|
HC GALLBLDR/LIVER FUNC
|
Facility
OP
|
$2,311.00
|
|
|
Service Code
|
CPT 78226
|
| Hospital Charge Code |
909301353
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$418.29 |
| Max. Negotiated Rate |
$2,032.47 |
| Rate for Payer: Adventist Health Commercial |
$462.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$657.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,587.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,032.47
|
| Rate for Payer: Blue Shield of California Commercial |
$1,688.69
|
| Rate for Payer: Blue Shield of California EPN |
$960.31
|
| Rate for Payer: Cash Price |
$1,039.95
|
| Rate for Payer: Cash Price |
$1,039.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,502.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: Dignity Health Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,502.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$515.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,430.51
|
| Rate for Payer: Heritage Provider Network Senior |
$1,430.51
|
| Rate for Payer: Humana Medicare |
$515.32
|
| Rate for Payer: IEHP Medi-Cal |
$453.98
|
| Rate for Payer: IEHP Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$979.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$418.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$608.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$577.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$649.30
|
| Rate for Payer: Multiplan Commercial |
$1,733.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$566.85
|
| Rate for Payer: TriValley Medical Group Senior |
$515.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC GALLIUM SCAN LIMITED
|
Facility
IP
|
$1,776.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
909301446
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$321.46 |
| Max. Negotiated Rate |
$1,332.00 |
| Rate for Payer: Adventist Health Commercial |
$355.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,220.11
|
| Rate for Payer: Cash Price |
$799.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,202.35
|
| Rate for Payer: Heritage Provider Network Senior |
$1,202.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$444.00
|
| Rate for Payer: Multiplan Commercial |
$1,332.00
|
|
|
HC GALLIUM SCAN LIMITED
|
Facility
OP
|
$1,776.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
909301446
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$139.03 |
| Max. Negotiated Rate |
$1,332.00 |
| Rate for Payer: Adventist Health Commercial |
$355.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$343.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,220.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Blue Shield of California Commercial |
$693.97
|
| Rate for Payer: Blue Shield of California EPN |
$394.64
|
| Rate for Payer: Cash Price |
$799.20
|
| Rate for Payer: Cash Price |
$799.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,154.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: Dignity Health Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,154.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$515.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,099.34
|
| Rate for Payer: Heritage Provider Network Senior |
$1,099.34
|
| Rate for Payer: Humana Medicare |
$515.32
|
| Rate for Payer: IEHP Medi-Cal |
$139.03
|
| Rate for Payer: IEHP Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$979.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$608.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$444.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$649.30
|
| Rate for Payer: Multiplan Commercial |
$1,332.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$566.85
|
| Rate for Payer: TriValley Medical Group Senior |
$515.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC GAMMA GLUTAMYL TRANSFERASE
|
Facility
OP
|
$20.00
|
|
|
Service Code
|
CPT 82977
|
| Hospital Charge Code |
900910225
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$60.52 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$20.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.92
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.52
|
| Rate for Payer: Blue Shield of California Commercial |
$56.24
|
| Rate for Payer: Blue Shield of California EPN |
$43.96
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.92
|
| Rate for Payer: Dignity Health Senior |
$7.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.38
|
| Rate for Payer: Heritage Provider Network Senior |
$12.38
|
| Rate for Payer: Humana Medicare |
$7.20
|
| Rate for Payer: IEHP Medi-Cal |
$9.98
|
| Rate for Payer: IEHP Medicare Advantage |
$7.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.07
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.20
|
| Rate for Payer: TriValley Medical Group Senior |
$7.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.92
|
| Rate for Payer: Vantage Medical Group Senior |
$7.20
|
|
|
HC GAMMA GLUTAMYL TRANSFERASE
|
Facility
IP
|
$244.00
|
|
|
Service Code
|
CPT 82977
|
| Hospital Charge Code |
900910225
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.16 |
| Max. Negotiated Rate |
$183.00 |
| Rate for Payer: Adventist Health Commercial |
$48.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$167.63
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$165.19
|
| Rate for Payer: Heritage Provider Network Senior |
$165.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.00
|
| Rate for Payer: Multiplan Commercial |
$183.00
|
|
|
HC GASTRIC EMPTYING
|
Facility
OP
|
$2,108.00
|
|
|
Service Code
|
CPT 78264
|
| Hospital Charge Code |
909301364
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$381.55 |
| Max. Negotiated Rate |
$1,581.00 |
| Rate for Payer: Adventist Health Commercial |
$421.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$531.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,448.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Blue Shield of California Commercial |
$842.71
|
| Rate for Payer: Blue Shield of California EPN |
$479.23
|
| Rate for Payer: Cash Price |
$948.60
|
| Rate for Payer: Cash Price |
$948.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,370.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: Dignity Health Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,370.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$515.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,304.85
|
| Rate for Payer: Heritage Provider Network Senior |
$1,304.85
|
| Rate for Payer: Humana Medicare |
$515.32
|
| Rate for Payer: IEHP Medi-Cal |
$461.25
|
