|
HC FUSION OF TENDONS AT WRIST
|
Facility
OP
|
$9,884.00
|
|
|
Service Code
|
CPT 25300
|
| Hospital Charge Code |
900501447
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$640.87 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: BCBS Transplant Transplant |
$5,930.40
|
| Rate for Payer: Cash Price |
$4,447.80
|
| Rate for Payer: Cash Price |
$4,447.80
|
| Rate for Payer: Cash Price |
$4,447.80
|
| Rate for Payer: Cigna of CA PPO |
$7,314.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Media |
$4,044.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Galaxy Health WC |
$8,401.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,930.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7,413.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,632.50
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,632.50
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,592.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$640.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,372.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Multiplan Commercial |
$7,907.20
|
| Rate for Payer: Networks By Design Commercial |
$6,424.60
|
| Rate for Payer: Prime Health Services Commercial |
$8,401.40
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5,930.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,930.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,942.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,942.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,942.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,942.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC GADOXETATE DISODIUM PER ML
|
Facility
IP
|
$71.00
|
|
|
Service Code
|
CPT A9581
|
| Hospital Charge Code |
908801701
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$17.04 |
| Max. Negotiated Rate |
$60.35 |
| Rate for Payer: Blue Shield of California Commercial |
$50.55
|
| Rate for Payer: Blue Shield of California EPN |
$36.35
|
| Rate for Payer: Cash Price |
$31.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.40
|
| Rate for Payer: Galaxy Health WC |
$60.35
|
| Rate for Payer: Global Benefits Group Commercial |
$42.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.04
|
| Rate for Payer: Multiplan Commercial |
$56.80
|
| Rate for Payer: Networks By Design Commercial |
$46.15
|
| Rate for Payer: Prime Health Services Commercial |
$60.35
|
|
|
HC GADOXETATE DISODIUM PER ML
|
Facility
OP
|
$71.00
|
|
|
Service Code
|
CPT A9581
|
| Hospital Charge Code |
908801701
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$17.04 |
| Max. Negotiated Rate |
$60.35 |
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$60.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$39.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$39.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.71
|
| Rate for Payer: BCBS Transplant Transplant |
$42.60
|
| Rate for Payer: Blue Shield of California Commercial |
$41.96
|
| Rate for Payer: Blue Shield of California EPN |
$33.30
|
| Rate for Payer: Cash Price |
$31.95
|
| Rate for Payer: Cash Price |
$31.95
|
| Rate for Payer: Cigna of CA HMO |
$45.44
|
| Rate for Payer: Cigna of CA PPO |
$52.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$60.35
|
| Rate for Payer: Dignity Health Media |
$60.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$60.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$28.40
|
| Rate for Payer: Galaxy Health WC |
$60.35
|
| Rate for Payer: Global Benefits Group Commercial |
$42.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$53.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.04
|
| Rate for Payer: Multiplan Commercial |
$56.80
|
| Rate for Payer: Networks By Design Commercial |
$46.15
|
| Rate for Payer: Prime Health Services Commercial |
$60.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$42.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.50
|
| Rate for Payer: United Healthcare All Other HMO |
$35.50
|
| Rate for Payer: United Healthcare HMO Rider |
$35.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$60.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$60.35
|
| Rate for Payer: Vantage Medical Group Senior |
$60.35
|
|
|
HC GAIT TRAINING 15 MIN MCAL
|
Facility
IP
|
$284.00
|
|
|
Service Code
|
CPT 97116
|
| Hospital Charge Code |
900400037
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$68.16 |
| Max. Negotiated Rate |
$241.40 |
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.60
|
| Rate for Payer: Galaxy Health WC |
$241.40
|
| Rate for Payer: Global Benefits Group Commercial |
$170.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$189.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.16
|
| Rate for Payer: Multiplan Commercial |
$227.20
|
| Rate for Payer: Networks By Design Commercial |
$184.60
|
| Rate for Payer: Prime Health Services Commercial |
$241.40
|
|
|
HC GAIT TRAINING 15 MIN MCAL
|
Facility
OP
|
$284.00
|
|
|
Service Code
|
CPT 97116
|
| Hospital Charge Code |
900400037
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.43 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$122.85
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$241.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$156.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$156.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: BCBS Transplant Transplant |
$170.40
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna of CA HMO |
$181.76
|
| Rate for Payer: Cigna of CA PPO |
$210.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$241.40
|
| Rate for Payer: Dignity Health Media |
$241.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$241.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.60
|
| Rate for Payer: Galaxy Health WC |
$241.40
|
| Rate for Payer: Global Benefits Group Commercial |
$170.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$213.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$189.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.16
|
| Rate for Payer: Multiplan Commercial |
$227.20
|
| Rate for Payer: Networks By Design Commercial |
