|
HC GECKO NASAL PAD SMALL
|
Facility
|
IP
|
$97.36
|
|
|
Service Code
|
CPT A7032
|
| Hospital Charge Code |
901606819
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$19.47 |
| Max. Negotiated Rate |
$87.62 |
| Rate for Payer: Adventist Health Commercial |
$19.47
|
| Rate for Payer: Blue Shield of California Commercial |
$75.26
|
| Rate for Payer: Blue Shield of California EPN |
$49.07
|
| Rate for Payer: Cash Price |
$53.55
|
| Rate for Payer: Central Health Plan Commercial |
$77.89
|
| Rate for Payer: Cigna of CA HMO |
$68.15
|
| Rate for Payer: Cigna of CA PPO |
$68.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.94
|
| Rate for Payer: EPIC Health Plan Senior |
$38.94
|
| Rate for Payer: Galaxy Health WC |
$82.76
|
| Rate for Payer: Global Benefits Group Commercial |
$58.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$87.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$60.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.47
|
| Rate for Payer: Multiplan Commercial |
$73.02
|
| Rate for Payer: Networks By Design Commercial |
$63.28
|
| Rate for Payer: Prime Health Services Commercial |
$82.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.54
|
| Rate for Payer: United Healthcare All Other HMO |
$35.57
|
| Rate for Payer: United Healthcare HMO Rider |
$34.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.89
|
|
|
HC GECKO NASAL PAD SMALL
|
Facility
|
OP
|
$97.36
|
|
|
Service Code
|
CPT A7032
|
| Hospital Charge Code |
901606819
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.89 |
| Max. Negotiated Rate |
$87.62 |
| Rate for Payer: Adventist Health Commercial |
$39.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$82.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$73.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.18
|
| Rate for Payer: Blue Shield of California Commercial |
$75.26
|
| Rate for Payer: Blue Shield of California EPN |
$49.07
|
| Rate for Payer: Cash Price |
$53.55
|
| Rate for Payer: Cash Price |
$53.55
|
| Rate for Payer: Central Health Plan Commercial |
$77.89
|
| Rate for Payer: Cigna of CA HMO |
$68.15
|
| Rate for Payer: Cigna of CA PPO |
$68.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$82.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$82.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$82.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.94
|
| Rate for Payer: EPIC Health Plan Senior |
$38.94
|
| Rate for Payer: Galaxy Health WC |
$82.76
|
| Rate for Payer: Global Benefits Group Commercial |
$58.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$87.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$52.99
|
| Rate for Payer: InnovAge PACE Commercial |
$48.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$60.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$68.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68.15
|
| Rate for Payer: Multiplan Commercial |
$73.02
|
| Rate for Payer: Networks By Design Commercial |
$48.68
|
| Rate for Payer: Prime Health Services Commercial |
$82.76
|
| Rate for Payer: Riverside University Health System MISP |
$38.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.54
|
| Rate for Payer: United Healthcare All Other HMO |
$35.57
|
| Rate for Payer: United Healthcare HMO Rider |
$34.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$82.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$82.76
|
| Rate for Payer: Vantage Medical Group Senior |
$82.76
|
|
|
HC GEL PILLOW W/COVER 6" X 9"
|
Facility
|
IP
|
$98.50
|
|
| Hospital Charge Code |
901698550
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.70 |
| Max. Negotiated Rate |
$88.65 |
| Rate for Payer: Adventist Health Commercial |
$19.70
|
| Rate for Payer: Cash Price |
$54.18
|
| Rate for Payer: Central Health Plan Commercial |
$78.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.40
|
| Rate for Payer: EPIC Health Plan Senior |
$39.40
|
| Rate for Payer: Galaxy Health WC |
$83.72
|
| Rate for Payer: Global Benefits Group Commercial |
$59.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$88.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$60.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.70
|
| Rate for Payer: Multiplan Commercial |
$73.88
|
| Rate for Payer: Networks By Design Commercial |
$64.03
|
| Rate for Payer: Prime Health Services Commercial |
$83.72
|
|
|
HC GEL PILLOW W/COVER 6" X 9"
|
Facility
|
OP
|
$98.50
|
|
| Hospital Charge Code |
901698550
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.70 |
| Max. Negotiated Rate |
$88.65 |
| Rate for Payer: Adventist Health Commercial |
$19.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$83.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$73.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$47.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.85
|
| Rate for Payer: Blue Shield of California Commercial |
$60.18
|
| Rate for Payer: Blue Shield of California EPN |
$39.30
|
| Rate for Payer: Cash Price |
$54.18
|
| Rate for Payer: Central Health Plan Commercial |
$78.80
|
| Rate for Payer: Cigna of CA HMO |
$63.04
|
| Rate for Payer: Cigna of CA PPO |
$72.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$83.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$83.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.40
|
| Rate for Payer: EPIC Health Plan Senior |
$39.40
|
| Rate for Payer: Galaxy Health WC |
$83.72
|
| Rate for Payer: Global Benefits Group Commercial |
$59.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$88.65
|
| Rate for Payer: InnovAge PACE Commercial |
$49.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$60.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$68.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68.95
