|
HC GASTROJEJUNOSTOMY SET SGL/LMN
|
Facility
|
OP
|
$619.00
|
|
| Hospital Charge Code |
909001041
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$154.75 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$253.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$382.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$526.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$340.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$464.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$248.84
|
| Rate for Payer: Blue Shield of California EPN |
$248.84
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$309.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$309.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$309.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$433.30
|
| Rate for Payer: Multiplan Commercial |
$464.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$223.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$204.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$526.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$526.15
|
| Rate for Payer: Vantage Medical Group Senior |
$526.15
|
|
|
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 |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$123.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$398.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$248.84
|
| Rate for Payer: Blue Shield of California EPN |
$248.84
|
| 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 |
$286.60
|
| Rate for Payer: Heritage Provider Network Senior |
$286.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$309.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$309.50
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$223.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$204.95
|
|
|
HC GASTRO PANEL NUCLEIC ACID
|
Facility
|
OP
|
$1,762.00
|
|
|
Service Code
|
CPT 87507
|
| Hospital Charge Code |
900913644
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$318.92 |
| Max. Negotiated Rate |
$3,266.96 |
| Rate for Payer: Adventist Health Commercial |
$352.40
|
| Rate for Payer: Adventist Health Commercial |
$296.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$915.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,088.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$625.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$625.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$458.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$458.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$416.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$416.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,968.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,968.79
|
| Rate for Payer: Blue Shield of California Commercial |
$3,266.96
|
| Rate for Payer: Blue Shield of California Commercial |
$3,266.96
|
| Rate for Payer: Blue Shield of California EPN |
$2,620.37
|
| Rate for Payer: Blue Shield of California EPN |
$2,620.37
|
| Rate for Payer: Cash Price |
$792.90
|
| Rate for Payer: Cash Price |
$792.90
|
| Rate for Payer: Cash Price |
$666.90
|
| Rate for Payer: Cash Price |
$666.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$963.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,145.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$625.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$625.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$458.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$458.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$416.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$416.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,145.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$963.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$416.78
|
| Rate for Payer: EPIC Health Plan Medicare |
$416.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$917.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,090.68
|
| Rate for Payer: Heritage Provider Network Senior |
$917.36
|
| Rate for Payer: Heritage Provider Network Senior |
$1,090.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$416.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$416.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$706.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$840.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$268.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$318.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$479.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$479.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$440.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$370.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$558.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$558.49
|
| Rate for Payer: Multiplan Commercial |
$1,111.50
|
| Rate for Payer: Multiplan Commercial |
$1,321.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$416.78
|
| Rate for Payer: TriValley Medical Group Commercial |
$416.78
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$450.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 Commercial/Exchange |
$625.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$458.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$458.46
|
| Rate for Payer: Vantage Medical Group Senior |
$416.78
|
| Rate for Payer: Vantage Medical Group Senior |
$416.78
|
|
|
HC GASTRO PANEL NUCLEIC ACID
|
Facility
|
IP
|
$1,762.00
|
|
|
Service Code
|
CPT 87507
|
| Hospital Charge Code |
900913644
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$318.92 |
| Max. Negotiated Rate |
$1,321.50 |
| Rate for Payer: Adventist Health Commercial |
$352.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,134.73
|
| Rate for Payer: Cash Price |
$792.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,192.87
|
| Rate for Payer: Heritage Provider Network Senior |
$1,192.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$318.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$440.50
|
| Rate for Payer: Multiplan Commercial |
$1,321.50
|
|
|
HC GASTROSTOMY TUBE PERCUT
|
Facility
|
OP
|
$3,368.00
|
|
|
Service Code
|
CPT 49440
|
| Hospital Charge Code |
906743750
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$673.60
|
| Rate for Payer: Adventist Health Commercial |
$591.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,827.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,081.42
|
| 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 |
$5,158.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| 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 |
$1,515.60
|
| Rate for Payer: Cash Price |
$1,515.60
|
| Rate for Payer: Cash Price |
$1,330.65
|
| Rate for Payer: Cash Price |
$1,330.65
|
| Rate for Payer: Cash Price |
$1,515.60
|
| Rate for Payer: Cash Price |
$1,330.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,922.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,189.20
|
| 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 |
$2,084.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,830.38
|