$184.60
|
| Rate for Payer: Prime Health Services Commercial |
$241.40
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$170.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$170.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$170.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$241.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$241.40
|
| Rate for Payer: Vantage Medical Group Senior |
$241.40
|
|
|
HC GALLBLDR/LIVER FUNC
|
Facility
OP
|
$3,096.00
|
|
|
Service Code
|
CPT 78226
|
| Hospital Charge Code |
909301353
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$515.32 |
| Max. Negotiated Rate |
$2,631.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,877.93
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,215.44
|
| Rate for Payer: BCBS Transplant Transplant |
$1,857.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,829.74
|
| Rate for Payer: Blue Shield of California EPN |
$1,452.02
|
| Rate for Payer: Cash Price |
$1,393.20
|
| Rate for Payer: Cash Price |
$1,393.20
|
| Rate for Payer: Cigna of CA HMO |
$1,981.44
|
| Rate for Payer: Cigna of CA PPO |
$2,291.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Media |
$515.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$695.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$515.32
|
| Rate for Payer: Galaxy Health WC |
$2,631.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,857.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,322.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$845.12
|
| Rate for Payer: Heritage Provider Network Transplant |
$845.12
|
| Rate for Payer: IEHP Medi-Cal |
$834.82
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$834.82
|
| Rate for Payer: IEHP Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,065.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$552.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$743.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$690.53
|
| Rate for Payer: Multiplan Commercial |
$2,476.80
|
| Rate for Payer: Networks By Design Commercial |
$2,012.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,631.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,857.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,857.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,857.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$751.01
|
| Rate for Payer: United Healthcare All Other HMO |
$751.01
|
| Rate for Payer: United Healthcare HMO Rider |
$751.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$751.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC GALLBLDR/LIVER FUNC
|
Facility
IP
|
$3,096.00
|
|
|
Service Code
|
CPT 78226
|
| Hospital Charge Code |
909301353
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$743.04 |
| Max. Negotiated Rate |
$2,631.60 |
| Rate for Payer: Cash Price |
$1,393.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,238.40
|
| Rate for Payer: Galaxy Health WC |
$2,631.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,857.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,065.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,179.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$743.04
|
| Rate for Payer: Multiplan Commercial |
$2,476.80
|
| Rate for Payer: Networks By Design Commercial |
$2,012.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,631.60
|
|
|
HC GALLIUM SCAN LIMITED
|
Facility
OP
|
$1,842.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
909301446
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$169.33 |
| Max. Negotiated Rate |
$1,565.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$981.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,097.46
|
| Rate for Payer: BCBS Transplant Transplant |
$1,105.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,088.62
|
| Rate for Payer: Blue Shield of California EPN |
$863.90
|
| Rate for Payer: Cash Price |
$828.90
|
| Rate for Payer: Cash Price |
$828.90
|
| Rate for Payer: Cigna of CA HMO |
$1,178.88
|
| Rate for Payer: Cigna of CA PPO |
$1,363.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Media |
$515.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$695.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$515.32
|
| Rate for Payer: Galaxy Health WC |
$1,565.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,105.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,381.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$845.12
|
| Rate for Payer: Heritage Provider Network Transplant |
$845.12
|
| Rate for Payer: IEHP Medi-Cal |
$834.82
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$834.82
|
| Rate for Payer: IEHP Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,228.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$169.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$442.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$690.53
|
| Rate for Payer: Multiplan Commercial |
$1,473.60
|
| Rate for Payer: Networks By Design Commercial |
$1,197.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,565.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,105.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,105.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,105.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$717.15
|
| Rate for Payer: United Healthcare All Other HMO |
$717.15
|
| Rate for Payer: United Healthcare HMO Rider |
$717.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$717.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC GALLIUM SCAN LIMITED
|
Facility
IP
|
$1,842.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
909301446
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$442.08 |
| Max. Negotiated Rate |
$1,565.70 |
| Rate for Payer: Cash Price |
$828.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$736.80
|
| Rate for Payer: Galaxy Health WC |
$1,565.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,105.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,228.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$701.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$442.08
