|
HC ERCP W/ENDO RETRO BLLN DIAL AM
|
Facility
|
OP
|
$7,086.00
|
|
|
Service Code
|
CPT 43271
|
| Hospital Charge Code |
906743271
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,417.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,417.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,023.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,897.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,314.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,431.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,161.61
|
| 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 |
$3,188.70
|
| Rate for Payer: Cash Price |
$3,188.70
|
| Rate for Payer: Central Health Plan Commercial |
$5,668.80
|
| Rate for Payer: Cigna of CA HMO |
$4,535.04
|
| Rate for Payer: Cigna of CA PPO |
$5,243.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,023.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,023.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,023.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,834.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,834.40
|
| Rate for Payer: Galaxy Health WC |
$6,023.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,251.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,377.40
|
| Rate for Payer: InnovAge PACE Commercial |
$3,543.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,726.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,699.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,386.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,417.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,960.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,960.20
|
| Rate for Payer: Multiplan Commercial |
$5,314.50
|
| Rate for Payer: Networks By Design Commercial |
$4,605.90
|
| Rate for Payer: Prime Health Services Commercial |
$6,023.10
|
| Rate for Payer: Riverside University Health System MISP |
$2,834.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,251.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,251.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,543.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,543.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,543.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,543.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,023.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,023.10
|
| Rate for Payer: Vantage Medical Group Senior |
$6,023.10
|
|
|
HC ERCP W/ENDO RETRO DESTRUCTION
|
Facility
|
OP
|
$5,492.00
|
|
|
Service Code
|
CPT 43265
|
| Hospital Charge Code |
906743265
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,098.40 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$1,098.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$7,563.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| 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 |
$2,471.40
|
| Rate for Payer: Cash Price |
$2,471.40
|
| Rate for Payer: Cash Price |
$2,471.40
|
| Rate for Payer: Central Health Plan Commercial |
$4,393.60
|
| Rate for Payer: Cigna of CA HMO |
$3,514.88
|
| Rate for Payer: Cigna of CA PPO |
$4,064.08
|
| 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 |
$4,668.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,295.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,942.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,404.37
|
| 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 |
$3,663.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,092.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,563.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,098.40
|
| 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 |
$4,119.00
|
| Rate for Payer: Networks By Design Commercial |
$3,569.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,563.64
|
| Rate for Payer: Prime Health Services Commercial |
$4,668.20
|
| 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 |
$3,295.20
|
| 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 W/ENDO RETRO DESTRUCTION
|
Facility
|
IP
|
$9,579.00
|
|
|
Service Code
|
CPT 43265
|
| Hospital Charge Code |
906743265
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,915.80 |
| Max. Negotiated Rate |
$8,621.10 |
| Rate for Payer: Adventist Health Commercial |
$1,915.80
|
| Rate for Payer: Cash Price |
$4,310.55
|
| Rate for Payer: Central Health Plan Commercial |
$7,663.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,831.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,831.60
|
| Rate for Payer: Galaxy Health WC |
$8,142.15
|
| Rate for Payer: Global Benefits Group Commercial |
$5,747.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,621.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,389.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,649.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,929.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,915.80
|
| Rate for Payer: Multiplan Commercial |
$7,184.25
|
| Rate for Payer: Networks By Design Commercial |
$6,226.35
|
| Rate for Payer: Prime Health Services Commercial |
$8,142.15
|
|
|
HC ERCP W/ENDO RETRO INSERT NASOB
|
Facility
|
OP
|
$5,766.00
|
|
|
Service Code
|
CPT 43267
|
| Hospital Charge Code |
906743267
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,153.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,153.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,901.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,171.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,324.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,791.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,386.37
|
| 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 |
$2,594.70
|
| Rate for Payer: Cash Price |
$2,594.70
