|
HC ERCP COMBINED SPHINCT
|
Facility
|
OP
|
$3,135.00
|
|
|
Service Code
|
CPT 74330
|
| Hospital Charge Code |
909001863
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$534.69 |
| Max. Negotiated Rate |
$2,664.75 |
| Rate for Payer: Adventist Health Commercial |
$627.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,937.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,664.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,724.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,351.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$850.93
|
| Rate for Payer: Blue Shield of California Commercial |
$664.90
|
| Rate for Payer: Blue Shield of California EPN |
$534.69
|
| Rate for Payer: Cash Price |
$1,410.75
|
| Rate for Payer: Cash Price |
$1,410.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,037.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,664.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,664.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,664.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,849.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,940.57
|
| Rate for Payer: Heritage Provider Network Senior |
$1,940.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,495.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$567.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$783.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,194.50
|
| Rate for Payer: Multiplan Commercial |
$2,351.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,567.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,567.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,664.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,664.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2,664.75
|
|
|
HC ERCP COMBINED SPHINCT
|
Facility
|
IP
|
$3,135.00
|
|
|
Service Code
|
CPT 74330
|
| Hospital Charge Code |
909001863
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$567.43 |
| Max. Negotiated Rate |
$2,351.25 |
| Rate for Payer: Adventist Health Commercial |
$627.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,018.94
|
| Rate for Payer: Cash Price |
$1,410.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,122.39
|
| Rate for Payer: Heritage Provider Network Senior |
$2,122.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$567.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$783.75
|
| Rate for Payer: Multiplan Commercial |
$2,351.25
|
|
|
HC ERCP DIAG W/ OR W/O COLLECT SP
|
Facility
|
IP
|
$3,671.00
|
|
|
Service Code
|
CPT 43260
|
| Hospital Charge Code |
906743260
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$664.45 |
| Max. Negotiated Rate |
$2,753.25 |
| Rate for Payer: Adventist Health Commercial |
$734.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,364.12
|
| Rate for Payer: Cash Price |
$1,651.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,485.27
|
| Rate for Payer: Heritage Provider Network Senior |
$2,485.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$664.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$917.75
|
| Rate for Payer: Multiplan Commercial |
$2,753.25
|
|
|
HC ERCP DIAG W/ OR W/O COLLECT SP
|
Facility
|
OP
|
$3,731.00
|
|
|
Service Code
|
CPT 43260
|
| Hospital Charge Code |
906743260
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$746.20
|
| Rate for Payer: Adventist Health Commercial |
$734.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,268.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,305.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,454.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,454.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,958.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,958.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,678.95
|
| Rate for Payer: Cash Price |
$1,678.95
|
| Rate for Payer: Cash Price |
$1,651.95
|
| Rate for Payer: Cash Price |
$1,651.95
|
| Rate for Payer: Cash Price |
$1,678.95
|
| Rate for Payer: Cash Price |
$1,651.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,386.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,425.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,454.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,454.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,958.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,958.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,958.78
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,958.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,309.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,272.35
|
| Rate for Payer: Heritage Provider Network Senior |
$6,099.30
|
| Rate for Payer: Heritage Provider Network Senior |
$6,099.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,958.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,958.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,751.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,779.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$675.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$664.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,702.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,702.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$917.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$932.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,644.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,644.77
|
| Rate for Payer: Multiplan Commercial |
$2,798.25
|
| Rate for Payer: Multiplan Commercial |
$2,753.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,454.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,454.66
|
| Rate for Payer: Vantage Medical Group Senior |
$4,958.78
|
| Rate for Payer: Vantage Medical Group Senior |
$4,958.78
|
|
|
HC ERCP DUCT STENT PLACEMENT
|
Facility
|
IP
|
$4,498.00
|
|
|
Service Code
|
CPT 43274
|
| Hospital Charge Code |
900100019
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$814.14 |
| Max. Negotiated Rate |
$3,373.50 |
| Rate for Payer: Adventist Health Commercial |
$899.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,896.71
|
| Rate for Payer: Cash Price |