|
| Rate for Payer: Multiplan Commercial |
$1,473.60
|
| Rate for Payer: Networks By Design Commercial |
$1,197.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,565.70
|
|
|
HC GAMMA GLUTAMYL TRANSFERASE
|
Facility
OP
|
$20.00
|
|
|
Service Code
|
CPT 82977
|
| Hospital Charge Code |
900910225
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$65.97 |
| Rate for Payer: Aetna of CA HMO/PPO |
$59.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.92
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.97
|
| Rate for Payer: BCBS Transplant Transplant |
$12.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12.92
|
| Rate for Payer: Blue Shield of California EPN |
$10.24
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.80
|
| Rate for Payer: Dignity Health Media |
$7.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.72
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.20
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$15.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.81
|
| Rate for Payer: Heritage Provider Network Transplant |
$11.81
|
| Rate for Payer: IEHP Medi-Cal |
$11.66
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$11.66
|
| Rate for Payer: IEHP Medicare Advantage |
$7.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.65
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.83
|
| Rate for Payer: United Healthcare All Other HMO |
$5.83
|
| Rate for Payer: United Healthcare HMO Rider |
$5.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.92
|
| Rate for Payer: Vantage Medical Group Senior |
$7.20
|
|
|
HC GASTRIC EMPTYING
|
Facility
IP
|
$3,393.00
|
|
|
Service Code
|
CPT 78264
|
| Hospital Charge Code |
909301364
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$814.32 |
| Max. Negotiated Rate |
$2,884.05 |
| Rate for Payer: Cash Price |
$1,526.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,357.20
|
| Rate for Payer: Galaxy Health WC |
$2,884.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,035.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,263.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,292.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$814.32
|
| Rate for Payer: Multiplan Commercial |
$2,714.40
|
| Rate for Payer: Networks By Design Commercial |
$2,205.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,884.05
|
|
|
HC GASTRIC EMPTYING
|
Facility
OP
|
$3,393.00
|
|
|
Service Code
|
CPT 78264
|
| Hospital Charge Code |
909301364
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$515.32 |
| Max. Negotiated Rate |
$2,884.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,520.52
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,021.55
|
| Rate for Payer: BCBS Transplant Transplant |
$2,035.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,005.26
|
| Rate for Payer: Blue Shield of California EPN |
$1,591.32
|
| Rate for Payer: Cash Price |
$1,526.85
|
| Rate for Payer: Cash Price |
$1,526.85
|
| Rate for Payer: Cigna of CA HMO |
$2,171.52
|
| Rate for Payer: Cigna of CA PPO |
$2,510.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Media |
$515.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$695.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$515.32
|
| Rate for Payer: Galaxy Health WC |
$2,884.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,035.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,544.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$845.12
|
| Rate for Payer: Heritage Provider Network Transplant |
$845.12
|
| Rate for Payer: IEHP Medi-Cal |
$834.82
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$834.82
|
| Rate for Payer: IEHP Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,263.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$561.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$814.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$690.53
|
| Rate for Payer: Multiplan Commercial |
$2,714.40
|
| Rate for Payer: Networks By Design Commercial |
$2,205.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,884.05
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,035.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,035.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,035.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$623.82
|
| Rate for Payer: United Healthcare All Other HMO |
$623.82
|
| Rate for Payer: United Healthcare HMO Rider |
$623.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$623.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC GASTRIC INTUB W/ASPIRATIOIN
|
Facility
IP
|
$888.00
|
|
|
Service Code
|
CPT 43753
|
| Hospital Charge Code |
900501762
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$213.12 |
| Max. Negotiated Rate |
$754.80 |
| Rate for Payer: Cash Price |
$399.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$355.20
|
| Rate for Payer: Galaxy Health WC |
$754.80
|
| Rate for Payer: Global Benefits Group Commercial |
$532.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$592.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$338.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.12
|
| Rate for Payer: Multiplan Commercial |
$710.40
|
| Rate for Payer: Networks By Design Commercial |
$577.20
|
| Rate for Payer: Prime Health Services Commercial |
$754.80
|
|
|
HC GASTRIC INTUB W/ASPIRATIOIN
|
Facility
OP
|
$888.00
|
|
|
Service Code
|
CPT 43753
|
| Hospital Charge Code |
900501762
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$32.85 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$532.80
|
| Rate for Payer: Cash Price |
$399.60
|
| Rate for Payer: Cash Price |
$399.60
|
| Rate for Payer: Cash Price |
$399.60
|
| Rate for Payer: Cigna of CA PPO |
$657.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Media |
$392.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$392.17
|
| Rate for Payer: Galaxy Health WC |
$754.80
|
| Rate for Payer: Global Benefits Group Commercial |
$532.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$666.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$643.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$643.16
