|
HC ENDOCERVICAL CURETTAGE
|
Facility
|
OP
|
$1,456.00
|
|
|
Service Code
|
CPT 57505
|
| Hospital Charge Code |
900501170
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$263.54 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$291.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,000.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,506.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,104.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,004.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$946.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,506.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,104.87
|
| Rate for Payer: Dignity Health Senior |
$1,004.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,004.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$985.71
|
| Rate for Payer: Heritage Provider Network Senior |
$985.71
|
| Rate for Payer: Humana Medicare |
$1,004.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,004.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$701.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$263.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,185.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$364.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,265.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,265.58
|
| Rate for Payer: Multiplan Commercial |
$1,092.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$528.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$486.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,506.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,104.87
|
| Rate for Payer: Vantage Medical Group Senior |
$1,004.43
|
|
|
HC ENDOCERVICAL CURETTAGE
|
Facility
|
IP
|
$1,456.00
|
|
|
Service Code
|
CPT 57505
|
| Hospital Charge Code |
900501170
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$263.54 |
| Max. Negotiated Rate |
$1,092.00 |
| Rate for Payer: Adventist Health Commercial |
$291.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,000.27
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$985.71
|
| Rate for Payer: Heritage Provider Network Senior |
$985.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$263.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$364.00
|
| Rate for Payer: Multiplan Commercial |
$1,092.00
|
|
|
HC ENDO EVAL SM INTESTINE W BX
|
Facility
|
IP
|
$2,299.00
|
|
|
Service Code
|
CPT 44386
|
| Hospital Charge Code |
906744386
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$416.12 |
| Max. Negotiated Rate |
$1,724.25 |
| Rate for Payer: Adventist Health Commercial |
$459.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,579.41
|
| Rate for Payer: Cash Price |
$1,034.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,556.42
|
| Rate for Payer: Heritage Provider Network Senior |
$1,556.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$416.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$574.75
|
| Rate for Payer: Multiplan Commercial |
$1,724.25
|
|
|
HC ENDO EVAL SM INTESTINE W BX
|
Facility
|
OP
|
$2,428.00
|
|
|
Service Code
|
CPT 44386
|
| Hospital Charge Code |
906744386
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$189.91 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$485.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,668.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,141.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,092.60
|
| Rate for Payer: Cash Price |
$1,092.60
|
| Rate for Payer: Cash Price |
$1,092.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,578.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,256.12
|
| Rate for Payer: Dignity Health Senior |
$1,141.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,141.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,502.93
|
| Rate for Payer: Heritage Provider Network Senior |
$1,404.57
|
| Rate for Payer: Humana Medicare |
$1,141.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$189.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,141.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,169.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$439.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,347.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$607.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,438.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,438.83
|
| Rate for Payer: Multiplan Commercial |
$1,821.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: Vantage Medical Group Senior |
$1,141.93
|
|
|
HC ENDO EVAL SM INTESTINE W WO COLLECT
|
Facility
|
IP
|
$2,299.00
|
|
|
Service Code
|
CPT 44385
|
| Hospital Charge Code |
906744385
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$416.12 |
| Max. Negotiated Rate |
$1,724.25 |
| Rate for Payer: Adventist Health Commercial |
$459.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,579.41
|
| Rate for Payer: Cash Price |
$1,034.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,556.42
|
| Rate for Payer: Heritage Provider Network Senior |
$1,556.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$416.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$574.75
|
| Rate for Payer: Multiplan Commercial |
$1,724.25
|
|
|
HC ENDO EVAL SM INTESTINE W WO COLLECT
|
Facility
|
OP
|
$2,428.00
|
|
|
Service Code
|
CPT 44385
|
| Hospital Charge Code |
906744385
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$187.59 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$485.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,668.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,141.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,092.60
|
| Rate for Payer: Cash Price |
$1,092.60
|
| Rate for Payer: Cash Price |
$1,092.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,578.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,256.12
|
| Rate for Payer: Dignity Health Senior |
$1,141.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,141.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,502.93
|
| Rate for Payer: Heritage Provider Network Senior |
$1,404.57
|
| Rate for Payer: Humana Medicare |
