|
HC COLONOSCOPY W ABLATION
|
Facility
|
OP
|
$1,681.00
|
|
|
Service Code
|
CPT 44401
|
| Hospital Charge Code |
906744401
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$336.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,154.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,498.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$924.55
|
| Rate for Payer: Cash Price |
$924.55
|
| Rate for Payer: Cash Price |
$924.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,092.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,647.95
|
| Rate for Payer: Dignity Health Senior |
$1,498.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,498.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,040.54
|
| Rate for Payer: Heritage Provider Network Senior |
$1,842.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,498.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$801.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$304.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,722.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$420.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,887.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,887.66
|
| Rate for Payer: Multiplan Commercial |
$1,260.75
|
| 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 |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,498.14
|
|
|
HC COLONOSCOPY W ABLATION TUMOR
|
Facility
|
IP
|
$3,955.00
|
|
|
Service Code
|
CPT 45388
|
| Hospital Charge Code |
906745388
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$715.86 |
| Max. Negotiated Rate |
$2,966.25 |
| Rate for Payer: Adventist Health Commercial |
$791.00
|
| Rate for Payer: Cash Price |
$2,175.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,677.53
|
| Rate for Payer: Heritage Provider Network Senior |
$2,677.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$715.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$988.75
|
| Rate for Payer: Multiplan Commercial |
$2,966.25
|
|
|
HC COLONOSCOPY W ABLATION TUMOR
|
Facility
|
OP
|
$3,955.00
|
|
|
Service Code
|
CPT 45388
|
| Hospital Charge Code |
906745388
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$791.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,717.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,498.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,175.25
|
| Rate for Payer: Cash Price |
$2,175.25
|
| Rate for Payer: Cash Price |
$2,175.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,570.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,647.95
|
| Rate for Payer: Dignity Health Senior |
$1,498.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,498.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,448.14
|
| Rate for Payer: Heritage Provider Network Senior |
$1,842.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,498.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,886.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$715.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,722.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$988.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,887.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,887.66
|
| Rate for Payer: Multiplan Commercial |
$2,966.25
|
| 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 |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,498.14
|
|
|
HC COLONOSCOPY W BAND LIGATION
|
Facility
|
IP
|
$2,005.00
|
|
|
Service Code
|
CPT 45398
|
| Hospital Charge Code |
906745398
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$362.90 |
| Max. Negotiated Rate |
$1,503.75 |
| Rate for Payer: Adventist Health Commercial |
$401.00
|
| Rate for Payer: Cash Price |
$1,102.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,357.38
|
| Rate for Payer: Heritage Provider Network Senior |
$1,357.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$362.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$501.25
|
| Rate for Payer: Multiplan Commercial |
$1,503.75
|
|
|
HC COLONOSCOPY W BAND LIGATION
|
Facility
|
OP
|
$2,005.00
|
|
|
Service Code
|
CPT 45398
|
| Hospital Charge Code |
906745398
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$401.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,377.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,498.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,102.75
|
| Rate for Payer: Cash Price |
$1,102.75
|
| Rate for Payer: Cash Price |
$1,102.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,303.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,647.95
|
| Rate for Payer: Dignity Health Senior |
$1,498.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,498.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,241.10
|
| Rate for Payer: Heritage Provider Network Senior |
$1,842.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,498.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$956.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$362.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,722.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$501.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,887.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,887.66
|
| Rate for Payer: Multiplan Commercial |
$1,503.75
|
| 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 |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,498.14
|
|
|
HC COLONOSCOPY W BX
|
Facility
|
IP
|
$4,700.00
|
|
|
Service Code
|
CPT 45380
|
| Hospital Charge Code |
906745380
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$850.70 |
| Max. Negotiated Rate |
$3,525.00 |
| Rate for Payer: Adventist Health Commercial |
$940.00
|
| Rate for Payer: Cash Price |
$2,585.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,181.90
|
| Rate for Payer: Heritage Provider Network Senior |
$3,181.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$850.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,175.00
|
| Rate for Payer: Multiplan Commercial |
$3,525.00
|
|
|
HC COLONOSCOPY W BX
|
Facility
|
OP
|
$4,700.00
|
|
|
Service Code
|
CPT 45380
|
| Hospital Charge Code |
906745380
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$940.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,228.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,498.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,585.00
|
| Rate for Payer: Cash Price |
$2,585.00
|
| Rate for Payer: Cash Price |
$2,585.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,055.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,647.95
|
| Rate for Payer: Dignity Health Senior |
