|
HC ERCP LESION ABLAT W DILATION
|
Facility
OP
|
$5,328.00
|
|
|
Service Code
|
CPT 43278
|
| Hospital Charge Code |
906743278
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,065.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,660.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,177.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,263.53
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,785.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$2,397.60
|
| Rate for Payer: Cash Price |
$2,397.60
|
| Rate for Payer: Cash Price |
$2,397.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,463.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,177.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,263.53
|
| Rate for Payer: Dignity Health Senior |
$4,785.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,785.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,298.03
|
| Rate for Payer: Heritage Provider Network Senior |
$5,885.59
|
| Rate for Payer: Humana Medicare |
$4,785.03
|
| Rate for Payer: IEHP Medi-Cal |
$610.41
|
| Rate for Payer: IEHP Medicare Advantage |
$4,785.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9,091.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$964.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,646.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,332.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,029.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,029.14
|
| Rate for Payer: Multiplan Commercial |
$3,996.00
|
| 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 |
$7,096.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,971.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,177.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,263.53
|
| Rate for Payer: Vantage Medical Group Senior |
$4,785.03
|
|
|
HC ERCP LESION ABLAT W DILATION
|
Facility
IP
|
$5,570.00
|
|
|
Service Code
|
CPT 43278
|
| Hospital Charge Code |
906743278
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,008.17 |
| Max. Negotiated Rate |
$4,177.50 |
| Rate for Payer: Adventist Health Commercial |
$1,114.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,826.59
|
| Rate for Payer: Cash Price |
$2,506.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,770.89
|
| Rate for Payer: Heritage Provider Network Senior |
$3,770.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,008.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,392.50
|
| Rate for Payer: Multiplan Commercial |
$4,177.50
|
|
|
HC ERCP PANCREATIC/SPHINCT
|
Facility
IP
|
$2,869.00
|
|
|
Service Code
|
CPT 74329
|
| Hospital Charge Code |
909001830
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$519.29 |
| Max. Negotiated Rate |
$2,151.75 |
| Rate for Payer: Adventist Health Commercial |
$573.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,971.00
|
| Rate for Payer: Cash Price |
$1,291.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,942.31
|
| Rate for Payer: Heritage Provider Network Senior |
$1,942.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$519.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$717.25
|
| Rate for Payer: Multiplan Commercial |
$2,151.75
|
|
|
HC ERCP PANCREATIC/SPHINCT
|
Facility
OP
|
$2,869.00
|
|
|
Service Code
|
CPT 74329
|
| Hospital Charge Code |
909001830
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$145.43 |
| Max. Negotiated Rate |
$2,438.65 |
| Rate for Payer: Adventist Health Commercial |
$573.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$145.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,971.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,438.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,577.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,151.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$750.14
|
| Rate for Payer: Blue Shield of California Commercial |
$645.50
|
| Rate for Payer: Blue Shield of California EPN |
$367.08
|
| Rate for Payer: Cash Price |
$1,291.05
|
| Rate for Payer: Cash Price |
$1,291.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,864.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,438.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,438.65
|
| Rate for Payer: Dignity Health Senior |
$2,438.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,864.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,775.91
|
| Rate for Payer: Heritage Provider Network Senior |
$1,775.91
|
| Rate for Payer: IEHP Medi-Cal |
$179.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,382.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$519.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$717.25
|
| Rate for Payer: Multiplan Commercial |
$2,151.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,438.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,438.65
|
|
|
HC ERCP W/BX SNGL OR MULTI
|
Facility
OP
|
$4,620.00
|
|
|
Service Code
|
CPT 43261
|
| Hospital Charge Code |
906743261
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$924.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,173.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,177.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,263.53
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,785.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$2,079.00
|
| Rate for Payer: Cash Price |
$2,079.00
|
| Rate for Payer: Cash Price |
$2,079.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,003.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,177.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,263.53
|
| Rate for Payer: Dignity Health Senior |
$4,785.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,785.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,859.78
|
| Rate for Payer: Heritage Provider Network Senior |
$5,885.59
|
| Rate for Payer: Humana Medicare |
