|
HC ENDOLUMINAL BRUSHING
|
Facility
|
OP
|
$1,102.00
|
|
|
Service Code
|
CPT 36010
|
| Hospital Charge Code |
909081376
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$145.36 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$220.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$936.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$606.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$826.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$533.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$647.20
|
| 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 |
$495.90
|
| Rate for Payer: Cash Price |
$495.90
|
| Rate for Payer: Cash Price |
$495.90
|
| Rate for Payer: Central Health Plan Commercial |
$881.60
|
| Rate for Payer: Cigna of CA HMO |
$705.28
|
| Rate for Payer: Cigna of CA PPO |
$815.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$936.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$936.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$936.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$440.80
|
| Rate for Payer: EPIC Health Plan Senior |
$440.80
|
| Rate for Payer: Galaxy Health WC |
$936.70
|
| Rate for Payer: Global Benefits Group Commercial |
$661.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$991.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$145.36
|
| Rate for Payer: InnovAge PACE Commercial |
$551.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$735.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$682.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$771.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$771.40
|
| Rate for Payer: Multiplan Commercial |
$826.50
|
| Rate for Payer: Networks By Design Commercial |
$716.30
|
| Rate for Payer: Prime Health Services Commercial |
$936.70
|
| Rate for Payer: Riverside University Health System MISP |
$440.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$661.20
|
| 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 |
$936.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$936.70
|
| Rate for Payer: Vantage Medical Group Senior |
$936.70
|
|
|
HC ENDOLUMINAL BRUSHING
|
Facility
|
OP
|
$1,102.00
|
|
|
Service Code
|
CPT 36010
|
| Hospital Charge Code |
909081376
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$160.57 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$220.40
|
| 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 |
$936.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$606.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$826.50
|
| 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: Cash Price |
$495.90
|
| Rate for Payer: Cash Price |
$495.90
|
| Rate for Payer: Cash Price |
$495.90
|
| Rate for Payer: Cash Price |
$495.90
|
| Rate for Payer: Central Health Plan Commercial |
$881.60
|
| Rate for Payer: Cigna of CA HMO |
$705.28
|
| Rate for Payer: Cigna of CA PPO |
$815.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$936.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$936.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$936.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$440.80
|
| Rate for Payer: EPIC Health Plan Senior |
$440.80
|
| Rate for Payer: Galaxy Health WC |
$936.70
|
| Rate for Payer: Global Benefits Group Commercial |
$661.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$991.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: InnovAge PACE Commercial |
$551.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$735.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$682.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$771.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$771.40
|
| Rate for Payer: Multiplan Commercial |
$826.50
|
| Rate for Payer: Networks By Design Commercial |
$716.30
|
| Rate for Payer: Prime Health Services Commercial |
$936.70
|
| Rate for Payer: Riverside University Health System MISP |
$440.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$661.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$551.00
|
| Rate for Payer: United Healthcare All Other HMO |
$551.00
|
| Rate for Payer: United Healthcare HMO Rider |
$551.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$551.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$936.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$936.70
|
| Rate for Payer: Vantage Medical Group Senior |
$936.70
|
|
|
HC ENDOLUMINAL BX BILIARY TREE
|
Facility
|
OP
|
$1,487.00
|
|
|
Service Code
|
CPT 47543
|
| Hospital Charge Code |
909047543
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$297.40 |
| Max. Negotiated Rate |
$7,764.00 |
| Rate for Payer: Adventist Health Commercial |
$297.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,263.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$817.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,115.25
|
| 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 |
$669.15
|
| Rate for Payer: Cash Price |
$669.15
|
| Rate for Payer: Cash Price |
$669.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,189.60
|
| Rate for Payer: Cigna of CA HMO |
$951.68
|
| Rate for Payer: Cigna of CA PPO |
$1,100.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,263.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,263.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,263.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$594.80
