|
HC DILAT ESOPH BOUGIE/SNGL OR MUL
|
Facility
OP
|
$3,481.00
|
|
|
Service Code
|
CPT 43450
|
| Hospital Charge Code |
906743450
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$3,132.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: BCBS Transplant Transplant |
$2,088.60
|
| Rate for Payer: Caremore Medicare Advantage |
$1,132.59
|
| Rate for Payer: Cash Price |
$1,566.45
|
| Rate for Payer: Cash Price |
$1,566.45
|
| Rate for Payer: Cash Price |
$1,566.45
|
| Rate for Payer: Cash Price |
$1,566.45
|
| Rate for Payer: Central Health Plan Commercial |
$2,784.80
|
| Rate for Payer: Cigna of CA PPO |
$2,575.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$2,958.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,088.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,132.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,610.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,857.45
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$1,132.59
|
| Rate for Payer: Innovage PACE Commercial |
$1,698.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,321.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$696.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,517.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$2,610.75
|
| Rate for Payer: Networks By Design Commercial |
$2,262.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,958.85
|
| Rate for Payer: Prime Health Services Medicare |
$1,200.55
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,088.60
|
| Rate for Payer: Riverside University Health MISP |
$1,245.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,088.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,740.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,740.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,740.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,740.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC DILAT ESOPH BOUGIE/SNGL OR MUL
|
Facility
OP
|
$3,481.00
|
|
|
Service Code
|
CPT 43450
|
| Hospital Charge Code |
906743450
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$696.20 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,132.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$2,088.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$1,132.59
|
| Rate for Payer: Cash Price |
$1,566.45
|
| Rate for Payer: Cash Price |
$1,566.45
|
| Rate for Payer: Cash Price |
$1,566.45
|
| Rate for Payer: Central Health Plan Commercial |
$2,784.80
|
| Rate for Payer: Cigna of CA PPO |
$2,575.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$2,958.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,088.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,132.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,610.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,857.45
|
| Rate for Payer: IEHP medi-cal |
$1,868.77
|
| Rate for Payer: IEHP Medicare Advantage |
$1,132.59
|
| Rate for Payer: Innovage PACE Commercial |
$1,698.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,321.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$696.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,517.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$2,610.75
|
| Rate for Payer: Networks By Design Commercial |
$2,262.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,958.85
|
| Rate for Payer: Prime Health Services Medicare |
$1,200.55
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,245.85
|
| Rate for Payer: Riverside University Health MISP |
$1,245.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,088.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,359.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC DILAT ESOPH BOUGIE/SNGL OR MUL
|
Facility
IP
|
$6,678.00
|
|
|
Service Code
|
CPT 43450
|
| Hospital Charge Code |
906743450
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,335.60 |
| Max. Negotiated Rate |
$6,010.20 |
| Rate for Payer: Cash Price |
$3,005.10
|
| Rate for Payer: Central Health Plan Commercial |
$5,342.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,671.20
|
| Rate for Payer: Galaxy Health WC |
$5,676.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,006.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,010.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,454.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,335.60
|
| Rate for Payer: Multiplan Commercial |
$5,008.50
|
| Rate for Payer: Networks By Design Commercial |
$4,340.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,676.30
|
|
|
HC DILAT ESOPH OVER GUIDE WIRE
|
Facility
OP
|
$3,475.00
|
|
|
Service Code
|
CPT 43453
|
| Hospital Charge Code |
906743453
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$695.00 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,377.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$2,085.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$2,377.45
|
| Rate for Payer: Cash Price |
$1,563.75
|
| Rate for Payer: Cash Price |
$1,563.75
|
| Rate for Payer: Cash Price |
$1,563.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,780.00
|
| Rate for Payer: Cigna of CA PPO |
$2,571.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Galaxy Health WC |
$2,953.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,085.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,127.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,606.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,899.02
|