$1,498.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,498.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,909.30
|
| Rate for Payer: Heritage Provider Network Senior |
$1,842.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$534.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,498.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,241.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$850.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,722.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,175.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,887.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,887.66
|
| Rate for Payer: Multiplan Commercial |
$3,525.00
|
| 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 |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,498.14
|
|
|
HC COLONOSCOPY W CNTRL BLEEDING
|
Facility
|
IP
|
$4,653.00
|
|
|
Service Code
|
CPT 45382
|
| Hospital Charge Code |
906745382
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$842.19 |
| Max. Negotiated Rate |
$3,489.75 |
| Rate for Payer: Adventist Health Commercial |
$930.60
|
| Rate for Payer: Cash Price |
$2,559.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,150.08
|
| Rate for Payer: Heritage Provider Network Senior |
$3,150.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$842.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,163.25
|
| Rate for Payer: Multiplan Commercial |
$3,489.75
|
|
|
HC COLONOSCOPY W CNTRL BLEEDING
|
Facility
|
OP
|
$4,653.00
|
|
|
Service Code
|
CPT 45382
|
| Hospital Charge Code |
906745382
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$930.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,196.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,498.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,559.15
|
| Rate for Payer: Cash Price |
$2,559.15
|
| Rate for Payer: Cash Price |
$2,559.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,024.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,647.95
|
| Rate for Payer: Dignity Health Senior |
$1,498.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,498.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,880.21
|
| Rate for Payer: Heritage Provider Network Senior |
$1,842.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$673.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,498.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,219.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$842.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,722.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,163.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,887.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,887.66
|
| Rate for Payer: Multiplan Commercial |
$3,489.75
|
| 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 |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,498.14
|
|
|
HC COLONOSCOPY W/CNTRL BLEEDING
|
Facility
|
OP
|
$1,681.00
|
|
|
Service Code
|
CPT 44391
|
| Hospital Charge Code |
906744391
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$336.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,154.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,498.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$924.55
|
| Rate for Payer: Cash Price |
$924.55
|
| Rate for Payer: Cash Price |
$924.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,092.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,647.95
|
| Rate for Payer: Dignity Health Senior |
$1,498.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,498.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,040.54
|
| Rate for Payer: Heritage Provider Network Senior |
$1,842.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$375.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,498.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$801.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$304.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,722.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$420.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,887.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,887.66
|
| Rate for Payer: Multiplan Commercial |
$1,260.75
|
| 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 |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,498.14
|
|
|
HC COLONOSCOPY W/CNTRL BLEEDING
|
Facility
|
IP
|
$1,681.00
|
|
|
Service Code
|
CPT 44391
|
| Hospital Charge Code |
906744391
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$304.26 |
| Max. Negotiated Rate |
$1,260.75 |
| Rate for Payer: Adventist Health Commercial |
$336.20
|
| Rate for Payer: Cash Price |
$924.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,138.04
|
| Rate for Payer: Heritage Provider Network Senior |
$1,138.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$304.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$420.25
|
| Rate for Payer: Multiplan Commercial |
$1,260.75
|
|
|
HC COLONOSCOPY W ENDO MCSL RESCT
|
Facility
|
OP
|
$2,332.00
|
|
|
Service Code
|
CPT 45390
|
| Hospital Charge Code |
906745390
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$466.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,602.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,226.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,832.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,484.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,282.60
|
| Rate for Payer: Cash Price |
$1,282.60
|
| Rate for Payer: Cash Price |
$1,282.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,515.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,226.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,832.93
|
| Rate for Payer: Dignity Health Senior |
$3,484.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,484.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,443.51
|
| Rate for Payer: Heritage Provider Network Senior |
$4,285.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,484.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,112.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$422.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,007.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$583.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,390.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,390.44
|
| Rate for Payer: Multiplan Commercial |
$1,749.00
|
| 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 |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,226.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,832.93
|
| Rate for Payer: Vantage Medical Group Senior |
$3,484.48
|
|
|
HC COLONOSCOPY W ENDO MCSL RESCT