|
| Rate for Payer: Central Health Plan Commercial |
$4,612.80
|
| Rate for Payer: Cigna of CA HMO |
$3,690.24
|
| Rate for Payer: Cigna of CA PPO |
$4,266.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,901.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,901.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,901.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,306.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,306.40
|
| Rate for Payer: Galaxy Health WC |
$4,901.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,459.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,189.40
|
| Rate for Payer: InnovAge PACE Commercial |
$2,883.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,845.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,196.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,569.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,153.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,036.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,036.20
|
| Rate for Payer: Multiplan Commercial |
$4,324.50
|
| Rate for Payer: Networks By Design Commercial |
$3,747.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,901.10
|
| Rate for Payer: Riverside University Health System MISP |
$2,306.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,459.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,459.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,883.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,883.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,883.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,883.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,901.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,901.10
|
| Rate for Payer: Vantage Medical Group Senior |
$4,901.10
|
|
|
HC ERCP W/ENDO RETRO INSERT TUBE
|
Facility
|
OP
|
$5,363.00
|
|
|
Service Code
|
CPT 43268
|
| Hospital Charge Code |
906743268
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,072.60 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,072.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,558.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,949.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,022.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,596.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,149.69
|
| 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 |
$2,413.35
|
| Rate for Payer: Cash Price |
$2,413.35
|
| Rate for Payer: Central Health Plan Commercial |
$4,290.40
|
| Rate for Payer: Cigna of CA HMO |
$3,432.32
|
| Rate for Payer: Cigna of CA PPO |
$3,968.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,558.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,558.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,558.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,145.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,145.20
|
| Rate for Payer: Galaxy Health WC |
$4,558.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,217.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,826.70
|
| Rate for Payer: InnovAge PACE Commercial |
$2,681.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,577.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,043.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,319.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,072.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,754.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,754.10
|
| Rate for Payer: Multiplan Commercial |
$4,022.25
|
| Rate for Payer: Networks By Design Commercial |
$3,485.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,558.55
|
| Rate for Payer: Riverside University Health System MISP |
$2,145.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,217.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,217.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,681.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,681.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,681.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,681.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,558.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,558.55
|
| Rate for Payer: Vantage Medical Group Senior |
$4,558.55
|
|
|
HC ERCP W/ENDO RETRO RMVL CALCULU
|
Facility
|
IP
|
$10,142.00
|
|
|
Service Code
|
CPT 43264
|
| Hospital Charge Code |
906743264
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,028.40 |
| Max. Negotiated Rate |
$9,127.80 |
| Rate for Payer: Adventist Health Commercial |
$2,028.40
|
| Rate for Payer: Cash Price |
$4,563.90
|
| Rate for Payer: Central Health Plan Commercial |
$8,113.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,056.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,056.80
|
| Rate for Payer: Galaxy Health WC |
$8,620.70
|
| Rate for Payer: Global Benefits Group Commercial |
$6,085.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,127.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,764.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,864.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,277.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,028.40
|
| Rate for Payer: Multiplan Commercial |
$7,606.50
|
| Rate for Payer: Networks By Design Commercial |
$6,592.30
|
| Rate for Payer: Prime Health Services Commercial |
$8,620.70
|
|
|
HC ERCP W/ENDO RETRO RMVL CALCULU
|
Facility
|
OP
|
$6,778.00
|
|
|
Service Code
|
CPT 43264
|
| Hospital Charge Code |
906743264
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$660.20 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$1,355.60
|
| 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 |
$3,050.10
|
| Rate for Payer: Cash Price |
$3,050.10
|
| Rate for Payer: Cash Price |