| Rate for Payer: IEHP medi-cal |
$3,922.79
|
| Rate for Payer: IEHP Medicare Advantage |
$2,377.45
|
| Rate for Payer: Innovage PACE Commercial |
$3,566.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,317.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$695.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,185.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Multiplan Commercial |
$2,606.25
|
| Rate for Payer: Networks By Design Commercial |
$2,258.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,953.75
|
| Rate for Payer: Prime Health Services Medicare |
$2,520.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,615.20
|
| Rate for Payer: Riverside University Health MISP |
$2,615.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,085.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,852.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC DILAT ESOPH OVER GUIDE WIRE
|
Facility
IP
|
$5,334.00
|
|
|
Service Code
|
CPT 43453
|
| Hospital Charge Code |
906743453
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,066.80 |
| Max. Negotiated Rate |
$4,800.60 |
| Rate for Payer: Cash Price |
$2,400.30
|
| Rate for Payer: Central Health Plan Commercial |
$4,267.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,133.60
|
| Rate for Payer: Galaxy Health WC |
$4,533.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,200.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,800.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,557.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,066.80
|
| Rate for Payer: Multiplan Commercial |
$4,000.50
|
| Rate for Payer: Networks By Design Commercial |
$3,467.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,533.90
|
|
|
HC DILATE TEAR DUCT OPENING
|
Facility
OP
|
$301.00
|
|
|
Service Code
|
CPT 68801
|
| Hospital Charge Code |
900501698
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$60.20 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$746.73
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$547.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$497.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: BCBS Transplant Transplant |
$180.60
|
| Rate for Payer: Caremore Medicare Advantage |
$497.82
|
| Rate for Payer: Cash Price |
$135.45
|
| Rate for Payer: Cash Price |
$135.45
|
| Rate for Payer: Cash Price |
$135.45
|
| Rate for Payer: Cash Price |
$135.45
|
| Rate for Payer: Central Health Plan Commercial |
$240.80
|
| Rate for Payer: Cigna of CA PPO |
$222.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$746.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.06
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$497.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$497.82
|
| Rate for Payer: Galaxy Health WC |
$255.85
|
| Rate for Payer: Global Benefits Group Commercial |
$180.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$270.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$225.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$816.42
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$497.82
|
| Rate for Payer: Innovage PACE Commercial |
$746.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$497.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$667.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.08
|
| Rate for Payer: Multiplan Commercial |
$225.75
|
| Rate for Payer: Networks By Design Commercial |
$195.65
|
| Rate for Payer: Prime Health Services Commercial |
$255.85
|
| Rate for Payer: Prime Health Services Medicare |
$527.69
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$180.60
|
| Rate for Payer: Riverside University Health MISP |
$547.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$180.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.50
|
| Rate for Payer: United Healthcare All Other HMO |
$150.50
|
| Rate for Payer: United Healthcare HMO Rider |
$150.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$150.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$746.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$547.60
|
| Rate for Payer: Vantage Medical Group Senior |
$497.82
|
|
|
HC DILATE TEAR DUCT OPENING
|
Facility
IP
|
$301.00
|
|
|
Service Code
|
CPT 68801
|
| Hospital Charge Code |
900501698
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$60.20 |
| Max. Negotiated Rate |
$270.90 |
| Rate for Payer: Cash Price |
$135.45
|
| Rate for Payer: Central Health Plan Commercial |
$240.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.40
|
| Rate for Payer: Galaxy Health WC |
$255.85
|
| Rate for Payer: Global Benefits Group Commercial |
$180.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$270.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.20
|
| Rate for Payer: Multiplan Commercial |
$225.75
|
| Rate for Payer: Networks By Design Commercial |
$195.65
|
| Rate for Payer: Prime Health Services Commercial |
$255.85
|
|
|
HC DILATION OF CERVICAL CANAL
|
Facility
OP
|
$16,982.00
|
|
|
Service Code
|
CPT 57800
|
| Hospital Charge Code |
900501483
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$15,283.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,906.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: BCBS Transplant Transplant |
$10,189.20
|
| Rate for Payer: Caremore Medicare Advantage |
$3,906.18
|
| Rate for Payer: Cash Price |
$7,641.90
|
| Rate for Payer: Cash Price |
$7,641.90
|
| Rate for Payer: Cash Price |
$7,641.90
|
| Rate for Payer: Cash Price |
