|
HC GI ENDOSCOPIC ULTRASOUND
|
Facility
|
IP
|
$1,355.00
|
|
|
Service Code
|
CPT 76975
|
| Hospital Charge Code |
906776975
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$245.25 |
| Max. Negotiated Rate |
$1,016.25 |
| Rate for Payer: Adventist Health Commercial |
$271.00
|
| Rate for Payer: Cash Price |
$745.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$917.34
|
| Rate for Payer: Heritage Provider Network Senior |
$917.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$245.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$338.75
|
| Rate for Payer: Multiplan Commercial |
$1,016.25
|
|
|
HC GI INJ TREATMENT NR
|
Facility
|
IP
|
$1,806.00
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
906764640
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$326.89 |
| Max. Negotiated Rate |
$1,354.50 |
| Rate for Payer: Adventist Health Commercial |
$361.20
|
| Rate for Payer: Cash Price |
$993.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,222.66
|
| Rate for Payer: Heritage Provider Network Senior |
$1,222.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$326.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$451.50
|
| Rate for Payer: Multiplan Commercial |
$1,354.50
|
|
|
HC GI INJ TREATMENT NR
|
Facility
|
OP
|
$1,806.00
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
906764640
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$361.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,240.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,131.20
|
| 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 |
$993.30
|
| Rate for Payer: Cash Price |
$993.30
|
| Rate for Payer: Cash Price |
$993.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,173.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,244.32
|
| Rate for Payer: Dignity Health Senior |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,083.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,131.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,117.91
|
| Rate for Payer: Heritage Provider Network Senior |
$1,391.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$203.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,131.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,149.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$326.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,300.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$451.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,425.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,425.31
|
| Rate for Payer: Multiplan Commercial |
$1,354.50
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,244.32
|
| Rate for Payer: TriValley Medical Group Senior |
$1,244.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,131.20
|
|
|
HC GI INJ TREATMENT NR
|
Facility
|
OP
|
$1,806.00
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
906764640
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$361.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,240.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,131.20
|
| 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 |
$993.30
|
| Rate for Payer: Cash Price |
$993.30
|
| Rate for Payer: Cash Price |
$993.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,173.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,244.32
|
| Rate for Payer: Dignity Health Senior |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,083.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,131.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,117.91
|
| Rate for Payer: Heritage Provider Network Senior |
$1,391.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$203.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,131.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$861.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$326.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,300.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$451.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,425.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,425.31
|
| Rate for Payer: Multiplan Commercial |
$1,354.50
|
| 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 |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,131.20
|
|
|
HC GI INJ TREATMENT NR
|
Facility
|
IP
|
$1,806.00
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
906764640
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$326.89 |
| Max. Negotiated Rate |
$1,354.50 |
| Rate for Payer: Adventist Health Commercial |
$361.20
|
| Rate for Payer: Cash Price |
$993.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,222.66
|
| Rate for Payer: Heritage Provider Network Senior |
$1,222.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$326.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$451.50
|
| Rate for Payer: Multiplan Commercial |
$1,354.50
|
|
|
HC GI MYOELECTRICAL STDY, STMCH THRGH COLON
|
Facility
|
OP
|
$1,076.00
|
|
|
Service Code
|
CPT 0779T
|
| Hospital Charge Code |
906700779
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$194.76 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$215.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$575.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$739.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$741.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$674.18
|
| 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 |
$591.80
|
| Rate for Payer: Cash Price |
$591.80
|
| Rate for Payer: Cash Price |
$591.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$699.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$741.60
|
| Rate for Payer: Dignity Health Senior |
$674.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$674.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$666.04
|
| Rate for Payer: Heritage Provider Network Senior |
$829.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$674.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$513.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$194.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$775.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$269.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$849.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$849.47
|
| Rate for Payer: Multiplan Commercial |
$807.00
|
| 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 |
$538.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$538.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$741.60
|
| Rate for Payer: Vantage Medical Group Senior |
$674.18
|
|
|
HC GI MYOELECTRICAL STDY, STMCH THRGH COLON
|
Facility
|
IP
|
$1,076.00
|
|
|
Service Code
|
CPT 0779T
|
| Hospital Charge Code |
906700779
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$194.76 |
| Max. Negotiated Rate |
$807.00 |
| Rate for Payer: Adventist Health Commercial |
$215.20
|
| Rate for Payer: Cash Price |
$591.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$728.45
|
| Rate for Payer: Heritage Provider Network Senior |
$728.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$194.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$269.00
|
| Rate for Payer: Multiplan Commercial |
$807.00
|
|
|
HC GI PROTEIN LOSS
|
Facility
|
OP
|
$1,233.00
|
|
|
Service Code
|
CPT 78282
|
| Hospital Charge Code |
909301367
