|
HC ECHO TRANSTHO W/CONT COMPLETE
|
Facility
|
IP
|
$1,700.00
|
|
|
Service Code
|
CPT C8921
|
| Hospital Charge Code |
900200240
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$307.70 |
| Max. Negotiated Rate |
$1,275.00 |
| Rate for Payer: Adventist Health Commercial |
$340.00
|
| Rate for Payer: Cash Price |
$935.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,150.90
|
| Rate for Payer: Heritage Provider Network Senior |
$1,150.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$307.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.00
|
| Rate for Payer: Multiplan Commercial |
$1,275.00
|
|
|
HC ECHO TTE W DOPPLER COMPLETE
|
Facility
|
OP
|
$2,713.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
900200248
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$264.00 |
| Max. Negotiated Rate |
$2,034.75 |
| Rate for Payer: Adventist Health Commercial |
$542.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,450.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,863.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$766.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$696.67
|
| Rate for Payer: Blue Shield of California Commercial |
$1,654.93
|
| Rate for Payer: Blue Shield of California EPN |
$1,323.94
|
| 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 |
$1,045.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$766.34
|
| Rate for Payer: Dignity Health Senior |
$696.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,763.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$696.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,679.35
|
| Rate for Payer: Heritage Provider Network Senior |
$1,679.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$388.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$696.67
|
| 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 |
$801.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$678.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$877.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$877.80
|
| Rate for Payer: Multiplan Commercial |
$2,034.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$766.34
|
| Rate for Payer: TriValley Medical Group Senior |
$696.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$313.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$264.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$766.34
|
| Rate for Payer: Vantage Medical Group Senior |
$696.67
|
|
|
HC ECHO TTE W DOPPLER COMPLETE
|
Facility
|
IP
|
$2,713.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
900200248
|
|
Hospital Revenue Code
|
483
|
| 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 ED EVAL & MGMT
|
Facility
|
IP
|
$1,118.00
|
|
|
Service Code
|
CPT 99281
|
| Hospital Charge Code |
900509281
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$202.36 |
| Max. Negotiated Rate |
$838.50 |
| Rate for Payer: Adventist Health Commercial |
$223.60
|
| Rate for Payer: Cash Price |
$614.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$756.89
|
| Rate for Payer: Heritage Provider Network Senior |
$756.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$202.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$279.50
|
| Rate for Payer: Multiplan Commercial |
$838.50
|
|
|
HC ED EVAL & MGMT
|
Facility
|
OP
|
$1,118.00
|
|
|
Service Code
|
CPT 99281
|
| Hospital Charge Code |
900509281
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$111.88 |
| Max. Negotiated Rate |
$1,915.00 |
| Rate for Payer: Adventist Health Commercial |
$223.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$996.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$768.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,915.00
|
| Rate for Payer: Cash Price |
$614.90
|
| Rate for Payer: Cash Price |
$614.90
|
| Rate for Payer: Cash Price |
$614.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$726.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Senior |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$726.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$756.89
|
| Rate for Payer: Heritage Provider Network Senior |
$756.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$533.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$202.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$279.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.97
|
| Rate for Payer: Multiplan Commercial |
$838.50
|
| Rate for Payer: Multiplan WC |
$178.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$402.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$370.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC ED EVAL & MGMT HIGH
|
Facility
|
IP
|
$4,944.00
|
|
|
Service Code
|
CPT 99285
|
| Hospital Charge Code |
900509285
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$894.86 |
| Max. Negotiated Rate |
$3,708.00 |
| Rate for Payer: Adventist Health Commercial |
$988.80
|
| Rate for Payer: Cash Price |
$2,719.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,347.09
|
| Rate for Payer: Heritage Provider Network Senior |
$3,347.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$894.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,236.00
|
| Rate for Payer: Multiplan Commercial |
$3,708.00
|
|
|
HC ED EVAL & MGMT HIGH
|
Facility
|
OP
|
$4,944.00
|
|
|
Service Code
|
CPT 99285
|
| Hospital Charge Code |
900509285
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$779.00 |
| Max. Negotiated Rate |
$3,708.00 |
| Rate for Payer: Adventist Health Commercial |
$988.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,624.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,396.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,168.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$856.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$779.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,915.00
|
| Rate for Payer: Cash Price |
$2,719.20
|
| Rate for Payer: Cash Price |
$2,719.20
|
| Rate for Payer: Cash Price |
$2,719.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,213.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,168.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$856.90
|
| Rate for Payer: Dignity Health Senior |
$779.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,213.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$779.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,347.09
|
| Rate for Payer: Heritage Provider Network Senior |
$3,347.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$779.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,358.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$894.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$895.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,236.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$981.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$981.54