|
| Rate for Payer: Multiplan Commercial |
$73.88
|
| Rate for Payer: Networks By Design Commercial |
$64.03
|
| Rate for Payer: Prime Health Services Commercial |
$83.72
|
| Rate for Payer: Riverside University Health System MISP |
$39.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$59.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$59.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.25
|
| Rate for Payer: United Healthcare All Other HMO |
$49.25
|
| Rate for Payer: United Healthcare HMO Rider |
$49.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$83.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.72
|
| Rate for Payer: Vantage Medical Group Senior |
$83.72
|
|
|
HC GENTAMICIN
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
900910406
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Adventist Health Commercial |
$9.80
|
| Rate for Payer: Cash Price |
$26.95
|
| Rate for Payer: Central Health Plan Commercial |
$39.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.60
|
| Rate for Payer: EPIC Health Plan Senior |
$19.60
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.80
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
| Rate for Payer: Networks By Design Commercial |
$31.85
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
|
|
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 |
$107.99 |
| Rate for Payer: Adventist Health Commercial |
$9.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.76
|
| 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 Exchange |
$107.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.92
|
| Rate for Payer: Blue Shield of California Commercial |
$29.74
|
| Rate for Payer: Blue Shield of California EPN |
$19.45
|
| Rate for Payer: Cash Price |
$26.95
|
| Rate for Payer: Cash Price |
$26.95
|
| Rate for Payer: Central Health Plan Commercial |
$39.20
|
| 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: Health Management Network EPO/PPO |
$44.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.38
|
| Rate for Payer: InnovAge PACE Commercial |
$24.57
|
| 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 |
$9.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.95
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
| Rate for Payer: Networks By Design Commercial |
$31.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.38
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
| Rate for Payer: Prime Health Services Medicare |
$17.36
|
| Rate for Payer: Riverside University Health System MISP |
$18.02
|
| 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
|
$3,571.00
|
|
|
Service Code
|
CPT 78278
|
| Hospital Charge Code |
909301360
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$714.20 |
| Max. Negotiated Rate |
$3,213.90 |
| Rate for Payer: Adventist Health Commercial |
$714.20
|
| Rate for Payer: Cash Price |
$1,964.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,856.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,428.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,428.40
|
| Rate for Payer: Galaxy Health WC |
$3,035.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,142.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,213.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,381.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,360.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,210.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$714.20
|
| Rate for Payer: Multiplan Commercial |
$2,678.25
|
| Rate for Payer: Networks By Design Commercial |
$2,321.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,035.35
|
|
|
HC GI BLEED SCAN
|
Facility
|
OP
|
$3,571.00
|
|
|
Service Code
|
CPT 78278
|
| Hospital Charge Code |
909301360
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$223.26 |
| Max. Negotiated Rate |
$3,213.90 |
| Rate for Payer: Adventist Health Commercial |
$714.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$510.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,168.67
|
| 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 Exchange |
$1,014.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,097.25
|
| Rate for Payer: Blue Shield of California Commercial |
$2,167.60
|
| Rate for Payer: Blue Shield of California EPN |
$1,417.69
|
| Rate for Payer: Cash Price |
$1,964.05
|
| Rate for Payer: Cash Price |
$1,964.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,856.80
|
| Rate for Payer: Cigna of CA HMO |
$2,285.44
|
| Rate for Payer: Cigna of CA PPO |
$2,642.54
|
| 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 |
$3,035.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,142.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,213.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$837.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$223.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: InnovAge PACE Commercial |
$765.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,381.86
|
| 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 |
$714.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$684.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$684.16
|
| Rate for Payer: Multiplan Commercial |
$2,678.25
|
| Rate for Payer: Networks By Design Commercial |
$2,321.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$510.57
|
| Rate for Payer: Prime Health Services Commercial |
$3,035.35
|
| Rate for Payer: Prime Health Services Medicare |
$541.20
|
| Rate for Payer: Riverside University Health System MISP |
$561.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,142.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,142.60
|
| 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 ENDOSCOPIC ULTRASOUND