$3,050.10
|
| Rate for Payer: Central Health Plan Commercial |
$5,422.40
|
| Rate for Payer: Cigna of CA HMO |
$4,337.92
|
| Rate for Payer: Cigna of CA PPO |
$5,015.72
|
| 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 |
$5,761.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,066.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,100.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,927.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$660.20
|
| 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 |
$4,520.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$729.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,834.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,355.60
|
| 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 |
$5,083.50
|
| Rate for Payer: Networks By Design Commercial |
$4,405.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,834.04
|
| Rate for Payer: Prime Health Services Commercial |
$5,761.30
|
| 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 |
$4,066.80
|
| 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 W ENDO RETRO RMVL FBTUBE
|
Facility
|
OP
|
$4,887.00
|
|
|
Service Code
|
CPT 43269
|
| Hospital Charge Code |
906743269
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$977.40 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$977.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,153.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,687.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,665.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,366.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,870.14
|
| 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 |
$2,199.15
|
| Rate for Payer: Cash Price |
$2,199.15
|
| Rate for Payer: Central Health Plan Commercial |
$3,909.60
|
| Rate for Payer: Cigna of CA HMO |
$3,127.68
|
| Rate for Payer: Cigna of CA PPO |
$3,616.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,153.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,153.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,153.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,954.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,954.80
|
| Rate for Payer: Galaxy Health WC |
$4,153.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,932.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,398.30
|
| Rate for Payer: InnovAge PACE Commercial |
$2,443.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,259.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,861.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,025.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$977.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,420.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,420.90
|
| Rate for Payer: Multiplan Commercial |
$3,665.25
|
| Rate for Payer: Networks By Design Commercial |
$3,176.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,153.95
|
| Rate for Payer: Riverside University Health System MISP |
$1,954.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,932.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,932.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,443.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,443.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,443.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,443.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,153.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,153.95
|
| Rate for Payer: Vantage Medical Group Senior |
$4,153.95
|
|
|
HC ERCP W/PRESS MSRMNT
|
Facility
|
OP
|
$4,233.00
|
|
|
Service Code
|
CPT 43263
|
| Hospital Charge Code |
906743263
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$459.14 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$846.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,410.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,410.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$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 |
$1,904.85
|
| Rate for Payer: Cash Price |
$1,904.85
|
| Rate for Payer: Cash Price |
$1,904.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,386.40
|
| Rate for Payer: Cigna of CA HMO |
$2,709.12
|
| Rate for Payer: Cigna of CA PPO |
$3,132.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,651.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,410.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,253.93
|
| Rate for Payer: EPIC Health Plan Senior |
$2,410.32
|
| Rate for Payer: Galaxy Health WC |
$3,598.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,539.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,809.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$459.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: InnovAge PACE Commercial |
$3,615.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,823.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$507.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$846.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,229.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,229.83
|
| Rate for Payer: Multiplan Commercial |
$3,174.75
|
| Rate for Payer: Networks By Design Commercial |
$2,751.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Prime Health Services Commercial |
$3,598.05
|
| Rate for Payer: Prime Health Services Medicare |
$2,554.94
|
| Rate for Payer: Riverside University Health System MISP |
$2,651.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,539.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,892.38
|
| 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 |
$2,410.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,410.32
|
|
|
HC ERCP W/PRESS MSRMNT
|
Facility
|
IP
|
$6,332.00
|
|