$7,641.90
|
| Rate for Payer: Central Health Plan Commercial |
$13,585.60
|
| Rate for Payer: Cigna of CA PPO |
$12,566.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,859.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,273.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,906.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,906.18
|
| Rate for Payer: Galaxy Health WC |
$14,434.70
|
| Rate for Payer: Global Benefits Group Commercial |
$10,189.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,283.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12,736.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,406.14
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$3,906.18
|
| Rate for Payer: Innovage PACE Commercial |
$5,859.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,326.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,906.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,396.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,234.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,234.28
|
| Rate for Payer: Multiplan Commercial |
$12,736.50
|
| Rate for Payer: Networks By Design Commercial |
$11,038.30
|
| Rate for Payer: Prime Health Services Commercial |
$14,434.70
|
| Rate for Payer: Prime Health Services Medicare |
$4,140.55
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$10,189.20
|
| Rate for Payer: Riverside University Health MISP |
$4,296.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,189.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,491.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,491.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,491.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,491.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,906.18
|
|
|
HC DILATION OF CERVICAL CANAL
|
Facility
IP
|
$16,982.00
|
|
|
Service Code
|
CPT 57800
|
| Hospital Charge Code |
900501483
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3,396.40 |
| Max. Negotiated Rate |
$15,283.80 |
| Rate for Payer: Cash Price |
$7,641.90
|
| Rate for Payer: Central Health Plan Commercial |
$13,585.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,792.80
|
| Rate for Payer: Galaxy Health WC |
$14,434.70
|
| Rate for Payer: Global Benefits Group Commercial |
$10,189.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,283.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,326.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,396.40
|
| Rate for Payer: Multiplan Commercial |
$12,736.50
|
| Rate for Payer: Networks By Design Commercial |
$11,038.30
|
| Rate for Payer: Prime Health Services Commercial |
$14,434.70
|
|
|
HC DILATION OF CERVICAL CANAL
|
Facility
IP
|
$16,982.00
|
|
|
Service Code
|
CPT 57800
|
| Hospital Charge Code |
900501483
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,396.40 |
| Max. Negotiated Rate |
$15,283.80 |
| Rate for Payer: Cash Price |
$7,641.90
|
| Rate for Payer: Central Health Plan Commercial |
$13,585.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,792.80
|
| Rate for Payer: Galaxy Health WC |
$14,434.70
|
| Rate for Payer: Global Benefits Group Commercial |
$10,189.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,283.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,326.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,396.40
|
| Rate for Payer: Multiplan Commercial |
$12,736.50
|
| Rate for Payer: Networks By Design Commercial |
$11,038.30
|
| Rate for Payer: Prime Health Services Commercial |
$14,434.70
|
|
|
HC DILATION OF CERVICAL CANAL
|
Facility
OP
|
$16,982.00
|
|
|
Service Code
|
CPT 57800
|
| Hospital Charge Code |
900501483
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,901.00 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,906.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,906.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$10,189.20
|
| Rate for Payer: Blue Shield of California Commercial |
$10,681.68
|
| Rate for Payer: Blue Shield of California EPN |
$8,304.20
|
| Rate for Payer: Caremore Medicare Advantage |
$3,906.18
|
| Rate for Payer: Cash Price |
$7,641.90
|
| Rate for Payer: Cash Price |
$7,641.90
|
| Rate for Payer: Cash Price |
$7,641.90
|
| Rate for Payer: Central Health Plan Commercial |
$13,585.60
|
| Rate for Payer: Cigna of CA HMO |
$10,868.48
|
| Rate for Payer: Cigna of CA PPO |
$12,566.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,859.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,273.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,906.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,906.18
|
| Rate for Payer: Galaxy Health WC |
$14,434.70
|
| Rate for Payer: Global Benefits Group Commercial |
$10,189.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,283.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12,736.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,406.14
|
| Rate for Payer: IEHP medi-cal |
$6,445.20
|
| Rate for Payer: IEHP Medicare Advantage |
$3,906.18
|
| Rate for Payer: Innovage PACE Commercial |
$5,859.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,326.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,906.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,396.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,234.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,234.28
|
| Rate for Payer: Multiplan Commercial |
$12,736.50
|
| Rate for Payer: Networks By Design Commercial |
$11,038.30