$2,024.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,045.15
|
| Rate for Payer: Heritage Provider Network Senior |
$3,045.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$814.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,124.50
|
| Rate for Payer: Multiplan Commercial |
$3,373.50
|
|
|
HC ERCP DUCT STENT PLACEMENT
|
Facility
|
OP
|
$5,584.00
|
|
|
Service Code
|
CPT 43274
|
| Hospital Charge Code |
900100019
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$11,712.28 |
| Rate for Payer: Adventist Health Commercial |
$1,116.80
|
| Rate for Payer: Adventist Health Commercial |
$899.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,779.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,450.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,589.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,589.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,808.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,808.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,512.80
|
| Rate for Payer: Cash Price |
$2,512.80
|
| Rate for Payer: Cash Price |
$2,024.10
|
| Rate for Payer: Cash Price |
$2,024.10
|
| Rate for Payer: Cash Price |
$2,512.80
|
| Rate for Payer: Cash Price |
$2,024.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,923.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,629.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,589.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,589.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,808.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,808.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,808.19
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,808.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,456.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,784.26
|
| Rate for Payer: Heritage Provider Network Senior |
$9,604.07
|
| Rate for Payer: Heritage Provider Network Senior |
$9,604.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,808.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,808.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,145.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,663.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,010.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$814.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,979.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,979.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,124.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,396.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,462.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,462.97
|
| Rate for Payer: Multiplan Commercial |
$4,188.00
|
| Rate for Payer: Multiplan Commercial |
$3,373.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,589.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,589.01
|
| Rate for Payer: Vantage Medical Group Senior |
$7,808.19
|
| Rate for Payer: Vantage Medical Group Senior |
$7,808.19
|
|
|
HC ERCP EA DUCT/AMPULLA DILATATION
|
Facility
|
OP
|
$6,862.00
|
|
|
Service Code
|
CPT 43277
|
| Hospital Charge Code |
900100020
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,372.40
|
| Rate for Payer: Adventist Health Commercial |
$745.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,302.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,240.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,454.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,454.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,958.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,958.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$3,087.90
|
| Rate for Payer: Cash Price |
$3,087.90
|
| Rate for Payer: Cash Price |
$1,676.25
|
| Rate for Payer: Cash Price |
$1,676.25
|
| Rate for Payer: Cash Price |
$3,087.90
|
| Rate for Payer: Cash Price |
$1,676.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,421.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,460.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,454.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,454.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,958.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,958.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,958.78
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,958.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,247.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,305.78
|
| Rate for Payer: Heritage Provider Network Senior |
$6,099.30
|
| Rate for Payer: Heritage Provider Network Senior |
$6,099.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,958.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,958.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,776.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,273.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,242.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$674.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,702.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,702.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$931.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,715.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,644.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,644.77
|
| Rate for Payer: Multiplan Commercial |
$5,146.50
|
| Rate for Payer: Multiplan Commercial |
$2,793.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,454.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,454.66
|
| Rate for Payer: Vantage Medical Group Senior |
$4,958.78
|
| Rate for Payer: Vantage Medical Group Senior |
$4,958.78
|
|
|
HC ERCP EA DUCT/AMPULLA DILATATION
|
Facility
|
IP
|
$3,725.00
|
|
|
Service Code
|
CPT 43277
|
| Hospital Charge Code |
900100020
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$674.23 |
| Max. Negotiated Rate |
$2,793.75 |
| Rate for Payer: Adventist Health Commercial |
$745.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,398.90
|
| Rate for Payer: Cash Price |
$1,676.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,521.82
|
| Rate for Payer: Heritage Provider Network Senior |
