|
HC ERCP W/PRESS MSRMNT
|
Facility
|
IP
|
$4,233.00
|
|
|
Service Code
|
CPT 43263
|
| Hospital Charge Code |
906743263
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$846.60 |
| Max. Negotiated Rate |
$3,809.70 |
| Rate for Payer: Adventist Health Commercial |
$846.60
|
| Rate for Payer: Cash Price |
$2,328.15
|
| Rate for Payer: Central Health Plan Commercial |
$3,386.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,693.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,693.20
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$2,823.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,612.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,620.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$846.60
|
| Rate for Payer: Multiplan Commercial |
$3,174.75
|
| Rate for Payer: Networks By Design Commercial |
$2,751.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,598.05
|
|
|
HC ERCP W RMVL FB STNT
|
Facility
|
IP
|
$4,734.00
|
|
|
Service Code
|
CPT 43275
|
| Hospital Charge Code |
906743275
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$946.80 |
| Max. Negotiated Rate |
$4,260.60 |
| Rate for Payer: Adventist Health Commercial |
$946.80
|
| Rate for Payer: Cash Price |
$2,603.70
|
| Rate for Payer: Central Health Plan Commercial |
$3,787.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,893.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,893.60
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$3,157.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,803.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,930.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$946.80
|
| Rate for Payer: Multiplan Commercial |
$3,550.50
|
| Rate for Payer: Networks By Design Commercial |
$3,077.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,023.90
|
|
|
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 |
$2,603.70
|
| Rate for Payer: Cash Price |
$2,603.70
|
| Rate for Payer: Cash Price |
$2,603.70
|
| 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 & 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 |
$2,856.70
|
| Rate for Payer: Cash Price |
$2,856.70
|
| Rate for Payer: Cash Price |
$2,856.70
|
| 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 RMVL & XCHNG OF STNT INCL SPINC EA STNT
|
Facility
|
IP
|
$5,194.00
|
|
|
Service Code
|
CPT 43276
|
| Hospital Charge Code |
906743276
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,038.80 |
| Max. Negotiated Rate |
$4,674.60 |
| Rate for Payer: Adventist Health Commercial |
$1,038.80
|
| Rate for Payer: Cash Price |
$2,856.70
|
| Rate for Payer: Central Health Plan Commercial |
$4,155.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,077.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,077.60
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$3,464.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,978.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,215.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,038.80
|
| Rate for Payer: Multiplan Commercial |
$3,895.50
|
| Rate for Payer: Networks By Design Commercial |
$3,376.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,414.90
|
|
|
HC ERCP W/SPHINCTERTMY
|
Facility
|
IP
|
$3,601.00
|
|
|
Service Code
|
CPT 43262
|
| Hospital Charge Code |
906743262
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$720.20 |
| Max. Negotiated Rate |
$3,240.90 |
| Rate for Payer: Adventist Health Commercial |
$720.20
|
| Rate for Payer: Cash Price |
$1,980.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,880.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,440.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,440.40
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$2,401.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,371.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,229.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$720.20
|
| Rate for Payer: Multiplan Commercial |
$2,700.75
|
| Rate for Payer: Networks By Design Commercial |
$2,340.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,060.85
|
|
|
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 |
$1,980.55
|
| Rate for Payer: Cash Price |
$1,980.55
|
| Rate for Payer: Cash Price |
$1,980.55
|
| 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
|
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 |
$282.70
|
| 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 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 |
$282.70
|
| Rate for Payer: Cash Price |
$282.70
|
| 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 ESBL DISK CONFIRMATION
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
CPT 87184
|
| Hospital Charge Code |
900912449
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$41.40 |
| Rate for Payer: Adventist Health Commercial |
$9.20
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Central Health Plan Commercial |
$36.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.40
|
| Rate for Payer: EPIC Health Plan Senior |
$18.40
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$30.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.20
|
| Rate for Payer: Multiplan Commercial |
$34.50
|
| Rate for Payer: Networks By Design Commercial |
$29.90
|
| Rate for Payer: Prime Health Services Commercial |
$39.10
|
|
|
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 |
$25.30
|
| Rate for Payer: Cash Price |
$25.30
|
| 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 |
