|
HC GECKO NASAL GEL PAD LARGE
|
Facility
|
IP
|
$97.58
|
|
|
Service Code
|
CPT A7032
|
| Hospital Charge Code |
901606818
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$19.52 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$19.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$43.91
|
| Rate for Payer: Cash Price |
$43.91
|
| Rate for Payer: Cigna of CA HMO |
$68.31
|
| Rate for Payer: Cigna of CA PPO |
$68.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.03
|
| Rate for Payer: EPIC Health Plan Senior |
$39.03
|
| Rate for Payer: Galaxy Health WC |
$82.94
|
| Rate for Payer: Global Benefits Group Commercial |
$58.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$60.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.42
|
| Rate for Payer: Multiplan Commercial |
$78.06
|
| Rate for Payer: Networks By Design Commercial |
$48.79
|
| Rate for Payer: Prime Health Services Commercial |
$82.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.62
|
| Rate for Payer: United Healthcare All Other HMO |
$35.65
|
| Rate for Payer: United Healthcare HMO Rider |
$34.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.96
|
|
|
HC GECKO NASAL GEL PAD LARGE
|
Facility
|
OP
|
$97.58
|
|
|
Service Code
|
CPT A7032
|
| Hospital Charge Code |
901606818
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$23.42 |
| Max. Negotiated Rate |
$82.94 |
| Rate for Payer: Adventist Health Commercial |
$40.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$82.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$73.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$56.52
|
| Rate for Payer: Blue Shield of California Commercial |
$72.01
|
| Rate for Payer: Blue Shield of California EPN |
$47.42
|
| Rate for Payer: Cash Price |
$43.91
|
| Rate for Payer: Cash Price |
$43.91
|
| Rate for Payer: Cigna of CA HMO |
$68.31
|
| Rate for Payer: Cigna of CA PPO |
$68.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$82.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$82.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$82.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.03
|
| Rate for Payer: EPIC Health Plan Senior |
$39.03
|
| Rate for Payer: Galaxy Health WC |
$82.94
|
| Rate for Payer: Global Benefits Group Commercial |
$58.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$51.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$60.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$68.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68.31
|
| Rate for Payer: Multiplan Commercial |
$78.06
|
| Rate for Payer: Networks By Design Commercial |
$48.79
|
| Rate for Payer: Prime Health Services Commercial |
$82.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.62
|
| Rate for Payer: United Healthcare All Other HMO |
$35.65
|
| Rate for Payer: United Healthcare HMO Rider |
$34.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$82.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$82.94
|
| Rate for Payer: Vantage Medical Group Senior |
$82.94
|
|
|
HC GECKO NASAL PAD SMALL
|
Facility
|
OP
|
$97.58
|
|
|
Service Code
|
CPT A7032
|
| Hospital Charge Code |
901606819
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$23.42 |
| Max. Negotiated Rate |
$82.94 |
| Rate for Payer: Adventist Health Commercial |
$40.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$82.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$73.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$56.52
|
| Rate for Payer: Blue Shield of California Commercial |
$72.01
|
| Rate for Payer: Blue Shield of California EPN |
$47.42
|
| Rate for Payer: Cash Price |
$43.91
|
| Rate for Payer: Cash Price |
$43.91
|
| Rate for Payer: Cigna of CA HMO |
$68.31
|
| Rate for Payer: Cigna of CA PPO |
$68.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$82.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$82.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$82.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.03
|
| Rate for Payer: EPIC Health Plan Senior |
$39.03
|
| Rate for Payer: Galaxy Health WC |
$82.94
|
| Rate for Payer: Global Benefits Group Commercial |
$58.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$51.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$60.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$68.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68.31
|
| Rate for Payer: Multiplan Commercial |
$78.06
|
| Rate for Payer: Networks By Design Commercial |
$48.79
|
| Rate for Payer: Prime Health Services Commercial |
$82.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.62
|
| Rate for Payer: United Healthcare All Other HMO |
$35.65
|
| Rate for Payer: United Healthcare HMO Rider |
$34.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$82.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$82.94
|
| Rate for Payer: Vantage Medical Group Senior |
$82.94
|
|
|
HC GECKO NASAL PAD SMALL
|
Facility
|
IP
|
$97.58
|
|
|
Service Code
|
CPT A7032
|
| Hospital Charge Code |
901606819
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$19.52 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$19.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$43.91
|
| Rate for Payer: Cash Price |
$43.91
|
| Rate for Payer: Cigna of CA HMO |
$68.31
|
| Rate for Payer: Cigna of CA PPO |
$68.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.03
|
| Rate for Payer: EPIC Health Plan Senior |
$39.03
|
| Rate for Payer: Galaxy Health WC |
$82.94
|
| Rate for Payer: Global Benefits Group Commercial |
$58.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$60.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.42
|
| Rate for Payer: Multiplan Commercial |
$78.06
|
| Rate for Payer: Networks By Design Commercial |
$48.79
|
| Rate for Payer: Prime Health Services Commercial |
$82.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.62
|
| Rate for Payer: United Healthcare All Other HMO |
$35.65
|