|
| Rate for Payer: Prime Health Services Commercial |
$14,434.70
|
| Rate for Payer: Prime Health Services Medicare |
$4,140.55
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$10,189.20
|
| Rate for Payer: Riverside University Health MISP |
$4,296.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,189.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10,189.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,491.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,491.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,491.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,491.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,906.18
|
|
|
HC DILATOR VESSEL 5-13 FR 20 CM
|
Facility
IP
|
$31.00
|
|
| Hospital Charge Code |
909001071
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$27.90 |
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Central Health Plan Commercial |
$24.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.40
|
| Rate for Payer: Galaxy Health WC |
$26.35
|
| Rate for Payer: Global Benefits Group Commercial |
$18.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.20
|
| Rate for Payer: Multiplan Commercial |
$23.25
|
| Rate for Payer: Networks By Design Commercial |
$20.15
|
| Rate for Payer: Prime Health Services Commercial |
$26.35
|
|
|
HC DILATOR VESSEL 5-13 FR 20 CM
|
Facility
OP
|
$31.00
|
|
| Hospital Charge Code |
909001071
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$27.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$18.83
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$26.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$17.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.31
|
| Rate for Payer: BCBS Transplant Transplant |
$18.60
|
| Rate for Payer: Blue Shield of California Commercial |
$19.50
|
| Rate for Payer: Blue Shield of California EPN |
$15.16
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Central Health Plan Commercial |
$24.80
|
| Rate for Payer: Cigna of CA HMO |
$19.84
|
| Rate for Payer: Cigna of CA PPO |
$22.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.40
|
| Rate for Payer: Galaxy Health WC |
$26.35
|
| Rate for Payer: Global Benefits Group Commercial |
$18.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$23.25
|
| Rate for Payer: IEHP medi-cal |
$10.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.20
|
| Rate for Payer: Multiplan Commercial |
$23.25
|
| Rate for Payer: Networks By Design Commercial |
$20.15
|
| Rate for Payer: Prime Health Services Commercial |
$26.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$18.60
|
| Rate for Payer: Riverside University Health MISP |
$12.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.50
|
| Rate for Payer: United Healthcare All Other HMO |
$15.50
|
| Rate for Payer: United Healthcare HMO Rider |
$15.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.35
|
| Rate for Payer: Vantage Medical Group Senior |
$26.35
|
|
|
HC DILAT RECTAL STRICTURE W ANESTH
|
Facility
OP
|
$7,526.00
|
|
|
Service Code
|
CPT 45910
|
| Hospital Charge Code |
906745910
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,474.42 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,474.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,211.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,474.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$4,515.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,733.85
|
| Rate for Payer: Blue Shield of California EPN |
$3,680.21
|
| Rate for Payer: Caremore Medicare Advantage |
$1,474.42
|
| Rate for Payer: Cash Price |
$3,386.70
|
| Rate for Payer: Cash Price |
$3,386.70
|
| Rate for Payer: Cash Price |
$3,386.70
|
| Rate for Payer: Central Health Plan Commercial |
$6,020.80
|
| Rate for Payer: Cigna of CA HMO |
$4,816.64
|
| Rate for Payer: Cigna of CA PPO |
$5,569.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,211.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,990.47
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,474.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,474.42
|
| Rate for Payer: Galaxy Health WC |
$6,397.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,515.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,773.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5,644.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,418.05
|
| Rate for Payer: IEHP medi-cal |
$2,432.79
|
| Rate for Payer: IEHP Medicare Advantage |
$1,474.42
|
| Rate for Payer: Innovage PACE Commercial |
$2,211.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,019.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,474.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,505.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,975.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,975.72
|
| Rate for Payer: Multiplan Commercial |
$5,644.50
|
| Rate for Payer: Networks By Design Commercial |
$4,891.90
|
| Rate for Payer: Prime Health Services Commercial |
$6,397.10
|
| Rate for Payer: Prime Health Services Medicare |
$1,562.89
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4,515.60
|
| Rate for Payer: Riverside University Health MISP |
$1,621.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,515.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,515.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,763.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,763.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,763.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,763.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: Vantage Medical Group Senior |