$1,147.85
|
| Rate for Payer: Cash Price |
$1,147.85
|
| Rate for Payer: Cash Price |
$1,147.85
|
| 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
|
$2,087.00
|
|
|
Service Code
|
CPT 91034
|
| Hospital Charge Code |
906791033
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$417.40 |
| Max. Negotiated Rate |
$1,878.30 |
| Rate for Payer: Adventist Health Commercial |
$417.40
|
| Rate for Payer: Cash Price |
$1,147.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,669.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$834.80
|
| Rate for Payer: EPIC Health Plan Senior |
$834.80
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$1,392.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$795.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,291.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$417.40
|
| Rate for Payer: Multiplan Commercial |
$1,565.25
|
| Rate for Payer: Networks By Design Commercial |
$1,356.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,773.95
|
|
|
HC ESOPHAG DIAG W BALLOON DILATION
|
Facility
|
OP
|
$3,057.00
|
|
|
Service Code
|
CPT 43220
|
| Hospital Charge Code |
909000188
|
|
Hospital Revenue Code
|
750
|
| 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: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,681.35
|
| Rate for Payer: Cash Price |
$1,681.35
|
| Rate for Payer: Cash Price |
$1,681.35
|
| 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: Networks By Design Commercial |
$1,987.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Prime Health Services Commercial |
$2,598.45
|
| 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 |
$1,834.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,892.38
|
| 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
|
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 |
$1,681.35
|
| Rate for Payer: Cash Price |
$1,681.35
|
| Rate for Payer: Cash Price |
$1,681.35
|
| 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
|
$3,057.00
|
|
|
Service Code
|
CPT 43220
|
| Hospital Charge Code |
909000188
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$611.40 |
| Max. Negotiated Rate |
$2,751.30 |
| Rate for Payer: Adventist Health Commercial |
$611.40
|
| Rate for Payer: Cash Price |
$1,681.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,445.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,222.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,222.80
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$2,039.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,164.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,892.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$611.40
|
| Rate for Payer: Multiplan Commercial |
$2,292.75
|
| Rate for Payer: Networks By Design Commercial |
$1,987.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,598.45
|
|
|
HC ESOPHAG DIAG W BALLOON DILATION
|
Facility
|
IP
|
$3,057.00
|
|
|
Service Code
|
CPT 43220
|
| Hospital Charge Code |
909000188
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$611.40 |
| Max. Negotiated Rate |
$2,751.30 |
| Rate for Payer: Adventist Health Commercial |
$611.40
|
| Rate for Payer: Cash Price |
$1,681.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,445.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,222.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,222.80
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$2,039.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,164.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,892.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$611.40
|
| Rate for Payer: Multiplan Commercial |
$2,292.75
|
| Rate for Payer: Networks By Design Commercial |
$1,987.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,598.45
|
|
|
HC ESOPHAGEAL DILATATION
|
Facility
|
OP
|
$1,052.00
|
|
|
Service Code
|
CPT 74360
|
| Hospital Charge Code |
909001829
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$132.31 |
| Max. Negotiated Rate |
$946.80 |
| Rate for Payer: Adventist Health Commercial |
$210.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$638.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$894.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$578.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$789.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$651.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.31
|
| Rate for Payer: Blue Shield of California Commercial |
$638.56
|
| Rate for Payer: Blue Shield of California EPN |
$417.64
|
| Rate for Payer: Cash Price |
$578.60
|
| Rate for Payer: Cash Price |
$578.60
|
| Rate for Payer: Central Health Plan Commercial |
$841.60
|
| Rate for Payer: Cigna of CA HMO |
$673.28
|
| Rate for Payer: Cigna of CA PPO |
$778.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$894.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$894.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$894.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$420.80
|
| Rate for Payer: EPIC Health Plan Senior |
$420.80
|
| Rate for Payer: Galaxy Health WC |
$894.20
|
| Rate for Payer: Global Benefits Group Commercial |
$631.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$946.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$187.45
|
| Rate for Payer: InnovAge PACE Commercial |
$526.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$701.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$207.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$651.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$736.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$736.40
