|
HC ESOPH LESION ABLATION
|
Facility
|
OP
|
$4,675.00
|
|
|
Service Code
|
CPT 43229
|
| Hospital Charge Code |
900100016
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$935.00
|
| Rate for Payer: Adventist Health Commercial |
$793.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,451.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,889.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,454.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,454.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,958.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,958.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| 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: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,103.75
|
| Rate for Payer: Cash Price |
$2,103.75
|
| Rate for Payer: Cash Price |
$1,785.15
|
| Rate for Payer: Cash Price |
$1,785.15
|
| Rate for Payer: Cash Price |
$2,103.75
|
| Rate for Payer: Cash Price |
$1,785.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,578.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,038.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,454.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,454.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,958.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,958.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,958.78
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,958.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,893.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,455.57
|
| Rate for Payer: Heritage Provider Network Senior |
$6,099.30
|
| Rate for Payer: Heritage Provider Network Senior |
$6,099.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,958.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,958.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,892.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,229.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$846.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$718.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,702.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,702.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$991.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,168.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,644.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,644.77
|
| Rate for Payer: Multiplan Commercial |
$3,506.25
|
| Rate for Payer: Multiplan Commercial |
$2,975.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,454.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,454.66
|
| Rate for Payer: Vantage Medical Group Senior |
$4,958.78
|
| Rate for Payer: Vantage Medical Group Senior |
$4,958.78
|
|
|
HC ESOPH LESION ABLATION
|
Facility
|
IP
|
$3,967.00
|
|
|
Service Code
|
CPT 43229
|
| Hospital Charge Code |
900100016
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$718.03 |
| Max. Negotiated Rate |
$2,975.25 |
| Rate for Payer: Adventist Health Commercial |
$793.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,554.75
|
| Rate for Payer: Cash Price |
$1,785.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,685.66
|
| Rate for Payer: Heritage Provider Network Senior |
$2,685.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$718.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$991.75
|
| Rate for Payer: Multiplan Commercial |
$2,975.25
|
|
|
HC ESOPH MOTILITY STUDY W/MECH/SI
|
Facility
|
IP
|
$1,406.00
|
|
|
Service Code
|
CPT 91013
|
| Hospital Charge Code |
906791011
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$254.49 |
| Max. Negotiated Rate |
$1,054.50 |
| Rate for Payer: Adventist Health Commercial |
$281.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$905.46
|
| Rate for Payer: Cash Price |
$632.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$951.86
|
| Rate for Payer: Heritage Provider Network Senior |
$951.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$254.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$351.50
|
| Rate for Payer: Multiplan Commercial |
$1,054.50
|
|
|
HC ESOPH MOTILITY STUDY W/MECH/SI
|
Facility
|
OP
|
$1,406.00
|
|
|
Service Code
|
CPT 91013
|
| Hospital Charge Code |
906791011
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$254.49 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$281.20
|
| Rate for Payer: Adventist Health Commercial |
$320.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$990.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$868.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,362.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,195.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$881.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$773.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,054.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,202.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$801.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$703.28
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| 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: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$721.35
|
| Rate for Payer: Cash Price |
$632.70
|
| Rate for Payer: Cash Price |
$632.70
|
| Rate for Payer: Cash Price |
$721.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$913.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,041.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,362.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,195.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,195.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,362.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,195.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,362.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$961.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$843.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$992.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$870.31
|
| Rate for Payer: Heritage Provider Network Senior |
$870.31
|
| Rate for Payer: Heritage Provider Network Senior |
$992.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$670.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$764.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$254.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$290.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$400.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$351.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,122.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$984.20
|
| Rate for Payer: Multiplan Commercial |
$1,202.25
|
| Rate for Payer: Multiplan Commercial |
$1,054.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,195.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,362.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,362.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,195.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,195.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,362.55
|
|
|
HC ESOPH MOTIL MANOMETRIC
|
Facility
|
IP
|
$2,470.00
|
|
|
Service Code
|
CPT 91010
|
| Hospital Charge Code |
906791010
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$447.07 |
| Max. Negotiated Rate |
$1,852.50 |
| Rate for Payer: Adventist Health Commercial |
$494.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,590.68
|
| Rate for Payer: Cash Price |
$1,111.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,672.19
|
| Rate for Payer: Heritage Provider Network Senior |
$1,672.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$447.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$617.50
|
| Rate for Payer: Multiplan Commercial |
$1,852.50
|
|
|
HC ESOPH MOTIL MANOMETRIC
|
Facility
|
OP
|
$2,470.00
|
|
|
Service Code
|
CPT 91010
|
| Hospital Charge Code |
906791010
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$494.00
|
| Rate for Payer: Adventist Health Commercial |
