|
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 |
$2,052.05
|
| Rate for Payer: Cash Price |
$2,052.05
|
| Rate for Payer: Cash Price |
$2,052.05
|
| 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 DIAG W/ OR W/O COLLECT SP
|
Facility
|
IP
|
$3,731.00
|
|
|
Service Code
|
CPT 43260
|
| Hospital Charge Code |
906743260
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$746.20 |
| Max. Negotiated Rate |
$3,357.90 |
| Rate for Payer: Adventist Health Commercial |
$746.20
|
| Rate for Payer: Cash Price |
$2,052.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,984.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,492.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,492.40
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$2,488.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,421.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,309.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$746.20
|
| Rate for Payer: Multiplan Commercial |
$2,798.25
|
| Rate for Payer: Networks By Design Commercial |
$2,425.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,171.35
|
|
|
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 |
$3,071.20
|
| Rate for Payer: Cash Price |
$3,071.20
|
| Rate for Payer: Cash Price |
$3,071.20
|
| 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
|
$5,584.00
|
|
|
Service Code
|
CPT 43274
|
| Hospital Charge Code |
900100019
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,116.80 |
| Max. Negotiated Rate |
$5,025.60 |
| Rate for Payer: Adventist Health Commercial |
$1,116.80
|
| Rate for Payer: Cash Price |
$3,071.20
|
| Rate for Payer: Central Health Plan Commercial |
$4,467.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,233.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,233.60
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$3,724.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,127.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,456.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,116.80
|
| Rate for Payer: Multiplan Commercial |
$4,188.00
|
| Rate for Payer: Networks By Design Commercial |
$3,629.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,746.40
|
|
|
HC ERCP EA DUCT/AMPULLA DILATATION
|
Facility
|
IP
|
$6,862.00
|
|
|
Service Code
|
CPT 43277
|
| Hospital Charge Code |
900100020
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,372.40 |
| Max. Negotiated Rate |
$6,175.80 |
| Rate for Payer: Adventist Health Commercial |
$1,372.40
|
| Rate for Payer: Cash Price |
$3,774.10
|
| Rate for Payer: Central Health Plan Commercial |
$5,489.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,744.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,744.80
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$4,576.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,614.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,247.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,372.40
|
| Rate for Payer: Multiplan Commercial |
$5,146.50
|
| Rate for Payer: Networks By Design Commercial |
$4,460.30
|
| Rate for Payer: Prime Health Services Commercial |
$5,832.70
|
|
|
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 |
$3,774.10
|
| Rate for Payer: Cash Price |
$3,774.10
|
| Rate for Payer: Cash Price |
$3,774.10
|
| 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
|
$4,303.00
|
|
|
Service Code
|
CPT 43278
|
| Hospital Charge Code |
906743278
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$860.60 |
| Max. Negotiated Rate |
$3,872.70 |
| Rate for Payer: Adventist Health Commercial |
$860.60
|
| Rate for Payer: Cash Price |
$2,366.65
|
| Rate for Payer: Central Health Plan Commercial |
$3,442.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,721.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,721.20
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$2,870.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,639.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,663.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$860.60
|
| Rate for Payer: Multiplan Commercial |
$3,227.25
|
| Rate for Payer: Networks By Design Commercial |
$2,796.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,657.55
|
|
|
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 |
$2,366.65
|
| Rate for Payer: Cash Price |
$2,366.65
|
| Rate for Payer: Cash Price |
$2,366.65
|
| 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 |
$957.55
|
| Rate for Payer: Cash Price |
$957.55
|
| 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 |
$957.55
|
| 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
|
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 |
$2,052.05
|
| Rate for Payer: Cash Price |
$2,052.05
|
| Rate for Payer: Cash Price |
$2,052.05
|
| 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
|
|
|
HC ERCP W/BX SNGL OR MULTI
|
Facility
|
IP
|
$3,731.00
|
|
|
Service Code
|
CPT 43261
|
| Hospital Charge Code |
906743261
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$746.20 |
| Max. Negotiated Rate |
$3,357.90 |
| Rate for Payer: Adventist Health Commercial |
$746.20
|
| Rate for Payer: Cash Price |
$2,052.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,984.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,492.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,492.40