|
| Rate for Payer: EPIC Health Plan Senior |
$594.80
|
| Rate for Payer: Galaxy Health WC |
$1,263.95
|
| Rate for Payer: Global Benefits Group Commercial |
$892.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,338.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,104.85
|
| Rate for Payer: InnovAge PACE Commercial |
$743.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$991.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,325.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$920.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,040.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,040.90
|
| Rate for Payer: Multiplan Commercial |
$1,115.25
|
| Rate for Payer: Networks By Design Commercial |
$966.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,263.95
|
| Rate for Payer: Riverside University Health System MISP |
$594.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$892.20
|
| 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 |
$1,263.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,263.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,263.95
|
|
|
HC ENDOLUMINAL BX BILIARY TREE
|
Facility
|
IP
|
$1,487.00
|
|
|
Service Code
|
CPT 47543
|
| Hospital Charge Code |
909047543
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$297.40 |
| Max. Negotiated Rate |
$1,338.30 |
| Rate for Payer: Adventist Health Commercial |
$297.40
|
| Rate for Payer: Cash Price |
$669.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,189.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$594.80
|
| Rate for Payer: EPIC Health Plan Senior |
$594.80
|
| Rate for Payer: Galaxy Health WC |
$1,263.95
|
| Rate for Payer: Global Benefits Group Commercial |
$892.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,338.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$991.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$566.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$920.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.40
|
| Rate for Payer: Multiplan Commercial |
$1,115.25
|
| Rate for Payer: Networks By Design Commercial |
$966.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,263.95
|
|
|
HC ENDOMETRIAL BIOPSY
|
Facility
|
IP
|
$905.00
|
|
|
Service Code
|
CPT 58100
|
| Hospital Charge Code |
900501615
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$181.00 |
| Max. Negotiated Rate |
$814.50 |
| Rate for Payer: Adventist Health Commercial |
$181.00
|
| Rate for Payer: Cash Price |
$407.25
|
| Rate for Payer: Central Health Plan Commercial |
$724.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$362.00
|
| Rate for Payer: EPIC Health Plan Senior |
$362.00
|
| Rate for Payer: Galaxy Health WC |
$769.25
|
| Rate for Payer: Global Benefits Group Commercial |
$543.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$814.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$603.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$344.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$560.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.00
|
| Rate for Payer: Multiplan Commercial |
$678.75
|
| Rate for Payer: Networks By Design Commercial |
$588.25
|
| Rate for Payer: Prime Health Services Commercial |
$769.25
|
|
|
HC ENDOMETRIAL BIOPSY
|
Facility
|
OP
|
$905.00
|
|
|
Service Code
|
CPT 58100
|
| Hospital Charge Code |
900501615
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$77.98 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$181.00
|
| 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 |
$383.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$281.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$255.61
|
| 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 |
$407.27
|
| Rate for Payer: Cash Price |
$407.25
|
| Rate for Payer: Cash Price |
$407.25
|
| Rate for Payer: Cash Price |
$407.25
|
| Rate for Payer: Cash Price |
$407.25
|
| Rate for Payer: Central Health Plan Commercial |
$724.00
|
| Rate for Payer: Cigna of CA HMO |
$579.20
|
| Rate for Payer: Cigna of CA PPO |
$669.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$383.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$281.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$255.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$345.07
|
| Rate for Payer: EPIC Health Plan Senior |
$255.61
|
| Rate for Payer: Galaxy Health WC |
$769.25
|
| Rate for Payer: Global Benefits Group Commercial |
$543.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$814.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$419.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$255.61
|
| Rate for Payer: InnovAge PACE Commercial |
$383.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$603.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$255.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$342.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$342.52
|
| Rate for Payer: Multiplan Commercial |
$678.75
|
| Rate for Payer: Multiplan WC |
$407.27
|
| Rate for Payer: Networks By Design Commercial |
$588.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$255.61
|
| Rate for Payer: Preferred Health Network WC |
$415.58
|
| Rate for Payer: Prime Health Services Commercial |
$769.25
|
| Rate for Payer: Prime Health Services Medicare |