| Rate for Payer: IEHP Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$979.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$381.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$608.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$527.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$649.30
|
| Rate for Payer: Multiplan Commercial |
$1,581.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$566.85
|
| Rate for Payer: TriValley Medical Group Senior |
$515.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC GASTRIC EMPTYING
|
Facility
IP
|
$2,108.00
|
|
|
Service Code
|
CPT 78264
|
| Hospital Charge Code |
909301364
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$381.55 |
| Max. Negotiated Rate |
$1,581.00 |
| Rate for Payer: Adventist Health Commercial |
$421.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,448.20
|
| Rate for Payer: Cash Price |
$948.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,427.12
|
| Rate for Payer: Heritage Provider Network Senior |
$1,427.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$381.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$527.00
|
| Rate for Payer: Multiplan Commercial |
$1,581.00
|
|
|
HC GASTRIC INTUB W/ASPIRATIOIN
|
Facility
IP
|
$834.00
|
|
|
Service Code
|
CPT 43753
|
| Hospital Charge Code |
900501762
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$150.95 |
| Max. Negotiated Rate |
$625.50 |
| Rate for Payer: Adventist Health Commercial |
$166.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$572.96
|
| Rate for Payer: Cash Price |
$375.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$564.62
|
| Rate for Payer: Heritage Provider Network Senior |
$564.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$150.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.50
|
| Rate for Payer: Multiplan Commercial |
$625.50
|
|
|
HC GASTRIC INTUB W/ASPIRATIOIN
|
Facility
OP
|
$834.00
|
|
|
Service Code
|
CPT 43753
|
| Hospital Charge Code |
900501762
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$150.95 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$166.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$572.96
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$375.30
|
| Rate for Payer: Cash Price |
$375.30
|
| Rate for Payer: Cash Price |
$375.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$542.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: Dignity Health Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$392.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$564.62
|
| Rate for Payer: Heritage Provider Network Senior |
$564.62
|
| Rate for Payer: Humana Medicare |
$392.17
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$392.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$401.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$150.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$462.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$494.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$494.13
|
| Rate for Payer: Multiplan Commercial |
$625.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$302.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$278.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC GASTRIC MOTIL MANOMETRC STUDY
|
Facility
IP
|
$2,001.00
|
|
|
Service Code
|
CPT 91020
|
| Hospital Charge Code |
906791020
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$362.18 |
| Max. Negotiated Rate |
$1,500.75 |
| Rate for Payer: Adventist Health Commercial |
$400.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,374.69
|
| Rate for Payer: Cash Price |
$900.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,354.68
|
| Rate for Payer: Heritage Provider Network Senior |
$1,354.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$362.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$500.25
|
| Rate for Payer: Multiplan Commercial |
$1,500.75
|
|
|
HC GASTRIC MOTIL MANOMETRC STUDY
|
Facility
OP
|
$1,212.00
|
|
|
Service Code
|
CPT 91020
|
| Hospital Charge Code |
906791020
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$143.66 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$242.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$832.64
|
| 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 |
$545.40
|
| Rate for Payer: Cash Price |
$545.40
|
| Rate for Payer: Cash Price |
$545.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$787.80
|
| 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 |
$727.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$669.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$750.23
|
| Rate for Payer: Heritage Provider Network Senior |
$823.71
|
| Rate for Payer: Humana Medicare |
$669.68
|
| Rate for Payer: IEHP Medi-Cal |
$143.66
|
| 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 |
$219.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$790.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.00
|
| 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 |
$909.00
|
| 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 |
$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 GASTRODUODENOSTOMY
|
Facility
IP
|
$7,726.00
|
|
|
Service Code
|
CPT 43810
|
| Hospital Charge Code |
906743810
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,398.41 |
| Max. Negotiated Rate |
$5,794.50 |
| Rate for Payer: Adventist Health Commercial |
$1,545.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,307.76
|
| Rate for Payer: Cash Price |
$3,476.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,230.50
|
| Rate for Payer: Heritage Provider Network Senior |
$5,230.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,398.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,931.50
|
| Rate for Payer: Multiplan Commercial |
$5,794.50
|
|
|
HC GASTRODUODENOSTOMY
|
Facility
OP
|
$7,726.00
|
|
|
Service Code
|
CPT 43810
|
| Hospital Charge Code |
906743810
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$171.91 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,545.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,012.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,307.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,567.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,249.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5,794.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,576.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$3,476.70
|
| Rate for Payer: Cash Price |
$3,476.70
|
| Rate for Payer: Cash Price |
$3,476.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,021.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,567.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,567.10