|
| Rate for Payer: Multiplan Commercial |
$3,708.00
|
| Rate for Payer: Multiplan WC |
$1,241.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,778.85
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,636.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,168.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$856.90
|
| Rate for Payer: Vantage Medical Group Senior |
$779.00
|
|
|
HC ED EVAL & MGMT LOW
|
Facility
|
IP
|
$3,074.00
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
900509283
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$556.39 |
| Max. Negotiated Rate |
$2,305.50 |
| Rate for Payer: Adventist Health Commercial |
$614.80
|
| Rate for Payer: Cash Price |
$1,690.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,081.10
|
| Rate for Payer: Heritage Provider Network Senior |
$2,081.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$556.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$768.50
|
| Rate for Payer: Multiplan Commercial |
$2,305.50
|
|
|
HC ED EVAL & MGMT LOW
|
Facility
|
OP
|
$3,074.00
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
900509283
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$351.82 |
| Max. Negotiated Rate |
$2,305.50 |
| Rate for Payer: Adventist Health Commercial |
$614.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,364.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,111.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$527.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$387.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$351.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,915.00
|
| Rate for Payer: Cash Price |
$1,690.70
|
| Rate for Payer: Cash Price |
$1,690.70
|
| Rate for Payer: Cash Price |
$1,690.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,998.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$527.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$387.00
|
| Rate for Payer: Dignity Health Senior |
$351.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,998.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$351.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,081.10
|
| Rate for Payer: Heritage Provider Network Senior |
$2,081.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$351.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,466.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$556.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$404.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$768.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$443.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$443.29
|
| Rate for Payer: Multiplan Commercial |
$2,305.50
|
| Rate for Payer: Multiplan WC |
$560.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,106.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,017.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$527.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$387.00
|
| Rate for Payer: Vantage Medical Group Senior |
$351.82
|
|
|
HC ED EVAL & MGMT MINOR
|
Facility
|
OP
|
$1,835.00
|
|
|
Service Code
|
CPT 99282
|
| Hospital Charge Code |
900509282
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$201.21 |
| Max. Negotiated Rate |
$1,915.00 |
| Rate for Payer: Adventist Health Commercial |
$367.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$996.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,260.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$301.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$221.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$201.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,915.00
|
| Rate for Payer: Cash Price |
$1,009.25
|
| Rate for Payer: Cash Price |
$1,009.25
|
| Rate for Payer: Cash Price |
$1,009.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,192.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$301.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$221.33
|
| Rate for Payer: Dignity Health Senior |
$201.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,192.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$201.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,242.30
|
| Rate for Payer: Heritage Provider Network Senior |
$1,242.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$201.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$875.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$332.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$231.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$458.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$253.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$253.52
|
| Rate for Payer: Multiplan Commercial |
$1,376.25
|
| Rate for Payer: Multiplan WC |
$320.59
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$660.23
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$607.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$301.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$221.33
|
| Rate for Payer: Vantage Medical Group Senior |
$201.21
|
|
|
HC ED EVAL & MGMT MINOR
|
Facility
|
IP
|
$1,835.00
|
|
|
Service Code
|
CPT 99282
|
| Hospital Charge Code |
900509282
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$332.13 |
| Max. Negotiated Rate |
$1,376.25 |
| Rate for Payer: Adventist Health Commercial |
$367.00
|
| Rate for Payer: Cash Price |
$1,009.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,242.30
|
| Rate for Payer: Heritage Provider Network Senior |
$1,242.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$332.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$458.75
|
| Rate for Payer: Multiplan Commercial |
$1,376.25
|
|
|
HC ED EVAL & MGMT MODERATE
|
Facility
|
IP
|
$4,500.00
|
|
|
Service Code
|
CPT 99284
|
| Hospital Charge Code |
900509284
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$814.50 |
| Max. Negotiated Rate |
$3,375.00 |
| Rate for Payer: Adventist Health Commercial |
$900.00
|
| Rate for Payer: Cash Price |
$2,475.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,046.50
|
| Rate for Payer: Heritage Provider Network Senior |
$3,046.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$814.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,125.00
|
| Rate for Payer: Multiplan Commercial |
$3,375.00
|
|
|
HC ED EVAL & MGMT MODERATE
|
Facility
|
OP
|
$4,500.00
|
|
|
Service Code
|
CPT 99284
|
| Hospital Charge Code |
900509284
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$541.05 |
| Max. Negotiated Rate |
$3,375.00 |
| Rate for Payer: Adventist Health Commercial |
$900.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,624.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,091.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$811.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$595.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$541.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,915.00