|
Facility
|
OP
|
$1,355.00
|
|
|
Service Code
|
CPT 76975
|
| Hospital Charge Code |
906776975
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$82.39 |
| Max. Negotiated Rate |
$1,219.50 |
| Rate for Payer: Adventist Health Commercial |
$271.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$307.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$822.89
|
| 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 Exchange |
$316.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$795.79
|
| Rate for Payer: Blue Shield of California Commercial |
$822.49
|
| Rate for Payer: Blue Shield of California EPN |
$537.93
|
| Rate for Payer: Cash Price |
$745.25
|
| Rate for Payer: Cash Price |
$745.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,084.00
|
| Rate for Payer: Cigna of CA HMO |
$867.20
|
| Rate for Payer: Cigna of CA PPO |
$1,002.70
|
| 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 |
$1,151.75
|
| Rate for Payer: Global Benefits Group Commercial |
$813.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,219.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$82.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: InnovAge PACE Commercial |
$460.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$903.78
|
| 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 |
$271.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$411.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$1,016.25
|
| Rate for Payer: Networks By Design Commercial |
$880.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$307.13
|
| Rate for Payer: Prime Health Services Commercial |
$1,151.75
|
| Rate for Payer: Prime Health Services Medicare |
$325.56
|
| Rate for Payer: Riverside University Health System MISP |
$337.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$813.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$813.00
|
| 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 ENDOSCOPIC ULTRASOUND
|
Facility
|
IP
|
$1,355.00
|
|
|
Service Code
|
CPT 76975
|
| Hospital Charge Code |
906776975
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$271.00 |
| Max. Negotiated Rate |
$1,219.50 |
| Rate for Payer: Adventist Health Commercial |
$271.00
|
| Rate for Payer: Cash Price |
$745.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,084.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$542.00
|
| Rate for Payer: EPIC Health Plan Senior |
$542.00
|
| Rate for Payer: Galaxy Health WC |
$1,151.75
|
| Rate for Payer: Global Benefits Group Commercial |
$813.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,219.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$903.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$516.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$838.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.00
|
| Rate for Payer: Multiplan Commercial |
$1,016.25
|
| Rate for Payer: Networks By Design Commercial |
$880.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,151.75
|
|
|
HC GI INJ TREATMENT NR
|
Facility
|
IP
|
$1,961.00
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
906764640
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$392.20 |
| Max. Negotiated Rate |
$1,764.90 |
| Rate for Payer: Adventist Health Commercial |
$392.20
|
| Rate for Payer: Cash Price |
$1,078.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,568.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$784.40
|
| Rate for Payer: EPIC Health Plan Senior |
$784.40
|
| Rate for Payer: Galaxy Health WC |
$1,666.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,176.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,764.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,307.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$747.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,213.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.20
|
| Rate for Payer: Multiplan Commercial |
$1,470.75
|
| Rate for Payer: Networks By Design Commercial |
$1,274.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,666.85
|
|
|
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 |
$215.81 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$392.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,131.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| 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 Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,078.55
|
| Rate for Payer: Cash Price |
$1,078.55
|
| Rate for Payer: Cash Price |
$1,078.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,568.80
|
| 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: Health Management Network EPO/PPO |
$1,764.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,855.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$215.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,131.20
|
| Rate for Payer: InnovAge PACE Commercial |
$1,696.80
|
| 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 |
$392.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,515.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,515.81
|
| Rate for Payer: Multiplan Commercial |
$1,470.75
|
| Rate for Payer: Networks By Design Commercial |
$1,274.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,131.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,666.85
|
| Rate for Payer: Prime Health Services Medicare |
$1,199.07
|
| Rate for Payer: Riverside University Health System MISP |
$1,244.32
|
| 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 PROTEIN LOSS
|
Facility
|
IP
|
$1,233.00
|
|
|
Service Code
|
CPT 78282
|
| Hospital Charge Code |
909301367
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$246.60 |
| Max. Negotiated Rate |
$1,109.70 |
| Rate for Payer: Adventist Health Commercial |