$2,521.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$674.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$931.25
|
| Rate for Payer: Multiplan Commercial |
$2,793.75
|
|
|
HC ERCP LESION ABLAT W DILATION
|
Facility
|
IP
|
$4,498.00
|
|
|
Service Code
|
CPT 43278
|
| Hospital Charge Code |
906743278
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$814.14 |
| Max. Negotiated Rate |
$3,373.50 |
| Rate for Payer: Adventist Health Commercial |
$899.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,896.71
|
| Rate for Payer: Cash Price |
$2,024.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,045.15
|
| Rate for Payer: Heritage Provider Network Senior |
$3,045.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$814.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,124.50
|
| Rate for Payer: Multiplan Commercial |
$3,373.50
|
|
|
HC ERCP LESION ABLAT W DILATION
|
Facility
|
OP
|
$4,498.00
|
|
|
Service Code
|
CPT 43278
|
| Hospital Charge Code |
906743278
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$899.60
|
| Rate for Payer: Adventist Health Commercial |
$860.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,659.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,779.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,454.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,454.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,958.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,958.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,024.10
|
| Rate for Payer: Cash Price |
$2,024.10
|
| Rate for Payer: Cash Price |
$1,936.35
|
| Rate for Payer: Cash Price |
$1,936.35
|
| Rate for Payer: Cash Price |
$2,024.10
|
| Rate for Payer: Cash Price |
$1,936.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,796.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,923.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,454.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,454.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,958.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,958.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,958.78
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,958.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,784.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,663.56
|
| Rate for Payer: Heritage Provider Network Senior |
$6,099.30
|
| Rate for Payer: Heritage Provider Network Senior |
$6,099.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,958.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,958.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,052.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,145.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$814.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$778.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,702.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,702.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,075.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,124.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,644.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,644.77
|
| Rate for Payer: Multiplan Commercial |
$3,373.50
|
| Rate for Payer: Multiplan Commercial |
$3,227.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,454.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,454.66
|
| Rate for Payer: Vantage Medical Group Senior |
$4,958.78
|
| Rate for Payer: Vantage Medical Group Senior |
$4,958.78
|
|
|
HC ERCP PANCREATIC/SPHINCT
|
Facility
|
IP
|
$3,135.00
|
|
|
Service Code
|
CPT 74329
|
| Hospital Charge Code |
909001830
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$567.43 |
| Max. Negotiated Rate |
$2,351.25 |
| Rate for Payer: Adventist Health Commercial |
$627.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,018.94
|
| Rate for Payer: Cash Price |
$1,410.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,122.39
|
| Rate for Payer: Heritage Provider Network Senior |
$2,122.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$567.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$783.75
|
| Rate for Payer: Multiplan Commercial |
$2,351.25
|
|
|
HC ERCP PANCREATIC/SPHINCT
|
Facility
|
OP
|
$3,135.00
|
|
|
Service Code
|
CPT 74329
|
| Hospital Charge Code |
909001830
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$534.69 |
| Max. Negotiated Rate |
$2,664.75 |
| Rate for Payer: Adventist Health Commercial |
$627.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,937.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,664.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,724.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,351.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$850.93
|
| Rate for Payer: Blue Shield of California Commercial |
$664.90
|
| Rate for Payer: Blue Shield of California EPN |
$534.69
|
| Rate for Payer: Cash Price |
$1,410.75
|
| Rate for Payer: Cash Price |
$1,410.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,037.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,664.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,664.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,664.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,849.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,940.57
|
| Rate for Payer: Heritage Provider Network Senior |
$1,940.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,495.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$567.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$783.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,194.50
|
| Rate for Payer: Multiplan Commercial |
$2,351.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,567.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,567.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,664.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,664.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2,664.75
|
|
|
HC ERCP W/BX SNGL OR MULTI
|
Facility
|
IP
|
$3,671.00
|
|
|
Service Code
|
CPT 43261
|
| Hospital Charge Code |
906743261
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$664.45 |
| Max. Negotiated Rate |
$2,753.25 |
| Rate for Payer: Adventist Health Commercial |