$1,141.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$187.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,141.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,169.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$439.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,347.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$607.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,438.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,438.83
|
| Rate for Payer: Multiplan Commercial |
$1,821.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: Vantage Medical Group Senior |
$1,141.93
|
|
|
HC ENDOLUMINAL BRUSHING
|
Facility
|
IP
|
$917.00
|
|
|
Service Code
|
CPT 36010
|
| Hospital Charge Code |
909081376
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.98 |
| Max. Negotiated Rate |
$687.75 |
| Rate for Payer: Adventist Health Commercial |
$183.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$629.98
|
| Rate for Payer: Cash Price |
$412.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$620.81
|
| Rate for Payer: Heritage Provider Network Senior |
$620.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.25
|
| Rate for Payer: Multiplan Commercial |
$687.75
|
|
|
HC ENDOLUMINAL BRUSHING
|
Facility
|
OP
|
$917.00
|
|
|
Service Code
|
CPT 36010
|
| Hospital Charge Code |
909081376
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$131.84 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$183.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$629.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$779.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$504.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$687.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$412.65
|
| Rate for Payer: Cash Price |
$412.65
|
| Rate for Payer: Cash Price |
$412.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$596.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$779.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$779.45
|
| Rate for Payer: Dignity Health Senior |
$779.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$567.62
|
| Rate for Payer: Heritage Provider Network Senior |
$567.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$131.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$441.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.25
|
| Rate for Payer: Multiplan Commercial |
$687.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$779.45
|
| Rate for Payer: Vantage Medical Group Senior |
$779.45
|
|
|
HC ENDOLUMINAL BRUSHING
|
Facility
|
IP
|
$917.00
|
|
|
Service Code
|
CPT 36010
|
| Hospital Charge Code |
909081376
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$165.98 |
| Max. Negotiated Rate |
$687.75 |
| Rate for Payer: Adventist Health Commercial |
$183.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$629.98
|
| Rate for Payer: Cash Price |
$412.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$620.81
|
| Rate for Payer: Heritage Provider Network Senior |
$620.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.25
|
| Rate for Payer: Multiplan Commercial |
$687.75
|
|
|
HC ENDOLUMINAL BRUSHING
|
Facility
|
OP
|
$917.00
|
|
|
Service Code
|
CPT 36010
|
| Hospital Charge Code |
909081376
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.98 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$183.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$629.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$779.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$504.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$687.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$412.65
|
| Rate for Payer: Cash Price |
$412.65
|
| Rate for Payer: Cash Price |
$412.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$596.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$779.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$779.45
|
| Rate for Payer: Dignity Health Senior |
$779.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$620.81
|
| Rate for Payer: Heritage Provider Network Senior |
$620.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$441.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.25
|
| Rate for Payer: Multiplan Commercial |
$687.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$332.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$306.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$779.45
|
| Rate for Payer: Vantage Medical Group Senior |
$779.45
|
|
|
HC ENDOLUMINAL BX BILIARY TREE
|
Facility
|
IP
|
$1,263.00
|
|
|
Service Code
|
CPT 47543
|
| Hospital Charge Code |
909047543
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$228.60 |
| Max. Negotiated Rate |
$947.25 |
| Rate for Payer: Adventist Health Commercial |
$252.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$867.68
|
| Rate for Payer: Cash Price |
$568.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$855.05
|
| Rate for Payer: Heritage Provider Network Senior |
$855.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$228.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$315.75
|
| Rate for Payer: Multiplan Commercial |
$947.25
|
|
|
HC ENDOLUMINAL BX BILIARY TREE
|
Facility
|
OP
|
$1,263.00
|
|
|
Service Code
|
CPT 47543
|
| Hospital Charge Code |
909047543
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$228.60 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$252.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$867.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,073.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$694.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$947.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,379.37
|
| Rate for Payer: Blue Shield of California EPN |
$4,623.32
|
| Rate for Payer: Cash Price |
$568.35
|
| Rate for Payer: Cash Price |
$568.35
|
| Rate for Payer: Cash Price |
$568.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$820.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,073.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,073.55
|
| Rate for Payer: Dignity Health Senior |
$1,073.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$781.80
|
| Rate for Payer: Heritage Provider Network Senior |
$781.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,909.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$608.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$228.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$315.75
|