$270.95
|
| Rate for Payer: Prime Health Services WC |
$403.11
|
| Rate for Payer: Riverside University Health System MISP |
$281.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$543.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$452.50
|
| Rate for Payer: United Healthcare All Other HMO |
$452.50
|
| Rate for Payer: United Healthcare HMO Rider |
$452.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$452.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$255.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$383.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$281.17
|
| Rate for Payer: Vantage Medical Group Senior |
$255.61
|
|
|
HC ENDOMETRIAL BIOPSY
|
Facility
|
OP
|
$905.00
|
|
|
Service Code
|
CPT 58100
|
| Hospital Charge Code |
900501615
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$70.59 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$181.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$255.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$383.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$281.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$255.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$438.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$531.51
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$407.27
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$407.25
|
| Rate for Payer: Cash Price |
$407.25
|
| Rate for Payer: Cash Price |
$407.25
|
| Rate for Payer: Central Health Plan Commercial |
$724.00
|
| Rate for Payer: Cigna of CA HMO |
$579.20
|
| Rate for Payer: Cigna of CA PPO |
$669.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$383.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$281.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$255.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$345.07
|
| Rate for Payer: EPIC Health Plan Senior |
$255.61
|
| Rate for Payer: Galaxy Health WC |
$769.25
|
| Rate for Payer: Global Benefits Group Commercial |
$543.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$814.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$419.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$70.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$255.61
|
| Rate for Payer: InnovAge PACE Commercial |
$383.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$603.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$255.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$342.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$342.52
|
| Rate for Payer: Multiplan Commercial |
$678.75
|
| Rate for Payer: Multiplan WC |
$407.27
|
| Rate for Payer: Networks By Design Commercial |
$588.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$255.61
|
| Rate for Payer: Preferred Health Network WC |
$415.58
|
| Rate for Payer: Prime Health Services Commercial |
$769.25
|
| Rate for Payer: Prime Health Services Medicare |
$270.95
|
| Rate for Payer: Prime Health Services WC |
$403.11
|
| Rate for Payer: Riverside University Health System MISP |
$281.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$543.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$255.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$383.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$281.17
|
| Rate for Payer: Vantage Medical Group Senior |
$255.61
|
|
|
HC ENDOMETRIAL BIOPSY
|
Facility
|
IP
|
$905.00
|
|
|
Service Code
|
CPT 58100
|
| Hospital Charge Code |
900501615
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$181.00 |
| Max. Negotiated Rate |
$814.50 |
| Rate for Payer: Adventist Health Commercial |
$181.00
|
| Rate for Payer: Cash Price |
$407.25
|
| Rate for Payer: Central Health Plan Commercial |
$724.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$362.00
|
| Rate for Payer: EPIC Health Plan Senior |
$362.00
|
| Rate for Payer: Galaxy Health WC |
$769.25
|
| Rate for Payer: Global Benefits Group Commercial |
$543.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$814.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$603.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$344.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$560.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.00
|
| Rate for Payer: Multiplan Commercial |
$678.75
|
| Rate for Payer: Networks By Design Commercial |
$588.25
|
| Rate for Payer: Prime Health Services Commercial |
$769.25
|
|
|
HC ENDOMETRIAL BX CONJUNCT W COLPOSCOPY
|
Facility
|
IP
|
$325.00
|
|
|
Service Code
|
CPT 58110
|
| Hospital Charge Code |
904000019
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$292.50 |
| Rate for Payer: Adventist Health Commercial |
$65.00
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Central Health Plan Commercial |
$260.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.00
|
| Rate for Payer: EPIC Health Plan Senior |
$130.00
|
| Rate for Payer: Galaxy Health WC |
$276.25
|
| Rate for Payer: Global Benefits Group Commercial |
$195.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$292.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$216.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$201.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.00
|
| Rate for Payer: Multiplan Commercial |
$243.75
|
| Rate for Payer: Networks By Design Commercial |
$211.25
|
| Rate for Payer: Prime Health Services Commercial |