|
| Rate for Payer: Multiplan Commercial |
$789.00
|
| Rate for Payer: Networks By Design Commercial |
$683.80
|
| Rate for Payer: Prime Health Services Commercial |
$894.20
|
| Rate for Payer: Riverside University Health System MISP |
$420.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$631.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$631.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$526.00
|
| Rate for Payer: United Healthcare All Other HMO |
$526.00
|
| Rate for Payer: United Healthcare HMO Rider |
$526.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$894.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$894.20
|
| Rate for Payer: Vantage Medical Group Senior |
$894.20
|
|
|
HC ESOPHAGEAL DILATATION
|
Facility
|
IP
|
$1,052.00
|
|
|
Service Code
|
CPT 74360
|
| Hospital Charge Code |
909001829
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$210.40 |
| Max. Negotiated Rate |
$946.80 |
| Rate for Payer: Adventist Health Commercial |
$210.40
|
| Rate for Payer: Cash Price |
$578.60
|
| Rate for Payer: Central Health Plan Commercial |
$841.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$420.80
|
| Rate for Payer: EPIC Health Plan Senior |
$420.80
|
| Rate for Payer: Galaxy Health WC |
$894.20
|
| Rate for Payer: Global Benefits Group Commercial |
$631.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$946.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$701.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$400.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$651.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.40
|
| Rate for Payer: Multiplan Commercial |
$789.00
|
| Rate for Payer: Networks By Design Commercial |
$683.80
|
| Rate for Payer: Prime Health Services Commercial |
$894.20
|
|
|
HC ESOPHAGOGASTRIC TMPONAD W/BLLN
|
Facility
|
IP
|
$4,353.00
|
|
|
Service Code
|
CPT 43460
|
| Hospital Charge Code |
906743460
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$870.60 |
| Max. Negotiated Rate |
$3,917.70 |
| Rate for Payer: Adventist Health Commercial |
$870.60
|
| Rate for Payer: Cash Price |
$2,394.15
|
| Rate for Payer: Central Health Plan Commercial |
$3,482.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,741.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,741.20
|
| Rate for Payer: Galaxy Health WC |
$3,700.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,611.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,917.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,903.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,658.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,694.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$870.60
|
| Rate for Payer: Multiplan Commercial |
$3,264.75
|
| Rate for Payer: Networks By Design Commercial |
$2,829.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,700.05
|
|
|
HC ESOPHAGOGASTRIC TMPONAD W/BLLN
|
Facility
|
OP
|
$4,353.00
|
|
|
Service Code
|
CPT 43460
|
| Hospital Charge Code |
906743460
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$158.17 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$870.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,700.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,394.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,264.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$2,394.15
|
| Rate for Payer: Cash Price |
$2,394.15
|
| Rate for Payer: Cash Price |
$2,394.15
|
| Rate for Payer: Central Health Plan Commercial |
$3,482.40
|
| Rate for Payer: Cigna of CA HMO |
$2,785.92
|
| Rate for Payer: Cigna of CA PPO |
$3,221.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,700.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,700.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,700.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,741.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,741.20
|
| Rate for Payer: Galaxy Health WC |
$3,700.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,611.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,917.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$158.17
|
| Rate for Payer: InnovAge PACE Commercial |
$2,176.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,903.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$174.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,694.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$870.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,047.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,047.10
|
| Rate for Payer: Multiplan Commercial |
$3,264.75
|
| Rate for Payer: Networks By Design Commercial |
$2,829.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,700.05
|
| Rate for Payer: Riverside University Health System MISP |
$1,741.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,611.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,611.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,700.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,700.05
|
| Rate for Payer: Vantage Medical Group Senior |
$3,700.05
|
|
|
HC ESOPHAGOSCOPY RIGID TRANSORAL
|
Facility
|
IP
|
$11,735.00
|
|
|
Service Code
|
CPT 43180
|
| Hospital Charge Code |
906743180
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,347.00 |
| Max. Negotiated Rate |
$10,561.50 |
| Rate for Payer: Adventist Health Commercial |
$2,347.00
|