|
Facility
|
IP
|
$2,332.00
|
|
|
Service Code
|
CPT 45390
|
| Hospital Charge Code |
906745390
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$422.09 |
| Max. Negotiated Rate |
$1,749.00 |
| Rate for Payer: Adventist Health Commercial |
$466.40
|
| Rate for Payer: Cash Price |
$1,282.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,578.76
|
| Rate for Payer: Heritage Provider Network Senior |
$1,578.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$422.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$583.00
|
| Rate for Payer: Multiplan Commercial |
$1,749.00
|
|
|
HC COLONOSCOPY W/ENDOS US
|
Facility
|
OP
|
$4,142.00
|
|
|
Service Code
|
CPT 45392
|
| Hospital Charge Code |
906745392
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$828.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,845.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,498.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,278.10
|
| Rate for Payer: Cash Price |
$2,278.10
|
| Rate for Payer: Cash Price |
$2,278.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,692.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,647.95
|
| Rate for Payer: Dignity Health Senior |
$1,498.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,498.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,563.90
|
| Rate for Payer: Heritage Provider Network Senior |
$1,842.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$348.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,498.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,975.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$749.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,722.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,035.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,887.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,887.66
|
| Rate for Payer: Multiplan Commercial |
$3,106.50
|
| 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 |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,498.14
|
|
|
HC COLONOSCOPY W/ENDOS US
|
Facility
|
IP
|
$4,142.00
|
|
|
Service Code
|
CPT 45392
|
| Hospital Charge Code |
906745392
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$749.70 |
| Max. Negotiated Rate |
$3,106.50 |
| Rate for Payer: Adventist Health Commercial |
$828.40
|
| Rate for Payer: Cash Price |
$2,278.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,804.13
|
| Rate for Payer: Heritage Provider Network Senior |
$2,804.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$749.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,035.50
|
| Rate for Payer: Multiplan Commercial |
$3,106.50
|
|
|
HC COLONOSCOPY W ENDOS US EXAM
|
Facility
|
OP
|
$4,152.00
|
|
|
Service Code
|
CPT 45391
|
| Hospital Charge Code |
906745391
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$830.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,852.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,498.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,283.60
|
| Rate for Payer: Cash Price |
$2,283.60
|
| Rate for Payer: Cash Price |
$2,283.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,698.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,647.95
|
| Rate for Payer: Dignity Health Senior |
$1,498.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,498.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,570.09
|
| Rate for Payer: Heritage Provider Network Senior |
$1,842.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$275.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,498.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,980.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$751.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,722.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,038.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,887.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,887.66
|
| Rate for Payer: Multiplan Commercial |
$3,114.00
|
| 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 |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,498.14
|
|
|
HC COLONOSCOPY W ENDOS US EXAM
|
Facility
|
IP
|
$4,152.00
|
|
|
Service Code
|
CPT 45391
|
| Hospital Charge Code |
906745391
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$751.51 |
| Max. Negotiated Rate |
$3,114.00 |
| Rate for Payer: Adventist Health Commercial |
$830.40
|
| Rate for Payer: Cash Price |
$2,283.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,810.90
|
| Rate for Payer: Heritage Provider Network Senior |
$2,810.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$751.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,038.00
|
| Rate for Payer: Multiplan Commercial |
$3,114.00
|
|
|
HC COLONOSCOPY W FB REMOVAL
|
Facility
|
OP
|
$2,522.00
|
|
|
Service Code
|
CPT 45379
|
| Hospital Charge Code |
906745379
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$504.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,732.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,498.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,387.10
|
| Rate for Payer: Cash Price |
$1,387.10
|
| Rate for Payer: Cash Price |
$1,387.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,639.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,647.95
|
| Rate for Payer: Dignity Health Senior |
$1,498.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,498.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,561.12
|
| Rate for Payer: Heritage Provider Network Senior |
$1,842.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$595.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,498.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,202.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$456.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,722.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$630.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,887.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,887.66
|
| Rate for Payer: Multiplan Commercial |
$1,891.50
|
| 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 |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,498.14
|
|
|
HC COLONOSCOPY W FB REMOVAL
|
Facility
|
IP
|
$2,522.00
|
|
|
Service Code
|
CPT 45379
|
| Hospital Charge Code |
906745379
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$456.48 |
| Max. Negotiated Rate |
$1,891.50 |
| Rate for Payer: Adventist Health Commercial |
$504.40
|
| Rate for Payer: Cash Price |
$1,387.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,707.39
|
| Rate for Payer: Heritage Provider Network Senior |