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$84.09 |
| Max. Negotiated Rate |
$924.75 |
| Rate for Payer: Adventist Health Commercial |
$246.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$659.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$847.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Blue Shield of California Commercial |
$316.56
|
| Rate for Payer: Blue Shield of California EPN |
$254.57
|
| Rate for Payer: Cash Price |
$678.15
|
| Rate for Payer: Cash Price |
$678.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$801.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Senior |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$801.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$510.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$763.23
|
| Rate for Payer: Heritage Provider Network Senior |
$763.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$84.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$588.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$223.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$308.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.32
|
| Rate for Payer: Multiplan Commercial |
$924.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$561.63
|
| Rate for Payer: TriValley Medical Group Senior |
$510.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$616.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$616.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC GI PROTEIN LOSS
|
Facility
|
IP
|
$1,233.00
|
|
|
Service Code
|
CPT 78282
|
| Hospital Charge Code |
909301367
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$223.17 |
| Max. Negotiated Rate |
$924.75 |
| Rate for Payer: Adventist Health Commercial |
$246.60
|
| Rate for Payer: Cash Price |
$678.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$834.74
|
| Rate for Payer: Heritage Provider Network Senior |
$834.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$223.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$308.25
|
| Rate for Payer: Multiplan Commercial |
$924.75
|
|
|
HC GI TRACT CAPSULE ENDO
|
Facility
|
IP
|
$4,791.00
|
|
|
Service Code
|
CPT 91110
|
| Hospital Charge Code |
906700355
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$867.17 |
| Max. Negotiated Rate |
$3,593.25 |
| Rate for Payer: Adventist Health Commercial |
$958.20
|
| Rate for Payer: Cash Price |
$2,635.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,243.51
|
| Rate for Payer: Heritage Provider Network Senior |
$3,243.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$867.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,197.75
|
| Rate for Payer: Multiplan Commercial |
$3,593.25
|
|
|
HC GI TRACT CAPSULE ENDO
|
Facility
|
OP
|
$4,791.00
|
|
|
Service Code
|
CPT 91110
|
| Hospital Charge Code |
906700355
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$958.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,560.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,291.42
|
| 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: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,635.05
|
| Rate for Payer: Cash Price |
$2,635.05
|
| Rate for Payer: Cash Price |
$2,635.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,114.15
|
| 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 |
$2,874.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,191.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,965.63
|
| Rate for Payer: Heritage Provider Network Senior |
$1,465.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,302.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,285.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$867.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,369.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,197.75
|
| 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 |
$3,593.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$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 GIVEN ENDO IMAGING
|
Facility
|
OP
|
$8,907.00
|
|
|
Service Code
|
CPT 91110
|
| Hospital Charge Code |
906776499
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$1,781.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,760.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,119.11
|
| 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: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$4,898.85
|
| Rate for Payer: Cash Price |
$4,898.85
|
| Rate for Payer: Cash Price |
$4,898.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,789.55
|
| 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 |
$5,344.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,191.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,513.43
|
| Rate for Payer: Heritage Provider Network Senior |
$1,465.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,302.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,248.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,612.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,369.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,226.75
|
| 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 |
$6,680.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$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 GIVEN ENDO IMAGING
|
Facility
|
IP
|
$8,907.00
|
|
|
Service Code
|
CPT 91110
|
| Hospital Charge Code |
906776499
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,612.17 |
| Max. Negotiated Rate |
$6,680.25 |
| Rate for Payer: Adventist Health Commercial |
$1,781.40
|
| Rate for Payer: Cash Price |
$4,898.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,030.04
|
| Rate for Payer: Heritage Provider Network Senior |
$6,030.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,612.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,226.75
|
| Rate for Payer: Multiplan Commercial |
$6,680.25
|
|
|
HC GLIADIN AB IGA
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913558
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$213.58 |
| Rate for Payer: Adventist Health Commercial |
$15.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$41.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$53.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$213.58
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$42.90
|
| Rate for Payer: Cash Price |
$42.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$50.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Senior |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.28
|
| Rate for Payer: Heritage Provider Network Senior |
$48.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$37.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.53
|
| Rate for Payer: Multiplan Commercial |
$58.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.53
|
| Rate for Payer: TriValley Medical Group Senior |
$11.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC GLIADIN AB IGA
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913558
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Adventist Health Commercial |
$15.60
|
| Rate for Payer: Cash Price |
$42.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.81
|
| Rate for Payer: Heritage Provider Network Senior |
$52.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.50
|
| Rate for Payer: Multiplan Commercial |
$58.50
|
|
|
HC GLIADIN AB IGG