|
| Rate for Payer: Dignity Health Senior |
$6,567.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,782.39
|
| Rate for Payer: Heritage Provider Network Senior |
$4,782.39
|
| Rate for Payer: IEHP Medi-Cal |
$171.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,723.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,398.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,931.50
|
| Rate for Payer: Multiplan Commercial |
$5,794.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,567.10
|
| Rate for Payer: Vantage Medical Group Senior |
$6,567.10
|
|
|
HC GASTROESOPHAGEAL REFLUX
|
Facility
OP
|
$1,695.00
|
|
|
Service Code
|
CPT 78262
|
| Hospital Charge Code |
909301365
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$168.70 |
| Max. Negotiated Rate |
$1,271.25 |
| Rate for Payer: Adventist Health Commercial |
$339.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$472.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,164.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Blue Shield of California Commercial |
$868.20
|
| Rate for Payer: Blue Shield of California EPN |
$493.72
|
| Rate for Payer: Cash Price |
$762.75
|
| Rate for Payer: Cash Price |
$762.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,101.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: Dignity Health Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,101.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$515.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,049.20
|
| Rate for Payer: Heritage Provider Network Senior |
$1,049.20
|
| Rate for Payer: Humana Medicare |
$515.32
|
| Rate for Payer: IEHP Medi-Cal |
$168.70
|
| Rate for Payer: IEHP Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$979.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$306.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$608.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$423.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$649.30
|
| Rate for Payer: Multiplan Commercial |
$1,271.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$566.85
|
| Rate for Payer: TriValley Medical Group Senior |
$515.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC GASTROESOPHAGEAL REFLUX
|
Facility
IP
|
$1,695.00
|
|
|
Service Code
|
CPT 78262
|
| Hospital Charge Code |
909301365
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$306.80 |
| Max. Negotiated Rate |
$1,271.25 |
| Rate for Payer: Adventist Health Commercial |
$339.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,164.46
|
| Rate for Payer: Cash Price |
$762.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,147.52
|
| Rate for Payer: Heritage Provider Network Senior |
$1,147.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$306.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$423.75
|
| Rate for Payer: Multiplan Commercial |
$1,271.25
|
|
|
HC GASTROESOPHAGEAL REFLUX TEST
|
Facility
IP
|
$884.00
|
|
|
Service Code
|
CPT 91035
|
| Hospital Charge Code |
906791035
|
|
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 GASTROESOPHAGEAL REFLUX TEST
|
Facility
IP
|
$3,575.00
|
|
|
Service Code
|
CPT 91034
|
| Hospital Charge Code |
906791034
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$647.08 |
| Max. Negotiated Rate |
$2,681.25 |
| Rate for Payer: Adventist Health Commercial |
$715.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,456.02
|
| Rate for Payer: Cash Price |
$1,608.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,420.28
|
| Rate for Payer: Heritage Provider Network Senior |
$2,420.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$647.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$893.75
|
| Rate for Payer: Multiplan Commercial |
$2,681.25
|
|
|
HC GASTROESOPHAGEAL REFLUX TEST
|
Facility
OP
|
$2,731.00
|
|
|
Service Code
|
CPT 91035
|
| Hospital Charge Code |
906791035
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$159.79 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$546.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$967.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,876.20
|
| 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 |
$1,228.95
|
| Rate for Payer: Cash Price |
$1,228.95
|
| Rate for Payer: Cash Price |
$1,228.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,775.15
|
| 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 |
$1,638.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$669.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,690.49
|
| Rate for Payer: Heritage Provider Network Senior |
$823.71
|
| Rate for Payer: Humana Medicare |
$669.68
|
| Rate for Payer: IEHP Medi-Cal |
$159.79
|
| 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 |
$494.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$790.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$682.75
|
| 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 |
$2,048.25
|
| 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 |
$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 GASTROESOPHAGEAL REFLUX TEST
|
Facility
OP
|
$1,578.00
|
|
|
Service Code
|
CPT 91034
|
| Hospital Charge Code |
906791034
|
|
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 GASTROJEJUNOSTOMY SET D/L
|
Facility
OP
|
$928.00
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
909001042
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$185.60 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$185.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$445.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$637.54
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$788.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$510.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$696.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$576.29
|
| Rate for Payer: Blue Shield of California EPN |
$544.74
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$426.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$788.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$788.80
|
| Rate for Payer: Dignity Health Senior |
$788.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$593.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$429.66
|
| Rate for Payer: Heritage Provider Network Senior |
$429.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$464.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$464.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$464.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$232.00
|
| Rate for Payer: Multiplan Commercial |