$276.25
|
|
|
HC ENDOMETRIAL BX CONJUNCT W COLPOSCOPY
|
Facility
|
OP
|
$325.00
|
|
|
Service Code
|
CPT 58110
|
| Hospital Charge Code |
904000019
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$65.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$276.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$178.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$243.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$157.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$190.87
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Central Health Plan Commercial |
$260.00
|
| Rate for Payer: Cigna of CA HMO |
$208.00
|
| Rate for Payer: Cigna of CA PPO |
$240.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$276.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$276.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$276.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.00
|
| Rate for Payer: EPIC Health Plan Senior |
$130.00
|
| Rate for Payer: Galaxy Health WC |
$276.25
|
| Rate for Payer: Global Benefits Group Commercial |
$195.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$292.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$76.66
|
| Rate for Payer: InnovAge PACE Commercial |
$162.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$216.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$201.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$227.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$227.50
|
| Rate for Payer: Multiplan Commercial |
$243.75
|
| Rate for Payer: Networks By Design Commercial |
$211.25
|
| Rate for Payer: Prime Health Services Commercial |
$276.25
|
| Rate for Payer: Riverside University Health System MISP |
$130.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$195.00
|
| 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 |
$276.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$276.25
|
| Rate for Payer: Vantage Medical Group Senior |
$276.25
|
|
|
HC ENDOMYCARDIAL BIOPSY
|
Facility
|
IP
|
$4,737.00
|
|
|
Service Code
|
CPT 93505
|
| Hospital Charge Code |
906811308
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$947.40 |
| Max. Negotiated Rate |
$4,263.30 |
| Rate for Payer: Adventist Health Commercial |
$947.40
|
| Rate for Payer: Cash Price |
$2,131.65
|
| Rate for Payer: Central Health Plan Commercial |
$3,789.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,894.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,894.80
|
| Rate for Payer: Galaxy Health WC |
$4,026.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,842.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,263.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,159.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,804.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,932.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$947.40
|
| Rate for Payer: Multiplan Commercial |
$3,552.75
|
| Rate for Payer: Networks By Design Commercial |
$3,079.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,026.45
|
|
|
HC ENDOMYCARDIAL BIOPSY
|
Facility
|
IP
|
$5,573.00
|
|
|
Service Code
|
CPT 93505
|
| Hospital Charge Code |
906820039
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,114.60 |
| Max. Negotiated Rate |
$5,015.70 |
| Rate for Payer: Adventist Health Commercial |
$1,114.60
|
| Rate for Payer: Cash Price |
$2,507.85
|
| Rate for Payer: Central Health Plan Commercial |
$4,458.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,229.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,229.20
|
| Rate for Payer: Galaxy Health WC |
$4,737.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,343.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,015.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,717.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,123.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,449.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,114.60
|
| Rate for Payer: Multiplan Commercial |
$4,179.75
|
| Rate for Payer: Networks By Design Commercial |
$3,622.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,737.05
|
|
|
HC ENDOMYCARDIAL BIOPSY
|
Facility
|
OP
|
$4,737.00
|
|
|
Service Code
|
CPT 93505
|
| Hospital Charge Code |
906811308
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$408.95 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$947.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,999.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| 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 |
$2,131.65
|
| Rate for Payer: Cash Price |
$2,131.65
|
| Rate for Payer: Cash Price |
$2,131.65
|
| Rate for Payer: Central Health Plan Commercial |
$3,789.60
|
| Rate for Payer: Cigna of CA HMO |
$3,079.05
|
| Rate for Payer: Cigna of CA PPO |
$3,505.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$4,026.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,842.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,263.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$408.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: InnovAge PACE Commercial |
$5,998.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,159.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$451.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$947.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,358.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$3,552.75
