|
HC GASTRIC MOTIL MANOMETRC STUDY
|
Facility
|
IP
|
$2,001.00
|
|
|
Service Code
|
CPT 91020
|
| Hospital Charge Code |
906791020
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$362.18 |
| Max. Negotiated Rate |
$1,500.75 |
| Rate for Payer: Adventist Health Commercial |
$400.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,374.69
|
| Rate for Payer: Cash Price |
$900.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,354.68
|
| Rate for Payer: Heritage Provider Network Senior |
$1,354.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$362.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$500.25
|
| Rate for Payer: Multiplan Commercial |
$1,500.75
|
|
|
HC GASTRIC MOTIL MANOMETRC STUDY
|
Facility
|
OP
|
$1,212.00
|
|
|
Service Code
|
CPT 91020
|
| Hospital Charge Code |
906791020
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$143.66 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$242.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$832.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$736.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$669.68
|
| 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 |
$545.40
|
| Rate for Payer: Cash Price |
$545.40
|
| Rate for Payer: Cash Price |
$545.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$787.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$736.65
|
| Rate for Payer: Dignity Health Senior |
$669.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$727.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$669.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$750.23
|
| Rate for Payer: Heritage Provider Network Senior |
$823.71
|
| Rate for Payer: Humana Medicare |
$669.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$143.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$669.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,272.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$790.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$843.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$843.80
|
| Rate for Payer: Multiplan Commercial |
$909.00
|
| 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 |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$736.65
|
| Rate for Payer: Vantage Medical Group Senior |
$669.68
|
|
|
HC GASTROESOPHAGEAL REFLUX
|
Facility
|
OP
|
$1,695.00
|
|
|
Service Code
|
CPT 78262
|
| Hospital Charge Code |
909301365
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$168.70 |
| Max. Negotiated Rate |
$1,271.25 |
| Rate for Payer: Adventist Health Commercial |
$339.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$472.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,164.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Blue Shield of California Commercial |
$868.20
|
| Rate for Payer: Blue Shield of California EPN |
$493.72
|
| Rate for Payer: Cash Price |
$762.75
|
| Rate for Payer: Cash Price |
$762.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,101.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: Dignity Health Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,101.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$515.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,049.20
|
| Rate for Payer: Heritage Provider Network Senior |
$1,049.20
|
| Rate for Payer: Humana Medicare |
$515.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$168.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$979.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$306.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$608.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$423.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$649.30
|
| Rate for Payer: Multiplan Commercial |
$1,271.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$566.85
|
| Rate for Payer: TriValley Medical Group Senior |
$515.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC GASTROESOPHAGEAL REFLUX
|
Facility
|
IP
|
$1,695.00
|
|
|
Service Code
|
CPT 78262
|
| Hospital Charge Code |
909301365
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$306.80 |
| Max. Negotiated Rate |
$1,271.25 |
| Rate for Payer: Adventist Health Commercial |
$339.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,164.46
|
| Rate for Payer: Cash Price |
$762.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,147.52
|
| Rate for Payer: Heritage Provider Network Senior |
$1,147.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$306.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$423.75
|
| Rate for Payer: Multiplan Commercial |
$1,271.25
|
|
|
HC GASTROESOPHAGEAL REFLUX TEST
|
Facility
|
IP
|
$3,575.00
|
|
|
Service Code
|
CPT 91034
|
| Hospital Charge Code |
906791034
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$647.08 |
| Max. Negotiated Rate |
$2,681.25 |
| Rate for Payer: Adventist Health Commercial |
$715.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,456.02
|
| Rate for Payer: Cash Price |
$1,608.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,420.28
|
| Rate for Payer: Heritage Provider Network Senior |
$2,420.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$647.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$893.75
|
| Rate for Payer: Multiplan Commercial |
$2,681.25
|
|
|
HC GASTROESOPHAGEAL REFLUX TEST
|
Facility
|
OP
|
$1,578.00
|
|
|
Service Code
|
CPT 91034
|
| Hospital Charge Code |
906791034
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$121.07 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$315.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$352.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,084.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$736.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$669.68
|
| 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 |
$710.10
|
| Rate for Payer: Cash Price |
$710.10
|
| Rate for Payer: Cash Price |
$710.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,025.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$736.65
|
| Rate for Payer: Dignity Health Senior |
$669.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$946.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$669.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$976.78
|
| Rate for Payer: Heritage Provider Network Senior |
$823.71
|
| Rate for Payer: Humana Medicare |
$669.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$121.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$669.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,272.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$285.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$790.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$394.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$843.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$843.80
|
| Rate for Payer: Multiplan Commercial |
$1,183.50
|
| 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 |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$736.65
|
| Rate for Payer: Vantage Medical Group Senior |
$669.68
|
|
|
HC GASTROESOPHAGEAL REFLUX TEST
|
Facility
|
OP
|
$2,731.00
|
|
|
Service Code
|
CPT 91035
|
| Hospital Charge Code |
906791035