$451.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,526.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,393.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$719.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$719.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$527.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$527.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$479.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$479.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,127.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,235.49
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| 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: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,111.50
|
| Rate for Payer: Cash Price |
$1,111.50
|
| Rate for Payer: Cash Price |
$1,014.75
|
| Rate for Payer: Cash Price |
$1,014.75
|
| Rate for Payer: Cash Price |
$1,111.50
|
| Rate for Payer: Cash Price |
$1,014.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,465.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,605.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$719.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$719.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$527.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$527.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$479.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$479.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,353.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,482.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$479.94
|
| Rate for Payer: EPIC Health Plan Medicare |
$479.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,528.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,395.85
|
| Rate for Payer: Heritage Provider Network Senior |
$590.33
|
| Rate for Payer: Heritage Provider Network Senior |
$590.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$479.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$479.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,075.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,178.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$447.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$408.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$551.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$551.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$563.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$617.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$643.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$643.12
|
| Rate for Payer: Multiplan Commercial |
$1,852.50
|
| Rate for Payer: Multiplan Commercial |
$1,691.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$719.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$719.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$527.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$527.93
|
| Rate for Payer: Vantage Medical Group Senior |
$479.94
|
| Rate for Payer: Vantage Medical Group Senior |
$479.94
|
|
|
HC ESOPHOGRAM
|
Facility
|
IP
|
$984.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
909001802
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$178.10 |
| Max. Negotiated Rate |
$738.00 |
| Rate for Payer: Adventist Health Commercial |
$196.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$633.70
|
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$666.17
|
| Rate for Payer: Heritage Provider Network Senior |
$666.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$178.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.00
|
| Rate for Payer: Multiplan Commercial |
$738.00
|
|
|
HC ESOPHOGRAM
|
Facility
|
OP
|
$984.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
909001802
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$137.33 |
| Max. Negotiated Rate |
$738.00 |
| Rate for Payer: Multiplan Commercial |
$738.00
|
| Rate for Payer: Adventist Health Commercial |
$196.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$608.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$302.10
|
| Rate for Payer: Blue Shield of California Commercial |
$249.02
|
| Rate for Payer: Blue Shield of California EPN |
$200.26
|
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$639.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$580.56
|
| Rate for Payer: EPIC Health Plan Medicare |
$225.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$609.10
|
| Rate for Payer: Heritage Provider Network Senior |
$609.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$469.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$178.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$259.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.59
|
| Rate for Payer: TriValley Medical Group Senior |
$225.59
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$137.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$137.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
|
HC ESOPH RETRO BALLOON
|
Facility
|
OP
|
$2,153.00
|
|
|
Service Code
|
CPT 43213
|
| Hospital Charge Code |
900100015
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$389.69 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$430.60
|
| Rate for Payer: Adventist Health Commercial |
$392.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,212.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,330.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| 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: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$968.85
|
| Rate for Payer: Cash Price |
$968.85
|
| Rate for Payer: Cash Price |
$882.90
|
| Rate for Payer: Cash Price |
$882.90
|
| Rate for Payer: Cash Price |
$968.85
|
| Rate for Payer: Cash Price |
$882.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,275.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,399.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,468.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,468.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,332.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,214.48
|
| Rate for Payer: Heritage Provider Network Senior |
$3,035.69
|
| Rate for Payer: Heritage Provider Network Senior |
$3,035.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$935.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,026.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$389.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$355.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,838.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,838.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$490.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$538.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$1,614.75
|
| Rate for Payer: Multiplan Commercial |
$1,471.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
|
|
HC ESOPH RETRO BALLOON
|
Facility
|
IP
|
$2,153.00
|
|
|
Service Code
|
CPT 43213
|
| Hospital Charge Code |
900100015
|
|
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: Aetna of CA Non-Gatekeeper |
$1,386.53
|
| Rate for Payer: Cash Price |
$968.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,457.58
|
| Rate for Payer: Heritage Provider Network Senior |
$1,457.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$389.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$538.25
|
| Rate for Payer: Multiplan Commercial |
$1,614.75
|
|
|
HC ESOPH STENT PLACEMENT
|
Facility
|
IP
|
$5,039.00
|
|
|
Service Code
|
CPT 43212
|
| Hospital Charge Code |
900100014
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$912.06 |
| Max. Negotiated Rate |
$3,779.25 |
| Rate for Payer: Adventist Health Commercial |
$1,007.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,245.12
|
| Rate for Payer: Cash Price |
$2,267.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,411.40
|
| Rate for Payer: Heritage Provider Network Senior |