|
Service Code
|
CPT 43263
|
| Hospital Charge Code |
906743263
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,266.40 |
| Max. Negotiated Rate |
$5,698.80 |
| Rate for Payer: Adventist Health Commercial |
$1,266.40
|
| Rate for Payer: Cash Price |
$2,849.40
|
| Rate for Payer: Central Health Plan Commercial |
$5,065.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,532.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,532.80
|
| Rate for Payer: Galaxy Health WC |
$5,382.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,799.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,698.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,223.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,412.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,919.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,266.40
|
| Rate for Payer: Multiplan Commercial |
$4,749.00
|
| Rate for Payer: Networks By Design Commercial |
$4,115.80
|
| Rate for Payer: Prime Health Services Commercial |
$5,382.20
|
|
|
HC ERCP W RMVL FB STNT
|
Facility
|
OP
|
$4,734.00
|
|
|
Service Code
|
CPT 43275
|
| Hospital Charge Code |
906743275
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$588.48 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$946.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,410.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,410.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$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 |
$2,130.30
|
| Rate for Payer: Cash Price |
$2,130.30
|
| Rate for Payer: Cash Price |
$2,130.30
|
| Rate for Payer: Central Health Plan Commercial |
$3,787.20
|
| Rate for Payer: Cigna of CA HMO |
$3,029.76
|
| Rate for Payer: Cigna of CA PPO |
$3,503.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,651.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,410.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,253.93
|
| Rate for Payer: EPIC Health Plan Senior |
$2,410.32
|
| Rate for Payer: Galaxy Health WC |
$4,023.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,840.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,260.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$588.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: InnovAge PACE Commercial |
$3,615.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,157.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$650.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$946.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,229.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,229.83
|
| Rate for Payer: Multiplan Commercial |
$3,550.50
|
| Rate for Payer: Networks By Design Commercial |
$3,077.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Prime Health Services Commercial |
$4,023.90
|
| Rate for Payer: Prime Health Services Medicare |
$2,554.94
|
| Rate for Payer: Riverside University Health System MISP |
$2,651.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,840.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,892.38
|
| 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 |
$2,410.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,410.32
|
|
|
HC ERCP W RMVL FB STNT
|
Facility
|
IP
|
$7,082.00
|
|
|
Service Code
|
CPT 43275
|
| Hospital Charge Code |
906743275
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,416.40 |
| Max. Negotiated Rate |
$6,373.80 |
| Rate for Payer: Adventist Health Commercial |
$1,416.40
|
| Rate for Payer: Cash Price |
$3,186.90
|
| Rate for Payer: Central Health Plan Commercial |
$5,665.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,832.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,832.80
|
| Rate for Payer: Galaxy Health WC |
$6,019.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,249.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,373.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,723.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,698.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,383.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,416.40
|
| Rate for Payer: Multiplan Commercial |
$5,311.50
|
| Rate for Payer: Networks By Design Commercial |
$4,603.30
|
| Rate for Payer: Prime Health Services Commercial |
$6,019.70
|
|
|
HC ERCP W RMVL & XCHNG OF STNT INCL SPINC EA STNT
|
Facility
|
IP
|
$7,772.00
|
|
|
Service Code
|
CPT 43276
|
| Hospital Charge Code |
906743276
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,554.40 |
| Max. Negotiated Rate |
$6,994.80 |
| Rate for Payer: Adventist Health Commercial |
$1,554.40
|
| Rate for Payer: Cash Price |
$3,497.40
|
| Rate for Payer: Central Health Plan Commercial |
$6,217.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,108.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,108.80
|
| Rate for Payer: Galaxy Health WC |
$6,606.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,663.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,994.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,183.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,961.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,810.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,554.40
|
| Rate for Payer: Multiplan Commercial |
$5,829.00
|
| Rate for Payer: Networks By Design Commercial |
$5,051.80
|
| Rate for Payer: Prime Health Services Commercial |
$6,606.20
|
|
|
HC ERCP W RMVL & XCHNG OF STNT INCL SPINC EA STNT
|
Facility
|
OP
|
$5,194.00
|
|
|
Service Code
|
CPT 43276
|
| Hospital Charge Code |
906743276
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$742.18 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$1,038.80
|
| 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 |
$2,337.30
|
| Rate for Payer: Cash Price |
