|
HC EPS VENT &/OR ATRIAL MAPPING
|
Facility
|
OP
|
$7,334.00
|
|
|
Service Code
|
CPT 93609
|
| Hospital Charge Code |
906820042
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$505.61 |
| Max. Negotiated Rate |
$9,620.00 |
| Rate for Payer: Adventist Health Commercial |
$1,466.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,233.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,033.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,500.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,551.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,307.26
|
| 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 |
$3,300.30
|
| Rate for Payer: Cash Price |
$3,300.30
|
| Rate for Payer: Cash Price |
$3,300.30
|
| Rate for Payer: Central Health Plan Commercial |
$5,867.20
|
| Rate for Payer: Cigna of CA HMO |
$4,693.76
|
| Rate for Payer: Cigna of CA PPO |
$5,427.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,233.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,233.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,233.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,933.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,933.60
|
| Rate for Payer: Galaxy Health WC |
$6,233.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,400.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,600.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$505.61
|
| Rate for Payer: InnovAge PACE Commercial |
$3,667.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,891.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$558.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,539.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,466.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,133.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,133.80
|
| Rate for Payer: Multiplan Commercial |
$5,500.50
|
| Rate for Payer: Networks By Design Commercial |
$4,767.10
|
| Rate for Payer: Prime Health Services Commercial |
$6,233.90
|
| Rate for Payer: Riverside University Health System MISP |
$2,933.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,400.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,400.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,233.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,233.90
|
| Rate for Payer: Vantage Medical Group Senior |
$6,233.90
|
|
|
HC EPS VENT &/OR ATRIAL MAPPING
|
Facility
|
OP
|
$6,234.00
|
|
|
Service Code
|
CPT 93609
|
| Hospital Charge Code |
906811323
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$505.61 |
| Max. Negotiated Rate |
$9,620.00 |
| Rate for Payer: Adventist Health Commercial |
$1,246.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,298.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,428.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,675.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,018.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,661.23
|
| 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 |
$2,805.30
|
| Rate for Payer: Cash Price |
$2,805.30
|
| Rate for Payer: Cash Price |
$2,805.30
|
| Rate for Payer: Central Health Plan Commercial |
$4,987.20
|
| Rate for Payer: Cigna of CA HMO |
$3,989.76
|
| Rate for Payer: Cigna of CA PPO |
$4,613.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,298.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,298.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,298.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,493.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,493.60
|
| Rate for Payer: Galaxy Health WC |
$5,298.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,740.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,610.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$505.61
|
| Rate for Payer: InnovAge PACE Commercial |
$3,117.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,158.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$558.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,858.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,246.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,363.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,363.80
|
| Rate for Payer: Multiplan Commercial |
$4,675.50
|
| Rate for Payer: Networks By Design Commercial |
$4,052.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,298.90
|
| Rate for Payer: Riverside University Health System MISP |
$2,493.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,740.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,740.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,298.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,298.90
|
| Rate for Payer: Vantage Medical Group Senior |
$5,298.90
|
|
|
HC EPS VENT &/OR ATRIAL MAPPING
|
Facility
|
IP
|
$6,234.00
|
|
|
Service Code
|
CPT 93609
|
| Hospital Charge Code |
906811323
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,246.80 |
| Max. Negotiated Rate |
$5,610.60 |
| Rate for Payer: Adventist Health Commercial |
$1,246.80
|
| Rate for Payer: Cash Price |
$2,805.30
|
| Rate for Payer: Central Health Plan Commercial |
$4,987.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,493.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,493.60
|
| Rate for Payer: Galaxy Health WC |
$5,298.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,740.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,610.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,158.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,375.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,858.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,246.80
|
| Rate for Payer: Multiplan Commercial |
$4,675.50
|
| Rate for Payer: Networks By Design Commercial |
$4,052.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,298.90
|
|
|
HC EPS VENTRICULAR PACING
|
Facility
|
IP
|
$7,041.00
|
|
|
Service Code
|
CPT 93612
|
| Hospital Charge Code |
906820044
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,408.20 |
| Max. Negotiated Rate |
$6,336.90 |
| Rate for Payer: Adventist Health Commercial |
$1,408.20
|
| Rate for Payer: Cash Price |
$3,168.45
|
| Rate for Payer: Central Health Plan Commercial |
$5,632.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,816.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,816.40
|
| Rate for Payer: Galaxy Health WC |
$5,984.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,224.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,336.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,696.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,682.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,358.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,408.20