| Rate for Payer: United Healthcare HMO Rider |
$34.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.96
|
|
|
HC GEL PILLOW W/COVER 6" X 9"
|
Facility
|
IP
|
$91.20
|
|
| Hospital Charge Code |
901698550
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.24 |
| Max. Negotiated Rate |
$77.52 |
| Rate for Payer: Adventist Health Commercial |
$18.24
|
| Rate for Payer: Cash Price |
$41.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.48
|
| Rate for Payer: EPIC Health Plan Senior |
$36.48
|
| Rate for Payer: Galaxy Health WC |
$77.52
|
| Rate for Payer: Global Benefits Group Commercial |
$54.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$56.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.89
|
| Rate for Payer: Multiplan Commercial |
$72.96
|
| Rate for Payer: Networks By Design Commercial |
$59.28
|
| Rate for Payer: Prime Health Services Commercial |
$77.52
|
|
|
HC GEL PILLOW W/COVER 6" X 9"
|
Facility
|
OP
|
$91.20
|
|
| Hospital Charge Code |
901698550
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.24 |
| Max. Negotiated Rate |
$77.52 |
| Rate for Payer: Adventist Health Commercial |
$18.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$77.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$50.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$68.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$56.01
|
| Rate for Payer: Cash Price |
$41.04
|
| Rate for Payer: Cigna of CA HMO |
$58.37
|
| Rate for Payer: Cigna of CA PPO |
$67.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$77.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$77.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$77.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.48
|
| Rate for Payer: EPIC Health Plan Senior |
$36.48
|
| Rate for Payer: Galaxy Health WC |
$77.52
|
| Rate for Payer: Global Benefits Group Commercial |
$54.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$56.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.84
|
| Rate for Payer: Multiplan Commercial |
$72.96
|
| Rate for Payer: Networks By Design Commercial |
$59.28
|
| Rate for Payer: Prime Health Services Commercial |
$77.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.60
|
| Rate for Payer: United Healthcare All Other HMO |
$45.60
|
| Rate for Payer: United Healthcare HMO Rider |
$45.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$45.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$77.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$77.52
|
| Rate for Payer: Vantage Medical Group Senior |
$77.52
|
|
|
HC GENETIC CNSLG PT/FMLY 30MIN EA
|
Facility
|
OP
|
$266.00
|
|
|
Service Code
|
CPT 96041
|
| Hospital Charge Code |
910406040
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$226.10 |
| Rate for Payer: Adventist Health Commercial |
$53.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$174.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$226.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$146.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$199.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$163.35
|
| Rate for Payer: Blue Shield of California Commercial |
$177.95
|
| Rate for Payer: Blue Shield of California EPN |
$117.57
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cigna of CA HMO |
$170.24
|
| Rate for Payer: Cigna of CA PPO |
$196.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$226.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$226.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.40
|
| Rate for Payer: EPIC Health Plan Senior |
$106.40
|
| Rate for Payer: Galaxy Health WC |
$226.10
|
| Rate for Payer: Global Benefits Group Commercial |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$177.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$164.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$186.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$186.20
|
| Rate for Payer: Multiplan Commercial |
$212.80
|
| Rate for Payer: Networks By Design Commercial |
$172.90
|
| Rate for Payer: Prime Health Services Commercial |
$226.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$159.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$159.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$133.00
|
| Rate for Payer: United Healthcare All Other HMO |
$133.00
|
| Rate for Payer: United Healthcare HMO Rider |
$133.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$133.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$226.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$226.10
|
| Rate for Payer: Vantage Medical Group Senior |
$226.10
|
|
|
HC GENETIC CNSLG PT/FMLY 30MIN EA
|
Facility
|
IP
|
$266.00
|
|
|
Service Code
|
CPT 96041
|
| Hospital Charge Code |
910406040
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$226.10 |
| Rate for Payer: Galaxy Health WC |
$226.10
|
| Rate for Payer: Adventist Health Commercial |
$53.20
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.40
|
| Rate for Payer: EPIC Health Plan Senior |
$106.40
|
| Rate for Payer: Global Benefits Group Commercial |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$177.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$164.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.84
|
| Rate for Payer: Multiplan Commercial |
$212.80
|
| Rate for Payer: Networks By Design Commercial |
$172.90
|
| Rate for Payer: Prime Health Services Commercial |
$226.10
|
|
|
HC GENTAMICIN
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
900910406
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.60 |
| Max. Negotiated Rate |
$185.30 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.20
|
| Rate for Payer: EPIC Health Plan Senior |
$87.20
|
| Rate for Payer: Galaxy Health WC |
$185.30
|
| Rate for Payer: Global Benefits Group Commercial |
$130.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$145.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$134.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.32