| 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 |
$1,410.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,606.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$609.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$535.22
|
| 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 |
$739.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$842.00
|
| 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 |
$2,526.00
|
| Rate for Payer: Multiplan Commercial |
$2,217.75
|
| 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 GASTROSTOMY TUBE PERCUT
|
Facility
|
IP
|
$2,957.00
|
|
|
Service Code
|
CPT 49440
|
| Hospital Charge Code |
906743750
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$535.22 |
| Max. Negotiated Rate |
$2,217.75 |
| Rate for Payer: Adventist Health Commercial |
$591.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,904.31
|
| Rate for Payer: Cash Price |
$1,330.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,001.89
|
| Rate for Payer: Heritage Provider Network Senior |
$2,001.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$535.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$739.25
|
| Rate for Payer: Multiplan Commercial |
$2,217.75
|
|
|
HC GASTROSTOMY TUBE REPOSITION
|
Facility
|
OP
|
$3,174.00
|
|
|
Service Code
|
CPT 43761
|
| Hospital Charge Code |
906743761
|
|
Hospital Revenue Code
|
949
|
| Min. Negotiated Rate |
$321.35 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$634.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,961.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$321.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,936.14
|
| Rate for Payer: Blue Shield of California EPN |
$1,548.91
|
| Rate for Payer: Cash Price |
$1,428.30
|
| Rate for Payer: Cash Price |
$1,428.30
|
| Rate for Payer: Cash Price |
$1,428.30
|
| Rate for Payer: Cash Price |
$1,428.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,063.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$482.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$353.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$321.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$321.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,964.71
|
| Rate for Payer: Heritage Provider Network Senior |
$1,964.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$321.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,514.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$574.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$369.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$793.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$430.61
|
| Rate for Payer: Multiplan Commercial |
$2,380.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$353.49
|
| Rate for Payer: TriValley Medical Group Senior |
$321.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$526.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$443.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Vantage Medical Group Senior |
$321.35
|
|
|
HC GASTROSTOMY TUBE REPOSITION
|
Facility
|
IP
|
$3,174.00
|
|
|
Service Code
|
CPT 43761
|
| Hospital Charge Code |
906743761
|
|
Hospital Revenue Code
|
949
|
| Min. Negotiated Rate |
$574.49 |
| Max. Negotiated Rate |
$2,380.50 |
| Rate for Payer: Adventist Health Commercial |
$634.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,044.06
|
| Rate for Payer: Cash Price |
$1,428.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,148.80
|
| Rate for Payer: Heritage Provider Network Senior |
$2,148.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$574.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$793.50
|
| Rate for Payer: Multiplan Commercial |
$2,380.50
|
|
|
HC GASTRO TUBE PLACEMENT
|
Facility
|
OP
|
$2,103.00
|
|
|
Service Code
|
CPT 44500
|
| Hospital Charge Code |
906744500
|
|
Hospital Revenue Code
|
949
|
| Min. Negotiated Rate |
$380.64 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$420.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,299.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,282.83
|
| Rate for Payer: Blue Shield of California EPN |
$1,026.26
|
| Rate for Payer: Cash Price |
$946.35
|
| Rate for Payer: Cash Price |
$946.35
|
| Rate for Payer: Cash Price |
$946.35
|
| Rate for Payer: Cash Price |
$946.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,366.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,166.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,301.76
|
| Rate for Payer: Heritage Provider Network Senior |
$1,301.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,003.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$380.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,341.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$525.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$1,577.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,283.18
|
| Rate for Payer: TriValley Medical Group Senior |
$1,166.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$526.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$443.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC GASTRO TUBE PLACEMENT
|
Facility
|
IP
|
$2,103.00
|
|
|
Service Code
|
CPT 44500
|
| Hospital Charge Code |
906744500
|
|
Hospital Revenue Code
|
949
|
| Min. Negotiated Rate |
$380.64 |
| Max. Negotiated Rate |
$1,577.25 |
| Rate for Payer: Adventist Health Commercial |
$420.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,354.33
|
| Rate for Payer: Cash Price |
$946.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,423.73
|
| Rate for Payer: Heritage Provider Network Senior |
$1,423.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$380.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$525.75
|
| Rate for Payer: Multiplan Commercial |
$1,577.25
|
|
|
HC GASTRO TUBE REMOVAL
|
Facility
|
IP
|
$10,594.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
900100022
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,917.51 |
| Max. Negotiated Rate |
$7,945.50 |
| Rate for Payer: Adventist Health Commercial |
$2,118.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,822.54
|
| Rate for Payer: Cash Price |
$4,767.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,172.14
|
| Rate for Payer: Heritage Provider Network Senior |
$7,172.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,917.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,648.50
|
| Rate for Payer: Multiplan Commercial |
$7,945.50
|
|
|
HC GASTRO TUBE REMOVAL
|
Facility
|
OP
|
$5,614.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
900100022
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,122.80
|
| Rate for Payer: Adventist Health Commercial |
$2,118.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,547.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,469.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,808.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,299.12
|
| 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 |
$2,526.30
|
| Rate for Payer: Cash Price |
$4,767.30
|
| Rate for Payer: Cash Price |
$4,767.30
|
| Rate for Payer: Cash Price |