$1,474.42
|
|
|
HC DILAT RECTAL STRICTURE W ANESTH
|
Facility
IP
|
$13,633.00
|
|
|
Service Code
|
CPT 45910
|
| Hospital Charge Code |
906745910
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,726.60 |
| Max. Negotiated Rate |
$12,269.70 |
| Rate for Payer: Cash Price |
$6,134.85
|
| Rate for Payer: Central Health Plan Commercial |
$10,906.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,453.20
|
| Rate for Payer: Galaxy Health WC |
$11,588.05
|
| Rate for Payer: Global Benefits Group Commercial |
$8,179.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,269.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,093.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,726.60
|
| Rate for Payer: Multiplan Commercial |
$10,224.75
|
| Rate for Payer: Networks By Design Commercial |
$8,861.45
|
| Rate for Payer: Prime Health Services Commercial |
$11,588.05
|
|
|
HC DILAT RECTAL STRICTURE W ANESTH
|
Facility
IP
|
$13,633.00
|
|
|
Service Code
|
CPT 45910
|
| Hospital Charge Code |
906745910
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,726.60 |
| Max. Negotiated Rate |
$12,269.70 |
| Rate for Payer: Cash Price |
$6,134.85
|
| Rate for Payer: Central Health Plan Commercial |
$10,906.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,453.20
|
| Rate for Payer: Galaxy Health WC |
$11,588.05
|
| Rate for Payer: Global Benefits Group Commercial |
$8,179.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,269.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,093.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,726.60
|
| Rate for Payer: Multiplan Commercial |
$10,224.75
|
| Rate for Payer: Networks By Design Commercial |
$8,861.45
|
| Rate for Payer: Prime Health Services Commercial |
$11,588.05
|
|
|
HC DILAT RECTAL STRICTURE W ANESTH
|
Facility
OP
|
$7,526.00
|
|
|
Service Code
|
CPT 45910
|
| Hospital Charge Code |
906745910
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,474.42 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,474.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,211.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,474.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$4,515.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$1,474.42
|
| Rate for Payer: Cash Price |
$3,386.70
|
| Rate for Payer: Cash Price |
$3,386.70
|
| Rate for Payer: Cash Price |
$3,386.70
|
| Rate for Payer: Central Health Plan Commercial |
$6,020.80
|
| Rate for Payer: Cigna of CA PPO |
$5,569.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,211.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,990.47
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,474.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,474.42
|
| Rate for Payer: Galaxy Health WC |
$6,397.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,515.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,773.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5,644.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,418.05
|
| Rate for Payer: IEHP medi-cal |
$2,432.79
|
| Rate for Payer: IEHP Medicare Advantage |
$1,474.42
|
| Rate for Payer: Innovage PACE Commercial |
$2,211.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,019.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,474.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,505.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,975.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,975.72
|
| Rate for Payer: Multiplan Commercial |
$5,644.50
|
| Rate for Payer: Networks By Design Commercial |
$4,891.90
|
| Rate for Payer: Prime Health Services Commercial |
$6,397.10
|
| Rate for Payer: Prime Health Services Medicare |
$1,562.89
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,621.86
|
| Rate for Payer: Riverside University Health MISP |
$1,621.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,515.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,769.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: Vantage Medical Group Senior |
$1,474.42
|
|
|
HC DILAT XST TRC NEW ACCESS RCS
|
Facility
OP
|
$10,839.00
|
|
|
Service Code
|
CPT 50437
|
| Hospital Charge Code |
909050437
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,167.80 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,355.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,355.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$6,503.40
|
| Rate for Payer: Blue Shield of California Commercial |
$12,373.72
|
| Rate for Payer: Blue Shield of California EPN |
$8,887.36
|
| Rate for Payer: Caremore Medicare Advantage |
$4,355.72
|
| Rate for Payer: Cash Price |
$4,877.55
|
| Rate for Payer: Cash Price |
$4,877.55
|
| Rate for Payer: Cash Price |
$4,877.55
|
| Rate for Payer: Central Health Plan Commercial |
$8,671.20
|
| Rate for Payer: Cigna of CA PPO |
$8,020.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,533.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,880.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,355.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,355.72
|
| Rate for Payer: Galaxy Health WC |
$9,213.15
|
| Rate for Payer: Global Benefits Group Commercial |
$6,503.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,755.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8,129.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,143.38