$734.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,364.12
|
| Rate for Payer: Cash Price |
$1,651.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,485.27
|
| Rate for Payer: Heritage Provider Network Senior |
$2,485.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$664.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$917.75
|
| Rate for Payer: Multiplan Commercial |
$2,753.25
|
|
|
HC ERCP W/BX SNGL OR MULTI
|
Facility
|
OP
|
$3,731.00
|
|
|
Service Code
|
CPT 43261
|
| Hospital Charge Code |
906743261
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$746.20
|
| Rate for Payer: Adventist Health Commercial |
$734.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,268.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,305.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,454.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,454.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,958.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,958.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,678.95
|
| Rate for Payer: Cash Price |
$1,678.95
|
| Rate for Payer: Cash Price |
$1,651.95
|
| Rate for Payer: Cash Price |
$1,651.95
|
| Rate for Payer: Cash Price |
$1,678.95
|
| Rate for Payer: Cash Price |
$1,651.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,386.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,425.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,454.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,454.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,958.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,958.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,958.78
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,958.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,309.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,272.35
|
| Rate for Payer: Heritage Provider Network Senior |
$6,099.30
|
| Rate for Payer: Heritage Provider Network Senior |
$6,099.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,958.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,958.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,751.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,779.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$675.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$664.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,702.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,702.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$917.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$932.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,644.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,644.77
|
| Rate for Payer: Multiplan Commercial |
$2,798.25
|
| Rate for Payer: Multiplan Commercial |
$2,753.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,454.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,454.66
|
| Rate for Payer: Vantage Medical Group Senior |
$4,958.78
|
| Rate for Payer: Vantage Medical Group Senior |
$4,958.78
|
|
|
HC ERCP W/ENDO RETRO DESTRUCTION
|
Facility
|
IP
|
$3,397.00
|
|
|
Service Code
|
CPT 43265
|
| Hospital Charge Code |
906743265
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$614.86 |
| Max. Negotiated Rate |
$2,547.75 |
| Rate for Payer: Adventist Health Commercial |
$679.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,187.67
|
| Rate for Payer: Cash Price |
$1,528.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,299.77
|
| Rate for Payer: Heritage Provider Network Senior |
$2,299.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$614.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$849.25
|
| Rate for Payer: Multiplan Commercial |
$2,547.75
|
|
|
HC ERCP W/ENDO RETRO DESTRUCTION
|
Facility
|
OP
|
$5,492.00
|
|
|
Service Code
|
CPT 43265
|
| Hospital Charge Code |
906743265
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$11,712.28 |
| Rate for Payer: Adventist Health Commercial |
$1,098.40
|
| Rate for Payer: Adventist Health Commercial |
$679.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,099.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,394.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,589.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,589.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,808.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,808.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,471.40
|
| Rate for Payer: Cash Price |
$2,471.40
|
| Rate for Payer: Cash Price |
$1,528.65
|
| Rate for Payer: Cash Price |
$1,528.65
|
| Rate for Payer: Cash Price |
$2,471.40
|
| Rate for Payer: Cash Price |
$1,528.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,208.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,569.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,589.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,589.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,808.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,808.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,808.19
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,808.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,399.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,102.74
|
| Rate for Payer: Heritage Provider Network Senior |
$9,604.07
|
| Rate for Payer: Heritage Provider Network Senior |
$9,604.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,808.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,808.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,620.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,619.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$994.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$614.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,979.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,979.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$849.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,373.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,462.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,462.97
|
| Rate for Payer: Multiplan Commercial |
$4,119.00
|
| Rate for Payer: Multiplan Commercial |
