|
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
|
|
|
HC GATED BLOOD POOL- MUGA
|
Facility
|
OP
|
$2,371.00
|
|
|
Service Code
|
CPT 78472
|
| Hospital Charge Code |
909301381
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$261.72 |
| Max. Negotiated Rate |
$1,778.25 |
| Rate for Payer: Adventist Health Commercial |
$474.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$450.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,628.88
|
| 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 |
$1,126.56
|
| Rate for Payer: Blue Shield of California EPN |
$640.64
|
| Rate for Payer: Cash Price |
$1,066.95
|
| Rate for Payer: Cash Price |
$1,066.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,541.15
|
| 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 |
$1,541.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$515.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,467.65
|
| Rate for Payer: Heritage Provider Network Senior |
$1,467.65
|
| Rate for Payer: Humana Medicare |
$515.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$261.72
|
| 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 |
$429.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$608.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$592.75
|
| 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 |
$1,778.25
|
| 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 GATED BLOOD POOL- MUGA
|
Facility
|
IP
|
$2,371.00
|
|
|
Service Code
|
CPT 78472
|
| Hospital Charge Code |
909301381
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$429.15 |
| Max. Negotiated Rate |
$1,778.25 |
| Rate for Payer: Adventist Health Commercial |
$474.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,628.88
|
| Rate for Payer: Cash Price |
$1,066.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,605.17
|
| Rate for Payer: Heritage Provider Network Senior |
$1,605.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$429.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$592.75
|
| Rate for Payer: Multiplan Commercial |
$1,778.25
|
|
|
HC GATED FIRST PASS
|
Facility
|
IP
|
$2,213.00
|
|
|
Service Code
|
CPT 78481
|
| Hospital Charge Code |
909301391
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$400.55 |
| Max. Negotiated Rate |
$1,659.75 |
| Rate for Payer: Adventist Health Commercial |
$442.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,520.33
|
| Rate for Payer: Cash Price |
$995.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,498.20
|
| Rate for Payer: Heritage Provider Network Senior |
$1,498.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$400.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$553.25
|
| Rate for Payer: Multiplan Commercial |
$1,659.75
|
|
|
HC GATED FIRST PASS
|
Facility
|
OP
|
$2,213.00
|
|
|
Service Code
|
CPT 78481
|
| Hospital Charge Code |
909301391
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$246.53 |
| Max. Negotiated Rate |
$1,659.75 |
| Rate for Payer: Adventist Health Commercial |
$442.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$355.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,520.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$675.33
|
| Rate for Payer: Blue Shield of California Commercial |
$1,066.86
|
| Rate for Payer: Blue Shield of California EPN |
$606.69
|
| Rate for Payer: Cash Price |
$995.85
|
| Rate for Payer: Cash Price |
$995.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,438.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$742.86
|
| Rate for Payer: Dignity Health Senior |
$675.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,438.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$675.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,369.85
|
| Rate for Payer: Heritage Provider Network Senior |
$1,369.85
|
| Rate for Payer: Humana Medicare |
$675.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$246.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$675.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,283.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$400.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$796.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$553.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$850.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$850.92
|
| Rate for Payer: Multiplan Commercial |
$1,659.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$742.86
|
| Rate for Payer: TriValley Medical Group Senior |
$675.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: Vantage Medical Group Senior |
$675.33
|
|
|
HC GB GALLBLADDER
|
Facility
|
IP
|
$455.00
|
|
|
Service Code
|
CPT 74290
|
| Hospital Charge Code |
909001818
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$82.36 |
| Max. Negotiated Rate |
$341.25 |
| Rate for Payer: Adventist Health Commercial |
$91.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$312.58
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$308.04
|
| Rate for Payer: Heritage Provider Network Senior |
$308.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.75
|
| Rate for Payer: Multiplan Commercial |
$341.25
|
|
|
HC GB GALLBLADDER
|
Facility
|
OP
|
$455.00
|
|
|
Service Code
|
CPT 74290
|
| Hospital Charge Code |
909001818
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$59.95 |
| Max. Negotiated Rate |
$436.16 |
| Rate for Payer: Adventist Health Commercial |
$91.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$117.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$312.58
|
| 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 |
$177.56
|
| Rate for Payer: Blue Shield of California Commercial |
$152.15
|
| Rate for Payer: Blue Shield of California EPN |
$86.52
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$295.75
|
| 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 |
$295.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$229.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$281.64
|
| Rate for Payer: Heritage Provider Network Senior |
$281.64
|
| Rate for Payer: Humana Medicare |
$229.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$59.95
|
| 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 |