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$159.79 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$546.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$967.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,876.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$736.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$669.68
|
| 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 |
$1,228.95
|
| Rate for Payer: Cash Price |
$1,228.95
|
| Rate for Payer: Cash Price |
$1,228.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,775.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$736.65
|
| Rate for Payer: Dignity Health Senior |
$669.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,638.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$669.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,690.49
|
| Rate for Payer: Heritage Provider Network Senior |
$823.71
|
| Rate for Payer: Humana Medicare |
$669.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$159.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$669.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,272.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$494.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$790.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$682.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$843.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$843.80
|
| Rate for Payer: Multiplan Commercial |
$2,048.25
|
| 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 |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$736.65
|
| Rate for Payer: Vantage Medical Group Senior |
$669.68
|
|
|
HC GASTROESOPHAGEAL REFLUX TEST
|
Facility
|
IP
|
$884.00
|
|
|
Service Code
|
CPT 91035
|
| Hospital Charge Code |
906791035
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$160.00 |
| Max. Negotiated Rate |
$663.00 |
| Rate for Payer: Adventist Health Commercial |
$176.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$607.31
|
| Rate for Payer: Cash Price |
$397.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$598.47
|
| Rate for Payer: Heritage Provider Network Senior |
$598.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.00
|
| Rate for Payer: Multiplan Commercial |
$663.00
|
|
|
HC GASTROJEJUNOSTOMY SET D/L
|
Facility
|
IP
|
$928.00
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
909001042
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$185.60 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$185.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$445.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$637.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$426.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$501.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$628.26
|
| Rate for Payer: Heritage Provider Network Senior |
$7,571.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$464.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$464.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$464.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$232.00
|
| Rate for Payer: Multiplan Commercial |
$696.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$338.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$310.04
|
|
|
HC GASTROJEJUNOSTOMY SET D/L
|
Facility
|
OP
|
$928.00
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
909001042
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$185.60 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$185.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$445.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$637.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$788.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$510.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$696.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$576.29
|
| Rate for Payer: Blue Shield of California EPN |
$544.74
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$426.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$788.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$788.80
|
| Rate for Payer: Dignity Health Senior |
$788.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$593.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$429.66
|
| Rate for Payer: Heritage Provider Network Senior |
$429.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$464.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$464.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$464.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$232.00
|
| Rate for Payer: Multiplan Commercial |
$696.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$338.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$310.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$788.80
|
| Rate for Payer: Vantage Medical Group Senior |
$788.80
|
|
|
HC GASTROJEJUNOSTOMY SET SGL/LMN
|
Facility
|
IP
|
$619.00
|
|
| Hospital Charge Code |
909001041
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$123.80 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$123.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$297.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$425.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$278.55
|
| Rate for Payer: Cash Price |
$278.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$284.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$334.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$419.06
|
| Rate for Payer: Heritage Provider Network Senior |
$7,571.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$309.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$309.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$309.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.75
|
| Rate for Payer: Multiplan Commercial |
$464.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$225.69
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$206.81
|
|
|
HC GASTROJEJUNOSTOMY SET SGL/LMN
|
Facility
|
OP
|
$619.00
|
|
| Hospital Charge Code |
909001041
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$123.80 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$123.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$297.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$425.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$526.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$340.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$464.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$384.40
|
| Rate for Payer: Blue Shield of California EPN |
$363.35
|
| Rate for Payer: Cash Price |
$278.55
|
| Rate for Payer: Cash Price |
$278.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$284.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$526.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$526.15
|
| Rate for Payer: Dignity Health Senior |
$526.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$396.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$286.60
|
| Rate for Payer: Heritage Provider Network Senior |
$286.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$309.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$309.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$309.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.75
|
| Rate for Payer: Multiplan Commercial |
$464.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$225.69
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$206.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$526.15