|
| Rate for Payer: Multiplan Commercial |
$5,280.75
|
| Rate for Payer: Networks By Design Commercial |
$4,576.65
|
| Rate for Payer: Prime Health Services Commercial |
$5,984.85
|
|
|
HC EPS VENTRICULAR PACING
|
Facility
|
OP
|
$7,041.00
|
|
|
Service Code
|
CPT 93612
|
| Hospital Charge Code |
906820044
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$182.11 |
| Max. Negotiated Rate |
$15,811.96 |
| Rate for Payer: Adventist Health Commercial |
$1,408.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$9,641.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,276.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,462.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,605.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,641.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,409.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,135.18
|
| 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 |
$3,168.45
|
| Rate for Payer: Cash Price |
$3,168.45
|
| Rate for Payer: Cash Price |
$3,168.45
|
| Rate for Payer: Central Health Plan Commercial |
$5,632.80
|
| Rate for Payer: Cigna of CA HMO |
$4,506.24
|
| Rate for Payer: Cigna of CA PPO |
$5,210.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,462.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,605.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,641.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,015.94
|
| Rate for Payer: EPIC Health Plan Senior |
$9,641.44
|
| Rate for Payer: Galaxy Health WC |
$5,984.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,224.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,336.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15,811.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$182.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,641.44
|
| Rate for Payer: InnovAge PACE Commercial |
$14,462.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,696.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$201.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,641.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,408.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,919.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,919.53
|
| Rate for Payer: Multiplan Commercial |
$5,280.75
|
| Rate for Payer: Networks By Design Commercial |
$4,576.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9,641.44
|
| Rate for Payer: Prime Health Services Commercial |
$5,984.85
|
| Rate for Payer: Prime Health Services Medicare |
$10,219.93
|
| Rate for Payer: Riverside University Health System MISP |
$10,605.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,224.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,224.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,641.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14,462.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,605.58
|
| Rate for Payer: Vantage Medical Group Senior |
$9,641.44
|
|
|
HC EPS VENTRICULAR PACING
|
Facility
|
OP
|
$5,985.00
|
|
|
Service Code
|
CPT 93612
|
| Hospital Charge Code |
906811325
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$182.11 |
| Max. Negotiated Rate |
$15,811.96 |
| Rate for Payer: Adventist Health Commercial |
$1,197.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$9,641.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,634.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,462.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,605.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,641.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,897.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,514.99
|
| 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 |
$2,693.25
|
| Rate for Payer: Cash Price |
$2,693.25
|
| Rate for Payer: Cash Price |
$2,693.25
|
| Rate for Payer: Central Health Plan Commercial |
$4,788.00
|
| Rate for Payer: Cigna of CA HMO |
$3,830.40
|
| Rate for Payer: Cigna of CA PPO |
$4,428.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,462.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,605.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,641.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,015.94
|
| Rate for Payer: EPIC Health Plan Senior |
$9,641.44
|
| Rate for Payer: Galaxy Health WC |
$5,087.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,591.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,386.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15,811.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$182.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,641.44
|
| Rate for Payer: InnovAge PACE Commercial |
$14,462.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,991.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$201.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,641.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,197.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,919.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,919.53
|
| Rate for Payer: Multiplan Commercial |
$4,488.75
|
| Rate for Payer: Networks By Design Commercial |
$3,890.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9,641.44
|
| Rate for Payer: Prime Health Services Commercial |
$5,087.25
|
| Rate for Payer: Prime Health Services Medicare |
$10,219.93
|
| Rate for Payer: Riverside University Health System MISP |
$10,605.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,591.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,591.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,641.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14,462.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,605.58
|
| Rate for Payer: Vantage Medical Group Senior |
$9,641.44
|
|
|
HC EPS VENTRICULAR PACING
|
Facility
|
IP
|
$5,985.00
|
|
|
Service Code
|
CPT 93612
|
| Hospital Charge Code |
906811325
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,197.00 |
| Max. Negotiated Rate |
$5,386.50 |
| Rate for Payer: Adventist Health Commercial |
$1,197.00
|
| Rate for Payer: Cash Price |
$2,693.25
|
| Rate for Payer: Central Health Plan Commercial |
$4,788.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,394.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,394.00
|
| Rate for Payer: Galaxy Health WC |