$246.60
|
| Rate for Payer: Cash Price |
$678.15
|
| Rate for Payer: Central Health Plan Commercial |
$986.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$493.20
|
| Rate for Payer: EPIC Health Plan Senior |
$493.20
|
| Rate for Payer: Galaxy Health WC |
$1,048.05
|
| Rate for Payer: Global Benefits Group Commercial |
$739.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,109.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$822.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$469.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$763.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.60
|
| Rate for Payer: Multiplan Commercial |
$924.75
|
| Rate for Payer: Networks By Design Commercial |
$801.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,048.05
|
|
|
HC GI PROTEIN LOSS
|
Facility
|
OP
|
$1,233.00
|
|
|
Service Code
|
CPT 78282
|
| Hospital Charge Code |
909301367
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$89.29 |
| Max. Negotiated Rate |
$1,109.70 |
| Rate for Payer: Adventist Health Commercial |
$246.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$510.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$748.80
|
| 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 Exchange |
$581.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$724.14
|
| Rate for Payer: Blue Shield of California Commercial |
$748.43
|
| Rate for Payer: Blue Shield of California EPN |
$489.50
|
| Rate for Payer: Cash Price |
$678.15
|
| Rate for Payer: Cash Price |
$678.15
|
| Rate for Payer: Central Health Plan Commercial |
$986.40
|
| Rate for Payer: Cigna of CA HMO |
$789.12
|
| Rate for Payer: Cigna of CA PPO |
$912.42
|
| 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 |
$1,048.05
|
| Rate for Payer: Global Benefits Group Commercial |
$739.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,109.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$837.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$89.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: InnovAge PACE Commercial |
$765.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$822.41
|
| 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 |
$246.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$684.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$684.16
|
| Rate for Payer: Multiplan Commercial |
$924.75
|
| Rate for Payer: Networks By Design Commercial |
$801.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$510.57
|
| Rate for Payer: Prime Health Services Commercial |
$1,048.05
|
| Rate for Payer: Prime Health Services Medicare |
$541.20
|
| Rate for Payer: Riverside University Health System MISP |
$561.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$739.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$739.80
|
| 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: 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 TRACT CAPSULE ENDO
|
Facility
|
OP
|
$2,539.00
|
|
|
Service Code
|
CPT 91110
|
| Hospital Charge Code |
906700355
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$507.80 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$507.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,191.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 Exchange |
$5,332.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,491.15
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$1,396.45
|
| Rate for Payer: Cash Price |
$1,396.45
|
| Rate for Payer: Cash Price |
$1,396.45
|
| Rate for Payer: Central Health Plan Commercial |
$2,031.20
|
| Rate for Payer: Cigna of CA HMO |
$1,624.96
|
| Rate for Payer: Cigna of CA PPO |
$1,878.86
|
| 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 |
$2,158.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,523.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,285.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,383.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: InnovAge PACE Commercial |
$1,786.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,693.51
|
| 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 |
$507.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,596.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,596.29
|
| Rate for Payer: Multiplan Commercial |
$1,904.25
|
| Rate for Payer: Networks By Design Commercial |
$1,650.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Prime Health Services Commercial |
$2,158.15
|
| Rate for Payer: Prime Health Services Medicare |
$1,262.74
|
| Rate for Payer: Riverside University Health System MISP |
$1,310.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,523.40
|
| 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 GI TRACT CAPSULE ENDO
|
Facility
|
IP
|
$2,539.00
|
|
|
Service Code
|
CPT 91110
|
| Hospital Charge Code |
906700355
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$507.80 |
| Max. Negotiated Rate |
$2,285.10 |
| Rate for Payer: Adventist Health Commercial |
$507.80
|
| Rate for Payer: Cash Price |
$1,396.45
|
| Rate for Payer: Central Health Plan Commercial |
$2,031.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,015.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,015.60
|
| Rate for Payer: Galaxy Health WC |
$2,158.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,523.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,285.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,693.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$967.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,571.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$507.80
|
| Rate for Payer: Multiplan Commercial |
$1,904.25
|
| Rate for Payer: Networks By Design Commercial |
$1,650.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,158.15
