERCP W/SPHINCTERTMY
|
Facility
|
IP
|
$5,390.00
|
|
|
Service Code
|
CPT 43262
|
| Hospital Charge Code |
906743262
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,078.00 |
| Max. Negotiated Rate |
$4,851.00 |
| Rate for Payer: Adventist Health Commercial |
$1,078.00
|
| Rate for Payer: Cash Price |
$2,425.50
|
| Rate for Payer: Central Health Plan Commercial |
$4,312.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,773.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,156.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,156.00
|
| Rate for Payer: Galaxy Health WC |
$4,581.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,234.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,851.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,422.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,180.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,078.00
|
| Rate for Payer: Multiplan Commercial |
$4,042.50
|
| Rate for Payer: Networks By Design Commercial |
$3,503.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,581.50
|
|
|
HC ESATB OP VISIT MINOR
|
Facility
|
OP
|
$514.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
947000150
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$102.80 |
| Max. Negotiated Rate |
$462.60 |
| Rate for Payer: Adventist Health Commercial |
$102.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$171.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$454.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$248.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$298.99
|
| Rate for Payer: Blue Shield of California Commercial |
$325.88
|
| Rate for Payer: Blue Shield of California EPN |
$205.09
|
| Rate for Payer: Cash Price |
$231.30
|
| Rate for Payer: Cash Price |
$231.30
|
| Rate for Payer: Central Health Plan Commercial |
$411.20
|
| Rate for Payer: Cigna of CA HMO |
$328.96
|
| Rate for Payer: Cigna of CA PPO |
$380.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$359.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.55
|
| Rate for Payer: EPIC Health Plan Senior |
$188.36
|
| Rate for Payer: Galaxy Health WC |
$436.90
|
| Rate for Payer: Global Benefits Group Commercial |
$308.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$462.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$326.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$186.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.46
|
| Rate for Payer: Multiplan Commercial |
$385.50
|
| Rate for Payer: Networks By Design Commercial |
$334.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.24
|
| Rate for Payer: Prime Health Services Commercial |
$436.90
|
| Rate for Payer: Prime Health Services Medicare |
$181.51
|
| Rate for Payer: Riverside University Health System MISP |
$188.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$308.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$308.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$257.00
|
| Rate for Payer: United Healthcare All Other HMO |
$257.00
|
| Rate for Payer: United Healthcare HMO Rider |
$257.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$257.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Vantage Medical Group Senior |
$171.24
|
|
|
HC ESATB OP VISIT MINOR
|
Facility
|
IP
|
$514.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
947000150
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$102.80 |
| Max. Negotiated Rate |
$462.60 |
| Rate for Payer: Adventist Health Commercial |
$102.80
|
| Rate for Payer: Cash Price |
$231.30
|
| Rate for Payer: Central Health Plan Commercial |
$411.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$359.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$205.60
|
| Rate for Payer: EPIC Health Plan Senior |
$205.60
|
| Rate for Payer: Galaxy Health WC |
$436.90
|
| Rate for Payer: Global Benefits Group Commercial |
$308.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$462.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$326.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$303.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.80
|
| Rate for Payer: Multiplan Commercial |
$385.50
|
| Rate for Payer: Networks By Design Commercial |
$334.10
|
| Rate for Payer: Prime Health Services Commercial |
$436.90
|
|
|
HC ESBL DISK CONFIRMATION
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT 87184
|
| Hospital Charge Code |
900912449
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Central Health Plan Commercial |
$168.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$147.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$133.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$123.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Networks By Design Commercial |
$136.50
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
|
|
HC ESBL DISK CONFIRMATION
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT 87184
|
| Hospital Charge Code |
900912449
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.06 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Adventist Health Commercial |
$9.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$7.48
|
| Rate for Payer: Adventist Health Medi-Cal |
$7.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$50.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$50.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$50.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$50.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.66
|
| Rate for Payer: Blue Shield of California Commercial |
$28.98
|
| Rate for Payer: Blue Shield of California Commercial |
$132.30
|
| Rate for Payer: Blue Shield of California EPN |
$18.26
|
| Rate for Payer: Blue Shield of California EPN |
$83.37
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Central Health Plan Commercial |
$168.00
|