| Rate for Payer: Cash Price |
$6,454.25
|
| Rate for Payer: Central Health Plan Commercial |
$9,388.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,694.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,694.00
|
| Rate for Payer: Galaxy Health WC |
$9,974.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7,041.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,561.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,827.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,471.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,263.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,347.00
|
| Rate for Payer: Multiplan Commercial |
$8,801.25
|
| Rate for Payer: Networks By Design Commercial |
$7,627.75
|
| Rate for Payer: Prime Health Services Commercial |
$9,974.75
|
|
|
HC ESOPHAGOSCOPY RIGID TRANSORAL
|
Facility
|
OP
|
$11,735.00
|
|
|
Service Code
|
CPT 43180
|
| Hospital Charge Code |
906743180
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$835.66 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$2,347.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$7,516.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,274.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,268.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,516.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$6,454.25
|
| Rate for Payer: Cash Price |
$6,454.25
|
| Rate for Payer: Cash Price |
$6,454.25
|
| Rate for Payer: Central Health Plan Commercial |
$9,388.00
|
| Rate for Payer: Cigna of CA HMO |
$7,510.40
|
| Rate for Payer: Cigna of CA PPO |
$8,683.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,274.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,268.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,516.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,147.19
|
| Rate for Payer: EPIC Health Plan Senior |
$7,516.44
|
| Rate for Payer: Galaxy Health WC |
$9,974.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7,041.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,561.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,326.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$835.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,516.44
|
| Rate for Payer: InnovAge PACE Commercial |
$11,274.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,827.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$923.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,516.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,347.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,072.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,072.03
|
| Rate for Payer: Multiplan Commercial |
$8,801.25
|
| Rate for Payer: Networks By Design Commercial |
$7,627.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,516.44
|
| Rate for Payer: Prime Health Services Commercial |
$9,974.75
|
| Rate for Payer: Prime Health Services Medicare |
$7,967.43
|
| Rate for Payer: Riverside University Health System MISP |
$8,268.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,041.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,019.73
|
| 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 |
$7,516.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,274.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,268.08
|
| Rate for Payer: Vantage Medical Group Senior |
$7,516.44
|
|
|
HC ESOPHAGOSCOPY W BLLN LT 30MM
|
Facility
|
OP
|
$4,574.00
|
|
|
Service Code
|
CPT 43220
|
| Hospital Charge Code |
900501292
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$339.53 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Commercial |
$914.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| 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 |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,840.40
|
| Rate for Payer: Cash Price |
$2,515.70
|
| Rate for Payer: Cash Price |
$2,515.70
|
| Rate for Payer: Cash Price |
$2,515.70
|
| Rate for Payer: Cash Price |
$2,515.70
|
| Rate for Payer: Central Health Plan Commercial |
$3,659.20
|
| Rate for Payer: Cigna of CA HMO |
$2,927.36
|
| Rate for Payer: Cigna of CA PPO |
$3,384.76
|
| 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 |
$3,887.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,744.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,116.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| 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 |
$3,050.86
|
| 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 |
$914.80
|
| 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 |
$3,430.50
|
| Rate for Payer: Multiplan WC |
$3,840.40
|
| Rate for Payer: Networks By Design Commercial |
$2,973.10
|
| 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 |
$3,887.90
|
| 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 |
$2,744.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,287.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,287.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,287.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,287.00
|
| 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 ESOPHAGOSCOPY W BLLN LT 30MM
|
Facility
|
IP
|
$4,574.00
|
|
|
Service Code
|
CPT 43220
|
| Hospital Charge Code |
900501292
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$914.80 |
| Max. Negotiated Rate |
$4,116.60 |
| Rate for Payer: Adventist Health Commercial |
$914.80
|
| Rate for Payer: Cash Price |
$2,515.70
|
| 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
|
|