$5,087.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,591.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,386.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,991.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,280.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,704.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,197.00
|
| Rate for Payer: Multiplan Commercial |
$4,488.75
|
| Rate for Payer: Networks By Design Commercial |
$3,890.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,087.25
|
|
|
HC ERCP BILIARY/SPHINCT
|
Facility
|
IP
|
$1,925.00
|
|
|
Service Code
|
CPT 74328
|
| Hospital Charge Code |
909001862
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$385.00 |
| Max. Negotiated Rate |
$1,732.50 |
| Rate for Payer: Adventist Health Commercial |
$385.00
|
| Rate for Payer: Cash Price |
$866.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,540.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$770.00
|
| Rate for Payer: EPIC Health Plan Senior |
$770.00
|
| Rate for Payer: Galaxy Health WC |
$1,636.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,155.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,732.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,283.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$733.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.00
|
| Rate for Payer: Multiplan Commercial |
$1,443.75
|
| Rate for Payer: Networks By Design Commercial |
$1,251.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,636.25
|
|
|
HC ERCP BILIARY/SPHINCT
|
Facility
|
OP
|
$1,925.00
|
|
|
Service Code
|
CPT 74328
|
| Hospital Charge Code |
909001862
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$132.32 |
| Max. Negotiated Rate |
$1,732.50 |
| Rate for Payer: Adventist Health Commercial |
$385.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,169.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,636.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,058.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,443.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$651.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.32
|
| Rate for Payer: Blue Shield of California Commercial |
$1,168.47
|
| Rate for Payer: Blue Shield of California EPN |
$764.23
|
| Rate for Payer: Cash Price |
$866.25
|
| Rate for Payer: Cash Price |
$866.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,540.00
|
| Rate for Payer: Cigna of CA HMO |
$1,232.00
|
| Rate for Payer: Cigna of CA PPO |
$1,424.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,636.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,636.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,636.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$770.00
|
| Rate for Payer: EPIC Health Plan Senior |
$770.00
|
| Rate for Payer: Galaxy Health WC |
$1,636.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,155.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,732.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$198.02
|
| Rate for Payer: InnovAge PACE Commercial |
$962.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,283.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,347.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,347.50
|
| Rate for Payer: Multiplan Commercial |
$1,443.75
|
| Rate for Payer: Networks By Design Commercial |
$1,251.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,636.25
|
| Rate for Payer: Riverside University Health System MISP |
$770.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,155.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,155.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$962.50
|
| Rate for Payer: United Healthcare All Other HMO |
$962.50
|
| Rate for Payer: United Healthcare HMO Rider |
$962.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$962.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,636.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,636.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,636.25
|
|
|
HC ERCP BILIARY/SPHINCT
|
Facility
|
IP
|
$1,925.00
|
|
|
Service Code
|
CPT 74328
|
| Hospital Charge Code |
909001862
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$385.00 |
| Max. Negotiated Rate |
$1,732.50 |
| Rate for Payer: Adventist Health Commercial |
$385.00
|
| Rate for Payer: Cash Price |
$866.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,540.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$770.00
|
| Rate for Payer: EPIC Health Plan Senior |
$770.00
|
| Rate for Payer: Galaxy Health WC |
$1,636.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,155.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,732.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,283.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$733.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.00
|
| Rate for Payer: Multiplan Commercial |
$1,443.75
|
| Rate for Payer: Networks By Design Commercial |
$1,251.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,636.25
|
|
|
HC ERCP BILIARY/SPHINCT
|
Facility
|
OP
|
$1,925.00
|
|
|
Service Code
|
CPT 74328
|
| Hospital Charge Code |
909001862
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$198.02 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$385.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,636.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,058.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,443.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$651.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,130.55
|
| 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 |
$866.25
|
| Rate for Payer: Cash Price |
$866.25
|
| Rate for Payer: Cash Price |
$866.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,540.00
|
| Rate for Payer: Cigna of CA HMO |
$1,232.00
|
| Rate for Payer: Cigna of CA PPO |
$1,424.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,636.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,636.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,636.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$770.00
|
| Rate for Payer: EPIC Health Plan Senior |
$770.00
|
| Rate for Payer: Galaxy Health WC |
$1,636.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,155.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,732.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$198.02
|
| Rate for Payer: InnovAge PACE Commercial |
$962.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,283.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,347.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,347.50
|
| Rate for Payer: Multiplan Commercial |
$1,443.75
|
| Rate for Payer: Networks By Design Commercial |