| Rate for Payer: Central Health Plan Commercial |
$36.80
|
| Rate for Payer: Cigna of CA HMO |
$29.44
|
| Rate for Payer: Cigna of CA HMO |
$134.40
|
| Rate for Payer: Cigna of CA PPO |
$34.04
|
| Rate for Payer: Cigna of CA PPO |
$155.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$147.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$32.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.34
|
| Rate for Payer: EPIC Health Plan Senior |
$8.23
|
| Rate for Payer: EPIC Health Plan Senior |
$8.23
|
| Rate for Payer: Galaxy Health WC |
$39.10
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$27.60
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12.27
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$133.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.02
|
| Rate for Payer: Multiplan Commercial |
$34.50
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Networks By Design Commercial |
$136.50
|
| Rate for Payer: Networks By Design Commercial |
$29.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7.48
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7.48
|
| Rate for Payer: Prime Health Services Commercial |
$39.10
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: Prime Health Services Medicare |
$7.93
|
| Rate for Payer: Prime Health Services Medicare |
$7.93
|
| Rate for Payer: Riverside University Health System MISP |
$8.23
|
| Rate for Payer: Riverside University Health System MISP |
$8.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.06
|
| Rate for Payer: United Healthcare All Other HMO |
$6.06
|
| Rate for Payer: United Healthcare All Other HMO |
$6.06
|
| Rate for Payer: United Healthcare HMO Rider |
$6.06
|
| Rate for Payer: United Healthcare HMO Rider |
$6.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.06
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.48
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.23
|
| Rate for Payer: Vantage Medical Group Senior |
$7.48
|
| Rate for Payer: Vantage Medical Group Senior |
$7.48
|
|
|
HC ESOPH ACID REFLX TEST
|
Facility
|
OP
|
$4,728.00
|
|
|
Service Code
|
CPT 91034
|
| Hospital Charge Code |
906791033
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$133.49 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$945.60
|
| Rate for Payer: Adventist Health Commercial |
$417.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$479.94
|
| Rate for Payer: Adventist Health Medi-Cal |
$479.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$719.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$719.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$527.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$527.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$479.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$479.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,370.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,370.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,750.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,214.01
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$939.15
|
| Rate for Payer: Cash Price |
$939.15
|
| Rate for Payer: Cash Price |
$2,127.60
|
| Rate for Payer: Cash Price |
$2,127.60
|
| Rate for Payer: Cash Price |
$2,127.60
|
| Rate for Payer: Cash Price |
$939.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,669.60
|
| Rate for Payer: Central Health Plan Commercial |
$3,782.40
|
| Rate for Payer: Cigna of CA HMO |
$3,025.92
|
| Rate for Payer: Cigna of CA HMO |
$1,335.68
|
| Rate for Payer: Cigna of CA PPO |
$1,544.38
|
| Rate for Payer: Cigna of CA PPO |
$3,498.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$719.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$719.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$527.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$527.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$479.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$479.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,309.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,460.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$791.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$791.90
|
| Rate for Payer: EPIC Health Plan Senior |
$527.93
|
| Rate for Payer: EPIC Health Plan Senior |
$527.93
|
| Rate for Payer: Galaxy Health WC |
$1,773.95
|
| Rate for Payer: Galaxy Health WC |
$4,018.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,836.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,252.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,255.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,878.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$787.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$787.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$133.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$133.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$479.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$479.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,325.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,002.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$147.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$147.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$671.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$671.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$417.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$945.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$643.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$643.12
|
| Rate for Payer: Multiplan Commercial |
$1,565.25
|
| Rate for Payer: Multiplan Commercial |
$3,546.00
|
| Rate for Payer: Networks By Design Commercial |
$1,356.55
|
| Rate for Payer: Networks By Design Commercial |
$3,073.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$479.94