|
| Rate for Payer: Multiplan Commercial |
$174.40
|
| Rate for Payer: Networks By Design Commercial |
$141.70
|
| Rate for Payer: Prime Health Services Commercial |
$185.30
|
|
|
HC GENTAMICIN
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
900910406
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$146.63 |
| Rate for Payer: Adventist Health Commercial |
$9.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$146.63
|
| Rate for Payer: Blue Shield of California Commercial |
$32.78
|
| Rate for Payer: Blue Shield of California EPN |
$21.66
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cigna of CA HMO |
$31.36
|
| Rate for Payer: Cigna of CA PPO |
$36.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.11
|
| Rate for Payer: EPIC Health Plan Senior |
$16.38
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.95
|
| Rate for Payer: Multiplan Commercial |
$39.20
|
| Rate for Payer: Networks By Design Commercial |
$31.85
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.27
|
| Rate for Payer: United Healthcare All Other HMO |
$13.27
|
| Rate for Payer: United Healthcare HMO Rider |
$13.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.27
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.02
|
| Rate for Payer: Vantage Medical Group Senior |
$16.38
|
|
|
HC GI BLEED SCAN
|
Facility
|
IP
|
$3,957.00
|
|
|
Service Code
|
CPT 78278
|
| Hospital Charge Code |
909301360
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$791.40 |
| Max. Negotiated Rate |
$3,363.45 |
| Rate for Payer: Adventist Health Commercial |
$791.40
|
| Rate for Payer: Cash Price |
$1,780.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,582.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,582.80
|
| Rate for Payer: Galaxy Health WC |
$3,363.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,374.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,639.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,507.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,449.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$949.68
|
| Rate for Payer: Multiplan Commercial |
$3,165.60
|
| Rate for Payer: Networks By Design Commercial |
$2,572.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,363.45
|
|
|
HC GI BLEED SCAN
|
Facility
|
OP
|
$3,957.00
|
|
|
Service Code
|
CPT 78278
|
| Hospital Charge Code |
909301360
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$218.06 |
| Max. Negotiated Rate |
$3,363.45 |
| Rate for Payer: Adventist Health Commercial |
$791.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,595.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,429.99
|
| Rate for Payer: Blue Shield of California Commercial |
$2,421.68
|
| Rate for Payer: Blue Shield of California EPN |
$1,598.63
|
| Rate for Payer: Cash Price |
$1,780.65
|
| Rate for Payer: Cash Price |
$1,780.65
|
| Rate for Payer: Cigna of CA HMO |
$2,532.48
|
| Rate for Payer: Cigna of CA PPO |
$2,928.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$689.27
|
| Rate for Payer: EPIC Health Plan Senior |
$510.57
|
| Rate for Payer: Galaxy Health WC |
$3,363.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,374.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$837.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$218.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,639.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$246.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$510.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$949.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$684.16
|
| Rate for Payer: Multiplan Commercial |
$3,165.60
|
| Rate for Payer: Networks By Design Commercial |
$2,572.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,363.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,374.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,374.20
|
| 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: Upland Medical Group Pediatric |
$510.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC GI ENDOSCOPIC ULTRASOUND
|
Facility
|
IP
|
$1,316.00
|
|
|
Service Code
|
CPT 76975
|
| Hospital Charge Code |
906776975
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$263.20 |
| Max. Negotiated Rate |
$1,118.60 |
| Rate for Payer: Adventist Health Commercial |
$263.20
|
| Rate for Payer: Cash Price |
$592.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$526.40
|
| Rate for Payer: EPIC Health Plan Senior |
$526.40
|
| Rate for Payer: Galaxy Health WC |
$1,118.60
|
| Rate for Payer: Global Benefits Group Commercial |
$789.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$877.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$501.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$814.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$315.84
|
| Rate for Payer: Multiplan Commercial |
$1,052.80
|
| Rate for Payer: Networks By Design Commercial |
$855.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,118.60
|
|
|
HC GI ENDOSCOPIC ULTRASOUND
|
Facility
|
OP
|
$1,316.00
|
|
|
Service Code
|
CPT 76975
|
| Hospital Charge Code |
906776975
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$80.47 |
| Max. Negotiated Rate |
$1,118.60 |
| Rate for Payer: Adventist Health Commercial |
$263.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$863.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$808.16
|
| Rate for Payer: Blue Shield of California Commercial |
$805.39
|
| Rate for Payer: Blue Shield of California EPN |
$531.66
|
| Rate for Payer: Cash Price |
$592.20
|
| Rate for Payer: Cash Price |
$592.20
|
| Rate for Payer: Cigna of CA HMO |
$842.24
|
| Rate for Payer: Cigna of CA PPO |
$973.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$1,118.60
|
| Rate for Payer: Global Benefits Group Commercial |
$789.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$80.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$877.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$315.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$1,052.80