$4,785.03
|
| Rate for Payer: IEHP Medi-Cal |
$532.01
|
| Rate for Payer: IEHP Medicare Advantage |
$4,785.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9,091.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$836.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,646.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,155.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,029.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,029.14
|
| Rate for Payer: Multiplan Commercial |
$3,465.00
|
| 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 |
$7,096.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,971.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,177.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,263.53
|
| Rate for Payer: Vantage Medical Group Senior |
$4,785.03
|
|
|
HC ERCP W/BX SNGL OR MULTI
|
Facility
IP
|
$4,546.00
|
|
|
Service Code
|
CPT 43261
|
| Hospital Charge Code |
906743261
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$822.83 |
| Max. Negotiated Rate |
$3,409.50 |
| Rate for Payer: Adventist Health Commercial |
$909.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,123.10
|
| Rate for Payer: Cash Price |
$2,045.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,077.64
|
| Rate for Payer: Heritage Provider Network Senior |
$3,077.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$822.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,136.50
|
| Rate for Payer: Multiplan Commercial |
$3,409.50
|
|
|
HC ERCP W/ENDO RETRO DESTRUCTION
|
Facility
IP
|
$4,546.00
|
|
|
Service Code
|
CPT 43265
|
| Hospital Charge Code |
906743265
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$822.83 |
| Max. Negotiated Rate |
$3,409.50 |
| Rate for Payer: Adventist Health Commercial |
$909.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,123.10
|
| Rate for Payer: Cash Price |
$2,045.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,077.64
|
| Rate for Payer: Heritage Provider Network Senior |
$3,077.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$822.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,136.50
|
| Rate for Payer: Multiplan Commercial |
$3,409.50
|
|
|
HC ERCP W/ENDO RETRO DESTRUCTION
|
Facility
OP
|
$6,801.00
|
|
|
Service Code
|
CPT 43265
|
| Hospital Charge Code |
906743265
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$13,529.58 |
| Rate for Payer: Adventist Health Commercial |
$1,360.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,672.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,681.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,832.91
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,120.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$3,060.45
|
| Rate for Payer: Cash Price |
$3,060.45
|
| Rate for Payer: Cash Price |
$3,060.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,420.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,681.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,832.91
|
| Rate for Payer: Dignity Health Senior |
$7,120.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,120.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,209.82
|
| Rate for Payer: Heritage Provider Network Senior |
$8,758.62
|
| Rate for Payer: Humana Medicare |
$7,120.83
|
| Rate for Payer: IEHP Medicare Advantage |
$7,120.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,529.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,230.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,402.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,700.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,972.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,972.25
|
| Rate for Payer: Multiplan Commercial |
$5,100.75
|
| 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 |
$7,096.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,971.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,681.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,832.91
|
| Rate for Payer: Vantage Medical Group Senior |
$7,120.83
|
|
|
HC ERCP W/ENDO RETRO RMVL CALCULU
|
Facility
OP
|
$8,394.00
|
|
|
Service Code
|
CPT 43264
|
| Hospital Charge Code |
906743264
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,678.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,766.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,177.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,263.53
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,785.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$3,777.30
|
| Rate for Payer: Cash Price |
$3,777.30
|
| Rate for Payer: Cash Price |
$3,777.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,456.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,177.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,263.53
|
| Rate for Payer: Dignity Health Senior |
$4,785.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,785.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,195.89
|
| Rate for Payer: Heritage Provider Network Senior |
$5,885.59
|
| Rate for Payer: Humana Medicare |
$4,785.03
|
| Rate for Payer: IEHP Medi-Cal |
$598.79
|
| Rate for Payer: IEHP Medicare Advantage |
$4,785.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9,091.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,519.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,646.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,098.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,029.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,029.14
|
| Rate for Payer: Multiplan Commercial |
$6,295.50
|
| 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 |
$7,096.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,971.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,177.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,263.53
|