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$479.94
|
| Rate for Payer: Prime Health Services Commercial |
$4,018.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,773.95
|
| Rate for Payer: Prime Health Services Medicare |
$508.74
|
| Rate for Payer: Prime Health Services Medicare |
$508.74
|
| Rate for Payer: Riverside University Health System MISP |
$527.93
|
| Rate for Payer: Riverside University Health System MISP |
$527.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,836.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,252.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$575.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$575.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,364.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,043.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| 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 HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$479.94
|
| Rate for Payer: Upland Medical Group Pediatric |
$479.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$719.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$719.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$527.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$527.93
|
| Rate for Payer: Vantage Medical Group Senior |
$479.94
|
| Rate for Payer: Vantage Medical Group Senior |
$479.94
|
|
|
HC ESOPH ACID REFLX TEST
|
Facility
|
IP
|
$4,728.00
|
|
|
Service Code
|
CPT 91034
|
| Hospital Charge Code |
906791033
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$945.60 |
| Max. Negotiated Rate |
$4,255.20 |
| Rate for Payer: Adventist Health Commercial |
$945.60
|
| Rate for Payer: Cash Price |
$2,127.60
|
| Rate for Payer: Central Health Plan Commercial |
$3,782.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,309.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,891.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,891.20
|
| Rate for Payer: Galaxy Health WC |
$4,018.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,836.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,255.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,002.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,789.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$945.60
|
| Rate for Payer: Multiplan Commercial |
$3,546.00
|
| Rate for Payer: Networks By Design Commercial |
$3,073.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,018.80
|
|
|
HC ESOPHAG DIAG W BALLOON DILATION
|
Facility
|
IP
|
$4,574.00
|
|
|
Service Code
|
CPT 43220
|
| Hospital Charge Code |
909000188
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$914.80 |
| Max. Negotiated Rate |
$4,116.60 |
| Rate for Payer: Adventist Health Commercial |
$914.80
|
| Rate for Payer: Cash Price |
$2,058.30
|
| Rate for Payer: Central Health Plan Commercial |
$3,659.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,201.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,829.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,829.60
|
| Rate for Payer: Galaxy Health WC |
$3,887.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,744.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,116.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,904.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,698.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$914.80
|
| Rate for Payer: Multiplan Commercial |
$3,430.50
|
| Rate for Payer: Networks By Design Commercial |
$2,973.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,887.90
|
|
|
HC ESOPHAG DIAG W BALLOON DILATION
|
Facility
|
IP
|
$4,574.00
|
|
|
Service Code
|
CPT 43220
|
| Hospital Charge Code |
909000188
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$914.80 |
| Max. Negotiated Rate |
$4,116.60 |
| Rate for Payer: Adventist Health Commercial |
$914.80
|
| Rate for Payer: Cash Price |
$2,058.30
|
| Rate for Payer: Central Health Plan Commercial |
$3,659.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,201.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,829.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,829.60
|
| Rate for Payer: Galaxy Health WC |
$3,887.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,744.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,116.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,904.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,698.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$914.80
|
| Rate for Payer: Multiplan Commercial |
$3,430.50
|
| Rate for Payer: Networks By Design Commercial |
$2,973.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,887.90
|
|
|
HC ESOPHAG DIAG W BALLOON DILATION
|
Facility
|
OP
|
$4,574.00
|
|
|
Service Code
|
CPT 43220
|
| Hospital Charge Code |
909000188
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$307.36 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$914.80
|
| Rate for Payer: Adventist Health Commercial |
$611.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,468.04
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,468.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,840.40
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,840.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,375.65
|
| Rate for Payer: Cash Price |
$1,375.65
|
| Rate for Payer: Cash Price |
$1,375.65
|
| Rate for Payer: Cash Price |
$2,058.30
|
| Rate for Payer: Cash Price |
$2,058.30
|
| Rate for Payer: Cash Price |
$2,058.30
|
| Rate for Payer: Central Health Plan Commercial |
$3,659.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,445.60
|
| Rate for Payer: Cigna of CA HMO |
$1,956.48
|
| Rate for Payer: Cigna of CA HMO |
$2,927.36
|
| Rate for Payer: Cigna of CA PPO |
$3,384.76
|
| Rate for Payer: Cigna of CA PPO |
$2,262.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,139.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,201.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: Galaxy Health WC |