$1,251.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,636.25
|
| Rate for Payer: Riverside University Health System MISP |
$770.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,155.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,155.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$962.50
|
| Rate for Payer: United Healthcare All Other HMO |
$962.50
|
| Rate for Payer: United Healthcare HMO Rider |
$962.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$962.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,636.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,636.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,636.25
|
|
|
HC ERCP COMBINED SPHINCT
|
Facility
|
IP
|
$2,291.00
|
|
|
Service Code
|
CPT 74330
|
| Hospital Charge Code |
909001863
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$458.20 |
| Max. Negotiated Rate |
$2,061.90 |
| Rate for Payer: Adventist Health Commercial |
$458.20
|
| Rate for Payer: Cash Price |
$1,030.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,832.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$916.40
|
| Rate for Payer: EPIC Health Plan Senior |
$916.40
|
| Rate for Payer: Galaxy Health WC |
$1,947.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,374.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,061.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,528.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$872.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,418.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$458.20
|
| Rate for Payer: Multiplan Commercial |
$1,718.25
|
| Rate for Payer: Networks By Design Commercial |
$1,489.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,947.35
|
|
|
HC ERCP COMBINED SPHINCT
|
Facility
|
OP
|
$2,291.00
|
|
|
Service Code
|
CPT 74330
|
| Hospital Charge Code |
909001863
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$132.32 |
| Max. Negotiated Rate |
$2,061.90 |
| Rate for Payer: Adventist Health Commercial |
$458.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,391.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,947.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,260.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,718.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$651.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.32
|
| Rate for Payer: Blue Shield of California Commercial |
$1,390.64
|
| Rate for Payer: Blue Shield of California EPN |
$909.53
|
| Rate for Payer: Cash Price |
$1,030.95
|
| Rate for Payer: Cash Price |
$1,030.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,832.80
|
| Rate for Payer: Cigna of CA HMO |
$1,466.24
|
| Rate for Payer: Cigna of CA PPO |
$1,695.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,947.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,947.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,947.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$916.40
|
| Rate for Payer: EPIC Health Plan Senior |
$916.40
|
| Rate for Payer: Galaxy Health WC |
$1,947.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,374.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,061.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$198.02
|
| Rate for Payer: InnovAge PACE Commercial |
$1,145.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,528.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,418.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$458.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,603.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,603.70
|
| Rate for Payer: Multiplan Commercial |
$1,718.25
|
| Rate for Payer: Networks By Design Commercial |
$1,489.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,947.35
|
| Rate for Payer: Riverside University Health System MISP |
$916.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,374.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,374.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,145.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,145.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,145.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,145.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,947.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,947.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,947.35
|
|
|
HC ERCP DIAG W/ OR W/O COLLECT SP
|
Facility
|
IP
|
$6,978.00
|
|
|
Service Code
|
CPT 43260
|
| Hospital Charge Code |
906743260
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,395.60 |
| Max. Negotiated Rate |
$6,280.20 |
| Rate for Payer: Adventist Health Commercial |
$1,395.60
|
| Rate for Payer: Cash Price |
$3,140.10
|
| Rate for Payer: Central Health Plan Commercial |
$5,582.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,791.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,791.20
|
| Rate for Payer: Galaxy Health WC |
$5,931.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,186.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,280.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,654.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,658.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,319.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,395.60
|
| Rate for Payer: Multiplan Commercial |
$5,233.50
|
| Rate for Payer: Networks By Design Commercial |
$4,535.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,931.30
|
|
|
HC ERCP DIAG W/ OR W/O COLLECT SP
|
Facility
|
OP
|
$3,731.00
|
|
|
Service Code
|
CPT 43260
|
| Hospital Charge Code |
906743260
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$531.50 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$746.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,834.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,251.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,317.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,834.04
|
| 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 |
$1,678.95
|
| Rate for Payer: Cash Price |
$1,678.95
|
| Rate for Payer: Cash Price |
$1,678.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,984.80
|
| Rate for Payer: Cigna of CA HMO |
$2,387.84
|
| Rate for Payer: Cigna of CA PPO |
$2,760.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,251.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,317.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,834.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,525.95
|
| Rate for Payer: EPIC Health Plan Senior |
$4,834.04
|
| Rate for Payer: Galaxy Health WC |