$2,547.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,589.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,589.01
|
| Rate for Payer: Vantage Medical Group Senior |
$7,808.19
|
| Rate for Payer: Vantage Medical Group Senior |
$7,808.19
|
|
|
HC ERCP W/ENDO RETRO RMVL CALCULU
|
Facility
|
IP
|
$3,671.00
|
|
|
Service Code
|
CPT 43264
|
| Hospital Charge Code |
906743264
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$664.45 |
| Max. Negotiated Rate |
$2,753.25 |
| Rate for Payer: Adventist Health Commercial |
$734.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,364.12
|
| Rate for Payer: Cash Price |
$1,651.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,485.27
|
| Rate for Payer: Heritage Provider Network Senior |
$2,485.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$664.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$917.75
|
| Rate for Payer: Multiplan Commercial |
$2,753.25
|
|
|
HC ERCP W/ENDO RETRO RMVL CALCULU
|
Facility
|
OP
|
$6,778.00
|
|
|
Service Code
|
CPT 43264
|
| Hospital Charge Code |
906743264
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,355.60
|
| Rate for Payer: Adventist Health Commercial |
$734.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,268.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,188.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,454.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,454.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,958.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,958.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$3,050.10
|
| Rate for Payer: Cash Price |
$3,050.10
|
| Rate for Payer: Cash Price |
$1,651.95
|
| Rate for Payer: Cash Price |
$1,651.95
|
| Rate for Payer: Cash Price |
$3,050.10
|
| Rate for Payer: Cash Price |
$1,651.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,386.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,405.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,454.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,454.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,958.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,958.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,958.78
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,958.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,195.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,272.35
|
| Rate for Payer: Heritage Provider Network Senior |
$6,099.30
|
| Rate for Payer: Heritage Provider Network Senior |
$6,099.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,958.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,958.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,751.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,233.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,226.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$664.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,702.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,702.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$917.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,694.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,644.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,644.77
|
| Rate for Payer: Multiplan Commercial |
$5,083.50
|
| Rate for Payer: Multiplan Commercial |
$2,753.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,454.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,454.66
|
| Rate for Payer: Vantage Medical Group Senior |
$4,958.78
|
| Rate for Payer: Vantage Medical Group Senior |
$4,958.78
|
|
|
HC ERCP W/PRESS MSRMNT
|
Facility
|
OP
|
$4,642.00
|
|
|
Service Code
|
CPT 43263
|
| Hospital Charge Code |
906743263
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Cash Price |
$2,088.90
|
| Rate for Payer: Adventist Health Commercial |
$928.40
|
| Rate for Payer: Adventist Health Commercial |
$846.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,615.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,868.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,088.90
|
| Rate for Payer: Cash Price |
$1,904.85
|
| Rate for Payer: Cash Price |
$1,904.85
|
| Rate for Payer: Cash Price |
$2,088.90
|
| Rate for Payer: Cash Price |
$1,904.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,751.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,017.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,468.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,468.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,873.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,620.23
|
| Rate for Payer: Heritage Provider Network Senior |
$3,035.69
|
| Rate for Payer: Heritage Provider Network Senior |
$3,035.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,019.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,214.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$840.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$766.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,838.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,838.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,058.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,160.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$3,481.50
|
| Rate for Payer: Multiplan Commercial |
$3,174.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
|
|
HC ERCP W/PRESS MSRMNT
|
Facility
|
IP
|
$4,642.00
|
|
|
Service Code
|
CPT 43263
|
| Hospital Charge Code |
906743263
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$840.20 |
| Max. Negotiated Rate |
$3,481.50 |
| Rate for Payer: Adventist Health Commercial |
$928.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,989.45
|
| Rate for Payer: Cash Price |
$2,088.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,142.63
|
| Rate for Payer: Heritage Provider Network Senior |
$3,142.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$840.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,160.50
|
| Rate for Payer: Multiplan Commercial |
$3,481.50
|
|
|
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 |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$946.80
|
| Rate for Payer: Adventist Health Commercial |