$2,526.30
|
| Rate for Payer: Cash Price |
$4,767.30
|
| Rate for Payer: Cash Price |
$2,526.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,886.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,649.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| 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 |
$1,166.53
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,166.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,475.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,557.69
|
| Rate for Payer: Heritage Provider Network Senior |
$1,434.83
|
| Rate for Payer: Heritage Provider Network Senior |
$1,434.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5,053.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,677.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,016.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,917.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,341.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,341.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,648.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,403.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$4,210.50
|
| Rate for Payer: Multiplan Commercial |
$7,945.50
|
| 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 |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC GASTRO UGI SMB W WO KUB
|
Facility
|
IP
|
$1,831.00
|
|
|
Service Code
|
CPT 74245
|
| Hospital Charge Code |
909001811
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$331.41 |
| Max. Negotiated Rate |
$1,373.25 |
| Rate for Payer: Adventist Health Commercial |
$366.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,179.16
|
| Rate for Payer: Cash Price |
$823.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,239.59
|
| Rate for Payer: Heritage Provider Network Senior |
$1,239.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$331.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$457.75
|
| Rate for Payer: Multiplan Commercial |
$1,373.25
|
|
|
HC GASTRO UGI SMB W WO KUB
|
Facility
|
OP
|
$1,831.00
|
|
|
Service Code
|
CPT 74245
|
| Hospital Charge Code |
909001811
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$331.41 |
| Max. Negotiated Rate |
$1,556.35 |
| Rate for Payer: Adventist Health Commercial |
$366.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,131.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,556.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,007.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,373.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$604.19
|
| Rate for Payer: Blue Shield of California Commercial |
$1,116.91
|
| Rate for Payer: Blue Shield of California EPN |
$893.53
|
| Rate for Payer: Cash Price |
$823.95
|
| Rate for Payer: Cash Price |
$823.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,190.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,556.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,556.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,556.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,080.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,133.39
|
| Rate for Payer: Heritage Provider Network Senior |
$1,133.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$873.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$331.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$457.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,281.70
|
| Rate for Payer: Multiplan Commercial |
$1,373.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$915.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$915.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,556.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,556.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,556.35
|
|
|
HC GASTRO UGI SNGL CNTRST
|
Facility
|
OP
|
$1,012.00
|
|
|
Service Code
|
CPT 74240
|
| Hospital Charge Code |
909001873
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$137.33 |
| Max. Negotiated Rate |
$759.00 |
| Rate for Payer: Adventist Health Commercial |
$202.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$625.42
|
| 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 |
$398.17
|
| Rate for Payer: Blue Shield of California Commercial |
$306.48
|
| Rate for Payer: Blue Shield of California EPN |
$246.46
|
| Rate for Payer: Cash Price |
$455.40
|
| Rate for Payer: Cash Price |
$455.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$657.80
|
| 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 |
$597.08
|
| Rate for Payer: EPIC Health Plan Medicare |
$225.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$626.43
|
| Rate for Payer: Heritage Provider Network Senior |
$626.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$482.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$183.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$259.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$759.00
|
| 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 GASTRO UGI SNGL CNTRST
|
Facility
|
IP
|
$1,012.00
|
|
|
Service Code
|
CPT 74240
|
| Hospital Charge Code |
909001873
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$183.17 |
| Max. Negotiated Rate |
$759.00 |
| Rate for Payer: Adventist Health Commercial |
$202.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$651.73
|
| Rate for Payer: Cash Price |
$455.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$685.12
|
| Rate for Payer: Heritage Provider Network Senior |
$685.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$183.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.00
|
| Rate for Payer: Multiplan Commercial |
$759.00
|
|
|
HC GASTRO UGI WITH KUB
|
Facility
|
OP
|
$1,172.00
|
|
|
Service Code
|
CPT 74241
|
| Hospital Charge Code |
909001796
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$212.13 |
| Max. Negotiated Rate |
$996.20 |
| Rate for Payer: Adventist Health Commercial |
$234.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$724.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$996.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$644.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$405.90
|
| Rate for Payer: Blue Shield of California Commercial |
$714.92
|
| Rate for Payer: Blue Shield of California EPN |
$571.94
|
| Rate for Payer: Cash Price |
$527.40
|
| Rate for Payer: Cash Price |
$527.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$761.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$996.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$996.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$996.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$691.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$725.47
|
| Rate for Payer: Heritage Provider Network Senior |
$725.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$559.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$212.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$293.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$820.40
|
| Rate for Payer: Multiplan Commercial |