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$2,488.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,421.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,309.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$746.20
|
| Rate for Payer: Multiplan Commercial |
$2,798.25
|
| Rate for Payer: Networks By Design Commercial |
$2,425.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,171.35
|
|
|
HC ERCP W/ENDO RETRO BLLN DIAL AM
|
Facility
|
IP
|
$7,086.00
|
|
|
Service Code
|
CPT 43271
|
| Hospital Charge Code |
906743271
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,417.20 |
| Max. Negotiated Rate |
$6,377.40 |
| Rate for Payer: Adventist Health Commercial |
$1,417.20
|
| Rate for Payer: Cash Price |
$3,897.30
|
| Rate for Payer: Central Health Plan Commercial |
$5,668.80
|
| 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: 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: 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
|
|
|
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 |
$3,897.30
|
| Rate for Payer: Cash Price |
$3,897.30
|
| 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 |
$3,020.60
|
| Rate for Payer: Cash Price |
$3,020.60
|
| Rate for Payer: Cash Price |
$3,020.60
|
| 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
|
$5,492.00
|
|
|
Service Code
|
CPT 43265
|
| Hospital Charge Code |
906743265
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,098.40 |
| Max. Negotiated Rate |
$4,942.80 |
| Rate for Payer: Adventist Health Commercial |
$1,098.40
|
| Rate for Payer: Cash Price |
$3,020.60
|
| Rate for Payer: Central Health Plan Commercial |
$4,393.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,196.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,196.80
|
| 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: 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 |
$3,399.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,098.40
|
| Rate for Payer: Multiplan Commercial |
$4,119.00
|
| Rate for Payer: Networks By Design Commercial |
$3,569.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,668.20
|
|
|
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 |
$3,171.30
|
| Rate for Payer: Cash Price |
$3,171.30
|
| 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 NASOB
|
Facility
|
IP
|
$5,766.00
|
|
|
Service Code
|
CPT 43267
|
| Hospital Charge Code |
906743267
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,153.20 |
| Max. Negotiated Rate |
$5,189.40 |
| Rate for Payer: Adventist Health Commercial |
$1,153.20
|
| Rate for Payer: Cash Price |
$3,171.30
|
| Rate for Payer: Central Health Plan Commercial |
$4,612.80
|
| 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: 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: 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
|
|
|
HC ERCP W/ENDO RETRO INSERT TUBE
|
Facility
|
IP
|
$5,363.00
|
|
|
Service Code
|
CPT 43268
|
| Hospital Charge Code |
906743268
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,072.60 |
| Max. Negotiated Rate |
$4,826.70 |
| Rate for Payer: Adventist Health Commercial |
$1,072.60
|
| Rate for Payer: Cash Price |
$2,949.65
|
| Rate for Payer: Central Health Plan Commercial |
$4,290.40
|
| 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: 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: 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
|
|
|
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 |
$2,949.65
|
| Rate for Payer: Cash Price |
$2,949.65
|
| 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
|
$6,778.00
|
|
|
Service Code
|
CPT 43264
|
| Hospital Charge Code |
906743264
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,355.60 |
| Max. Negotiated Rate |
$6,100.20 |
| Rate for Payer: Adventist Health Commercial |
$1,355.60
|
| Rate for Payer: Cash Price |
$3,727.90
|
| Rate for Payer: Central Health Plan Commercial |
$5,422.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,711.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,711.20
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$4,520.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,582.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,195.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,355.60
|
| Rate for Payer: Multiplan Commercial |
$5,083.50
|
| Rate for Payer: Networks By Design Commercial |
$4,405.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,761.30
|
|
|
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 |
$3,727.90
|
| Rate for Payer: Cash Price |
$3,727.90
|
| Rate for Payer: Cash Price |
$3,727.90
|
| 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 |
$2,687.85
|
| Rate for Payer: Cash Price |
$2,687.85
|
| 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 ENDO RETRO RMVL FBTUBE
|
Facility
|
IP
|
$4,887.00
|
|
|
Service Code
|
CPT 43269
|
| Hospital Charge Code |
906743269
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$977.40 |
| Max. Negotiated Rate |
$4,398.30 |
| Rate for Payer: Adventist Health Commercial |
$977.40
|
| Rate for Payer: Cash Price |
$2,687.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,909.60
|
| 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: 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: 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
|
|
|
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 |
$2,328.15
|
| Rate for Payer: Cash Price |
$2,328.15
|
| Rate for Payer: Cash Price |
$2,328.15
|
| 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
|
|