$3,411.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$912.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,259.75
|
| Rate for Payer: Multiplan Commercial |
$3,779.25
|
|
|
HC ESOPH STENT PLACEMENT
|
Facility
|
OP
|
$8,172.00
|
|
|
Service Code
|
CPT 43212
|
| Hospital Charge Code |
900100014
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$11,712.28 |
| Rate for Payer: Adventist Health Commercial |
$1,634.40
|
| Rate for Payer: Adventist Health Commercial |
$1,007.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,114.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,050.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,589.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,589.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,808.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,808.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| 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: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$3,677.40
|
| Rate for Payer: Cash Price |
$3,677.40
|
| Rate for Payer: Cash Price |
$2,267.55
|
| Rate for Payer: Cash Price |
$2,267.55
|
| Rate for Payer: Cash Price |
$3,677.40
|
| Rate for Payer: Cash Price |
$2,267.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,275.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,311.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,589.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,589.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,808.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,808.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,808.19
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,808.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,058.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,119.14
|
| Rate for Payer: Heritage Provider Network Senior |
$9,604.07
|
| Rate for Payer: Heritage Provider Network Senior |
$9,604.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,808.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,808.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,403.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,898.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,479.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$912.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,979.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,979.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,259.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,043.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,462.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,462.97
|
| Rate for Payer: Multiplan Commercial |
$6,129.00
|
| Rate for Payer: Multiplan Commercial |
$3,779.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,589.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,589.01
|
| Rate for Payer: Vantage Medical Group Senior |
$7,808.19
|
| Rate for Payer: Vantage Medical Group Senior |
$7,808.19
|
|
|
HC ESTABLISH BRAIN CAVITY SHUNT
|
Facility
|
IP
|
$10,962.00
|
|
|
Service Code
|
CPT 62180
|
| Hospital Charge Code |
900501661
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,984.12 |
| Max. Negotiated Rate |
$8,221.50 |
| Rate for Payer: Adventist Health Commercial |
$2,192.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,059.53
|
| Rate for Payer: Cash Price |
$4,932.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,421.27
|
| Rate for Payer: Heritage Provider Network Senior |
$7,421.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,984.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,740.50
|
| Rate for Payer: Multiplan Commercial |
$8,221.50
|
|
|
HC ESTABLISH BRAIN CAVITY SHUNT
|
Facility
|
OP
|
$10,962.00
|
|
|
Service Code
|
CPT 62180
|
| Hospital Charge Code |
900501661
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,984.12 |
| Max. Negotiated Rate |
$9,317.70 |
| Rate for Payer: Adventist Health Commercial |
$2,192.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,774.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,317.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,029.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,221.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,136.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,206.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,143.64
|
| Rate for Payer: Cash Price |
$4,932.90
|
| Rate for Payer: Cash Price |
$4,932.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,125.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,317.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,317.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,317.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,125.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,421.27
|
| Rate for Payer: Heritage Provider Network Senior |
$7,421.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5,228.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,984.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,740.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7,673.40
|
| Rate for Payer: Multiplan Commercial |
$8,221.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$6,577.20
|
| Rate for Payer: TriValley Medical Group Senior |
$6,577.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,317.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,317.70
|
| Rate for Payer: Vantage Medical Group Senior |
$9,317.70
|
|
|
HC ESTAB OP VISIT HIGH SEVERITY
|
Facility
|
IP
|
$473.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908710010
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$85.61 |
| Max. Negotiated Rate |
$354.75 |
| Rate for Payer: Adventist Health Commercial |
$94.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$304.61
|
| Rate for Payer: Cash Price |
$212.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$320.22
|
| Rate for Payer: Heritage Provider Network Senior |
$320.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$85.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.25
|
| Rate for Payer: Multiplan Commercial |
$354.75
|
|
|
HC ESTAB OP VISIT HIGH SEVERITY
|
Facility
|
IP
|
$473.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600114
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$85.61 |
| Max. Negotiated Rate |
$354.75 |
| Rate for Payer: Adventist Health Commercial |
$94.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$304.61
|
| Rate for Payer: Cash Price |
$212.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$320.22
|
| Rate for Payer: Heritage Provider Network Senior |
$320.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$85.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.25
|
| Rate for Payer: Multiplan Commercial |
$354.75
|
|
|
HC ESTAB OP VISIT HIGH SEVERITY
|
Facility
|
OP
|
$473.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908710010
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$85.61 |
| Max. Negotiated Rate |
$354.75 |
| Rate for Payer: Adventist Health Commercial |
$94.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$292.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$236.59
|
| Rate for Payer: Blue Shield of California Commercial |
$288.53
|
| Rate for Payer: Blue Shield of California EPN |
$230.82
|
| Rate for Payer: Cash Price |
$212.85
|
| Rate for Payer: Cash Price |
$212.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$279.07
|
| Rate for Payer: EPIC Health Plan Medicare |
$171.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$292.79
|
| Rate for Payer: Heritage Provider Network Senior |
$292.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$225.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$85.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$196.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.46
|
| Rate for Payer: Multiplan Commercial |
$354.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$236.50