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$392.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$592.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$494.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.51
|
| Rate for Payer: Multiplan Commercial |
$710.40
|
| Rate for Payer: Networks By Design Commercial |
$577.20
|
| Rate for Payer: Prime Health Services Commercial |
$754.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$532.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$532.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$444.00
|
| Rate for Payer: United Healthcare All Other HMO |
$444.00
|
| Rate for Payer: United Healthcare HMO Rider |
$444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$444.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC GASTRIC MOTIL MANOMETRC STUDY
|
Facility
OP
|
$1,212.00
|
|
|
Service Code
|
CPT 91020
|
| Hospital Charge Code |
906791020
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$174.97 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,004.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$736.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$669.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$722.11
|
| Rate for Payer: BCBS Transplant Transplant |
$727.20
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$545.40
|
| Rate for Payer: Cash Price |
$545.40
|
| Rate for Payer: Cash Price |
$545.40
|
| Rate for Payer: Cigna of CA PPO |
$896.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Dignity Health Media |
$669.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$736.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$904.07
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$669.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$669.68
|
| Rate for Payer: Galaxy Health WC |
$1,030.20
|
| Rate for Payer: Global Benefits Group Commercial |
$727.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$909.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,098.28
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,098.28
|
| Rate for Payer: IEHP Medi-Cal |
$1,084.88
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$1,084.88
|
| Rate for Payer: IEHP Medicare Advantage |
$669.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$808.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$174.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$669.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$290.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$843.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$897.37
|
| Rate for Payer: Multiplan Commercial |
$969.60
|
| Rate for Payer: Networks By Design Commercial |
$787.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,030.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$736.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$727.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$803.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$736.65
|
| Rate for Payer: Vantage Medical Group Senior |
$669.68
|
|
|
HC GASTRIC MOTIL MANOMETRC STUDY
|
Facility
IP
|
$2,001.00
|
|
|
Service Code
|
CPT 91020
|
| Hospital Charge Code |
906791020
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$480.24 |
| Max. Negotiated Rate |
$1,700.85 |
| Rate for Payer: Cash Price |
$900.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$800.40
|
| Rate for Payer: Galaxy Health WC |
$1,700.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,200.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,334.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$762.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$480.24
|
| Rate for Payer: Multiplan Commercial |
$1,600.80
|
| Rate for Payer: Networks By Design Commercial |
$1,300.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,700.85
|
|
|
HC GASTRODUODENOSTOMY
|
Facility
IP
|
$7,340.00
|
|
|
Service Code
|
CPT 43810
|
| Hospital Charge Code |
906743810
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,761.60 |
| Max. Negotiated Rate |
$6,239.00 |
| Rate for Payer: Cash Price |
$3,303.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,936.00
|
| Rate for Payer: Galaxy Health WC |
$6,239.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,404.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,895.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,796.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,761.60
|
| Rate for Payer: Multiplan Commercial |
$5,872.00
|
| Rate for Payer: Networks By Design Commercial |
$4,771.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,239.00
|
|
|
HC GASTRODUODENOSTOMY
|
Facility
OP
|
$7,340.00
|
|
|
Service Code
|
CPT 43810
|
| Hospital Charge Code |
906743810
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$209.38 |
| Max. Negotiated Rate |
$8,628.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5,752.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,239.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,037.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,037.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,628.00
|
| Rate for Payer: BCBS Transplant Transplant |
$4,404.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$3,303.00
|
| Rate for Payer: Cash Price |
$3,303.00
|
| Rate for Payer: Cigna of CA PPO |
$5,431.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,239.00
|
| Rate for Payer: Dignity Health Media |
$6,239.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,239.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,936.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,936.00
|
| Rate for Payer: Galaxy Health WC |
$6,239.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,404.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5,505.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,895.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$209.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,761.60
|
| Rate for Payer: Multiplan Commercial |
$5,872.00
|
| Rate for Payer: Networks By Design Commercial |