|
| Rate for Payer: Networks By Design Commercial |
$3,079.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Prime Health Services Commercial |
$4,026.45
|
| Rate for Payer: Prime Health Services Medicare |
$4,239.16
|
| Rate for Payer: Riverside University Health System MISP |
$4,399.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,842.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC ENDOMYCARDIAL BIOPSY
|
Facility
|
OP
|
$5,573.00
|
|
|
Service Code
|
CPT 93505
|
| Hospital Charge Code |
906820039
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$408.95 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$1,114.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,999.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| 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 |
$2,507.85
|
| Rate for Payer: Cash Price |
$2,507.85
|
| Rate for Payer: Cash Price |
$2,507.85
|
| Rate for Payer: Central Health Plan Commercial |
$4,458.40
|
| Rate for Payer: Cigna of CA HMO |
$3,622.45
|
| Rate for Payer: Cigna of CA PPO |
$4,124.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$4,737.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,343.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,015.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$408.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: InnovAge PACE Commercial |
$5,998.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,717.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$451.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,114.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,358.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$4,179.75
|
| Rate for Payer: Networks By Design Commercial |
$3,622.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Prime Health Services Commercial |
$4,737.05
|
| Rate for Payer: Prime Health Services Medicare |
$4,239.16
|
| Rate for Payer: Riverside University Health System MISP |
$4,399.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,343.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC ENDO POLY HIP, PNEU/HYD/ROT
|
Facility
|
IP
|
$13,267.75
|
|
|
Service Code
|
CPT L5961
|
| Hospital Charge Code |
915355961
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,653.55 |
| Max. Negotiated Rate |
$11,940.98 |
| Rate for Payer: Adventist Health Commercial |
$2,653.55
|
| Rate for Payer: Blue Shield of California Commercial |
$10,255.97
|
| Rate for Payer: Blue Shield of California EPN |
$6,686.95
|
| Rate for Payer: Cash Price |
$5,970.49
|
| Rate for Payer: Central Health Plan Commercial |
$10,614.20
|
| Rate for Payer: Cigna of CA HMO |
$9,287.42
|
| Rate for Payer: Cigna of CA PPO |
$9,287.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,307.10
|
| Rate for Payer: EPIC Health Plan Senior |
$5,307.10
|
| Rate for Payer: Galaxy Health WC |
$11,277.59
|
| Rate for Payer: Global Benefits Group Commercial |
$7,960.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,940.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,849.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,055.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,212.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,653.55
|
| Rate for Payer: Multiplan Commercial |
$9,950.81
|
| Rate for Payer: Networks By Design Commercial |
$8,624.04
|
| Rate for Payer: Prime Health Services Commercial |
$11,277.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,979.39
|
| Rate for Payer: United Healthcare All Other HMO |
$4,846.71
|
| Rate for Payer: United Healthcare HMO Rider |
$4,741.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,345.19
|
|
|
HC ENDO POLY HIP, PNEU/HYD/ROT
|
Facility
|
IP
|
$13,267.75
|
|
|
Service Code
|
CPT L5961
|
| Hospital Charge Code |
905355961
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,653.55 |
| Max. Negotiated Rate |
$11,940.98 |
| Rate for Payer: Adventist Health Commercial |
$2,653.55
|
| Rate for Payer: Blue Shield of California Commercial |
$10,255.97
|
| Rate for Payer: Blue Shield of California EPN |
$6,686.95
|
| Rate for Payer: Cash Price |
$5,970.49
|
| Rate for Payer: Central Health Plan Commercial |
$10,614.20
|
| Rate for Payer: Cigna of CA HMO |
$9,287.42
|
| Rate for Payer: Cigna of CA PPO |
$9,287.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,307.10
|
| Rate for Payer: EPIC Health Plan Senior |
$5,307.10
|
| Rate for Payer: Galaxy Health WC |
$11,277.59
|
| Rate for Payer: Global Benefits Group Commercial |
$7,960.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,940.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,849.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,055.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,212.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,653.55
|
| Rate for Payer: Multiplan Commercial |
$9,950.81
|
| Rate for Payer: Networks By Design Commercial |
$8,624.04
|
| Rate for Payer: Prime Health Services Commercial |
$11,277.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,979.39
|
| Rate for Payer: United Healthcare All Other HMO |
$4,846.71
|
| Rate for Payer: United Healthcare HMO Rider |
$4,741.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,345.19
|
|
|
HC ENDO POLY HIP, PNEU/HYD/ROT
|
Facility
|
OP
|
$13,267.75
|
|
|