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913557
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$213.58 |
| Rate for Payer: Adventist Health Commercial |
$15.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$41.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$53.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$213.58
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$42.90
|
| Rate for Payer: Cash Price |
$42.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$50.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Senior |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.28
|
| Rate for Payer: Heritage Provider Network Senior |
$48.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$37.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.53
|
| Rate for Payer: Multiplan Commercial |
$58.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.53
|
| Rate for Payer: TriValley Medical Group Senior |
$11.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC GLIADIN AB IGG
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913557
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Adventist Health Commercial |
$15.60
|
| Rate for Payer: Cash Price |
$42.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.81
|
| Rate for Payer: Heritage Provider Network Senior |
$52.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.50
|
| Rate for Payer: Multiplan Commercial |
$58.50
|
|
|
HC GLIADIN IGA
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913658
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.58 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.33
|
| Rate for Payer: Heritage Provider Network Senior |
$43.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.00
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
|
|
HC GLIADIN IGA
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913658
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$213.58 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$34.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$213.58
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$41.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Senior |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.62
|
| Rate for Payer: Heritage Provider Network Senior |
$39.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$30.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.53
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.53
|
| Rate for Payer: TriValley Medical Group Senior |
$11.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC GLIADIN IGG
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913659
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$213.58 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$34.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$213.58
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$41.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Senior |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.62
|
| Rate for Payer: Heritage Provider Network Senior |
$39.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$30.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.53
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.53
|
| Rate for Payer: TriValley Medical Group Senior |
$11.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC GLIADIN IGG
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913659
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.58 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.33
|
| Rate for Payer: Heritage Provider Network Senior |
$43.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.00
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
|
|
HC GLIDECATH 4FR X 150CM ANGLED
|
Facility
|
IP
|
$435.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
900101865
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.73 |
| Max. Negotiated Rate |
$326.25 |
| Rate for Payer: Adventist Health Commercial |
$87.00
|
| Rate for Payer: Cash Price |
$239.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$294.50
|
| Rate for Payer: Heritage Provider Network Senior |
$294.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.75
|
| Rate for Payer: Multiplan Commercial |
$326.25
|
|
|
HC GLIDECATH 4FR X 150CM ANGLED
|
Facility
|
OP
|
$435.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
900101865
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.73 |
| Max. Negotiated Rate |
$369.75 |
| Rate for Payer: Adventist Health Commercial |
$87.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$232.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$298.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$369.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$326.25
|
| Rate for Payer: Blue Shield of California Commercial |
$265.35
|
| Rate for Payer: Blue Shield of California EPN |
$212.28
|
| Rate for Payer: Cash Price |
$239.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$282.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$369.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$369.75
|
| Rate for Payer: Dignity Health Senior |
$369.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$269.26
|
| Rate for Payer: Heritage Provider Network Senior |
$269.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$207.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$304.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$304.50
|
| Rate for Payer: Multiplan Commercial |
$326.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$217.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$217.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$369.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$369.75
|
| Rate for Payer: Vantage Medical Group Senior |
$369.75
|
|
|
HC GLUCOSE
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 82947
|
| Hospital Charge Code |
900910498
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.74 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Cash Price |
$53.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$66.35
|
| Rate for Payer: Heritage Provider Network Senior |
$66.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
|
|
HC GLUCOSE
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 82947
|
| Hospital Charge Code |
900910498
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$52.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$67.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.89
|
| Rate for Payer: Blue Shield of California Commercial |
$31.56
|
| Rate for Payer: Blue Shield of California EPN |
$25.32
|
| Rate for Payer: Cash Price |
$53.90
|
| Rate for Payer: Cash Price |
$53.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$63.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.32
|
| Rate for Payer: Dignity Health Senior |
$3.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$3.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.66
|
| Rate for Payer: Heritage Provider Network Senior |
$60.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$46.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.95
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.93
|
| Rate for Payer: TriValley Medical Group Senior |
$3.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.32
|
| Rate for Payer: Vantage Medical Group Senior |
$3.93
|
|