|
| Rate for Payer: Networks By Design Commercial |
$855.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,118.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$789.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$789.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$389.46
|
| Rate for Payer: United Healthcare All Other HMO |
$389.46
|
| Rate for Payer: United Healthcare HMO Rider |
$389.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$389.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC GI INJ TREATMENT NR
|
Facility
|
OP
|
$1,961.00
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
906764640
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$210.79 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$392.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,131.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$882.45
|
| Rate for Payer: Cash Price |
$882.45
|
| Rate for Payer: Cash Price |
$882.45
|
| Rate for Payer: Cigna of CA HMO |
$1,255.04
|
| Rate for Payer: Cigna of CA PPO |
$1,451.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,244.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,527.12
|
| Rate for Payer: EPIC Health Plan Senior |
$1,131.20
|
| Rate for Payer: Galaxy Health WC |
$1,666.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,176.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,855.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$210.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,131.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,307.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$238.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,131.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$470.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,425.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,515.81
|
| Rate for Payer: Multiplan Commercial |
$1,568.80
|
| Rate for Payer: Networks By Design Commercial |
$1,274.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,666.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,176.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,357.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,131.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,131.20
|
|
|
HC GI INJ TREATMENT NR
|
Facility
|
IP
|
$3,283.00
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
906764640
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$656.60 |
| Max. Negotiated Rate |
$2,790.55 |
| Rate for Payer: Adventist Health Commercial |
$656.60
|
| Rate for Payer: Cash Price |
$1,477.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,313.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,313.20
|
| Rate for Payer: Galaxy Health WC |
$2,790.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,969.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,189.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,250.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,032.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$787.92
|
| Rate for Payer: Multiplan Commercial |
$2,626.40
|
| Rate for Payer: Networks By Design Commercial |
$2,133.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,790.55
|
|
|
HC GI PROTEIN LOSS
|
Facility
|
OP
|
$1,366.00
|
|
|
Service Code
|
CPT 78282
|
| Hospital Charge Code |
909301367
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$87.21 |
| Max. Negotiated Rate |
$1,161.10 |
| Rate for Payer: Adventist Health Commercial |
$273.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$895.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$838.86
|
| Rate for Payer: Blue Shield of California Commercial |
$835.99
|
| Rate for Payer: Blue Shield of California EPN |
$551.86
|
| Rate for Payer: Cash Price |
$614.70
|
| Rate for Payer: Cash Price |
$614.70
|
| Rate for Payer: Cigna of CA HMO |
$874.24
|
| Rate for Payer: Cigna of CA PPO |
$1,010.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$689.27
|
| Rate for Payer: EPIC Health Plan Senior |
$510.57
|
| Rate for Payer: Galaxy Health WC |
$1,161.10
|
| Rate for Payer: Global Benefits Group Commercial |
$819.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$837.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$87.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$911.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$510.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$327.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$684.16
|
| Rate for Payer: Multiplan Commercial |
$1,092.80
|
| Rate for Payer: Networks By Design Commercial |
$887.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,161.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$819.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$819.60
|
| 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: Upland Medical Group Pediatric |
$510.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC GI PROTEIN LOSS
|
Facility
|
IP
|
$1,366.00
|
|
|
Service Code
|
CPT 78282
|
| Hospital Charge Code |
909301367
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$273.20 |
| Max. Negotiated Rate |
$1,161.10 |
| Rate for Payer: Adventist Health Commercial |
$273.20
|
| Rate for Payer: Cash Price |
$614.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$546.40
|
| Rate for Payer: EPIC Health Plan Senior |
$546.40
|
| Rate for Payer: Galaxy Health WC |
$1,161.10
|
| Rate for Payer: Global Benefits Group Commercial |
$819.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$911.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$520.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$845.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$327.84
|
| Rate for Payer: Multiplan Commercial |
$1,092.80
|
| Rate for Payer: Networks By Design Commercial |
$887.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,161.10
|
|
|
HC GIVEN ENDO IMAGING
|
Facility
|
OP
|
$9,577.00