Service Code
|
CPT L5961
|
| Hospital Charge Code |
905355961
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4,345.19 |
| Max. Negotiated Rate |
$11,940.98 |
| Rate for Payer: Adventist Health Commercial |
$5,439.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,277.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,297.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,950.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,792.15
|
| Rate for Payer: Blue Shield of California Commercial |
$10,255.97
|
| Rate for Payer: Blue Shield of California EPN |
$6,686.95
|
| Rate for Payer: Cash Price |
$5,970.49
|
| Rate for Payer: Central Health Plan Commercial |
$10,614.20
|
| Rate for Payer: Cigna of CA HMO |
$9,287.42
|
| Rate for Payer: Cigna of CA PPO |
$9,287.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,277.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,277.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,277.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,307.10
|
| Rate for Payer: EPIC Health Plan Senior |
$5,307.10
|
| Rate for Payer: Galaxy Health WC |
$11,277.59
|
| Rate for Payer: Global Benefits Group Commercial |
$7,960.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,940.98
|
| Rate for Payer: InnovAge PACE Commercial |
$6,633.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,849.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,212.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,439.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,287.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,287.42
|
| Rate for Payer: Multiplan Commercial |
$9,950.81
|
| Rate for Payer: Networks By Design Commercial |
$6,633.88
|
| Rate for Payer: Prime Health Services Commercial |
$11,277.59
|
| Rate for Payer: Riverside University Health System MISP |
$5,307.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,960.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,960.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,979.39
|
| Rate for Payer: United Healthcare All Other HMO |
$4,846.71
|
| Rate for Payer: United Healthcare HMO Rider |
$4,741.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,345.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,277.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,277.59
|
| Rate for Payer: Vantage Medical Group Senior |
$11,277.59
|
|
|
HC ENDO POLY HIP, PNEU/HYD/ROT
|
Facility
|
OP
|
$13,267.75
|
|
|
Service Code
|
CPT L5961
|
| Hospital Charge Code |
915355961
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4,345.19 |
| Max. Negotiated Rate |
$11,940.98 |
| Rate for Payer: Adventist Health Commercial |
$5,439.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,277.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,297.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,950.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,792.15
|
| Rate for Payer: Blue Shield of California Commercial |
$10,255.97
|
| Rate for Payer: Blue Shield of California EPN |
$6,686.95
|
| Rate for Payer: Cash Price |
$5,970.49
|
| Rate for Payer: Central Health Plan Commercial |
$10,614.20
|
| Rate for Payer: Cigna of CA HMO |
$9,287.42
|
| Rate for Payer: Cigna of CA PPO |
$9,287.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,277.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,277.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,277.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,307.10
|
| Rate for Payer: EPIC Health Plan Senior |
$5,307.10
|
| Rate for Payer: Galaxy Health WC |
$11,277.59
|
| Rate for Payer: Global Benefits Group Commercial |
$7,960.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,940.98
|
| Rate for Payer: InnovAge PACE Commercial |
$6,633.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,849.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,212.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,439.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,287.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,287.42
|
| Rate for Payer: Multiplan Commercial |
$9,950.81
|
| Rate for Payer: Networks By Design Commercial |
$6,633.88
|
| Rate for Payer: Prime Health Services Commercial |
$11,277.59
|
| Rate for Payer: Riverside University Health System MISP |
$5,307.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,960.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,960.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,979.39
|
| Rate for Payer: United Healthcare All Other HMO |
$4,846.71
|
| Rate for Payer: United Healthcare HMO Rider |
$4,741.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,345.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,277.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,277.59
|
| Rate for Payer: Vantage Medical Group Senior |
$11,277.59
|
|
|
HC ENDO RESTORE2 W CLLCTN ADPTR 7.0-8.5MM
|
Facility
|
IP
|
$230.00
|
|
| Hospital Charge Code |
900800921
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.00 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Adventist Health Commercial |
$46.00
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Central Health Plan Commercial |
$184.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.00
|
| Rate for Payer: EPIC Health Plan Senior |
$92.00
|
| Rate for Payer: Galaxy Health WC |
$195.50