|
| Rate for Payer: TriValley Medical Group Senior |
$236.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$236.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$236.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Vantage Medical Group Senior |
$171.24
|
|
|
HC ESTAB OP VISIT HIGH SEVERITY
|
Facility
|
OP
|
$473.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600114
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$85.61 |
| Max. Negotiated Rate |
$354.75 |
| Rate for Payer: Adventist Health Commercial |
$94.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$292.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$236.59
|
| Rate for Payer: Blue Shield of California Commercial |
$288.53
|
| Rate for Payer: Blue Shield of California EPN |
$230.82
|
| Rate for Payer: Cash Price |
$212.85
|
| Rate for Payer: Cash Price |
$212.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$279.07
|
| Rate for Payer: EPIC Health Plan Medicare |
$171.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$292.79
|
| Rate for Payer: Heritage Provider Network Senior |
$292.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$225.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$85.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$196.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.46
|
| Rate for Payer: Multiplan Commercial |
$354.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$236.50
|
| Rate for Payer: TriValley Medical Group Senior |
$236.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$236.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$236.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Vantage Medical Group Senior |
$171.24
|
|
|
HC ESTAB OP VISIT LOW TO MOD
|
Facility
|
OP
|
$294.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908710008
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$53.21 |
| Max. Negotiated Rate |
$256.86 |
| Rate for Payer: Blue Shield of California EPN |
$143.47
|
| Rate for Payer: Adventist Health Commercial |
$58.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$181.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.06
|
| Rate for Payer: Blue Shield of California Commercial |
$179.34
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$173.46
|
| Rate for Payer: EPIC Health Plan Medicare |
$171.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$181.99
|
| Rate for Payer: Heritage Provider Network Senior |
$181.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$140.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$53.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$196.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.46
|
| Rate for Payer: Multiplan Commercial |
$220.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$147.00
|
| Rate for Payer: TriValley Medical Group Senior |
$147.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$147.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$147.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Vantage Medical Group Senior |
$171.24
|
|
|
HC ESTAB OP VISIT LOW TO MOD
|
Facility
|
IP
|
$294.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908710008
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$53.21 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Adventist Health Commercial |
$58.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$189.34
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$199.04
|
| Rate for Payer: Heritage Provider Network Senior |
$199.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$53.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.50
|
| Rate for Payer: Multiplan Commercial |
$220.50
|
|
|
HC ESTAB OP VISIT LOW TO MOD
|
Facility
|
IP
|
$294.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600112
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$53.21 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Adventist Health Commercial |
$58.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$189.34
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$199.04
|
| Rate for Payer: Heritage Provider Network Senior |
$199.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$53.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.50
|
| Rate for Payer: Multiplan Commercial |
$220.50
|
|
|
HC ESTAB OP VISIT LOW TO MOD
|
Facility
|
OP
|
$294.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600112
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$53.21 |
| Max. Negotiated Rate |
$256.86 |
| Rate for Payer: Adventist Health Commercial |
$58.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$181.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.06
|
| Rate for Payer: Blue Shield of California Commercial |
$179.34
|
| Rate for Payer: Blue Shield of California EPN |
$143.47
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$173.46
|
| Rate for Payer: EPIC Health Plan Medicare |
$171.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$181.99
|
| Rate for Payer: Heritage Provider Network Senior |
$181.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$140.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$53.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$196.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.46
|
| Rate for Payer: Multiplan Commercial |
$220.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$147.00
|
| Rate for Payer: TriValley Medical Group Senior |
$147.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$147.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$147.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Vantage Medical Group Senior |
$171.24
|
|
|
HC ESTAB OP VISIT MINIMAL
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
902890311
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.75 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Adventist Health Commercial |
$38.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$123.65
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$129.98
|
| Rate for Payer: Heritage Provider Network Senior |
$129.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$144.00
|
|
|
HC ESTAB OP VISIT MINIMAL
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600110
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.75 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Adventist Health Commercial |
$38.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$123.65
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$129.98
|
| Rate for Payer: Heritage Provider Network Senior |
$129.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$144.00
|
|
|
HC ESTAB OP VISIT MINIMAL
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
902890311
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.75 |
| Max. Negotiated Rate |
$3,224.00 |
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Adventist Health Commercial |
$38.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$118.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$96.04
|
| Rate for Payer: Blue Shield of California Commercial |
$117.12
|
| Rate for Payer: Blue Shield of California EPN |
$93.70
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$124.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$171.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$118.85
|
| Rate for Payer: Heritage Provider Network Senior |
$118.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$91.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$196.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.46
|
| Rate for Payer: Multiplan Commercial |
$144.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$188.36
|
| Rate for Payer: TriValley Medical Group Senior |
$188.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$96.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$96.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Vantage Medical Group Senior |
$171.24
|
|