$3,171.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,238.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,357.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,927.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$531.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,834.04
|
| Rate for Payer: InnovAge PACE Commercial |
$7,251.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,488.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$587.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,834.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$746.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,477.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,477.61
|
| Rate for Payer: Multiplan Commercial |
$2,798.25
|
| Rate for Payer: Networks By Design Commercial |
$2,425.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,834.04
|
| Rate for Payer: Prime Health Services Commercial |
$3,171.35
|
| Rate for Payer: Prime Health Services Medicare |
$5,124.08
|
| Rate for Payer: Riverside University Health System MISP |
$5,317.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,238.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,800.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,834.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,251.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,317.44
|
| Rate for Payer: Vantage Medical Group Senior |
$4,834.04
|
|
|
HC ERCP DUCT STENT PLACEMENT
|
Facility
|
OP
|
$5,584.00
|
|
|
Service Code
|
CPT 43274
|
| Hospital Charge Code |
900100019
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$713.35 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$1,116.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$7,563.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,345.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,320.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,563.64
|
| 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 |
$2,512.80
|
| Rate for Payer: Cash Price |
$2,512.80
|
| Rate for Payer: Cash Price |
$2,512.80
|
| Rate for Payer: Central Health Plan Commercial |
$4,467.20
|
| Rate for Payer: Cigna of CA HMO |
$3,573.76
|
| Rate for Payer: Cigna of CA PPO |
$4,132.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,345.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,320.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,563.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,210.91
|
| Rate for Payer: EPIC Health Plan Senior |
$7,563.64
|
| Rate for Payer: Galaxy Health WC |
$4,746.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,350.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,025.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,404.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$713.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,563.64
|
| Rate for Payer: InnovAge PACE Commercial |
$11,345.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,724.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$788.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,563.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,116.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,135.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,135.28
|
| Rate for Payer: Multiplan Commercial |
$4,188.00
|
| Rate for Payer: Networks By Design Commercial |
$3,629.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,563.64
|
| Rate for Payer: Prime Health Services Commercial |
$4,746.40
|
| Rate for Payer: Prime Health Services Medicare |
$8,017.46
|
| Rate for Payer: Riverside University Health System MISP |
$8,320.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,350.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,076.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,563.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,345.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,320.00
|
| Rate for Payer: Vantage Medical Group Senior |
$7,563.64
|
|
|
HC ERCP DUCT STENT PLACEMENT
|
Facility
|
IP
|
$8,357.00
|
|
|
Service Code
|
CPT 43274
|
| Hospital Charge Code |
900100019
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,671.40 |
| Max. Negotiated Rate |
$7,521.30 |
| Rate for Payer: Adventist Health Commercial |
$1,671.40
|
| Rate for Payer: Cash Price |
$3,760.65
|
| Rate for Payer: Central Health Plan Commercial |
$6,685.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,342.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,342.80
|
| Rate for Payer: Galaxy Health WC |
$7,103.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,014.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,521.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,574.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,184.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,172.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,671.40
|
| Rate for Payer: Multiplan Commercial |
$6,267.75
|
| Rate for Payer: Networks By Design Commercial |
$5,432.05
|
| Rate for Payer: Prime Health Services Commercial |
$7,103.45
|
|
|
HC ERCP EA DUCT/AMPULLA DILATATION
|
Facility
|
IP
|
$10,267.00
|
|
|
Service Code
|
CPT 43277
|
| Hospital Charge Code |
900100020
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,053.40 |
| Max. Negotiated Rate |
$9,240.30 |
| Rate for Payer: Adventist Health Commercial |
$2,053.40
|
| Rate for Payer: Cash Price |
$4,620.15
|
| Rate for Payer: Central Health Plan Commercial |
$8,213.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,106.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,106.80
|
| Rate for Payer: Galaxy Health WC |
$8,726.95
|
| Rate for Payer: Global Benefits Group Commercial |
$6,160.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,240.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,848.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,911.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,355.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,053.40
|
| Rate for Payer: Multiplan Commercial |
$7,700.25
|
| Rate for Payer: Networks By Design Commercial |
$6,673.55
|
| Rate for Payer: Prime Health Services Commercial |
$8,726.95
|
|
|
HC ERCP EA DUCT/AMPULLA DILATATION
|
Facility
|
OP
|
$6,862.00
|
|
|
Service Code
|
CPT 43277
|
| Hospital Charge Code |
900100020
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$591.70 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$1,372.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,834.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,251.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,317.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,834.04