| Rate for Payer: Vantage Medical Group Senior |
$4,785.03
|
|
|
HC ERCP W/ENDO RETRO RMVL CALCULU
|
Facility
IP
|
$4,546.00
|
|
|
Service Code
|
CPT 43264
|
| Hospital Charge Code |
906743264
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$822.83 |
| Max. Negotiated Rate |
$3,409.50 |
| Rate for Payer: Adventist Health Commercial |
$909.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,123.10
|
| Rate for Payer: Cash Price |
$2,045.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,077.64
|
| Rate for Payer: Heritage Provider Network Senior |
$3,077.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$822.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,136.50
|
| Rate for Payer: Multiplan Commercial |
$3,409.50
|
|
|
HC ERCP W/PRESS MSRMNT
|
Facility
OP
|
$5,242.00
|
|
|
Service Code
|
CPT 43263
|
| Hospital Charge Code |
906743263
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$416.43 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,048.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,601.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$2,358.90
|
| Rate for Payer: Cash Price |
$2,358.90
|
| Rate for Payer: Cash Price |
$2,358.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,407.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: Dignity Health Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,377.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,244.80
|
| Rate for Payer: Heritage Provider Network Senior |
$2,924.26
|
| Rate for Payer: Humana Medicare |
$2,377.45
|
| Rate for Payer: IEHP Medi-Cal |
$416.43
|
| Rate for Payer: IEHP Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,517.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$948.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,805.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,310.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,995.59
|
| Rate for Payer: Multiplan Commercial |
$3,931.50
|
| 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 |
$7,096.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,971.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC ERCP W/PRESS MSRMNT
|
Facility
IP
|
$5,748.00
|
|
|
Service Code
|
CPT 43263
|
| Hospital Charge Code |
906743263
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,040.39 |
| Max. Negotiated Rate |
$4,311.00 |
| Rate for Payer: Adventist Health Commercial |
$1,149.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,948.88
|
| Rate for Payer: Cash Price |
$2,586.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,891.40
|
| Rate for Payer: Heritage Provider Network Senior |
$3,891.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,040.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,437.00
|
| Rate for Payer: Multiplan Commercial |
$4,311.00
|
|
|
HC ERCP W RMVL FB STNT
|
Facility
IP
|
$5,570.00
|
|
|
Service Code
|
CPT 43275
|
| Hospital Charge Code |
906743275
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,008.17 |
| Max. Negotiated Rate |
$4,177.50 |
| Rate for Payer: Adventist Health Commercial |
$1,114.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,826.59
|
| Rate for Payer: Cash Price |
$2,506.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,770.89
|
| Rate for Payer: Heritage Provider Network Senior |
$3,770.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,008.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,392.50
|
| Rate for Payer: Multiplan Commercial |
$4,177.50
|
|
|
HC ERCP W RMVL FB STNT
|
Facility
OP
|
$5,862.00
|
|
|
Service Code
|
CPT 43275
|
| Hospital Charge Code |
906743275
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,172.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,027.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$2,637.90
|
| Rate for Payer: Cash Price |
$2,637.90
|
| Rate for Payer: Cash Price |
$2,637.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,810.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: Dignity Health Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,377.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,628.58
|
| Rate for Payer: Heritage Provider Network Senior |
$2,924.26
|
| Rate for Payer: Humana Medicare |
$2,377.45
|
| Rate for Payer: IEHP Medi-Cal |
$533.74
|
| Rate for Payer: IEHP Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,517.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,061.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,805.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,465.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,995.59
|
| Rate for Payer: Multiplan Commercial |
$4,396.50
|
| 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 |
$7,096.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,971.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC ERCP W RMVL & XCHNG OF STNT INCL SPINC EA STNT
|
Facility
IP
|
$4,613.00
|
|
|
Service Code
|
CPT 43276
|
| Hospital Charge Code |
906743276
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$834.95 |
| Max. Negotiated Rate |
$3,459.75 |
| Rate for Payer: Adventist Health Commercial |
$922.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,169.13
|
| Rate for Payer: Cash Price |
$2,075.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,123.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,123.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$834.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,153.25
|
| Rate for Payer: Multiplan Commercial |
$3,459.75
|
|
|
HC ERCP W RMVL & XCHNG OF STNT INCL SPINC EA STNT
|
Facility
OP
|
$6,432.00
|
|
|
Service Code
|
CPT 43276
|
| Hospital Charge Code |
906743276
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$13,529.58 |
| Rate for Payer: Adventist Health Commercial |