$82.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$270.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.75
|
| 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 |
$341.25
|
| 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 GDC 2-DIAMETER
|
Facility
|
OP
|
$1,764.00
|
|
| Hospital Charge Code |
909081817
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$352.80 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$352.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$846.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,211.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,499.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$970.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,323.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,095.44
|
| Rate for Payer: Blue Shield of California EPN |
$1,035.47
|
| Rate for Payer: Cash Price |
$793.80
|
| Rate for Payer: Cash Price |
$793.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$811.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,499.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,499.40
|
| Rate for Payer: Dignity Health Senior |
$1,499.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,128.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$816.73
|
| Rate for Payer: Heritage Provider Network Senior |
$816.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$882.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$882.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$882.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$441.00
|
| Rate for Payer: Multiplan Commercial |
$1,323.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$643.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$589.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,499.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,499.40
|
|
|
HC GDC 2-DIAMETER
|
Facility
|
IP
|
$1,764.00
|
|
| Hospital Charge Code |
909081817
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$352.80 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$352.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$846.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,211.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$793.80
|
| Rate for Payer: Cash Price |
$793.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$811.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$952.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,194.23
|
| Rate for Payer: Heritage Provider Network Senior |
$1,194.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$882.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$882.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$882.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$441.00
|
| Rate for Payer: Multiplan Commercial |
$1,323.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$643.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$589.35
|
|
|
HC GDC 3-D SHAPE
|
Facility
|
IP
|
$3,900.00
|
|
| Hospital Charge Code |
909081818
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,872.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,679.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,794.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,106.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,640.30
|
| Rate for Payer: Heritage Provider Network Senior |
$2,640.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,950.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,421.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,302.99
|
|
|
HC GDC 3-D SHAPE
|
Facility
|
OP
|
$3,900.00
|
|
| Hospital Charge Code |
909081818
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,872.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,679.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,421.90
|
| Rate for Payer: Blue Shield of California EPN |
$2,289.30
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,794.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Senior |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,496.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,805.70
|
| Rate for Payer: Heritage Provider Network Senior |
$1,805.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,950.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,421.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,302.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC GDC SOFT
|
Facility
|
IP
|
$1,530.00
|
|
| Hospital Charge Code |
909081814
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$306.00 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$306.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$734.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,051.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$703.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$826.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,035.81
|
| Rate for Payer: Heritage Provider Network Senior |
$1,035.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$765.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$765.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$765.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$382.50
|
| Rate for Payer: Multiplan Commercial |
$1,147.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$557.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$511.17
|
|
|
HC GDC SOFT
|
Facility
|
OP
|
$1,530.00
|
|
| Hospital Charge Code |
909081814
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$306.00 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$306.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$734.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,051.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,300.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$841.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,147.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$950.13
|
| Rate for Payer: Blue Shield of California EPN |
$898.11
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$703.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,300.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,300.50
|
| Rate for Payer: Dignity Health Senior |
$1,300.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$979.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$708.39