$879.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$586.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$586.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$996.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$996.20
|
| Rate for Payer: Vantage Medical Group Senior |
$996.20
|
|
|
HC GASTRO UGI WITH KUB
|
Facility
|
IP
|
$1,172.00
|
|
|
Service Code
|
CPT 74241
|
| Hospital Charge Code |
909001796
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$212.13 |
| Max. Negotiated Rate |
$879.00 |
| Rate for Payer: Adventist Health Commercial |
$234.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$754.77
|
| Rate for Payer: Cash Price |
$527.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$793.44
|
| Rate for Payer: Heritage Provider Network Senior |
$793.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$212.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$293.00
|
| Rate for Payer: Multiplan Commercial |
$879.00
|
|
|
HC GASTROVIEW PER ML
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT Q9960
|
| Hospital Charge Code |
909001017
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.64
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.68
|
| Rate for Payer: Heritage Provider Network Senior |
$0.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
|
|
HC GASTROVIEW PER ML
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT Q9960
|
| Hospital Charge Code |
909001017
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.36
|
| Rate for Payer: Blue Shield of California Commercial |
$0.61
|
| Rate for Payer: Blue Shield of California EPN |
$0.49
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.62
|
| Rate for Payer: Heritage Provider Network Senior |
$0.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.40
|
| Rate for Payer: TriValley Medical Group Senior |
$0.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Vantage Medical Group Senior |
$0.85
|
|
|
HC GATED BLOOD POOL- MUGA
|
Facility
|
IP
|
$2,590.00
|
|
|
Service Code
|
CPT 78472
|
| Hospital Charge Code |
909301381
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$468.79 |
| Max. Negotiated Rate |
$1,942.50 |
| Rate for Payer: Adventist Health Commercial |
$518.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,667.96
|
| Rate for Payer: Cash Price |
$1,165.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,753.43
|
| Rate for Payer: Heritage Provider Network Senior |
$1,753.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$468.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$647.50
|
| Rate for Payer: Multiplan Commercial |
$1,942.50
|
|
|
HC GATED BLOOD POOL- MUGA
|
Facility
|
OP
|
$2,590.00
|
|
|
Service Code
|
CPT 78472
|
| Hospital Charge Code |
909301381
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$468.79 |
| Max. Negotiated Rate |
$1,942.50 |
| Rate for Payer: Adventist Health Commercial |
$518.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,600.62
|
| 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 |
$1,295.52
|
| Rate for Payer: Blue Shield of California Commercial |
$1,160.40
|
| Rate for Payer: Blue Shield of California EPN |
$933.15
|
| Rate for Payer: Cash Price |
$1,165.50
|
| Rate for Payer: Cash Price |
$1,165.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,683.50
|
| 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 |
$1,683.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$514.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,603.21
|
| Rate for Payer: Heritage Provider Network Senior |
$1,603.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$514.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,235.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$468.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$591.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$647.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$688.99
|
| Rate for Payer: Multiplan Commercial |
$1,942.50
|
| 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 |
$1,295.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,295.00
|
| 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 GATED FIRST PASS
|
Facility
|
IP
|
$1,297.00
|
|
|
Service Code
|
CPT 78481
|
| Hospital Charge Code |
909301391
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$234.76 |
| Max. Negotiated Rate |
$972.75 |
| Rate for Payer: Adventist Health Commercial |
$259.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$835.27
|
| Rate for Payer: Cash Price |
$583.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$878.07
|
| Rate for Payer: Heritage Provider Network Senior |
$878.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$234.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.25
|
| Rate for Payer: Multiplan Commercial |
$972.75
|
|
|
HC GATED FIRST PASS
|
Facility
|
OP
|
$1,297.00
|
|
|
Service Code
|
CPT 78481
|
| Hospital Charge Code |
909301391
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$234.76 |
| Max. Negotiated Rate |
$1,098.91 |
| Rate for Payer: Adventist Health Commercial |
$259.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$801.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$698.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$648.76
|
| Rate for Payer: Blue Shield of California Commercial |
$1,098.91
|
| Rate for Payer: Blue Shield of California EPN |
$883.71
|
| Rate for Payer: Cash Price |
$583.65
|
| Rate for Payer: Cash Price |
$583.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$843.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$768.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$698.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$843.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$698.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$802.84
|
| Rate for Payer: Heritage Provider Network Senior |
$802.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$698.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$618.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$234.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$803.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$935.79
|
| Rate for Payer: Multiplan Commercial |
$972.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$768.18
|
| Rate for Payer: TriValley Medical Group Senior |
$698.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$648.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$648.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Vantage Medical Group Senior |
$698.35
|
|
|
HC GB GALLBLADDER
|
Facility
|
IP
|
$497.00
|
|
|
Service Code
|
CPT 74290
|
| Hospital Charge Code |
909001818
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.96 |
| Max. Negotiated Rate |
$372.75 |
| Rate for Payer: Adventist Health Commercial |
$99.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$320.07
|
| Rate for Payer: Cash Price |
$223.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$336.47
|
| Rate for Payer: Heritage Provider Network Senior |
$336.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$89.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.25
|
| Rate for Payer: Multiplan Commercial |
$372.75
|
|
