|
HC GAL D 1 (EGG WHITE), IGE
|
Facility
|
IP
|
$13.27
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913722
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$9.95 |
| Rate for Payer: Adventist Health Commercial |
$2.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.55
|
| Rate for Payer: Cash Price |
$5.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.98
|
| Rate for Payer: Heritage Provider Network Senior |
$8.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.32
|
| Rate for Payer: Multiplan Commercial |
$9.95
|
|
|
HC GAL D 2 (EGG WHITE), IGE
|
Facility
|
IP
|
$13.27
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913723
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$9.95 |
| Rate for Payer: Adventist Health Commercial |
$2.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.55
|
| Rate for Payer: Cash Price |
$5.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.98
|
| Rate for Payer: Heritage Provider Network Senior |
$8.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.32
|
| Rate for Payer: Multiplan Commercial |
$9.95
|
|
|
HC GAL D 2 (EGG WHITE), IGE
|
Facility
|
OP
|
$13.27
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913723
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$157.06 |
| Rate for Payer: Adventist Health Commercial |
$2.65
|
| Rate for Payer: Adventist Health Commercial |
$2.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.06
|
| Rate for Payer: Blue Shield of California Commercial |
$127.53
|
| Rate for Payer: Blue Shield of California Commercial |
$127.53
|
| Rate for Payer: Blue Shield of California EPN |
$102.29
|
| Rate for Payer: Blue Shield of California EPN |
$102.29
|
| Rate for Payer: Cash Price |
$5.97
|
| Rate for Payer: Cash Price |
$5.97
|
| Rate for Payer: Cash Price |
$4.98
|
| Rate for Payer: Cash Price |
$4.98
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.53
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.21
|
| Rate for Payer: Heritage Provider Network Senior |
$6.85
|
| Rate for Payer: Heritage Provider Network Senior |
$8.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$8.29
|
| Rate for Payer: Multiplan Commercial |
$9.95
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC GALLBLDR/LIVER FUNC
|
Facility
|
IP
|
$2,375.00
|
|
|
Service Code
|
CPT 78226
|
| Hospital Charge Code |
909301353
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$429.88 |
| Max. Negotiated Rate |
$1,781.25 |
| Rate for Payer: Adventist Health Commercial |
$475.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,529.50
|
| Rate for Payer: Cash Price |
$1,068.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,607.88
|
| Rate for Payer: Heritage Provider Network Senior |
$1,607.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$429.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$593.75
|
| Rate for Payer: Multiplan Commercial |
$1,781.25
|
|
|
HC GALLBLDR/LIVER FUNC
|
Facility
|
OP
|
$2,375.00
|
|
|
Service Code
|
CPT 78226
|
| Hospital Charge Code |
909301353
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$429.88 |
| Max. Negotiated Rate |
$2,305.54 |
| Rate for Payer: Adventist Health Commercial |
$475.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,467.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$514.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,305.54
|
| Rate for Payer: Blue Shield of California Commercial |
$1,739.42
|
| Rate for Payer: Blue Shield of California EPN |
$1,398.79
|
| Rate for Payer: Cash Price |
$1,068.75
|
| Rate for Payer: Cash Price |
$1,068.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,543.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$771.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,543.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$514.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,470.12
|
| Rate for Payer: Heritage Provider Network Senior |
$1,470.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$514.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,132.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$429.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$591.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$593.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$688.99
|
| Rate for Payer: Multiplan Commercial |
$1,781.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$565.59
|
| Rate for Payer: TriValley Medical Group Senior |
$514.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,187.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,187.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Vantage Medical Group Senior |
$514.17
|
|
|
HC GALLIUM SCAN LIMITED
|
Facility
|
IP
|
$1,413.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
909301446
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$255.75 |
| Max. Negotiated Rate |
$1,059.75 |
| Rate for Payer: Adventist Health Commercial |
$282.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$909.97
|
| Rate for Payer: Cash Price |
$635.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$956.60
|
| Rate for Payer: Heritage Provider Network Senior |
$956.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$255.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$353.25
|
| Rate for Payer: Multiplan Commercial |
$1,059.75
|
|
|
HC GALLIUM SCAN LIMITED
|
Facility
|
OP
|
$1,413.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
909301446
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$255.75 |
| Max. Negotiated Rate |
$1,059.75 |
| Rate for Payer: Adventist Health Commercial |
$282.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$873.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$514.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$706.78
|
| Rate for Payer: Blue Shield of California Commercial |
$714.82
|
| Rate for Payer: Blue Shield of California EPN |
$574.83
|
| Rate for Payer: Cash Price |
$635.85
|
| Rate for Payer: Cash Price |
$635.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$918.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$771.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$918.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$514.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$874.65
|
| Rate for Payer: Heritage Provider Network Senior |
$874.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$514.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$674.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$255.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$591.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$353.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$688.99
|
| Rate for Payer: Multiplan Commercial |
$1,059.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$565.59
|
| Rate for Payer: TriValley Medical Group Senior |
$514.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$706.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$706.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Vantage Medical Group Senior |
$514.17
|
|
|
HC GAMMA GLUTAMYL TRANSFERASE
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
CPT 82977
|
| Hospital Charge Code |
900910225
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$68.65 |
| Rate for Payer: Adventist Health Commercial |