|
|
|
Service Code
|
CPT 91110
|
| Hospital Charge Code |
906776499
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,191.26 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,915.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,881.24
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$4,309.65
|
| Rate for Payer: Cash Price |
$4,309.65
|
| Rate for Payer: Cash Price |
$4,309.65
|
| Rate for Payer: Cigna of CA HMO |
$6,129.28
|
| Rate for Payer: Cigna of CA PPO |
$7,086.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,608.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,191.26
|
| Rate for Payer: Galaxy Health WC |
$8,140.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,746.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,351.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,387.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,528.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,298.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,500.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,596.29
|
| Rate for Payer: Multiplan Commercial |
$7,661.60
|
| Rate for Payer: Networks By Design Commercial |
$6,225.05
|
| Rate for Payer: Prime Health Services Commercial |
$8,140.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,746.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,429.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,191.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC GIVEN ENDO IMAGING
|
Facility
|
IP
|
$8,616.00
|
|
|
Service Code
|
CPT 91110
|
| Hospital Charge Code |
906776499
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,723.20 |
| Max. Negotiated Rate |
$7,323.60 |
| Rate for Payer: Adventist Health Commercial |
$1,723.20
|
| Rate for Payer: Cash Price |
$3,877.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,446.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,446.40
|
| Rate for Payer: Galaxy Health WC |
$7,323.60
|
| Rate for Payer: Global Benefits Group Commercial |
$5,169.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,746.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,282.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,333.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,067.84
|
| Rate for Payer: Multiplan Commercial |
$6,892.80
|
| Rate for Payer: Networks By Design Commercial |
$5,600.40
|
| Rate for Payer: Prime Health Services Commercial |
$7,323.60
|
|
|
HC GLIADIN AB IGA
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913558
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$66.30 |
| Rate for Payer: Adventist Health Commercial |
$15.60
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.20
|
| Rate for Payer: EPIC Health Plan Senior |
$31.20
|
| Rate for Payer: Galaxy Health WC |
$66.30
|
| Rate for Payer: Global Benefits Group Commercial |
$46.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.72
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: Networks By Design Commercial |
$50.70
|
| Rate for Payer: Prime Health Services Commercial |
$66.30
|
|
|
HC GLIADIN AB IGA
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913558
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.34 |
| Max. Negotiated Rate |
$231.08 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$231.08
|
| Rate for Payer: Blue Shield of California Commercial |
$36.13
|
| Rate for Payer: Blue Shield of California EPN |
$23.87
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna of CA HMO |
$34.56
|
| Rate for Payer: Cigna of CA PPO |
$39.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.57
|
| Rate for Payer: EPIC Health Plan Senior |
$11.53
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: Networks By Design Commercial |
$35.10
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC GLIADIN AB IGG
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913557
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$66.30 |
| Rate for Payer: Adventist Health Commercial |
$15.60
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.20
|
| Rate for Payer: EPIC Health Plan Senior |
$31.20
|
| Rate for Payer: Galaxy Health WC |
$66.30
|
| Rate for Payer: Global Benefits Group Commercial |
$46.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.72
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: Networks By Design Commercial |
$50.70
|
| Rate for Payer: Prime Health Services Commercial |
$66.30
|
|
|
HC GLIADIN AB IGG
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913557
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.34 |
| Max. Negotiated Rate |
$231.08 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$231.08
|
| Rate for Payer: Blue Shield of California Commercial |
$36.13
|
| Rate for Payer: Blue Shield of California EPN |
$23.87
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna of CA HMO |
$34.56
|
| Rate for Payer: Cigna of CA PPO |
$39.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.57
|
| Rate for Payer: EPIC Health Plan Senior |
$11.53
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: Networks By Design Commercial |
$35.10
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC GLIADIN IGA
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913658
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.34 |
| Max. Negotiated Rate |
$231.08 |
| Rate for Payer: Adventist Health Commercial |
$9.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$231.08
|
| Rate for Payer: Blue Shield of California Commercial |
$32.78
|
| Rate for Payer: Blue Shield of California EPN |
$21.66
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cigna of CA HMO |
$31.36
|
| Rate for Payer: Cigna of CA PPO |
$36.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.57
|
| Rate for Payer: EPIC Health Plan Senior |
$11.53
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$39.20
|
| Rate for Payer: Networks By Design Commercial |
$31.85
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