|
| Rate for Payer: IEHP medi-cal |
$7,186.94
|
| Rate for Payer: IEHP Medicare Advantage |
$4,355.72
|
| Rate for Payer: Innovage PACE Commercial |
$6,533.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,229.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,355.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,167.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,836.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,836.66
|
| Rate for Payer: Multiplan Commercial |
$8,129.25
|
| Rate for Payer: Networks By Design Commercial |
$7,045.35
|
| Rate for Payer: Prime Health Services Commercial |
$9,213.15
|
| Rate for Payer: Prime Health Services Medicare |
$4,617.06
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6,503.40
|
| Rate for Payer: Riverside University Health MISP |
$4,791.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,503.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: Vantage Medical Group Senior |
$4,355.72
|
|
|
HC DILAT XST TRC NEW ACCESS RCS
|
Facility
IP
|
$10,839.00
|
|
|
Service Code
|
CPT 50437
|
| Hospital Charge Code |
909050437
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,167.80 |
| Max. Negotiated Rate |
$9,755.10 |
| Rate for Payer: Cash Price |
$4,877.55
|
| Rate for Payer: Central Health Plan Commercial |
$8,671.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,335.60
|
| Rate for Payer: Galaxy Health WC |
$9,213.15
|
| Rate for Payer: Global Benefits Group Commercial |
$6,503.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,755.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,229.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,167.80
|
| Rate for Payer: Multiplan Commercial |
$8,129.25
|
| Rate for Payer: Networks By Design Commercial |
$7,045.35
|
| Rate for Payer: Prime Health Services Commercial |
$9,213.15
|
|
|
HC DIRECT ADMIT OBS A/D SAME DT HIGH COMPLEX
|
Facility
OP
|
$795.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902100072
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$159.00 |
| Max. Negotiated Rate |
$9,113.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$802.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,772.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,203.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$882.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$802.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,981.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,545.00
|
| Rate for Payer: BCBS Transplant Transplant |
$477.00
|
| Rate for Payer: Blue Shield of California Commercial |
$500.06
|
| Rate for Payer: Blue Shield of California EPN |
$388.76
|
| Rate for Payer: Caremore Medicare Advantage |
$802.53
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Central Health Plan Commercial |
$636.00
|
| Rate for Payer: Cigna of CA PPO |
$588.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,203.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,083.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$802.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$802.53
|
| Rate for Payer: Galaxy Health WC |
$675.75
|
| Rate for Payer: Global Benefits Group Commercial |
$477.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$715.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$596.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,316.15
|
| Rate for Payer: IEHP medi-cal |
$1,324.17
|
| Rate for Payer: IEHP Medicare Advantage |
$802.53
|
| Rate for Payer: Innovage PACE Commercial |
$1,203.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$802.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,075.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,075.39
|
| Rate for Payer: Multiplan Commercial |
$596.25
|
| Rate for Payer: Networks By Design Commercial |
$516.75
|
| Rate for Payer: Prime Health Services Commercial |
$675.75
|
| Rate for Payer: Prime Health Services Medicare |
$850.68
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$477.00
|
| Rate for Payer: Riverside University Health MISP |
$882.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$477.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,113.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,112.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,007.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,493.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,203.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$882.78
|
| Rate for Payer: Vantage Medical Group Senior |
$802.53
|
|
|
HC DIRECT ADMIT OBS A/D SAME DT HIGH COMPLEX
|
Facility
IP
|
$795.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902100072
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$159.00 |
| Max. Negotiated Rate |
$715.50 |
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Central Health Plan Commercial |
$636.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.00
|
| Rate for Payer: Galaxy Health WC |
$675.75
|
| Rate for Payer: Global Benefits Group Commercial |
$477.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$715.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.00
|
| Rate for Payer: Multiplan Commercial |
$596.25
|
| Rate for Payer: Networks By Design Commercial |
$516.75
|
| Rate for Payer: Prime Health Services Commercial |
$675.75
|
|
|
HC DIRECT ADMIT OBS A/D SAME DT LOW COMPLEX
|
Facility
OP
|
$795.00
|
|
|
Service Code
|
CPT 99234
|