$8.80
|
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$166.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.65
|
| Rate for Payer: Blue Shield of California Commercial |
$57.95
|
| Rate for Payer: Blue Shield of California Commercial |
$57.95
|
| Rate for Payer: Blue Shield of California EPN |
$46.48
|
| Rate for Payer: Blue Shield of California EPN |
$46.48
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$175.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$28.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$159.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$167.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.24
|
| Rate for Payer: Heritage Provider Network Senior |
$167.13
|
| Rate for Payer: Heritage Provider Network Senior |
$27.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$128.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$20.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$48.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.65
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
| Rate for Payer: Multiplan Commercial |
$33.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.20
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$7.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 Commercial/Exchange |
$10.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.92
|
| Rate for Payer: Vantage Medical Group Senior |
$7.20
|
| Rate for Payer: Vantage Medical Group Senior |
$7.20
|
|
|
HC GAMMA GLUTAMYL TRANSFERASE
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT 82977
|
| Hospital Charge Code |
900910225
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.87 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$173.88
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$182.79
|
| Rate for Payer: Heritage Provider Network Senior |
$182.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$48.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.50
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
|
|
HC GASTRIC EMPTYING
|
Facility
|
OP
|
$2,303.00
|
|
|
Service Code
|
CPT 78264
|
| Hospital Charge Code |
909301364
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$416.84 |
| Max. Negotiated Rate |
$1,727.25 |
| Rate for Payer: Adventist Health Commercial |
$460.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,423.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$514.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,151.96
|
| Rate for Payer: Blue Shield of California Commercial |
$868.03
|
| Rate for Payer: Blue Shield of California EPN |
$698.04
|
| Rate for Payer: Cash Price |
$1,036.35
|
| Rate for Payer: Cash Price |
$1,036.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,496.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$771.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,496.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$514.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,425.56
|
| Rate for Payer: Heritage Provider Network Senior |
$1,425.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$514.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,098.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$416.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$591.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$575.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$688.99
|
| Rate for Payer: Multiplan Commercial |
$1,727.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$565.59
|
| Rate for Payer: TriValley Medical Group Senior |
$514.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,151.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,151.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Vantage Medical Group Senior |
$514.17
|
|
|
HC GASTRIC EMPTYING
|
Facility
|
IP
|
$2,303.00
|
|
|
Service Code
|
CPT 78264
|
| Hospital Charge Code |
909301364
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$416.84 |
| Max. Negotiated Rate |
$1,727.25 |
| Rate for Payer: Adventist Health Commercial |
$460.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,483.13
|
| Rate for Payer: Cash Price |
$1,036.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,559.13
|
| Rate for Payer: Heritage Provider Network Senior |
$1,559.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$416.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$575.75
|
| Rate for Payer: Multiplan Commercial |
$1,727.25
|
|
|
HC GASTRIC INTUB W/ASPIRATIOIN
|
Facility
|
IP
|
$911.00
|
|
|
Service Code
|
CPT 43753
|
| Hospital Charge Code |
900501762
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$164.89 |
| Max. Negotiated Rate |
$683.25 |
| Rate for Payer: Adventist Health Commercial |
$182.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$586.68
|
| Rate for Payer: Cash Price |
$409.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$616.75
|
| Rate for Payer: Heritage Provider Network Senior |
$616.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$164.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$227.75
|
| Rate for Payer: Multiplan Commercial |
$683.25
|
|
|
HC GASTRIC INTUB W/ASPIRATIOIN
|
Facility
|
OP
|
$911.00
|
|
|
Service Code
|
CPT 43753
|
| Hospital Charge Code |
900501762
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$164.89 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$182.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$563.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$432.73
|
| Rate for Payer: Blue Shield of California EPN |
$344.36
|
| Rate for Payer: Cash Price |
$409.95
|
| Rate for Payer: Cash Price |
$409.95
|
| Rate for Payer: Cash Price |
$409.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$592.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$416.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$305.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$277.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$277.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$616.75
|
| Rate for Payer: Heritage Provider Network Senior |
$616.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$277.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$434.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$164.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$319.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$227.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$372.13
|
| Rate for Payer: Multiplan Commercial |
$683.25
|
| Rate for Payer: Multiplan WC |
$630.41
|
| Rate for Payer: TriValley Medical Group Commercial |
$546.60
|
| Rate for Payer: TriValley Medical Group Senior |
$546.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Vantage Medical Group Senior |
$277.71
|
|
|
HC GASTRIC MOTIL MANOMETRC STUDY
|
Facility
|
OP
|
$1,756.00
|
|
|
Service Code
|
CPT 91020
|
| Hospital Charge Code |
906791020
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$317.84 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$351.20
|
| Rate for Payer: Adventist Health Commercial |
$320.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,085.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$990.65
|
| 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 |
$801.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$878.35