|
|
|
HC GI TRANS & PRESS WRLS CAPSULE
|
Facility
|
OP
|
$980.00
|
|
|
Service Code
|
CPT 91112
|
| Hospital Charge Code |
906791112
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$196.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,191.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,245.30
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$539.00
|
| Rate for Payer: Cash Price |
$539.00
|
| Rate for Payer: Cash Price |
$539.00
|
| Rate for Payer: Central Health Plan Commercial |
$784.00
|
| Rate for Payer: Cigna of CA HMO |
$627.20
|
| Rate for Payer: Cigna of CA PPO |
$725.20
|
| 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 |
$833.00
|
| Rate for Payer: Global Benefits Group Commercial |
$588.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$882.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,859.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: InnovAge PACE Commercial |
$1,786.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$653.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,054.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,596.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,596.29
|
| Rate for Payer: Multiplan Commercial |
$735.00
|
| Rate for Payer: Networks By Design Commercial |
$637.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Prime Health Services Commercial |
$833.00
|
| Rate for Payer: Prime Health Services Medicare |
$1,262.74
|
| Rate for Payer: Riverside University Health System MISP |
$1,310.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$588.00
|
| 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 GI TRANS & PRESS WRLS CAPSULE
|
Facility
|
IP
|
$980.00
|
|
|
Service Code
|
CPT 91112
|
| Hospital Charge Code |
906791112
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$882.00 |
| Rate for Payer: Adventist Health Commercial |
$196.00
|
| Rate for Payer: Cash Price |
$539.00
|
| Rate for Payer: Central Health Plan Commercial |
$784.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$392.00
|
| Rate for Payer: EPIC Health Plan Senior |
$392.00
|
| Rate for Payer: Galaxy Health WC |
$833.00
|
| Rate for Payer: Global Benefits Group Commercial |
$588.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$882.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$653.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$373.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$606.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.00
|
| Rate for Payer: Multiplan Commercial |
$735.00
|
| Rate for Payer: Networks By Design Commercial |
$637.00
|
| Rate for Payer: Prime Health Services Commercial |
$833.00
|
|
|
HC GI TRC IMG INTRAL COLON INT AND RPT
|
Facility
|
IP
|
$2,745.00
|
|
|
Service Code
|
CPT 91113
|
| Hospital Charge Code |
906701113
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$549.00 |
| Max. Negotiated Rate |
$2,470.50 |
| Rate for Payer: Adventist Health Commercial |
$549.00
|
| Rate for Payer: Cash Price |
$1,509.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,196.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,098.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,098.00
|
| Rate for Payer: Galaxy Health WC |
$2,333.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,647.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,470.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,830.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,045.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,699.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$549.00
|
| Rate for Payer: Multiplan Commercial |
$2,058.75
|
| Rate for Payer: Networks By Design Commercial |
$1,784.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,333.25
|
|
|
HC GI TRC IMG INTRAL COLON INT AND RPT
|
Facility
|
OP
|
$2,745.00
|
|
|
Service Code
|
CPT 91113
|
| Hospital Charge Code |
906701113
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$549.00 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$549.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,158.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,158.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,695.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,612.14
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$1,509.75
|
| Rate for Payer: Cash Price |
$1,509.75
|
| Rate for Payer: Cash Price |
$1,509.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,196.00
|
| Rate for Payer: Cigna of CA HMO |
$1,756.80
|
| Rate for Payer: Cigna of CA PPO |
$2,031.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,274.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,158.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,563.87
|
| Rate for Payer: EPIC Health Plan Senior |
$1,158.42
|
| Rate for Payer: Galaxy Health WC |
$2,333.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,647.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,470.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,899.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,529.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,158.42
|
| Rate for Payer: InnovAge PACE Commercial |
$1,737.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,830.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,689.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,158.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$549.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,552.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,552.28
|
| Rate for Payer: Multiplan Commercial |
$2,058.75
|
| Rate for Payer: Networks By Design Commercial |
$1,784.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,158.42
|
| Rate for Payer: Prime Health Services Commercial |