| Rate for Payer: Multiplan Commercial |
$947.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,073.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,073.55
|
|
|
HC ENDOMETRIAL BIOPSY
|
Facility
|
IP
|
$368.00
|
|
|
Service Code
|
CPT 58100
|
| Hospital Charge Code |
900501615
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$66.61 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: Adventist Health Commercial |
$73.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$252.82
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$249.14
|
| Rate for Payer: Heritage Provider Network Senior |
$249.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.00
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
|
|
HC ENDOMETRIAL BIOPSY
|
Facility
|
OP
|
$368.00
|
|
|
Service Code
|
CPT 58100
|
| Hospital Charge Code |
900501615
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$66.61 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$73.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$252.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$373.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$273.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$248.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$239.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$373.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$273.87
|
| Rate for Payer: Dignity Health Senior |
$248.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$248.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$249.14
|
| Rate for Payer: Heritage Provider Network Senior |
$249.14
|
| Rate for Payer: Humana Medicare |
$248.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$248.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$177.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$293.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$313.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$313.70
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$133.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$122.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$373.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$273.87
|
| Rate for Payer: Vantage Medical Group Senior |
$248.97
|
|
|
HC ENDOMYCARDIAL BIOPSY
|
Facility
|
OP
|
$5,866.00
|
|
|
Service Code
|
CPT 93505
|
| Hospital Charge Code |
906820039
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$370.91 |
| Max. Negotiated Rate |
$9,520.00 |
| Rate for Payer: Adventist Health Commercial |
$1,173.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,029.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$2,639.70
|
| Rate for Payer: Cash Price |
$2,639.70
|
| Rate for Payer: Cash Price |
$2,639.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,812.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,631.05
|
| Rate for Payer: Heritage Provider Network Senior |
$4,898.54
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$370.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,061.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,466.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$4,399.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,810.00
|
| Rate for Payer: TriValley Medical Group Senior |
$1,810.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,520.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,039.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC ENDOMYCARDIAL BIOPSY
|
Facility
|
IP
|
$5,866.00
|
|
|
Service Code
|
CPT 93505
|
| Hospital Charge Code |
906820039
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,061.75 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$1,173.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,029.94
|
| Rate for Payer: Cash Price |
$2,639.70
|
| Rate for Payer: Cash Price |
$2,639.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,061.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,466.50
|
| Rate for Payer: Multiplan Commercial |
$4,399.50
|
|
|
HC ENDOMYCARDIAL BIOPSY
|
Facility
|
IP
|
$7,558.00
|
|
|
Service Code
|
CPT 93505
|
| Hospital Charge Code |
906811308
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,368.00 |
| Max. Negotiated Rate |
$5,668.50 |
| Rate for Payer: Adventist Health Commercial |
$1,511.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,192.35
|
| Rate for Payer: Cash Price |
$3,401.10
|
| Rate for Payer: Cash Price |
$3,401.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,368.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,889.50
|
| Rate for Payer: Multiplan Commercial |
$5,668.50
|
|
|
HC ENDOMYCARDIAL BIOPSY
|
Facility
|
OP
|
$7,558.00
|
|
|
Service Code
|
CPT 93505
|
| Hospital Charge Code |
906811308
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$370.91 |
| Max. Negotiated Rate |
$9,520.00 |
| Rate for Payer: Adventist Health Commercial |
$1,511.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,192.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$3,401.10
|
| Rate for Payer: Cash Price |
$3,401.10
|
| Rate for Payer: Cash Price |
$3,401.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,912.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,678.40
|
| Rate for Payer: Heritage Provider Network Senior |
$4,898.54
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$370.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,368.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,889.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$5,668.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,810.00
|
| Rate for Payer: TriValley Medical Group Senior |
$1,810.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,520.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,039.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC ENDOSCOPIC PANCREATOSCOPY
|
Facility
|
IP
|
$5,743.00
|
|
|
Service Code
|
CPT 43273
|
| Hospital Charge Code |
906743273
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,039.48 |
| Max. Negotiated Rate |
$4,307.25 |
| Rate for Payer: Adventist Health Commercial |
$1,148.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,945.44
|
| Rate for Payer: Cash Price |
$2,584.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,888.01
|
| Rate for Payer: Heritage Provider Network Senior |