|
| Rate for Payer: Vantage Medical Group Senior |
$526.15
|
|
|
HC GASTRO PANEL NUCLEIC ACID
|
Facility
|
OP
|
$644.00
|
|
|
Service Code
|
CPT 87507
|
| Hospital Charge Code |
900913644
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$116.56 |
| Max. Negotiated Rate |
$3,170.54 |
| Rate for Payer: Adventist Health Commercial |
$128.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,172.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$442.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$625.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$458.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$416.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,617.17
|
| Rate for Payer: Blue Shield of California Commercial |
$3,170.54
|
| Rate for Payer: Blue Shield of California EPN |
$2,478.58
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$418.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$625.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$458.46
|
| Rate for Payer: Dignity Health Senior |
$416.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$418.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$416.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$398.64
|
| Rate for Payer: Heritage Provider Network Senior |
$398.64
|
| Rate for Payer: Humana Medicare |
$416.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$577.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$416.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$791.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$491.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$525.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.14
|
| Rate for Payer: Multiplan Commercial |
$483.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$416.78
|
| Rate for Payer: TriValley Medical Group Senior |
$416.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$450.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$450.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$625.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$458.46
|
| Rate for Payer: Vantage Medical Group Senior |
$416.78
|
|
|
HC GASTRO PANEL NUCLEIC ACID
|
Facility
|
IP
|
$766.00
|
|
|
Service Code
|
CPT 87507
|
| Hospital Charge Code |
900913644
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$138.65 |
| Max. Negotiated Rate |
$574.50 |
| Rate for Payer: Adventist Health Commercial |
$153.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$526.24
|
| Rate for Payer: Cash Price |
$344.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$518.58
|
| Rate for Payer: Heritage Provider Network Senior |
$518.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$138.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.50
|
| Rate for Payer: Multiplan Commercial |
$574.50
|
|
|
HC GASTROSTOMY TUBE PERCUT
|
Facility
|
IP
|
$2,706.00
|
|
|
Service Code
|
CPT 49440
|
| Hospital Charge Code |
906743750
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$489.79 |
| Max. Negotiated Rate |
$2,029.50 |
| Rate for Payer: Adventist Health Commercial |
$541.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,859.02
|
| Rate for Payer: Cash Price |
$1,217.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,831.96
|
| Rate for Payer: Heritage Provider Network Senior |
$1,831.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$489.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$676.50
|
| Rate for Payer: Multiplan Commercial |
$2,029.50
|
|
|
HC GASTROSTOMY TUBE PERCUT
|
Facility
|
OP
|
$2,547.00
|
|
|
Service Code
|
CPT 49440
|
| Hospital Charge Code |
906743750
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$509.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,749.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| 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 |
$1,146.15
|
| Rate for Payer: Cash Price |
$1,146.15
|
| Rate for Payer: Cash Price |
$1,146.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,655.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: Dignity Health Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,377.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,576.59
|
| Rate for Payer: Heritage Provider Network Senior |
$2,924.26
|
| Rate for Payer: Humana Medicare |
$2,377.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,436.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,517.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$461.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,805.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$636.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,995.59
|
| Rate for Payer: Multiplan Commercial |
$1,910.25
|
| 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 |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC GASTROSTOMY TUBE REPOSITION
|
Facility
|
IP
|
$3,076.00
|
|
|
Service Code
|
CPT 43761
|
| Hospital Charge Code |
906743761
|
|
Hospital Revenue Code
|
949
|
| Min. Negotiated Rate |
$556.76 |
| Max. Negotiated Rate |
$2,307.00 |
| Rate for Payer: Adventist Health Commercial |
$615.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,113.21
|
| Rate for Payer: Cash Price |
$1,384.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,082.45
|
| Rate for Payer: Heritage Provider Network Senior |
$2,082.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$556.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$769.00
|
| Rate for Payer: Multiplan Commercial |
$2,307.00
|
|
|
HC GASTROSTOMY TUBE REPOSITION
|
Facility
|
OP
|
$3,076.00
|
|
|
Service Code
|
CPT 43761
|
| Hospital Charge Code |
906743761
|
|
Hospital Revenue Code
|
949
|
| Min. Negotiated Rate |
$123.71 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$615.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,113.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$308.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,910.20
|
| Rate for Payer: Blue Shield of California EPN |
$1,805.61
|
| Rate for Payer: Cash Price |
$1,384.20
|
| Rate for Payer: Cash Price |
$1,384.20
|
| Rate for Payer: Cash Price |
$1,384.20
|
| Rate for Payer: Cash Price |
$1,384.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,999.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.67
|
| Rate for Payer: Dignity Health Senior |
$308.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$308.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,904.04
|
| Rate for Payer: Heritage Provider Network Senior |
$1,904.04
|
| Rate for Payer: Humana Medicare |
$308.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$123.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$308.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$586.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$556.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$364.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$769.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$389.08
|
| Rate for Payer: Multiplan Commercial |
$2,307.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$339.67
|
| Rate for Payer: TriValley Medical Group Senior |
$308.79
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$501.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$422.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Vantage Medical Group Senior |