|
| Rate for Payer: Global Benefits Group Commercial |
$138.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$207.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$153.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$142.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.00
|
| Rate for Payer: Multiplan Commercial |
$172.50
|
| Rate for Payer: Networks By Design Commercial |
$149.50
|
| Rate for Payer: Prime Health Services Commercial |
$195.50
|
|
|
HC ENDO RESTORE2 W CLLCTN ADPTR 7.0-8.5MM
|
Facility
|
OP
|
$230.00
|
|
| Hospital Charge Code |
900800921
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.00 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Adventist Health Commercial |
$46.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$139.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$195.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$126.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$172.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$111.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$135.08
|
| Rate for Payer: Blue Shield of California Commercial |
$140.53
|
| Rate for Payer: Blue Shield of California EPN |
$91.77
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Central Health Plan Commercial |
$184.00
|
| Rate for Payer: Cigna of CA HMO |
$147.20
|
| Rate for Payer: Cigna of CA PPO |
$170.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$195.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$195.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$195.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.00
|
| Rate for Payer: EPIC Health Plan Senior |
$92.00
|
| Rate for Payer: Galaxy Health WC |
$195.50
|
| Rate for Payer: Global Benefits Group Commercial |
$138.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$207.00
|
| Rate for Payer: InnovAge PACE Commercial |
$115.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$153.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$142.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$161.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$161.00
|
| Rate for Payer: Multiplan Commercial |
$172.50
|
| Rate for Payer: Networks By Design Commercial |
$149.50
|
| Rate for Payer: Prime Health Services Commercial |
$195.50
|
| Rate for Payer: Riverside University Health System MISP |
$92.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$138.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$138.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$115.00
|
| Rate for Payer: United Healthcare All Other HMO |
$115.00
|
| Rate for Payer: United Healthcare HMO Rider |
$115.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$115.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$195.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$195.50
|
| Rate for Payer: Vantage Medical Group Senior |
$195.50
|
|
|
HC ENDOSCOPIC PANCREATOSCOPY
|
Facility
|
OP
|
$6,389.00
|
|
|
Service Code
|
CPT 43273
|
| Hospital Charge Code |
906743273
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$160.73 |
| Max. Negotiated Rate |
$6,333.00 |
| Rate for Payer: Adventist Health Commercial |
$1,277.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,430.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,513.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,791.75
|
| 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 |
$4,245.30
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$2,875.05
|
| Rate for Payer: Cash Price |
$2,875.05
|
| Rate for Payer: Cash Price |
$2,875.05
|
| Rate for Payer: Central Health Plan Commercial |
$5,111.20
|
| Rate for Payer: Cigna of CA HMO |
$4,088.96
|
| Rate for Payer: Cigna of CA PPO |
$4,727.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,430.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,430.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,430.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,555.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,555.60
|
| Rate for Payer: Galaxy Health WC |
$5,430.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,833.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,750.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$160.73
|
| Rate for Payer: InnovAge PACE Commercial |
$3,194.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,261.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$177.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,954.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,277.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,472.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,472.30
|
| Rate for Payer: Multiplan Commercial |
$4,791.75
|
| Rate for Payer: Networks By Design Commercial |
$4,152.85
|
| Rate for Payer: Prime Health Services Commercial |
$5,430.65
|
| Rate for Payer: Riverside University Health System MISP |
$2,555.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,833.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,833.40
|
| 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 |
$5,430.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,430.65
|
| Rate for Payer: Vantage Medical Group Senior |
$5,430.65
|
|
|
HC ENDOSCOPIC PANCREATOSCOPY
|
Facility
|
IP
|
$9,226.00
|
|
|
Service Code
|
CPT 43273
|
| Hospital Charge Code |
906743273