$1,707.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$456.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$630.50
|
| Rate for Payer: Multiplan Commercial |
$1,891.50
|
|
|
HC COLONOSCOPY W POLYPECTOMY
|
Facility
|
OP
|
$3,126.00
|
|
|
Service Code
|
CPT 45384
|
| Hospital Charge Code |
906745384
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$625.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,147.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,498.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,719.30
|
| Rate for Payer: Cash Price |
$1,719.30
|
| Rate for Payer: Cash Price |
$1,719.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,031.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,647.95
|
| Rate for Payer: Dignity Health Senior |
$1,498.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,498.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,934.99
|
| Rate for Payer: Heritage Provider Network Senior |
$1,842.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$607.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,498.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,491.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$565.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,722.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$781.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,887.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,887.66
|
| Rate for Payer: Multiplan Commercial |
$2,344.50
|
| 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 |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,498.14
|
|
|
HC COLONOSCOPY W POLYPECTOMY
|
Facility
|
IP
|
$3,126.00
|
|
|
Service Code
|
CPT 45384
|
| Hospital Charge Code |
906745384
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$565.81 |
| Max. Negotiated Rate |
$2,344.50 |
| Rate for Payer: Adventist Health Commercial |
$625.20
|
| Rate for Payer: Cash Price |
$1,719.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,116.30
|
| Rate for Payer: Heritage Provider Network Senior |
$2,116.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$565.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$781.50
|
| Rate for Payer: Multiplan Commercial |
$2,344.50
|
|
|
HC COLONOSCOPY W STENT PLCMNT
|
Facility
|
IP
|
$4,306.00
|
|
|
Service Code
|
CPT 45389
|
| Hospital Charge Code |
906745389
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$779.39 |
| Max. Negotiated Rate |
$3,229.50 |
| Rate for Payer: Adventist Health Commercial |
$861.20
|
| Rate for Payer: Cash Price |
$2,368.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,915.16
|
| Rate for Payer: Heritage Provider Network Senior |
$2,915.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$779.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,076.50
|
| Rate for Payer: Multiplan Commercial |
$3,229.50
|
|
|
HC COLONOSCOPY W STENT PLCMNT
|
Facility
|
OP
|
$4,306.00
|
|
|
Service Code
|
CPT 45389
|
| Hospital Charge Code |
906745389
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$11,345.46 |
| Rate for Payer: Adventist Health Commercial |
$861.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,958.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,345.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,320.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,563.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,368.30
|
| Rate for Payer: Cash Price |
$2,368.30
|
| Rate for Payer: Cash Price |
$2,368.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,798.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,345.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,320.00
|
| Rate for Payer: Dignity Health Senior |
$7,563.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,563.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,665.41
|
| Rate for Payer: Heritage Provider Network Senior |
$9,303.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,563.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,053.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$779.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,698.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,076.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,530.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,530.19
|
| Rate for Payer: Multiplan Commercial |
$3,229.50
|
| 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 |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,345.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,320.00
|
| Rate for Payer: Vantage Medical Group Senior |
$7,563.64
|
|
|
HC COLONOSCOPY W SUBMUCOSAL INJ
|
Facility
|
IP
|
$2,713.00
|
|
|
Service Code
|
CPT 45381
|
| Hospital Charge Code |
906745381
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$491.05 |
| Max. Negotiated Rate |
$2,034.75 |
| Rate for Payer: Adventist Health Commercial |
$542.60
|
| Rate for Payer: Cash Price |
$1,492.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,836.70
|
| Rate for Payer: Heritage Provider Network Senior |
$1,836.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$491.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$678.25
|
| Rate for Payer: Multiplan Commercial |
$2,034.75
|
|
|
HC COLONOSCOPY W SUBMUCOSAL INJ
|
Facility
|
OP
|
$2,713.00
|
|
|
Service Code
|
CPT 45381
|
| Hospital Charge Code |
906745381
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$542.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,863.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,498.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,492.15
|
| Rate for Payer: Cash Price |
$1,492.15
|
| Rate for Payer: Cash Price |
$1,492.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,763.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,647.95
|
| Rate for Payer: Dignity Health Senior |
$1,498.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,498.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,679.35
|
| Rate for Payer: Heritage Provider Network Senior |
$1,842.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$668.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,498.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,294.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$491.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,722.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$678.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,887.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,887.66
|
| Rate for Payer: Multiplan Commercial |
$2,034.75
|
| 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 |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,498.14
|
|