|
| 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 |
$3,087.90
|
| Rate for Payer: Cash Price |
$3,087.90
|
| Rate for Payer: Cash Price |
$3,087.90
|
| Rate for Payer: Central Health Plan Commercial |
$5,489.60
|
| Rate for Payer: Cigna of CA HMO |
$4,391.68
|
| Rate for Payer: Cigna of CA PPO |
$5,077.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,251.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,317.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,834.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,525.95
|
| Rate for Payer: EPIC Health Plan Senior |
$4,834.04
|
| Rate for Payer: Galaxy Health WC |
$5,832.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,117.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,175.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,927.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$591.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,834.04
|
| Rate for Payer: InnovAge PACE Commercial |
$7,251.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,576.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$653.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,834.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,372.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,477.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,477.61
|
| Rate for Payer: Multiplan Commercial |
$5,146.50
|
| Rate for Payer: Networks By Design Commercial |
$4,460.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,834.04
|
| Rate for Payer: Prime Health Services Commercial |
$5,832.70
|
| Rate for Payer: Prime Health Services Medicare |
$5,124.08
|
| Rate for Payer: Riverside University Health System MISP |
$5,317.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,117.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,800.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,834.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,251.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,317.44
|
| Rate for Payer: Vantage Medical Group Senior |
$4,834.04
|
|
|
HC ERCP LESION ABLAT W DILATION
|
Facility
|
IP
|
$5,455.00
|
|
|
Service Code
|
CPT 43278
|
| Hospital Charge Code |
906743278
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,091.00 |
| Max. Negotiated Rate |
$4,909.50 |
| Rate for Payer: Adventist Health Commercial |
$1,091.00
|
| Rate for Payer: Cash Price |
$2,454.75
|
| Rate for Payer: Central Health Plan Commercial |
$4,364.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,182.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,182.00
|
| Rate for Payer: Galaxy Health WC |
$4,636.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,273.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,909.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,638.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,078.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,376.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,091.00
|
| Rate for Payer: Multiplan Commercial |
$4,091.25
|
| Rate for Payer: Networks By Design Commercial |
$3,545.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,636.75
|
|
|
HC ERCP LESION ABLAT W DILATION
|
Facility
|
OP
|
$4,303.00
|
|
|
Service Code
|
CPT 43278
|
| Hospital Charge Code |
906743278
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$673.02 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$860.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,834.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,251.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,317.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,834.04
|
| 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 |
$1,936.35
|
| Rate for Payer: Cash Price |
$1,936.35
|
| Rate for Payer: Cash Price |
$1,936.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,442.40
|
| Rate for Payer: Cigna of CA HMO |
$2,753.92
|
| Rate for Payer: Cigna of CA PPO |
$3,184.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,251.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,317.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,834.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,525.95
|
| Rate for Payer: EPIC Health Plan Senior |
$4,834.04
|
| Rate for Payer: Galaxy Health WC |
$3,657.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,581.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,872.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,927.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$673.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,834.04
|
| Rate for Payer: InnovAge PACE Commercial |
$7,251.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,870.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$743.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,834.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$860.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,477.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,477.61
|
| Rate for Payer: Multiplan Commercial |
$3,227.25
|
| Rate for Payer: Networks By Design Commercial |
$2,796.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,834.04
|
| Rate for Payer: Prime Health Services Commercial |
$3,657.55
|
| Rate for Payer: Prime Health Services Medicare |
$5,124.08
|
| Rate for Payer: Riverside University Health System MISP |
$5,317.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,581.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,800.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,834.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,251.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,317.44
|
| Rate for Payer: Vantage Medical Group Senior |
$4,834.04
|
|
|
HC ERCP PANCREATIC/SPHINCT
|
Facility
|
OP
|
$1,741.00
|
|
|
Service Code
|
CPT 74329
|
| Hospital Charge Code |
909001830
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$132.32 |
| Max. Negotiated Rate |
$1,566.90 |
| Rate for Payer: Adventist Health Commercial |
$348.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,057.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,479.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$957.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,305.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$651.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.32
|
| Rate for Payer: Blue Shield of California Commercial |
$1,056.79
|
| Rate for Payer: Blue Shield of California EPN |