|
| Rate for Payer: Cash Price |
$2,475.00
|
| Rate for Payer: Cash Price |
$2,475.00
|
| Rate for Payer: Cash Price |
$2,475.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,925.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$811.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$595.15
|
| Rate for Payer: Dignity Health Senior |
$541.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,925.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$541.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,046.50
|
| Rate for Payer: Heritage Provider Network Senior |
$3,046.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$541.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,146.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$814.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$622.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,125.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$681.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$681.72
|
| Rate for Payer: Multiplan Commercial |
$3,375.00
|
| Rate for Payer: Multiplan WC |
$862.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,619.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,489.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$811.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$595.15
|
| Rate for Payer: Vantage Medical Group Senior |
$541.05
|
|
|
HC EEG EXTENDED MONITORING LT 1 HR
|
Facility
|
OP
|
$2,255.00
|
|
|
Service Code
|
CPT 95812
|
| Hospital Charge Code |
900600201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$395.66 |
| Max. Negotiated Rate |
$1,915.00 |
| Rate for Payer: Adventist Health Commercial |
$451.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,205.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,549.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$395.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,915.00
|
| Rate for Payer: Cash Price |
$1,240.25
|
| Rate for Payer: Cash Price |
$1,240.25
|
| Rate for Payer: Cash Price |
$1,240.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,465.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$435.23
|
| Rate for Payer: Dignity Health Senior |
$395.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,465.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$395.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,526.63
|
| Rate for Payer: Heritage Provider Network Senior |
$1,526.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$395.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,075.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$408.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$455.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$563.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$498.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$498.53
|
| Rate for Payer: Multiplan Commercial |
$1,691.25
|
| Rate for Payer: Multiplan WC |
$630.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$811.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$746.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Vantage Medical Group Senior |
$395.66
|
|
|
HC EEG EXTENDED MONITORING LT 1 HR
|
Facility
|
IP
|
$2,255.00
|
|
|
Service Code
|
CPT 95812
|
| Hospital Charge Code |
900600201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$408.15 |
| Max. Negotiated Rate |
$1,691.25 |
| Rate for Payer: Adventist Health Commercial |
$451.00
|
| Rate for Payer: Cash Price |
$1,240.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,526.63
|
| Rate for Payer: Heritage Provider Network Senior |
$1,526.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$408.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$563.75
|
| Rate for Payer: Multiplan Commercial |
$1,691.25
|
|
|
HC EGD BLLN DILA ESOPH 30MM OR GT
|
Facility
|
OP
|
$2,153.00
|
|
|
Service Code
|
CPT 43233
|
| Hospital Charge Code |
906743233
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$430.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,479.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,410.32
|
| 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 |
$1,184.15
|
| Rate for Payer: Cash Price |
$1,184.15
|
| Rate for Payer: Cash Price |
$1,184.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,399.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,651.35
|
| Rate for Payer: Dignity Health Senior |
$2,410.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,410.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,332.71
|
| Rate for Payer: Heritage Provider Network Senior |
$2,964.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$326.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,026.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$389.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,771.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$538.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,037.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,037.00
|
| Rate for Payer: Multiplan Commercial |
$1,614.75
|
| 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 |
$3,615.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,410.32
|
|
|
HC EGD BLLN DILA ESOPH 30MM OR GT
|
Facility
|
IP
|
$2,153.00
|
|
|
Service Code
|
CPT 43233
|
| Hospital Charge Code |
906743233
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$389.69 |
| Max. Negotiated Rate |
$1,614.75 |
| Rate for Payer: Adventist Health Commercial |
$430.60
|
| Rate for Payer: Cash Price |
$1,184.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,457.58
|
| Rate for Payer: Heritage Provider Network Senior |
$1,457.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$389.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$538.25
|
| Rate for Payer: Multiplan Commercial |
$1,614.75
|
|
|
HC EGD DIAG W/ OR W/O COLLECTION
|
Facility
|
OP
|
$4,487.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
902100084
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$897.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,082.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Cash Price |
$2,467.85
|
| Rate for Payer: Cash Price |
$2,467.85
|
| Rate for Payer: Cash Price |
$2,467.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,916.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Senior |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,191.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,037.70
|
| Rate for Payer: Heritage Provider Network Senior |
$3,037.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,140.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$812.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,369.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,121.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,500.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,500.99