$1,286.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,418.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,681.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,832.91
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,120.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$2,894.40
|
| Rate for Payer: Cash Price |
$2,894.40
|
| Rate for Payer: Cash Price |
$2,894.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,180.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,681.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,832.91
|
| Rate for Payer: Dignity Health Senior |
$7,120.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,120.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,981.41
|
| Rate for Payer: Heritage Provider Network Senior |
$8,758.62
|
| Rate for Payer: Humana Medicare |
$7,120.83
|
| Rate for Payer: IEHP Medi-Cal |
$673.14
|
| Rate for Payer: IEHP Medicare Advantage |
$7,120.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,529.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,164.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,402.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,608.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,972.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,972.25
|
| Rate for Payer: Multiplan Commercial |
$4,824.00
|
| 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 |
$7,096.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,971.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,681.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,832.91
|
| Rate for Payer: Vantage Medical Group Senior |
$7,120.83
|
|
|
HC ERCP W/SPHINCTERTMY
|
Facility
OP
|
$4,460.00
|
|
|
Service Code
|
CPT 43262
|
| Hospital Charge Code |
906743262
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$892.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,064.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,177.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,263.53
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,785.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$2,007.00
|
| Rate for Payer: Cash Price |
$2,007.00
|
| Rate for Payer: Cash Price |
$2,007.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,899.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,177.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,263.53
|
| Rate for Payer: Dignity Health Senior |
$4,785.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,785.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,760.74
|
| Rate for Payer: Heritage Provider Network Senior |
$5,885.59
|
| Rate for Payer: Humana Medicare |
$4,785.03
|
| Rate for Payer: IEHP Medi-Cal |
$577.89
|
| Rate for Payer: IEHP Medicare Advantage |
$4,785.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9,091.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$807.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,646.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,115.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,029.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,029.14
|
| Rate for Payer: Multiplan Commercial |
$3,345.00
|
| 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 |
$7,096.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,971.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,177.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,263.53
|
| Rate for Payer: Vantage Medical Group Senior |
$4,785.03
|
|
|
HC ERCP W/SPHINCTERTMY
|
Facility
IP
|
$5,570.00
|
|
|
Service Code
|
CPT 43262
|
| Hospital Charge Code |
906743262
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,008.17 |
| Max. Negotiated Rate |
$4,177.50 |
| Rate for Payer: Adventist Health Commercial |
$1,114.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,826.59
|
| Rate for Payer: Cash Price |
$2,506.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,770.89
|
| Rate for Payer: Heritage Provider Network Senior |
$3,770.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,008.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,392.50
|
| Rate for Payer: Multiplan Commercial |
$4,177.50
|
|
|
HC ESBL DISK CONFIRMATION
|
Facility
OP
|
$13.00
|
|
|
Service Code
|
CPT 87184
|
| Hospital Charge Code |
900912449
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$57.65 |
| Rate for Payer: Adventist Health Commercial |
$2.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$20.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.93
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.65
|
| Rate for Payer: Blue Shield of California Commercial |
$53.83
|
| Rate for Payer: Blue Shield of California EPN |
$42.08
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.23
|
| Rate for Payer: Dignity Health Senior |
$7.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.05
|
| Rate for Payer: Heritage Provider Network Senior |
$8.05
|
| Rate for Payer: Humana Medicare |
$7.48
|
| Rate for Payer: IEHP Medi-Cal |
$6.60
|
| Rate for Payer: IEHP Medicare Advantage |
$7.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.42
|
| Rate for Payer: Multiplan Commercial |
$9.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.48
|
| Rate for Payer: TriValley Medical Group Senior |
$7.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.23
|
| Rate for Payer: Vantage Medical Group Senior |
$7.48
|
|
|
HC ESBL DISK CONFIRMATION
|
Facility
IP
|
$215.00
|
|
|
Service Code
|
CPT 87184
|
| Hospital Charge Code |
900912449
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$38.92 |
| Max. Negotiated Rate |
$161.25 |
| Rate for Payer: Adventist Health Commercial |
$43.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$147.70
|
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$145.56
|
| Rate for Payer: Heritage Provider Network Senior |
$145.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.75
|