$691.18
|
| Rate for Payer: Cash Price |
$783.45
|
| Rate for Payer: Cash Price |
$783.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,392.80
|
| Rate for Payer: Cigna of CA HMO |
$1,114.24
|
| Rate for Payer: Cigna of CA PPO |
$1,288.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,479.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,479.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,479.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$696.40
|
| Rate for Payer: EPIC Health Plan Senior |
$696.40
|
| Rate for Payer: Galaxy Health WC |
$1,479.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,044.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,566.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$198.02
|
| Rate for Payer: InnovAge PACE Commercial |
$870.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,161.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,077.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$348.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,218.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,218.70
|
| Rate for Payer: Multiplan Commercial |
$1,305.75
|
| Rate for Payer: Networks By Design Commercial |
$1,131.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,479.85
|
| Rate for Payer: Riverside University Health System MISP |
$696.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,044.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,044.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$870.50
|
| Rate for Payer: United Healthcare All Other HMO |
$870.50
|
| Rate for Payer: United Healthcare HMO Rider |
$870.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$870.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,479.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,479.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,479.85
|
|
|
HC ERCP PANCREATIC/SPHINCT
|
Facility
|
IP
|
$1,741.00
|
|
|
Service Code
|
CPT 74329
|
| Hospital Charge Code |
909001830
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$348.20 |
| Max. Negotiated Rate |
$1,566.90 |
| Rate for Payer: Adventist Health Commercial |
$348.20
|
| Rate for Payer: Cash Price |
$783.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,392.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$696.40
|
| Rate for Payer: EPIC Health Plan Senior |
$696.40
|
| Rate for Payer: Galaxy Health WC |
$1,479.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,044.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,566.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,161.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$663.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,077.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$348.20
|
| Rate for Payer: Multiplan Commercial |
$1,305.75
|
| Rate for Payer: Networks By Design Commercial |
$1,131.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,479.85
|
|
|
HC ERCP W/BX SNGL OR MULTI
|
Facility
|
IP
|
$5,582.00
|
|
|
Service Code
|
CPT 43261
|
| Hospital Charge Code |
906743261
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,116.40 |
| Max. Negotiated Rate |
$5,023.80 |
| Rate for Payer: Adventist Health Commercial |
$1,116.40
|
| Rate for Payer: Cash Price |
$2,511.90
|
| Rate for Payer: Central Health Plan Commercial |
$4,465.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,232.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,232.80
|
| Rate for Payer: Galaxy Health WC |
$4,744.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,349.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,023.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,723.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,126.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,455.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,116.40
|
| Rate for Payer: Multiplan Commercial |
$4,186.50
|
| Rate for Payer: Networks By Design Commercial |
$3,628.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,744.70
|
|
|
HC ERCP W/BX SNGL OR MULTI
|
Facility
|
OP
|
$3,731.00
|
|
|
Service Code
|
CPT 43261
|
| Hospital Charge Code |
906743261
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$586.57 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$746.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,834.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,251.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,317.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,834.04
|
| 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 |
$1,678.95
|
| Rate for Payer: Cash Price |
$1,678.95
|
| Rate for Payer: Cash Price |
$1,678.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,984.80
|
| Rate for Payer: Cigna of CA HMO |
$2,387.84
|
| Rate for Payer: Cigna of CA PPO |
$2,760.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,251.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,317.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,834.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,525.95
|
| Rate for Payer: EPIC Health Plan Senior |
$4,834.04
|
| Rate for Payer: Galaxy Health WC |
$3,171.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,238.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,357.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,927.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$586.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,834.04
|
| Rate for Payer: InnovAge PACE Commercial |
$7,251.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,488.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$647.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,834.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$746.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,477.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,477.61
|
| Rate for Payer: Multiplan Commercial |
$2,798.25
|
| Rate for Payer: Networks By Design Commercial |
$2,425.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,834.04
|
| Rate for Payer: Prime Health Services Commercial |
$3,171.35
|
| Rate for Payer: Prime Health Services Medicare |
$5,124.08
|
| Rate for Payer: Riverside University Health System MISP |
$5,317.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,238.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,800.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,834.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,251.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,317.44
|
| Rate for Payer: Vantage Medical Group Senior |
$4,834.04
|
|