$2,337.30
|
| Rate for Payer: Cash Price |
$2,337.30
|
| Rate for Payer: Central Health Plan Commercial |
$4,155.20
|
| Rate for Payer: Cigna of CA HMO |
$3,324.16
|
| Rate for Payer: Cigna of CA PPO |
$3,843.56
|
| 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 |
$4,414.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,116.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,674.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,404.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$742.18
|
| 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 |
$3,464.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$819.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,563.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,038.80
|
| 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 |
$3,895.50
|
| Rate for Payer: Networks By Design Commercial |
$3,376.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,563.64
|
| Rate for Payer: Prime Health Services Commercial |
$4,414.90
|
| 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 |
$3,116.40
|
| 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 W/SPHINCTERTMY
|
Facility
|
IP
|
$5,390.00
|
|
|
Service Code
|
CPT 43262
|
| Hospital Charge Code |
906743262
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,078.00 |
| Max. Negotiated Rate |
$4,851.00 |
| Rate for Payer: Adventist Health Commercial |
$1,078.00
|
| Rate for Payer: Cash Price |
$2,425.50
|
| Rate for Payer: Central Health Plan Commercial |
$4,312.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,156.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,156.00
|
| Rate for Payer: Galaxy Health WC |
$4,581.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,234.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,851.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,595.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,053.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,336.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,078.00
|
| Rate for Payer: Multiplan Commercial |
$4,042.50
|
| Rate for Payer: Networks By Design Commercial |
$3,503.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,581.50
|
|
|
HC ERCP W/SPHINCTERTMY
|
Facility
|
OP
|
$3,601.00
|
|
|
Service Code
|
CPT 43262
|
| Hospital Charge Code |
906743262
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$637.16 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$720.20
|
| 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 |
$1,620.45
|
| Rate for Payer: Cash Price |
$1,620.45
|
| Rate for Payer: Cash Price |
$1,620.45
|
| Rate for Payer: Central Health Plan Commercial |
$2,880.80
|
| Rate for Payer: Cigna of CA HMO |
$2,304.64
|
| Rate for Payer: Cigna of CA PPO |
$2,664.74
|
| 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 |
$3,060.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,160.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,240.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,927.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$637.16
|
| 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 |
$2,401.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$703.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,834.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$720.20
|
| 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 |
$2,700.75
|
| Rate for Payer: Networks By Design Commercial |
$2,340.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,834.04
|
| Rate for Payer: Prime Health Services Commercial |
$3,060.85
|
| 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 |
$2,160.60
|
| 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 ESATB OP VISIT MINOR
|
Facility
|
OP
|
$514.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
947000150
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$102.80 |
| Max. Negotiated Rate |
$462.60 |
| Rate for Payer: Adventist Health Commercial |
$102.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$163.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$312.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$248.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$301.87
|
| Rate for Payer: Blue Shield of California Commercial |
$314.05
|
| Rate for Payer: Blue Shield of California EPN |
$205.09
|
| Rate for Payer: Cash Price |
$231.30
|
| Rate for Payer: Cash Price |
$231.30
|
| Rate for Payer: Central Health Plan Commercial |
$411.20
|
| Rate for Payer: Cigna of CA HMO |
$328.96
|
| Rate for Payer: Cigna of CA PPO |
$380.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.05
|
| Rate for Payer: EPIC Health Plan Senior |
$163.74
|
| Rate for Payer: Galaxy Health WC |
$436.90
|
| Rate for Payer: Global Benefits Group Commercial |
$308.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$462.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$268.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.74
|
| Rate for Payer: InnovAge PACE Commercial |
$245.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$342.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$219.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.41
|
| Rate for Payer: Multiplan Commercial |
$385.50
|
| Rate for Payer: Networks By Design Commercial |
$334.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$163.74
|
| Rate for Payer: Prime Health Services Commercial |
$436.90
|
| Rate for Payer: Prime Health Services Medicare |
$173.56
|
| Rate for Payer: Riverside University Health System MISP |
$180.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$308.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$308.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$257.00
|
| Rate for Payer: United Healthcare All Other HMO |