|
| Rate for Payer: Heritage Provider Network Senior |
$708.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$765.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$765.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$765.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$382.50
|
| Rate for Payer: Multiplan Commercial |
$1,147.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$557.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$511.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,300.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,300.50
|
|
|
HC GDC STANDARD
|
Facility
|
IP
|
$4,347.50
|
|
| Hospital Charge Code |
909081815
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$869.50 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$869.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,086.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,986.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$1,956.38
|
| Rate for Payer: Cash Price |
$1,956.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,999.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,347.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,943.26
|
| Rate for Payer: Heritage Provider Network Senior |
$2,943.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,173.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,173.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,173.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,086.88
|
| Rate for Payer: Multiplan Commercial |
$3,260.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,585.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,452.50
|
|
|
HC GDC STANDARD
|
Facility
|
OP
|
$4,347.50
|
|
| Hospital Charge Code |
909081815
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$869.50 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$869.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,086.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,986.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,695.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,391.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,260.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.80
|
| Rate for Payer: Blue Shield of California EPN |
$2,551.98
|
| Rate for Payer: Cash Price |
$1,956.38
|
| Rate for Payer: Cash Price |
$1,956.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,999.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,695.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,695.38
|
| Rate for Payer: Dignity Health Senior |
$3,695.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,782.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,012.89
|
| Rate for Payer: Heritage Provider Network Senior |
$2,012.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,173.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,173.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,173.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,086.88
|
| Rate for Payer: Multiplan Commercial |
$3,260.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,585.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,452.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,695.38
|
| Rate for Payer: Vantage Medical Group Senior |
$3,695.38
|
|
|
HC GDC STRETCH RESISTANT
|
Facility
|
OP
|
$1,536.00
|
|
| Hospital Charge Code |
909081816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$278.02 |
| Max. Negotiated Rate |
$1,305.60 |
| Rate for Payer: Adventist Health Commercial |
$307.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$820.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,055.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,305.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$844.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,152.00
|
| Rate for Payer: Blue Shield of California Commercial |
$953.86
|
| Rate for Payer: Blue Shield of California EPN |
$901.63
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$998.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,305.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,305.60
|
| Rate for Payer: Dignity Health Senior |
$1,305.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$998.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$950.78
|
| Rate for Payer: Heritage Provider Network Senior |
$950.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$740.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$278.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.00
|
| Rate for Payer: Multiplan Commercial |
$1,152.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,305.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,305.60
|
|
|
HC GDC STRETCH RESISTANT
|
Facility
|
IP
|
$1,536.00
|
|
| Hospital Charge Code |
909081816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$278.02 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Adventist Health Commercial |
$307.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,055.23
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,039.87
|
| Rate for Payer: Heritage Provider Network Senior |
$1,039.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$278.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.00
|
| Rate for Payer: Multiplan Commercial |
$1,152.00
|
|
|
HC GENTAMICIN
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
900910406
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.36 |
| Max. Negotiated Rate |
$167.25 |
| Rate for Payer: Adventist Health Commercial |
$44.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$153.20
|
| Rate for Payer: Cash Price |
$100.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$150.97
|
| Rate for Payer: Heritage Provider Network Senior |
$150.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.75
|
| Rate for Payer: Multiplan Commercial |
$167.25
|
|
|
HC GENTAMICIN
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
900910406
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$128.01 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$47.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.25
|
| Rate for Payer: Blue Shield of California Commercial |