$3,887.90
|
| Rate for Payer: Galaxy Health WC |
$2,598.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,744.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,834.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,751.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,116.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$307.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$307.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,904.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,941.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$339.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$339.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$611.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$914.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$3,430.50
|
| Rate for Payer: Multiplan Commercial |
$2,292.75
|
| Rate for Payer: Multiplan WC |
$3,840.40
|
| Rate for Payer: Multiplan WC |
$3,840.40
|
| Rate for Payer: Networks By Design Commercial |
$1,987.05
|
| Rate for Payer: Networks By Design Commercial |
$2,973.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,468.04
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Preferred Health Network WC |
$3,918.78
|
| Rate for Payer: Preferred Health Network WC |
$3,918.78
|
| Rate for Payer: Prime Health Services Commercial |
$3,887.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,598.45
|
| Rate for Payer: Prime Health Services Medicare |
$2,616.12
|
| Rate for Payer: Prime Health Services Medicare |
$2,616.12
|
| Rate for Payer: Prime Health Services WC |
$3,801.22
|
| Rate for Payer: Prime Health Services WC |
$3,801.22
|
| Rate for Payer: Riverside University Health System MISP |
$2,714.84
|
| Rate for Payer: Riverside University Health System MISP |
$2,714.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,744.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,834.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,528.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,287.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
|
|
HC ESOPHAG DIAG W BALLOON DILATION
|
Facility
|
OP
|
$4,574.00
|
|
|
Service Code
|
CPT 43220
|
| Hospital Charge Code |
909000188
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$307.36 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$914.80
|
| Rate for Payer: Adventist Health Commercial |
$611.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,468.04
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,468.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$2,058.30
|
| Rate for Payer: Cash Price |
$2,058.30
|
| Rate for Payer: Cash Price |
$1,375.65
|
| Rate for Payer: Cash Price |
$2,058.30
|
| Rate for Payer: Cash Price |
$1,375.65
|
| Rate for Payer: Cash Price |
$1,375.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,445.60
|
| Rate for Payer: Central Health Plan Commercial |
$3,659.20
|
| Rate for Payer: Cigna of CA HMO |
$1,956.48
|
| Rate for Payer: Cigna of CA HMO |
$2,927.36
|
| Rate for Payer: Cigna of CA PPO |
$3,384.76
|
| Rate for Payer: Cigna of CA PPO |
$2,262.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,139.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,201.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: Galaxy Health WC |
$3,887.90
|
| Rate for Payer: Galaxy Health WC |
$2,598.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,834.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,744.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,751.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,116.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$307.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$307.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,941.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,904.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$339.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$339.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$914.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$611.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$3,430.50
|
| Rate for Payer: Multiplan Commercial |
$2,292.75
|
| Rate for Payer: Networks By Design Commercial |
$2,973.10
|
| Rate for Payer: Networks By Design Commercial |
$1,987.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,468.04
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Prime Health Services Commercial |
$2,598.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,887.90
|
| Rate for Payer: Prime Health Services Medicare |
$2,616.12
|
| Rate for Payer: Prime Health Services Medicare |
$2,616.12
|
| Rate for Payer: Riverside University Health System MISP |
$2,714.84
|
| Rate for Payer: Riverside University Health System MISP |
$2,714.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,834.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,744.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,961.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,961.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,287.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,528.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
|
|
HC ESOPHAGEAL DILATATION
|
Facility
|
OP
|
$1,052.00
|
|
|
Service Code
|
CPT 74360
|
| Hospital Charge Code |
909001829
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$187.45 |
| Max. Negotiated Rate |
$946.80 |
| Rate for Payer: Adventist Health Commercial |
$210.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$575.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$894.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$578.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$789.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$651.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$906.35