$861.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,661.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,925.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,130.30
|
| Rate for Payer: Cash Price |
$2,130.30
|
| Rate for Payer: Cash Price |
$1,937.70
|
| Rate for Payer: Cash Price |
$1,937.70
|
| Rate for Payer: Cash Price |
$2,130.30
|
| Rate for Payer: Cash Price |
$1,937.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,798.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,077.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,468.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,468.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,930.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,665.41
|
| Rate for Payer: Heritage Provider Network Senior |
$3,035.69
|
| Rate for Payer: Heritage Provider Network Senior |
$3,035.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,053.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,258.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$856.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$779.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,838.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,838.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,076.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,183.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$3,550.50
|
| Rate for Payer: Multiplan Commercial |
$3,229.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
|
|
HC ERCP W RMVL FB STNT
|
Facility
|
IP
|
$4,306.00
|
|
|
Service Code
|
CPT 43275
|
| Hospital Charge Code |
906743275
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$779.39 |
| Max. Negotiated Rate |
$3,229.50 |
| Rate for Payer: Adventist Health Commercial |
$861.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,773.06
|
| Rate for Payer: Cash Price |
$1,937.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,915.16
|
| Rate for Payer: Heritage Provider Network Senior |
$2,915.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$779.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,076.50
|
| Rate for Payer: Multiplan Commercial |
$3,229.50
|
|
|
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 |
$425.00 |
| Max. Negotiated Rate |
$11,712.28 |
| Rate for Payer: Adventist Health Commercial |
$1,038.80
|
| Rate for Payer: Adventist Health Commercial |
$745.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,302.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,209.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,589.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,589.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,808.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,808.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,337.30
|
| Rate for Payer: Cash Price |
$2,337.30
|
| Rate for Payer: Cash Price |
$1,676.25
|
| Rate for Payer: Cash Price |
$1,676.25
|
| Rate for Payer: Cash Price |
$2,337.30
|
| Rate for Payer: Cash Price |
$1,676.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,421.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,376.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,589.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,589.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,808.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,808.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,808.19
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,808.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,215.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,305.78
|
| Rate for Payer: Heritage Provider Network Senior |
$9,604.07
|
| Rate for Payer: Heritage Provider Network Senior |
$9,604.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,808.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,808.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,776.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,477.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$940.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$674.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,979.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,979.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$931.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,298.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,462.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,462.97
|
| Rate for Payer: Multiplan Commercial |
$3,895.50
|
| Rate for Payer: Multiplan Commercial |
$2,793.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,589.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,589.01
|
| Rate for Payer: Vantage Medical Group Senior |
$7,808.19
|
| Rate for Payer: Vantage Medical Group Senior |
$7,808.19
|
|
|
HC ERCP W RMVL & XCHNG OF STNT INCL SPINC EA STNT
|
Facility
|
IP
|
$3,725.00
|
|
|
Service Code
|
CPT 43276
|
| Hospital Charge Code |
906743276
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$674.23 |
| Max. Negotiated Rate |
$2,793.75 |
| Rate for Payer: Adventist Health Commercial |
$745.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,398.90
|
| Rate for Payer: Cash Price |
$1,676.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,521.82
|
| Rate for Payer: Heritage Provider Network Senior |
$2,521.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$674.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$931.25
|
| Rate for Payer: Multiplan Commercial |
$2,793.75
|
|
|
HC ERCP W/SPHINCTERTMY
|
Facility
|
IP
|
$4,498.00
|
|
|
Service Code
|
CPT 43262
|
| Hospital Charge Code |
906743262
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$814.14 |
| Max. Negotiated Rate |
$3,373.50 |
| Rate for Payer: Adventist Health Commercial |
$899.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,896.71
|
| Rate for Payer: Cash Price |
$2,024.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,045.15
|
| Rate for Payer: Heritage Provider Network Senior |
$3,045.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$814.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,124.50
|
| Rate for Payer: Multiplan Commercial |
$3,373.50
|
|