$257.00
|
| Rate for Payer: United Healthcare HMO Rider |
$257.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$257.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Vantage Medical Group Senior |
$163.74
|
|
|
HC ESATB OP VISIT MINOR
|
Facility
|
IP
|
$514.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
947000150
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$102.80 |
| Max. Negotiated Rate |
$462.60 |
| Rate for Payer: Adventist Health Commercial |
$102.80
|
| Rate for Payer: Cash Price |
$231.30
|
| Rate for Payer: Central Health Plan Commercial |
$411.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$205.60
|
| Rate for Payer: EPIC Health Plan Senior |
$205.60
|
| Rate for Payer: Galaxy Health WC |
$436.90
|
| Rate for Payer: Global Benefits Group Commercial |
$308.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$462.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$342.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$318.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.80
|
| Rate for Payer: Multiplan Commercial |
$385.50
|
| Rate for Payer: Networks By Design Commercial |
$334.10
|
| Rate for Payer: Prime Health Services Commercial |
$436.90
|
|
|
HC ESBL DISK CONFIRMATION
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT 87184
|
| Hospital Charge Code |
900912449
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Central Health Plan Commercial |
$168.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$129.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Networks By Design Commercial |
$136.50
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
|
|
HC ESBL DISK CONFIRMATION
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 87184
|
| Hospital Charge Code |
900912449
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.06 |
| Max. Negotiated Rate |
$50.10 |
| Rate for Payer: Adventist Health Commercial |
$9.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$7.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$50.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.17
|
| Rate for Payer: Blue Shield of California Commercial |
$27.92
|
| Rate for Payer: Blue Shield of California EPN |
$18.26
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Central Health Plan Commercial |
$36.80
|
| Rate for Payer: Cigna of CA HMO |
$29.44
|
| Rate for Payer: Cigna of CA PPO |
$34.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.10
|
| Rate for Payer: EPIC Health Plan Senior |
$7.48
|
| Rate for Payer: Galaxy Health WC |
$39.10
|
| Rate for Payer: Global Benefits Group Commercial |
$27.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.48
|
| Rate for Payer: InnovAge PACE Commercial |
$11.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.02
|
| Rate for Payer: Multiplan Commercial |
$34.50
|
| Rate for Payer: Networks By Design Commercial |
$29.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7.48
|
| Rate for Payer: Prime Health Services Commercial |
$39.10
|
| Rate for Payer: Prime Health Services Medicare |
$7.93
|
| Rate for Payer: Riverside University Health System MISP |
$8.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.06
|
| Rate for Payer: United Healthcare All Other HMO |
$6.06
|
| Rate for Payer: United Healthcare HMO Rider |
$6.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.06
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.23
|
| Rate for Payer: Vantage Medical Group Senior |
$7.48
|
|
|
HC ESOPH ACID REFLX TEST
|
Facility
|
OP
|
$2,087.00
|
|
|
Service Code
|
CPT 91034
|
| Hospital Charge Code |
906791033
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$133.49 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$417.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$674.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$741.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$674.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,370.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,225.70
|
| 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 |
$939.15
|
| Rate for Payer: Cash Price |
$939.15
|
| Rate for Payer: Cash Price |
$939.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,669.60
|
| Rate for Payer: Cigna of CA HMO |
$1,335.68
|
| Rate for Payer: Cigna of CA PPO |
$1,544.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$741.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$674.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$910.14
|
| Rate for Payer: EPIC Health Plan Senior |
$674.18
|
| Rate for Payer: Galaxy Health WC |
$1,773.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,252.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,878.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,105.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$133.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$674.18
|
| Rate for Payer: InnovAge PACE Commercial |
$1,011.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,392.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$147.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$674.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$417.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$903.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$903.40
|
| Rate for Payer: Multiplan Commercial |
$1,565.25
|
| Rate for Payer: Networks By Design Commercial |
$1,356.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$674.18
|
| Rate for Payer: Prime Health Services Commercial |
$1,773.95
|
| Rate for Payer: Prime Health Services Medicare |
$714.63
|
| Rate for Payer: Riverside University Health System MISP |
$741.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,252.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$809.02