$128.01
|
| Rate for Payer: Blue Shield of California EPN |
$100.07
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.02
|
| Rate for Payer: Dignity Health Senior |
$16.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.95
|
| Rate for Payer: Heritage Provider Network Senior |
$30.95
|
| Rate for Payer: Humana Medicare |
$16.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$31.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.64
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.38
|
| Rate for Payer: TriValley Medical Group Senior |
$16.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.69
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.02
|
| Rate for Payer: Vantage Medical Group Senior |
$16.38
|
|
|
HC GI BLEED SCAN
|
Facility
|
IP
|
$2,192.00
|
|
|
Service Code
|
CPT 78278
|
| Hospital Charge Code |
909301360
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$396.75 |
| Max. Negotiated Rate |
$1,644.00 |
| Rate for Payer: Adventist Health Commercial |
$438.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,505.90
|
| Rate for Payer: Cash Price |
$986.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,483.98
|
| Rate for Payer: Heritage Provider Network Senior |
$1,483.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$396.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$548.00
|
| Rate for Payer: Multiplan Commercial |
$1,644.00
|
|
|
HC GI BLEED SCAN
|
Facility
|
OP
|
$2,192.00
|
|
|
Service Code
|
CPT 78278
|
| Hospital Charge Code |
909301360
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$202.49 |
| Max. Negotiated Rate |
$1,644.00 |
| Rate for Payer: Adventist Health Commercial |
$438.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$532.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,505.90
|
| 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 |
$994.02
|
| Rate for Payer: Blue Shield of California EPN |
$565.27
|
| Rate for Payer: Cash Price |
$986.40
|
| Rate for Payer: Cash Price |
$986.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,424.80
|
| 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 |
$1,424.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$515.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,356.85
|
| Rate for Payer: Heritage Provider Network Senior |
$1,356.85
|
| Rate for Payer: Humana Medicare |
$515.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$202.49
|
| 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 |
$396.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$608.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$548.00
|
| 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 |
$1,644.00
|
| 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 GI ENDOSCOPIC ULTRASOUND
|
Facility
|
IP
|
$1,205.00
|
|
|
Service Code
|
CPT 76975
|
| Hospital Charge Code |
906776975
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$218.10 |
| Max. Negotiated Rate |
$903.75 |
| Rate for Payer: Adventist Health Commercial |
$241.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$827.84
|
| Rate for Payer: Cash Price |
$542.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$815.78
|
| Rate for Payer: Heritage Provider Network Senior |
$815.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$301.25
|
| Rate for Payer: Multiplan Commercial |
$903.75
|
|
|
HC GI ENDOSCOPIC ULTRASOUND
|
Facility
|
OP
|
$1,205.00
|
|
|
Service Code
|
CPT 76975
|
| Hospital Charge Code |
906776975
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$74.72 |
| Max. Negotiated Rate |
$903.75 |
| Rate for Payer: Adventist Health Commercial |
$241.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$340.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$827.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Blue Shield of California Commercial |
$312.13
|
| Rate for Payer: Blue Shield of California EPN |
$177.50
|
| Rate for Payer: Cash Price |
$542.25
|
| Rate for Payer: Cash Price |
$542.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$783.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: Dignity Health Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$783.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$745.90
|
| Rate for Payer: Heritage Provider Network Senior |
$745.90
|
| Rate for Payer: Humana Medicare |
$306.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$74.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$581.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$301.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$385.76
|
| Rate for Payer: Multiplan Commercial |
$903.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$306.16
|
| Rate for Payer: TriValley Medical Group Senior |
$306.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$243.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$243.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC GI INJ TREATMENT NR
|
Facility
|
IP
|
$1,653.00
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
906764640
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$299.19 |
| Max. Negotiated Rate |
$1,239.75 |
| Rate for Payer: Adventist Health Commercial |
$330.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,135.61
|
| Rate for Payer: Cash Price |
$743.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,119.08
|
| Rate for Payer: Heritage Provider Network Senior |
$1,119.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$299.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$413.25
|
| Rate for Payer: Multiplan Commercial |
$1,239.75
|
|
|
HC GI INJ TREATMENT NR
|
Facility
|
IP
|
$1,653.00
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
906764640
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$299.19 |
| Max. Negotiated Rate |
$1,239.75 |
| Rate for Payer: Adventist Health Commercial |
$330.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,135.61
|
| Rate for Payer: Cash Price |
$743.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,119.08
|
| Rate for Payer: Heritage Provider Network Senior |
$1,119.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$299.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$413.25
|
| Rate for Payer: Multiplan Commercial |
$1,239.75
|
|