|
| Rate for Payer: Blue Shield of California Commercial |
$662.76
|
| Rate for Payer: Blue Shield of California EPN |
$417.64
|
| Rate for Payer: Cash Price |
$473.40
|
| Rate for Payer: Cash Price |
$473.40
|
| Rate for Payer: Central Health Plan Commercial |
$841.60
|
| Rate for Payer: Cigna of CA HMO |
$673.28
|
| Rate for Payer: Cigna of CA PPO |
$778.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$894.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$894.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$894.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$736.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$420.80
|
| Rate for Payer: EPIC Health Plan Senior |
$420.80
|
| Rate for Payer: Galaxy Health WC |
$894.20
|
| Rate for Payer: Global Benefits Group Commercial |
$631.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$946.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$187.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$668.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$207.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$620.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$736.40
|
| Rate for Payer: Multiplan Commercial |
$789.00
|
| Rate for Payer: Networks By Design Commercial |
$683.80
|
| Rate for Payer: Prime Health Services Commercial |
$894.20
|
| Rate for Payer: Riverside University Health System MISP |
$420.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$631.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$631.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$526.00
|
| Rate for Payer: United Healthcare All Other HMO |
$526.00
|
| Rate for Payer: United Healthcare HMO Rider |
$526.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$894.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$894.20
|
| Rate for Payer: Vantage Medical Group Senior |
$894.20
|
|
|
HC ESOPHAGEAL DILATATION
|
Facility
|
IP
|
$1,052.00
|
|
|
Service Code
|
CPT 74360
|
| Hospital Charge Code |
909001829
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$210.40 |
| Max. Negotiated Rate |
$946.80 |
| Rate for Payer: Adventist Health Commercial |
$210.40
|
| Rate for Payer: Cash Price |
$473.40
|
| Rate for Payer: Central Health Plan Commercial |
$841.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$736.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$420.80
|
| Rate for Payer: EPIC Health Plan Senior |
$420.80
|
| Rate for Payer: Galaxy Health WC |
$894.20
|
| Rate for Payer: Global Benefits Group Commercial |
$631.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$946.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$668.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$620.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.40
|
| Rate for Payer: Multiplan Commercial |
$789.00
|
| Rate for Payer: Networks By Design Commercial |
$683.80
|
| Rate for Payer: Prime Health Services Commercial |
$894.20
|
|
|
HC ESOPHAGOGASTRIC TMPONAD W/BLLN
|
Facility
|
IP
|
$6,570.00
|
|
|
Service Code
|
CPT 43460
|
| Hospital Charge Code |
906743460
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,314.00 |
| Max. Negotiated Rate |
$5,913.00 |
| Rate for Payer: Adventist Health Commercial |
$1,314.00
|
| Rate for Payer: Cash Price |
$2,956.50
|
| Rate for Payer: Central Health Plan Commercial |
$5,256.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,599.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,628.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,628.00
|
| Rate for Payer: Galaxy Health WC |
$5,584.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,942.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,913.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,171.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,876.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,314.00
|
| Rate for Payer: Multiplan Commercial |
$4,927.50
|
| Rate for Payer: Networks By Design Commercial |
$4,270.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,584.50
|
|
|
HC ESOPHAGOGASTRIC TMPONAD W/BLLN
|
Facility
|
OP
|
$4,353.00
|
|
|
Service Code
|
CPT 43460
|
| Hospital Charge Code |
906743460
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$158.17 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$870.60
|
| Rate for Payer: Adventist Health Commercial |
$1,314.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,584.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,700.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,394.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,613.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,927.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,264.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,958.85
|
| Rate for Payer: Cash Price |
$2,956.50
|
| Rate for Payer: Cash Price |
$1,958.85
|
| Rate for Payer: Cash Price |
$1,958.85
|
| Rate for Payer: Cash Price |
$2,956.50
|
| Rate for Payer: Cash Price |
$2,956.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,482.40
|
| Rate for Payer: Central Health Plan Commercial |
$5,256.00
|
| Rate for Payer: Cigna of CA HMO |
$2,785.92
|
| Rate for Payer: Cigna of CA HMO |
$4,204.80
|
| Rate for Payer: Cigna of CA PPO |
$4,861.80
|
| Rate for Payer: Cigna of CA PPO |
$3,221.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,700.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,584.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,584.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,700.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,700.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,584.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,599.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,047.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,741.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,628.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,741.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,628.00