$3,888.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,039.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,435.75
|
| Rate for Payer: Multiplan Commercial |
$4,307.25
|
|
|
HC ENDOSCOPIC PANCREATOSCOPY
|
Facility
|
OP
|
$5,425.00
|
|
|
Service Code
|
CPT 43273
|
| Hospital Charge Code |
906743273
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$145.78 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,085.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,726.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,611.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,983.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,068.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$2,441.25
|
| Rate for Payer: Cash Price |
$2,441.25
|
| Rate for Payer: Cash Price |
$2,441.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,526.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,611.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,611.25
|
| Rate for Payer: Dignity Health Senior |
$4,611.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,358.08
|
| Rate for Payer: Heritage Provider Network Senior |
$3,358.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$145.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,614.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$981.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,356.25
|
| Rate for Payer: Multiplan Commercial |
$4,068.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,611.25
|
| Rate for Payer: Vantage Medical Group Senior |
$4,611.25
|
|
|
HC ENDOSCOPIC STUDY SWALLOW FUNCT
|
Facility
|
OP
|
$746.00
|
|
|
Service Code
|
CPT 92612
|
| Hospital Charge Code |
905601751
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$125.00 |
| Max. Negotiated Rate |
$634.10 |
| Rate for Payer: Adventist Health Commercial |
$149.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$155.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$512.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$634.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$410.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$559.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$484.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$634.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$634.10
|
| Rate for Payer: Dignity Health Senior |
$634.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$484.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$461.77
|
| Rate for Payer: Heritage Provider Network Senior |
$461.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$179.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$359.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.50
|
| Rate for Payer: Multiplan Commercial |
$559.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$634.10
|
| Rate for Payer: Vantage Medical Group Senior |
$634.10
|
|
|
HC ENDOSCOPIC STUDY SWALLOW FUNCT
|
Facility
|
IP
|
$746.00
|
|
|
Service Code
|
CPT 92612
|
| Hospital Charge Code |
905601751
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$135.03 |
| Max. Negotiated Rate |
$559.50 |
| Rate for Payer: Adventist Health Commercial |
$149.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$512.50
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$505.04
|
| Rate for Payer: Heritage Provider Network Senior |
$505.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.50
|
| Rate for Payer: Multiplan Commercial |
$559.50
|
|
|
HC ENDOSCOPIC STUDY SWALLOW FUNCT MCAL
|
Facility
|
IP
|
$1,307.00
|
|
|
Service Code
|
CPT 92612
|
| Hospital Charge Code |
907000015
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$236.57 |
| Max. Negotiated Rate |
$980.25 |
| Rate for Payer: Adventist Health Commercial |
$261.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$897.91
|
| Rate for Payer: Cash Price |
$588.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$884.84
|
| Rate for Payer: Heritage Provider Network Senior |
$884.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$236.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$326.75
|
| Rate for Payer: Multiplan Commercial |
$980.25
|
|
|
HC ENDOSCOPIC STUDY SWALLOW FUNCT MCAL
|
Facility
|
OP
|
$1,307.00
|
|
|
Service Code
|
CPT 92612
|
| Hospital Charge Code |
907000015
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$125.00 |
| Max. Negotiated Rate |
$1,110.95 |
| Rate for Payer: Adventist Health Commercial |
$261.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$155.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$897.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,110.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$718.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$980.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$588.15
|
| Rate for Payer: Cash Price |
$588.15
|
| Rate for Payer: Cash Price |
$588.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$849.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,110.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,110.95
|
| Rate for Payer: Dignity Health Senior |
$1,110.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$849.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$809.03
|
| Rate for Payer: Heritage Provider Network Senior |
$809.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$179.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$629.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$236.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$326.75
|
| Rate for Payer: Multiplan Commercial |
$980.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,110.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,110.95
|
|
|
HC ENDOSCOPIC US EXAM
|
Facility
|
IP
|
$2,449.00
|
|
|
Service Code
|
CPT 43237
|
| Hospital Charge Code |
906743237
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$443.27 |
| Max. Negotiated Rate |
$1,836.75 |
| Rate for Payer: Adventist Health Commercial |
$489.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,682.46
|
| Rate for Payer: Cash Price |
$1,102.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,657.97
|
| Rate for Payer: Heritage Provider Network Senior |
$1,657.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$443.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$612.25
|
| Rate for Payer: Multiplan Commercial |
$1,836.75
|
|