| Rate for Payer: Multiplan Commercial |
$161.25
|
|
|
HC ESD INCL ENDSCPY OR CLNSCPY, MCSL CLSR
|
Facility
OP
|
$6,691.00
|
|
|
Service Code
|
CPT C9779
|
| Hospital Charge Code |
906749779
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,211.07 |
| Max. Negotiated Rate |
$9,091.56 |
| Rate for Payer: Adventist Health Commercial |
$1,338.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,596.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,177.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,263.53
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,785.03
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$3,010.95
|
| Rate for Payer: Cash Price |
$3,010.95
|
| Rate for Payer: Cash Price |
$3,010.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,349.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,177.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,263.53
|
| Rate for Payer: Dignity Health Senior |
$4,785.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,014.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,785.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,141.73
|
| Rate for Payer: Heritage Provider Network Senior |
$5,885.59
|
| Rate for Payer: Humana Medicare |
$4,785.03
|
| Rate for Payer: IEHP Medicare Advantage |
$4,785.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9,091.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,211.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,646.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,672.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,029.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,029.14
|
| Rate for Payer: Multiplan Commercial |
$5,018.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,263.53
|
| Rate for Payer: TriValley Medical Group Senior |
$5,263.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,096.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,971.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,177.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,263.53
|
| Rate for Payer: Vantage Medical Group Senior |
$4,785.03
|
|
|
HC ESD INCL ENDSCPY OR CLNSCPY, MCSL CLSR
|
Facility
IP
|
$6,691.00
|
|
|
Service Code
|
CPT C9779
|
| Hospital Charge Code |
906749779
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,211.07 |
| Max. Negotiated Rate |
$5,018.25 |
| Rate for Payer: Adventist Health Commercial |
$1,338.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,596.72
|
| Rate for Payer: Cash Price |
$3,010.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,529.81
|
| Rate for Payer: Heritage Provider Network Senior |
$4,529.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,211.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,672.75
|
| Rate for Payer: Multiplan Commercial |
$5,018.25
|
|
|
HC ESOPH ACID REFLX TEST
|
Facility
OP
|
$1,578.00
|
|
|
Service Code
|
CPT 91034
|
| Hospital Charge Code |
906791033
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$121.07 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$315.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$352.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,084.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,004.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$736.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$669.68
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$710.10
|
| Rate for Payer: Cash Price |
$710.10
|
| Rate for Payer: Cash Price |
$710.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,025.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$736.65
|
| Rate for Payer: Dignity Health Senior |
$669.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$946.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$669.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$976.78
|
| Rate for Payer: Heritage Provider Network Senior |
$823.71
|
| Rate for Payer: Humana Medicare |
$669.68
|
| Rate for Payer: IEHP Medi-Cal |
$121.07
|
| Rate for Payer: IEHP Medicare Advantage |
$669.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,272.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$285.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$790.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$394.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$843.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$843.80
|
| Rate for Payer: Multiplan Commercial |
$1,183.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$736.65
|
| Rate for Payer: Vantage Medical Group Senior |
$669.68
|
|
|
HC ESOPH ACID REFLX TEST
|
Facility
IP
|
$884.00
|
|
|
Service Code
|
CPT 91034
|
| Hospital Charge Code |
906791033
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$160.00 |
| Max. Negotiated Rate |
$663.00 |
| Rate for Payer: Adventist Health Commercial |
$176.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$607.31
|
| Rate for Payer: Cash Price |
$397.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$598.47
|
| Rate for Payer: Heritage Provider Network Senior |
$598.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.00
|
| Rate for Payer: Multiplan Commercial |
$663.00
|
|
|
HC ESOPHAG DIAG W BALLOON DILATION
|
Facility
IP
|
$5,664.00
|
|
|
Service Code
|
CPT 43220
|
| Hospital Charge Code |
909000188
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,025.18 |
| Max. Negotiated Rate |
$4,248.00 |
| Rate for Payer: Adventist Health Commercial |
$1,132.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,891.17
|
| Rate for Payer: Cash Price |
$2,548.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,834.53
|
| Rate for Payer: Heritage Provider Network Senior |
$3,834.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,025.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,416.00
|
| Rate for Payer: Multiplan Commercial |
$4,248.00
|
|