|
| 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 |
$790.20
|
| Rate for Payer: Cash Price |
$790.20
|
| Rate for Payer: Cash Price |
$721.35
|
| Rate for Payer: Cash Price |
$721.35
|
| Rate for Payer: Cash Price |
$790.20
|
| Rate for Payer: Cash Price |
$721.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,041.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,141.40
|
| 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 |
$961.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,053.60
|
| 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 |
$1,086.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$992.26
|
| 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 |
$764.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$837.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$317.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$290.14
|
| 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 |
$400.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$439.00
|
| 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 |
$1,317.00
|
| Rate for Payer: Multiplan Commercial |
$1,202.25
|
| 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 GASTRIC MOTIL MANOMETRC STUDY
|
Facility
|
IP
|
$1,756.00
|
|
|
Service Code
|
CPT 91020
|
| Hospital Charge Code |
906791020
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$317.84 |
| Max. Negotiated Rate |
$1,317.00 |
| Rate for Payer: Adventist Health Commercial |
$351.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,130.86
|
| Rate for Payer: Cash Price |
$790.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,188.81
|
| Rate for Payer: Heritage Provider Network Senior |
$1,188.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$317.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$439.00
|
| Rate for Payer: Multiplan Commercial |
$1,317.00
|
|
|
HC GASTRODUODENOSTOMY
|
Facility
|
OP
|
$10,218.00
|
|
|
Service Code
|
CPT 43810
|
| Hospital Charge Code |
906743810
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,728.00 |
| Rate for Payer: Adventist Health Commercial |
$2,043.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,314.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,685.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,619.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,663.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,728.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$4,598.10
|
| Rate for Payer: Cash Price |
$4,598.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,641.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,685.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,685.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,685.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,324.94
|
| Rate for Payer: Heritage Provider Network Senior |
$6,324.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,873.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,849.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,554.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7,152.60
|
| Rate for Payer: Multiplan Commercial |
$7,663.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,685.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,685.30
|
| Rate for Payer: Vantage Medical Group Senior |
$8,685.30
|
|
|
HC GASTRODUODENOSTOMY
|
Facility
|
IP
|
$10,218.00
|
|
|
Service Code
|
CPT 43810
|
| Hospital Charge Code |
906743810
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,849.46 |
| Max. Negotiated Rate |
$7,663.50 |
| Rate for Payer: Adventist Health Commercial |
$2,043.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,580.39
|
| Rate for Payer: Cash Price |
$4,598.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,917.59
|
| Rate for Payer: Heritage Provider Network Senior |
$6,917.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,849.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,554.50
|
| Rate for Payer: Multiplan Commercial |
$7,663.50
|
|
|
HC GASTROESOPHAGEAL REFLUX
|
Facility
|
OP
|
$1,552.00
|
|
|
Service Code
|
CPT 78262
|
| Hospital Charge Code |
909301365
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$280.91 |
| Max. Negotiated Rate |
$1,164.00 |
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Adventist Health Commercial |
$310.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$959.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$514.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$776.31
|
| Rate for Payer: Blue Shield of California Commercial |
$894.29
|
| Rate for Payer: Blue Shield of California EPN |
$719.16
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,008.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$771.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,008.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$514.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$960.69
|
| Rate for Payer: Heritage Provider Network Senior |
$960.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$514.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$740.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$280.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$591.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$388.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$688.99
|
| Rate for Payer: Multiplan Commercial |
$1,164.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$565.59
|
| Rate for Payer: TriValley Medical Group Senior |
$514.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$776.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$776.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Vantage Medical Group Senior |
$514.17
|
|
|
HC GASTROESOPHAGEAL REFLUX
|
Facility
|
IP
|
$1,552.00
|
|
|
Service Code
|
CPT 78262
|
| Hospital Charge Code |
909301365
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$280.91 |
| Max. Negotiated Rate |
$1,164.00 |
| Rate for Payer: Adventist Health Commercial |
$310.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$999.49
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,050.70
|
| Rate for Payer: Heritage Provider Network Senior |
$1,050.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$280.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$388.00
|
| Rate for Payer: Multiplan Commercial |
$1,164.00
|
|
|
HC GASTROESOPHAGEAL REFLUX TEST
|
Facility
|
IP
|
$966.00
|
|
|
Service Code
|
CPT 91035
|
| Hospital Charge Code |
906791035
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$174.85 |
| Max. Negotiated Rate |
$724.50 |
| Rate for Payer: Adventist Health Commercial |
$193.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$622.10
|
| Rate for Payer: Cash Price |
$434.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$653.98
|
| Rate for Payer: Heritage Provider Network Senior |
$653.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$174.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$241.50
|
| Rate for Payer: Multiplan Commercial |
$724.50
|
|
|
HC GASTROESOPHAGEAL REFLUX TEST
|
Facility
|
OP
|
$966.00
|
|
|
Service Code
|
CPT 91035
|
| Hospital Charge Code |
906791035
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$174.85 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$193.20
|