$2,333.25
|
| Rate for Payer: Prime Health Services Medicare |
$1,227.93
|
| Rate for Payer: Riverside University Health System MISP |
$1,274.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,647.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,390.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,372.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,372.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,372.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,372.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,158.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Vantage Medical Group Senior |
$1,158.42
|
|
|
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 |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,915.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,191.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 Exchange |
$5,332.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,624.57
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$5,267.35
|
| Rate for Payer: Cash Price |
$5,267.35
|
| Rate for Payer: Cash Price |
$5,267.35
|
| Rate for Payer: Central Health Plan Commercial |
$7,661.60
|
| 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: Health Management Network EPO/PPO |
$8,619.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,383.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: InnovAge PACE Commercial |
$1,786.89
|
| 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 |
$1,915.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,596.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,596.29
|
| Rate for Payer: Multiplan Commercial |
$7,182.75
|
| Rate for Payer: Networks By Design Commercial |
$6,225.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Prime Health Services Commercial |
$8,140.45
|
| Rate for Payer: Prime Health Services Medicare |
$1,262.74
|
| Rate for Payer: Riverside University Health System MISP |
$1,310.39
|
| 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
|
$9,577.00
|
|
|
Service Code
|
CPT 91110
|
| Hospital Charge Code |
906776499
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,915.40 |
| Max. Negotiated Rate |
$8,619.30 |
| Rate for Payer: Adventist Health Commercial |
$1,915.40
|
| Rate for Payer: Cash Price |
$5,267.35
|
| Rate for Payer: Central Health Plan Commercial |
$7,661.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,830.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,830.80
|
| Rate for Payer: Galaxy Health WC |
$8,140.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,746.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,619.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,387.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,648.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,928.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,915.40
|
| Rate for Payer: Multiplan Commercial |
$7,182.75
|
| Rate for Payer: Networks By Design Commercial |
$6,225.05
|
| Rate for Payer: Prime Health Services Commercial |
$8,140.45
|
|
|
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 |
$170.20 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.79
|
| 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 Exchange |
$170.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.54
|
| Rate for Payer: Blue Shield of California Commercial |
$32.78
|
| Rate for Payer: Blue Shield of California EPN |
$21.44
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Central Health Plan Commercial |
$43.20
|
| 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: Health Management Network EPO/PPO |
$48.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: InnovAge PACE Commercial |
$17.30
|
| 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 |
$10.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: Networks By Design Commercial |
$35.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.53
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
| Rate for Payer: Prime Health Services Medicare |
$12.22
|
| Rate for Payer: Riverside University Health System MISP |
$12.68
|
| 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 IGA
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913558
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$48.60 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Central Health Plan Commercial |
$43.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.60
|
| Rate for Payer: EPIC Health Plan Senior |
$21.60
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: Networks By Design Commercial |
$35.10
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
|
|
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 |
$170.20 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.79
|
| 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 Exchange |
$170.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.54
|
| Rate for Payer: Blue Shield of California Commercial |
$32.78
|
| Rate for Payer: Blue Shield of California EPN |
$21.44
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Central Health Plan Commercial |
$43.20
|
| 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: Health Management Network EPO/PPO |
$48.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: InnovAge PACE Commercial |
$17.30
|
| 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 |
$10.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: Networks By Design Commercial |
$35.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.53
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
| Rate for Payer: Prime Health Services Medicare |
$12.22
|
| Rate for Payer: Riverside University Health System MISP |
$12.68
|
| 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
|
|