$4,771.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,239.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4,404.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,404.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,404.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,239.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,239.00
|
| Rate for Payer: Vantage Medical Group Senior |
$6,239.00
|
|
|
HC GASTROESOPHAGEAL REFLUX
|
Facility
IP
|
$2,023.00
|
|
|
Service Code
|
CPT 78262
|
| Hospital Charge Code |
909301365
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$485.52 |
| Max. Negotiated Rate |
$1,719.55 |
| Rate for Payer: Cash Price |
$910.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$809.20
|
| Rate for Payer: Galaxy Health WC |
$1,719.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,213.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,349.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$770.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$485.52
|
| Rate for Payer: Multiplan Commercial |
$1,618.40
|
| Rate for Payer: Networks By Design Commercial |
$1,314.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,719.55
|
|
|
HC GASTROESOPHAGEAL REFLUX
|
Facility
OP
|
$2,023.00
|
|
|
Service Code
|
CPT 78262
|
| Hospital Charge Code |
909301365
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$205.47 |
| Max. Negotiated Rate |
$1,719.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,349.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,205.30
|
| Rate for Payer: BCBS Transplant Transplant |
$1,213.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,195.59
|
| Rate for Payer: Blue Shield of California EPN |
$948.79
|
| Rate for Payer: Cash Price |
$910.35
|
| Rate for Payer: Cash Price |
$910.35
|
| Rate for Payer: Cigna of CA HMO |
$1,294.72
|
| Rate for Payer: Cigna of CA PPO |
$1,497.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Media |
$515.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$695.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$515.32
|
| Rate for Payer: Galaxy Health WC |
$1,719.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,213.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,517.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$845.12
|
| Rate for Payer: Heritage Provider Network Transplant |
$845.12
|
| Rate for Payer: IEHP Medi-Cal |
$834.82
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$834.82
|
| Rate for Payer: IEHP Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,349.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$485.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$690.53
|
| Rate for Payer: Multiplan Commercial |
$1,618.40
|
| Rate for Payer: Networks By Design Commercial |
$1,314.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,719.55
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,213.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,213.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,213.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$623.82
|
| Rate for Payer: United Healthcare All Other HMO |
$623.82
|
| Rate for Payer: United Healthcare HMO Rider |
$623.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$623.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC GASTROESOPHAGEAL REFLUX TEST
|
Facility
IP
|
$3,575.00
|
|
|
Service Code
|
CPT 91034
|
| Hospital Charge Code |
906791034
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$858.00 |
| Max. Negotiated Rate |
$3,038.75 |
| Rate for Payer: Cash Price |
$1,608.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,430.00
|
| Rate for Payer: Galaxy Health WC |
$3,038.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,145.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,384.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,362.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$858.00
|
| Rate for Payer: Multiplan Commercial |
$2,860.00
|
| Rate for Payer: Networks By Design Commercial |
$2,323.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,038.75
|
|
|
HC GASTROESOPHAGEAL REFLUX TEST
|
Facility
IP
|
$4,947.00
|
|
|
Service Code
|
CPT 91035
|
| Hospital Charge Code |
906791035
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,187.28 |
| Max. Negotiated Rate |
$4,204.95 |
| Rate for Payer: Cash Price |
$2,226.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,978.80
|
| Rate for Payer: Galaxy Health WC |
$4,204.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,968.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,299.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,884.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,187.28
|
| Rate for Payer: Multiplan Commercial |
$3,957.60
|
| Rate for Payer: Networks By Design Commercial |
$3,215.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,204.95
|
|
|
HC GASTROESOPHAGEAL REFLUX TEST
|
Facility
OP
|
$1,578.00
|
|
|
Service Code
|
CPT 91034
|
| Hospital Charge Code |
906791034
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$147.46 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,006.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,004.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$736.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$669.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$940.17
|
| Rate for Payer: BCBS Transplant Transplant |
$946.80
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$710.10
|
| Rate for Payer: Cash Price |
$710.10
|
| Rate for Payer: Cash Price |
$710.10
|
| Rate for Payer: Cigna of CA PPO |
$1,167.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Dignity Health Media |
$669.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$736.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$904.07
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$669.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$669.68
|
| Rate for Payer: Galaxy Health WC |
$1,341.30
|
| Rate for Payer: Global Benefits Group Commercial |