$308.79
|
|
|
HC GASTRO TUBE PLACEMENT
|
Facility
|
OP
|
$1,928.00
|
|
|
Service Code
|
CPT 44500
|
| Hospital Charge Code |
906744500
|
|
Hospital Revenue Code
|
949
|
| Min. Negotiated Rate |
$30.20 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$385.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$51.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,324.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,197.29
|
| Rate for Payer: Blue Shield of California EPN |
$1,131.74
|
| Rate for Payer: Cash Price |
$867.60
|
| Rate for Payer: Cash Price |
$867.60
|
| Rate for Payer: Cash Price |
$867.60
|
| Rate for Payer: Cash Price |
$867.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,253.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: Dignity Health Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,132.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,193.43
|
| Rate for Payer: Heritage Provider Network Senior |
$1,193.43
|
| Rate for Payer: Humana Medicare |
$1,132.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,151.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$348.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,336.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$482.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,427.06
|
| Rate for Payer: Multiplan Commercial |
$1,446.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,245.85
|
| Rate for Payer: TriValley Medical Group Senior |
$1,132.59
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$501.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$422.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC GASTRO TUBE PLACEMENT
|
Facility
|
IP
|
$1,928.00
|
|
|
Service Code
|
CPT 44500
|
| Hospital Charge Code |
906744500
|
|
Hospital Revenue Code
|
949
|
| Min. Negotiated Rate |
$348.97 |
| Max. Negotiated Rate |
$1,446.00 |
| Rate for Payer: Adventist Health Commercial |
$385.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,324.54
|
| Rate for Payer: Cash Price |
$867.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,305.26
|
| Rate for Payer: Heritage Provider Network Senior |
$1,305.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$348.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$482.00
|
| Rate for Payer: Multiplan Commercial |
$1,446.00
|
|
|
HC GASTRO TUBE REMOVAL
|
Facility
|
IP
|
$8,010.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
900100022
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,449.81 |
| Max. Negotiated Rate |
$6,007.50 |
| Rate for Payer: Adventist Health Commercial |
$1,602.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,502.87
|
| Rate for Payer: Cash Price |
$3,604.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,422.77
|
| Rate for Payer: Heritage Provider Network Senior |
$5,422.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,449.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,002.50
|
| Rate for Payer: Multiplan Commercial |
$6,007.50
|
|
|
HC GASTRO TUBE REMOVAL
|
Facility
|
OP
|
$4,245.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
900100022
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$849.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,916.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| 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 |
$1,910.25
|
| Rate for Payer: Cash Price |
$1,910.25
|
| Rate for Payer: Cash Price |
$1,910.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,759.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: Dignity Health Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,132.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,627.66
|
| Rate for Payer: Heritage Provider Network Senior |
$1,393.09
|
| Rate for Payer: Humana Medicare |
$1,132.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,151.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$768.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,336.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,061.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,427.06
|
| Rate for Payer: Multiplan Commercial |
$3,183.75
|
| 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 |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC GASTRO UGI SNGL CNTRST
|
Facility
|
OP
|
$926.00
|
|
|
Service Code
|
CPT 74240
|
| Hospital Charge Code |
909001873
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$137.33 |
| Max. Negotiated Rate |
$694.50 |
| Rate for Payer: Adventist Health Commercial |
$185.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$173.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$636.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$351.01
|
| Rate for Payer: Blue Shield of California Commercial |
$297.54
|
| Rate for Payer: Blue Shield of California EPN |
$169.20
|
| Rate for Payer: Cash Price |
$416.70
|
| Rate for Payer: Cash Price |
$416.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$601.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: Dignity Health Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$601.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$229.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.19
|
| Rate for Payer: Heritage Provider Network Senior |
$573.19
|
| Rate for Payer: Humana Medicare |
$229.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$159.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$436.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$167.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$270.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$289.25
|
| Rate for Payer: Multiplan Commercial |
$694.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$229.56
|
| Rate for Payer: TriValley Medical Group Senior |
$229.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$137.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$137.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC GASTRO UGI SNGL CNTRST
|
Facility
|
IP
|
$926.00
|
|
|
Service Code
|
CPT 74240
|
| Hospital Charge Code |
909001873
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$167.61 |
| Max. Negotiated Rate |
$694.50 |
| Rate for Payer: Adventist Health Commercial |
$185.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$636.16
|
| Rate for Payer: Cash Price |
$416.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$626.90
|
| Rate for Payer: Heritage Provider Network Senior |
$626.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$167.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.50
|
| Rate for Payer: Multiplan Commercial |
$694.50
|
|
|
HC GASTROVIEW PER ML
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT Q9960
|
| Hospital Charge Code |
909001017
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.32
|
| Rate for Payer: Blue Shield of California Commercial |
$0.62
|
| Rate for Payer: Blue Shield of California EPN |
$0.59
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.85
|
| Rate for Payer: Dignity Health Senior |
$0.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.62
|
| Rate for Payer: Heritage Provider Network Senior |
$0.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.40
|
| Rate for Payer: TriValley Medical Group Senior |
$0.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Vantage Medical Group Senior |
$0.85
|
|