| Hospital Charge Code |
902100070
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$159.00 |
| Max. Negotiated Rate |
$9,113.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,772.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$675.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$437.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$437.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,981.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,545.00
|
| Rate for Payer: BCBS Transplant Transplant |
$477.00
|
| Rate for Payer: Blue Shield of California Commercial |
$500.06
|
| Rate for Payer: Blue Shield of California EPN |
$388.76
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Central Health Plan Commercial |
$636.00
|
| Rate for Payer: Cigna of CA PPO |
$588.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$675.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$318.00
|
| Rate for Payer: Galaxy Health WC |
$675.75
|
| Rate for Payer: Global Benefits Group Commercial |
$477.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$715.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$596.25
|
| Rate for Payer: IEHP medi-cal |
$278.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.00
|
| Rate for Payer: Multiplan Commercial |
$596.25
|
| Rate for Payer: Networks By Design Commercial |
$516.75
|
| Rate for Payer: Prime Health Services Commercial |
$675.75
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$477.00
|
| Rate for Payer: Riverside University Health MISP |
$318.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$477.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,113.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,112.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,007.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$675.75
|
| Rate for Payer: Vantage Medical Group Senior |
$675.75
|
|
|
HC DIRECT ADMIT OBS A/D SAME DT LOW COMPLEX
|
Facility
IP
|
$795.00
|
|
|
Service Code
|
CPT 99234
|
| Hospital Charge Code |
902100070
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$159.00 |
| Max. Negotiated Rate |
$715.50 |
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Central Health Plan Commercial |
$636.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.00
|
| Rate for Payer: Galaxy Health WC |
$675.75
|
| Rate for Payer: Global Benefits Group Commercial |
$477.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$715.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.00
|
| Rate for Payer: Multiplan Commercial |
$596.25
|
| Rate for Payer: Networks By Design Commercial |
$516.75
|
| Rate for Payer: Prime Health Services Commercial |
$675.75
|
|
|
HC DIRECT ADMIT OBS A/D SAME DT MOD COMPLEX
|
Facility
IP
|
$795.00
|
|
|
Service Code
|
CPT 99235
|
| Hospital Charge Code |
902100071
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$159.00 |
| Max. Negotiated Rate |
$715.50 |
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Central Health Plan Commercial |
$636.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.00
|
| Rate for Payer: Galaxy Health WC |
$675.75
|
| Rate for Payer: Global Benefits Group Commercial |
$477.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$715.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.00
|
| Rate for Payer: Multiplan Commercial |
$596.25
|
| Rate for Payer: Networks By Design Commercial |
$516.75
|
| Rate for Payer: Prime Health Services Commercial |
$675.75
|
|
|
HC DIRECT ADMIT OBS A/D SAME DT MOD COMPLEX
|
Facility
OP
|
$795.00
|
|
|
Service Code
|
CPT 99235
|
| Hospital Charge Code |
902100071
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$159.00 |
| Max. Negotiated Rate |
$9,113.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,772.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$675.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$437.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$437.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,981.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,545.00
|
| Rate for Payer: BCBS Transplant Transplant |
$477.00
|
| Rate for Payer: Blue Shield of California Commercial |
$500.06
|
| Rate for Payer: Blue Shield of California EPN |
$388.76
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Central Health Plan Commercial |
$636.00
|
| Rate for Payer: Cigna of CA PPO |
$588.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$675.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$318.00
|
| Rate for Payer: Galaxy Health WC |
$675.75
|
| Rate for Payer: Global Benefits Group Commercial |
$477.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$715.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$596.25
|
| Rate for Payer: IEHP medi-cal |
$278.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.00
|
| Rate for Payer: Multiplan Commercial |
$596.25
|
| Rate for Payer: Networks By Design Commercial |
$516.75
|
| Rate for Payer: Prime Health Services Commercial |
$675.75
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$477.00
|
| Rate for Payer: Riverside University Health MISP |
$318.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$477.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,113.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,112.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,007.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$675.75
|
| Rate for Payer: Vantage Medical Group Senior |
$675.75
|
|