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,845.20 |
| Max. Negotiated Rate |
$8,303.40 |
| Rate for Payer: Adventist Health Commercial |
$1,845.20
|
| Rate for Payer: Cash Price |
$4,151.70
|
| Rate for Payer: Central Health Plan Commercial |
$7,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,690.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,690.40
|
| Rate for Payer: Galaxy Health WC |
$7,842.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,535.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,303.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,153.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,515.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,710.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,845.20
|
| Rate for Payer: Multiplan Commercial |
$6,919.50
|
| Rate for Payer: Networks By Design Commercial |
$5,996.90
|
| Rate for Payer: Prime Health Services Commercial |
$7,842.10
|
|
|
HC ENDOSCOPIC STUDY SWALLOW FUNCT
|
Facility
|
OP
|
$1,177.00
|
|
|
Service Code
|
CPT 92612
|
| Hospital Charge Code |
905601751
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$197.66 |
| Max. Negotiated Rate |
$1,059.30 |
| Rate for Payer: Adventist Health Commercial |
$482.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$714.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,000.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$647.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$882.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$529.65
|
| Rate for Payer: Cash Price |
$529.65
|
| Rate for Payer: Cash Price |
$529.65
|
| Rate for Payer: Cash Price |
$529.65
|
| Rate for Payer: Central Health Plan Commercial |
$941.60
|
| Rate for Payer: Cigna of CA HMO |
$753.28
|
| Rate for Payer: Cigna of CA PPO |
$870.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,000.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,000.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,000.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$470.80
|
| Rate for Payer: EPIC Health Plan Senior |
$470.80
|
| Rate for Payer: Galaxy Health WC |
$1,000.45
|
| Rate for Payer: Global Benefits Group Commercial |
$706.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,059.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$197.66
|
| Rate for Payer: InnovAge PACE Commercial |
$588.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$785.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$728.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$482.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$823.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$823.90
|
| Rate for Payer: Multiplan Commercial |
$882.75
|
| Rate for Payer: Networks By Design Commercial |
$765.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,000.45
|
| Rate for Payer: Riverside University Health System MISP |
$470.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$706.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$706.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,000.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,000.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,000.45
|
|
|
HC ENDOSCOPIC STUDY SWALLOW FUNCT
|
Facility
|
IP
|
$1,177.00
|
|
|
Service Code
|
CPT 92612
|
| Hospital Charge Code |
905601751
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$235.40 |
| Max. Negotiated Rate |
$1,059.30 |
| Rate for Payer: Adventist Health Commercial |
$235.40
|
| Rate for Payer: Cash Price |
$529.65
|
| Rate for Payer: Central Health Plan Commercial |
$941.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$470.80
|
| Rate for Payer: EPIC Health Plan Senior |
$470.80
|
| Rate for Payer: Galaxy Health WC |
$1,000.45
|
| Rate for Payer: Global Benefits Group Commercial |
$706.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,059.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$785.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$448.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$728.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.40
|
| Rate for Payer: Multiplan Commercial |
$882.75
|
| Rate for Payer: Networks By Design Commercial |
$765.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,000.45
|
|
|
HC ENDOSCOPIC STUDY SWALLOW FUNCT MCAL
|
Facility
|
IP
|
$1,177.00
|
|
|
Service Code
|
CPT 92612
|
| Hospital Charge Code |
907000015
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$235.40 |
| Max. Negotiated Rate |
$1,059.30 |
| Rate for Payer: Adventist Health Commercial |
$235.40
|
| Rate for Payer: Cash Price |
$529.65
|
| Rate for Payer: Central Health Plan Commercial |
$941.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$470.80
|
| Rate for Payer: EPIC Health Plan Senior |
$470.80
|
| Rate for Payer: Galaxy Health WC |
$1,000.45
|
| Rate for Payer: Global Benefits Group Commercial |
$706.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,059.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$785.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$448.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$728.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.40
|
| Rate for Payer: Multiplan Commercial |
$882.75
|
| Rate for Payer: Networks By Design Commercial |
$765.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,000.45
|
|