|
| Rate for Payer: Multiplan Commercial |
$3,365.25
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,614.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,485.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC EGD DIAG W/ OR W/O COLLECTION
|
Facility
|
IP
|
$3,288.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
906743235
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$595.13 |
| Max. Negotiated Rate |
$2,466.00 |
| Rate for Payer: Adventist Health Commercial |
$657.60
|
| Rate for Payer: Cash Price |
$1,808.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,225.98
|
| Rate for Payer: Heritage Provider Network Senior |
$2,225.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$595.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$822.00
|
| Rate for Payer: Multiplan Commercial |
$2,466.00
|
|
|
HC EGD DIAG W/ OR W/O COLLECTION
|
Facility
|
OP
|
$3,288.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
906743235
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$657.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,258.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Anthem Blue Cross of CA 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 |
$1,808.40
|
| Rate for Payer: Cash Price |
$1,808.40
|
| Rate for Payer: Cash Price |
$1,808.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,137.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Senior |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,191.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,035.27
|
| Rate for Payer: Heritage Provider Network Senior |
$1,465.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$363.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,568.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$595.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,369.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$822.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,500.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,500.99
|
| Rate for Payer: Multiplan Commercial |
$2,466.00
|
| 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 |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC EGD DIAG W/ OR W/O COLLECTION
|
Facility
|
IP
|
$4,487.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
902100084
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$812.15 |
| Max. Negotiated Rate |
$3,365.25 |
| Rate for Payer: Adventist Health Commercial |
$897.40
|
| Rate for Payer: Cash Price |
$2,467.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,037.70
|
| Rate for Payer: Heritage Provider Network Senior |
$3,037.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$812.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,121.75
|
| Rate for Payer: Multiplan Commercial |
$3,365.25
|
|
|
HC EGD DIAG W/SUBMUC INJ ANY SUBSTANCE
|
Facility
|
IP
|
$3,414.00
|
|
|
Service Code
|
CPT 43236
|
| Hospital Charge Code |
906743236
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$617.93 |
| Max. Negotiated Rate |
$2,560.50 |
| Rate for Payer: Adventist Health Commercial |
$682.80
|
| Rate for Payer: Cash Price |
$1,877.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,311.28
|
| Rate for Payer: Heritage Provider Network Senior |
$2,311.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$617.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$853.50
|
| Rate for Payer: Multiplan Commercial |
$2,560.50
|
|
|
HC EGD DIAG W/SUBMUC INJ ANY SUBSTANCE
|
Facility
|
OP
|
$3,414.00
|
|
|
Service Code
|
CPT 43236
|
| Hospital Charge Code |
906743236
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$682.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,345.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Anthem Blue Cross of CA 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 |
$1,877.70
|
| Rate for Payer: Cash Price |
$1,877.70
|
| Rate for Payer: Cash Price |
$1,877.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,219.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Senior |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,191.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,113.27
|
| Rate for Payer: Heritage Provider Network Senior |
$1,465.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$393.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,628.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$617.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,369.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$853.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,500.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,500.99
|
| Rate for Payer: Multiplan Commercial |
$2,560.50
|
| 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 |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC EGD DIAG W WO COLLECTION
|
Facility
|
OP
|
$3,288.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
900501432
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$657.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,258.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Cash Price |
$1,808.40
|
| Rate for Payer: Cash Price |
$1,808.40
|
| Rate for Payer: Cash Price |
$1,808.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,137.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Senior |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,191.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,225.98
|
| Rate for Payer: Heritage Provider Network Senior |
$2,225.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,568.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$595.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,369.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$822.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,500.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,500.99
|
| Rate for Payer: Multiplan Commercial |
$2,466.00
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,183.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,088.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC EGD DIAG W WO COLLECTION
|
Facility
|
IP
|
$3,288.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
900501432
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$595.13 |
| Max. Negotiated Rate |
$2,466.00 |
| Rate for Payer: Adventist Health Commercial |
$657.60
|
| Rate for Payer: Cash Price |
$1,808.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,225.98
|
| Rate for Payer: Heritage Provider Network Senior |
$2,225.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$595.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$822.00
|
| Rate for Payer: Multiplan Commercial |
$2,466.00
|
|