|
| Rate for Payer: Galaxy Health WC |
$3,700.05
|
| Rate for Payer: Galaxy Health WC |
$5,584.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,611.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,942.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,913.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,917.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$158.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$158.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,764.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,171.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$174.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$174.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,568.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,876.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,314.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$870.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,047.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,599.00
|
| Rate for Payer: Multiplan Commercial |
$4,927.50
|
| Rate for Payer: Multiplan Commercial |
$3,264.75
|
| Rate for Payer: Networks By Design Commercial |
$4,270.50
|
| Rate for Payer: Networks By Design Commercial |
$2,829.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,700.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,584.50
|
| Rate for Payer: Riverside University Health System MISP |
$2,628.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,741.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,611.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,942.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,611.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,942.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,285.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,176.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,700.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,584.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,584.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,700.05
|
| Rate for Payer: Vantage Medical Group Senior |
$3,700.05
|
| Rate for Payer: Vantage Medical Group Senior |
$5,584.50
|
|
|
HC ESOPHAGOSCOPY RIGID TRANSORAL
|
Facility
|
OP
|
$11,735.00
|
|
|
Service Code
|
CPT 43180
|
| Hospital Charge Code |
906743180
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$835.66 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,347.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$7,613.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,375.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,613.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$5,280.75
|
| Rate for Payer: Cash Price |
$5,280.75
|
| Rate for Payer: Cash Price |
$5,280.75
|
| Rate for Payer: Central Health Plan Commercial |
$9,388.00
|
| Rate for Payer: Cigna of CA HMO |
$7,510.40
|
| Rate for Payer: Cigna of CA PPO |
$8,683.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,375.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,613.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,214.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,562.92
|
| Rate for Payer: EPIC Health Plan Senior |
$8,375.28
|
| Rate for Payer: Galaxy Health WC |
$9,974.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7,041.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,561.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,486.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$835.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,613.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,451.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$923.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,659.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,347.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,202.61
|
| Rate for Payer: Multiplan Commercial |
$8,801.25
|
| Rate for Payer: Networks By Design Commercial |
$7,627.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,613.89
|
| Rate for Payer: Prime Health Services Commercial |
$9,974.75
|
| Rate for Payer: Prime Health Services Medicare |
$8,070.72
|
| Rate for Payer: Riverside University Health System MISP |
$8,375.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,041.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,136.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,867.50
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,613.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,375.28
|
| Rate for Payer: Vantage Medical Group Senior |
$7,613.89
|
|
|
HC ESOPHAGOSCOPY RIGID TRANSORAL
|
Facility
|
IP
|
$11,735.00
|
|
|
Service Code
|
CPT 43180
|
| Hospital Charge Code |
906743180
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,347.00 |
| Max. Negotiated Rate |
$10,561.50 |
| Rate for Payer: Adventist Health Commercial |
$2,347.00
|
| Rate for Payer: Cash Price |
$5,280.75
|
| Rate for Payer: Central Health Plan Commercial |
$9,388.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,214.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,694.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,694.00
|
| Rate for Payer: Galaxy Health WC |
$9,974.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7,041.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,561.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,451.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,923.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,347.00
|
| Rate for Payer: Multiplan Commercial |
$8,801.25
|
| Rate for Payer: Networks By Design Commercial |
$7,627.75
|
| Rate for Payer: Prime Health Services Commercial |
$9,974.75
|
|