$696.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$338.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$310.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$788.80
|
| Rate for Payer: Vantage Medical Group Senior |
$788.80
|
|
|
HC GASTROJEJUNOSTOMY SET D/L
|
Facility
IP
|
$928.00
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
909001042
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$185.60 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$185.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$445.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$637.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$426.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$501.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$628.26
|
| Rate for Payer: Heritage Provider Network Senior |
$7,571.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$464.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$464.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$464.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$232.00
|
| Rate for Payer: Multiplan Commercial |
$696.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$338.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$310.04
|
|
|
HC GASTROJEJUNOSTOMY SET SGL/LMN
|
Facility
IP
|
$619.00
|
|
| Hospital Charge Code |
909001041
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$123.80 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$123.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$297.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$425.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$278.55
|
| Rate for Payer: Cash Price |
$278.55
|
| Rate for Payer: Cash Price |
$278.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$284.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$334.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$419.06
|
| Rate for Payer: Heritage Provider Network Senior |
$7,571.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$309.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$309.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$309.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.75
|
| Rate for Payer: Multiplan Commercial |
$464.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$225.69
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$206.81
|
|
|
HC GASTROJEJUNOSTOMY SET SGL/LMN
|
Facility
OP
|
$619.00
|
|
| Hospital Charge Code |
909001041
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$123.80 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$123.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$297.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$425.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$526.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$340.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$464.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$384.40
|
| Rate for Payer: Blue Shield of California EPN |
$363.35
|
| Rate for Payer: Cash Price |
$278.55
|
| Rate for Payer: Cash Price |
$278.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$284.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$526.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$526.15
|
| Rate for Payer: Dignity Health Senior |
$526.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$396.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$286.60
|
| Rate for Payer: Heritage Provider Network Senior |
$286.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$309.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$309.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$309.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.75
|
| Rate for Payer: Multiplan Commercial |
$464.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$225.69
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$206.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$526.15
|
| Rate for Payer: Vantage Medical Group Senior |
$526.15
|
|
|
HC GASTRO PANEL NUCLEIC ACID
|
Facility
OP
|
$644.00
|
|
|
Service Code
|
CPT 87507
|
| Hospital Charge Code |
900913644
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$116.56 |
| Max. Negotiated Rate |
$3,170.54 |
| Rate for Payer: Adventist Health Commercial |
$128.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,172.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$442.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$625.17
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$458.46
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$416.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,617.17
|
| Rate for Payer: Blue Shield of California Commercial |
$3,170.54
|
| Rate for Payer: Blue Shield of California EPN |
$2,478.58
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$418.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$625.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$458.46
|
| Rate for Payer: Dignity Health Senior |
$416.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$418.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$416.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$398.64
|
| Rate for Payer: Heritage Provider Network Senior |
$398.64
|
| Rate for Payer: Humana Medicare |
$416.78
|
| Rate for Payer: IEHP Medi-Cal |
$577.93
|
| Rate for Payer: IEHP Medicare Advantage |
$416.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$791.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$491.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$525.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.14
|
| Rate for Payer: Multiplan Commercial |
$483.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$416.78
|
| Rate for Payer: TriValley Medical Group Senior |
$416.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$450.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$450.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$625.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$458.46
|
| Rate for Payer: Vantage Medical Group Senior |
$416.78
|
|
|
HC GASTRO PANEL NUCLEIC ACID
|
Facility
IP
|
$766.00
|
|
|
Service Code
|
CPT 87507
|
| Hospital Charge Code |
900913644
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$138.65 |
| Max. Negotiated Rate |
$574.50 |
| Rate for Payer: Adventist Health Commercial |
$153.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$526.24
|
| Rate for Payer: Cash Price |
$344.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$518.58
|
| Rate for Payer: Heritage Provider Network Senior |
$518.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$138.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.50
|
| Rate for Payer: Multiplan Commercial |
$574.50
|
|