| Rate for Payer: Adventist Health Commercial |
$596.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$596.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,843.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,656.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,656.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,214.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,214.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,104.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,104.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,492.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$483.19
|
| 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 |
$434.70
|
| Rate for Payer: Cash Price |
$434.70
|
| Rate for Payer: Cash Price |
$1,342.35
|
| Rate for Payer: Cash Price |
$1,342.35
|
| Rate for Payer: Cash Price |
$434.70
|
| Rate for Payer: Cash Price |
$1,342.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,938.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$627.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,656.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,656.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,214.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,214.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,104.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,104.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,789.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$579.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,104.48
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,104.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$597.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,846.48
|
| Rate for Payer: Heritage Provider Network Senior |
$1,358.51
|
| Rate for Payer: Heritage Provider Network Senior |
$1,358.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,104.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,104.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,422.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$460.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$174.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$539.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,270.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,270.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$745.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$241.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,480.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,480.00
|
| Rate for Payer: Multiplan Commercial |
$724.50
|
| Rate for Payer: Multiplan Commercial |
$2,237.25
|
| 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 |
$1,656.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,656.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,214.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,214.93
|
| Rate for Payer: Vantage Medical Group Senior |
$1,104.48
|
| Rate for Payer: Vantage Medical Group Senior |
$1,104.48
|
|
|
HC GASTROESOPHAGEAL REFLUX TEST
|
Facility
|
OP
|
$4,728.00
|
|
|
Service Code
|
CPT 91034
|
| Hospital Charge Code |
906791034
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$945.60
|
| Rate for Payer: Adventist Health Commercial |
$417.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,921.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,289.77
|
| 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 |
$1,043.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,364.95
|
| 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 |
$2,127.60
|
| Rate for Payer: Cash Price |
$2,127.60
|
| Rate for Payer: Cash Price |
$939.15
|
| Rate for Payer: Cash Price |
$939.15
|
| Rate for Payer: Cash Price |
$2,127.60
|
| Rate for Payer: Cash Price |
$939.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,356.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,073.20
|
| 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 |
$1,252.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,836.80
|
| 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 |
$2,926.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,291.85
|
| 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 |
$995.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,255.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$855.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$377.75
|
| 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 |
$521.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,182.00
|
| 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 |
$3,546.00
|
| Rate for Payer: Multiplan Commercial |
$1,565.25
|
| 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 GASTROESOPHAGEAL REFLUX TEST
|
Facility
|
IP
|
$4,728.00
|
|
|
Service Code
|
CPT 91034
|
| Hospital Charge Code |
906791034
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$855.77 |
| Max. Negotiated Rate |
$3,546.00 |
| Rate for Payer: Adventist Health Commercial |
$945.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,044.83
|
| Rate for Payer: Cash Price |
$2,127.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,200.86
|
| Rate for Payer: Heritage Provider Network Senior |
$3,200.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$855.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,182.00
|
| Rate for Payer: Multiplan Commercial |
$3,546.00
|
|
|
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 |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$185.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$597.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$373.06
|
| Rate for Payer: Blue Shield of California EPN |
$373.06
|
| 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 |
$429.66
|
| Rate for Payer: Heritage Provider Network Senior |
$429.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$464.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$464.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$335.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$307.26
|
|
|
HC GASTROJEJUNOSTOMY SET D/L
|
Facility
|
OP
|
$928.00
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
909001042
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$232.00 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$380.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$573.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$788.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$510.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$696.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$373.06
|
| Rate for Payer: Blue Shield of California EPN |
$373.06
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$464.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$464.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$464.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$232.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$649.60
|
| Rate for Payer: Multiplan Commercial |
$696.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$335.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$307.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$788.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$788.80
|
| Rate for Payer: Vantage Medical Group Senior |
$788.80
|
|