|
| 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 |
$674.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$741.60
|
| Rate for Payer: Vantage Medical Group Senior |
$674.18
|
|
|
HC ESOPH ACID REFLX TEST
|
Facility
|
IP
|
$4,728.00
|
|
|
Service Code
|
CPT 91034
|
| Hospital Charge Code |
906791033
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$945.60 |
| Max. Negotiated Rate |
$4,255.20 |
| Rate for Payer: Adventist Health Commercial |
$945.60
|
| Rate for Payer: Cash Price |
$2,127.60
|
| Rate for Payer: Central Health Plan Commercial |
$3,782.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,891.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,891.20
|
| Rate for Payer: Galaxy Health WC |
$4,018.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,836.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,255.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,153.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,801.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,926.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$945.60
|
| Rate for Payer: Multiplan Commercial |
$3,546.00
|
| Rate for Payer: Networks By Design Commercial |
$3,073.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,018.80
|
|
|
HC ESOPHAG DIAG W BALLOON DILATION
|
Facility
|
IP
|
$4,574.00
|
|
|
Service Code
|
CPT 43220
|
| Hospital Charge Code |
909000188
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$914.80 |
| Max. Negotiated Rate |
$4,116.60 |
| Rate for Payer: Adventist Health Commercial |
$914.80
|
| Rate for Payer: Cash Price |
$2,058.30
|
| Rate for Payer: Central Health Plan Commercial |
$3,659.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,829.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,829.60
|
| Rate for Payer: Galaxy Health WC |
$3,887.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,744.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,116.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,050.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,742.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,831.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$914.80
|
| Rate for Payer: Multiplan Commercial |
$3,430.50
|
| Rate for Payer: Networks By Design Commercial |
$2,973.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,887.90
|
|
|
HC ESOPHAG DIAG W BALLOON DILATION
|
Facility
|
OP
|
$3,057.00
|
|
|
Service Code
|
CPT 43220
|
| Hospital Charge Code |
909000188
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$307.36 |
| Max. Negotiated Rate |
$7,378.00 |
| Rate for Payer: Adventist Health Commercial |
$611.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,410.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,410.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,840.40
|
| 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 |
$1,375.65
|
| Rate for Payer: Cash Price |
$1,375.65
|
| Rate for Payer: Cash Price |
$1,375.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,445.60
|
| Rate for Payer: Cigna of CA HMO |
$1,956.48
|
| Rate for Payer: Cigna of CA PPO |
$2,262.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,651.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,410.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,253.93
|
| Rate for Payer: EPIC Health Plan Senior |
$2,410.32
|
| Rate for Payer: Galaxy Health WC |
$2,598.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,834.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,751.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$307.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: InnovAge PACE Commercial |
$3,615.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,039.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$339.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$611.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,229.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,229.83
|
| Rate for Payer: Multiplan Commercial |
$2,292.75
|
| Rate for Payer: Multiplan WC |
$3,840.40
|
| Rate for Payer: Networks By Design Commercial |
$1,987.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Preferred Health Network WC |
$3,918.78
|
| Rate for Payer: Prime Health Services Commercial |
$2,598.45
|
| Rate for Payer: Prime Health Services Medicare |
$2,554.94
|
| Rate for Payer: Prime Health Services WC |
$3,801.22
|
| Rate for Payer: Riverside University Health System MISP |
$2,651.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,834.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,410.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,410.32
|
|
|
HC ESOPHAG DIAG W BALLOON DILATION
|
Facility
|
IP
|
$4,574.00
|
|
|
Service Code
|
CPT 43220
|
| Hospital Charge Code |
909000188
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$914.80 |
| Max. Negotiated Rate |
$4,116.60 |
| Rate for Payer: Adventist Health Commercial |
$914.80
|
| Rate for Payer: Cash Price |
$2,058.30
|
| Rate for Payer: Central Health Plan Commercial |
$3,659.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,829.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,829.60
|
| Rate for Payer: Galaxy Health WC |
$3,887.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,744.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,116.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,050.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,742.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,831.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$914.80
|
| Rate for Payer: Multiplan Commercial |
$3,430.50
|
| Rate for Payer: Networks By Design Commercial |
$2,973.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,887.90
|
|