$946.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,183.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,098.28
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,098.28
|
| Rate for Payer: IEHP Medi-Cal |
$1,084.88
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$1,084.88
|
| Rate for Payer: IEHP Medicare Advantage |
$669.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,052.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$147.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$669.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$378.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$843.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$897.37
|
| Rate for Payer: Multiplan Commercial |
$1,262.40
|
| Rate for Payer: Networks By Design Commercial |
$1,025.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,341.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$736.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$946.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$803.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$736.65
|
| Rate for Payer: Vantage Medical Group Senior |
$669.68
|
|
|
HC GASTROESOPHAGEAL REFLUX TEST
|
Facility
OP
|
$2,731.00
|
|
|
Service Code
|
CPT 91035
|
| Hospital Charge Code |
906791035
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$194.62 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,765.52
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,004.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$736.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$669.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,627.13
|
| Rate for Payer: BCBS Transplant Transplant |
$1,638.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$1,228.95
|
| Rate for Payer: Cash Price |
$1,228.95
|
| Rate for Payer: Cash Price |
$1,228.95
|
| Rate for Payer: Cigna of CA PPO |
$2,020.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Dignity Health Media |
$669.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$736.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$904.07
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$669.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$669.68
|
| Rate for Payer: Galaxy Health WC |
$2,321.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,638.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,048.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,098.28
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,098.28
|
| Rate for Payer: IEHP Medi-Cal |
$1,084.88
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$1,084.88
|
| Rate for Payer: IEHP Medicare Advantage |
$669.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,821.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$194.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$669.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$655.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$843.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$897.37
|
| Rate for Payer: Multiplan Commercial |
$2,184.80
|
| Rate for Payer: Networks By Design Commercial |
$1,775.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,321.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$736.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,638.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$803.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$736.65
|
| Rate for Payer: Vantage Medical Group Senior |
$669.68
|
|
|
HC GASTRO PANEL NUCLEIC ACID
|
Facility
OP
|
$644.00
|
|
|
Service Code
|
CPT 87507
|
| Hospital Charge Code |
900913644
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$154.56 |
| Max. Negotiated Rate |
$3,351.66 |
| Rate for Payer: Dignity Health Medi-Cal |
$458.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$562.65
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,351.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$625.17
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$458.46
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$416.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,852.78
|
| Rate for Payer: BCBS Transplant Transplant |
$386.40
|
| Rate for Payer: Blue Shield of California Commercial |
$416.02
|
| Rate for Payer: Blue Shield of California EPN |
$329.73
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: Cigna of CA HMO |
$412.16
|
| Rate for Payer: Cigna of CA PPO |
$476.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$625.17
|
| Rate for Payer: Dignity Health Media |
$416.78
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$416.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$416.78
|
| Rate for Payer: Galaxy Health WC |
$547.40
|
| Rate for Payer: Global Benefits Group Commercial |
$386.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$483.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$683.52
|
| Rate for Payer: Heritage Provider Network Transplant |
$683.52
|
| Rate for Payer: IEHP Medi-Cal |
$675.18
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$675.18
|
| Rate for Payer: IEHP Medicare Advantage |
$416.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$429.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$703.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$416.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$525.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$558.49
|
| Rate for Payer: Multiplan Commercial |
$515.20
|
| Rate for Payer: Networks By Design Commercial |
$418.60
|
| Rate for Payer: Prime Health Services Commercial |
$547.40
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$386.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$386.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$386.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$337.59
|
| Rate for Payer: United Healthcare All Other HMO |
$337.59
|
| Rate for Payer: United Healthcare HMO Rider |
$337.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$337.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$625.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$458.46
|
| Rate for Payer: Vantage Medical Group Senior |
$416.78
|
|
