|
HC GB GALLBLADDER
|
Facility
|
OP
|
$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 |
$307.15
|
| 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 |
$201.42
|
| Rate for Payer: Blue Shield of California Commercial |
$156.72
|
| Rate for Payer: Blue Shield of California EPN |
$126.03
|
| Rate for Payer: Cash Price |
$223.65
|
| Rate for Payer: Cash Price |
$223.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$323.05
|
| 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 |
$293.23
|
| Rate for Payer: EPIC Health Plan Medicare |
$225.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$307.64
|
| Rate for Payer: Heritage Provider Network Senior |
$307.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$237.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$89.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$259.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$372.75
|
| 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 GDC 2-DIAMETER
|
Facility
|
IP
|
$1,764.00
|
|
| Hospital Charge Code |
909081817
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$352.80 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$352.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,136.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$709.13
|
| Rate for Payer: Blue Shield of California EPN |
$709.13
|
| Rate for Payer: Cash Price |
$793.80
|
| Rate for Payer: Cash Price |
$793.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$811.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$952.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$816.73
|
| Rate for Payer: Heritage Provider Network Senior |
$816.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$882.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$882.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$882.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$441.00
|
| Rate for Payer: Multiplan Commercial |
$1,323.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$637.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$584.06
|
|
|
HC GDC 2-DIAMETER
|
Facility
|
OP
|
$1,764.00
|
|
| Hospital Charge Code |
909081817
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$352.80 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$352.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,090.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,499.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$970.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,323.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$709.13
|
| Rate for Payer: Blue Shield of California EPN |
$709.13
|
| Rate for Payer: Cash Price |
$793.80
|
| Rate for Payer: Cash Price |
$793.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$811.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,499.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,499.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,499.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,128.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$816.73
|
| Rate for Payer: Heritage Provider Network Senior |
$816.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$882.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$882.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$882.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$441.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,234.80
|
| Rate for Payer: Multiplan Commercial |
$1,323.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$637.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$584.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,499.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,499.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,499.40
|
|
|
HC GDC 3-D SHAPE
|
Facility
|
OP
|
$3,900.00
|
|
| Hospital Charge Code |
909081818
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,410.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,567.80
|
| Rate for Payer: Blue Shield of California EPN |
$1,567.80
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,794.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,496.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,805.70
|
| Rate for Payer: Heritage Provider Network Senior |
$1,805.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,950.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,950.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,409.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,291.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC GDC 3-D SHAPE
|
Facility
|
IP
|
$3,900.00
|
|
| Hospital Charge Code |
909081818
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,511.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,567.80
|
| Rate for Payer: Blue Shield of California EPN |
$1,567.80
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,794.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,106.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,805.70
|
| Rate for Payer: Heritage Provider Network Senior |
$1,805.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,950.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,950.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,409.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,291.29
|
|
|
HC GDC SOFT
|
Facility
|
OP
|
$1,530.00
|
|
| Hospital Charge Code |
909081814
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$306.00 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,300.50
|
| Rate for Payer: Adventist Health Commercial |
$306.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$945.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,300.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$841.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,147.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$615.06
|
| Rate for Payer: Blue Shield of California EPN |
$615.06
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$703.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,300.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,300.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,300.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$979.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$708.39
|
| Rate for Payer: Heritage Provider Network Senior |
$708.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$765.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$765.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$765.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$382.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,071.00
|
| Rate for Payer: Multiplan Commercial |
$1,147.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$552.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$506.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,300.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,300.50
|
|
|
HC GDC SOFT
|
Facility
|
IP
|
$1,530.00
|
|
| Hospital Charge Code |
909081814
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$306.00 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$306.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$985.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$615.06
|
| Rate for Payer: Blue Shield of California EPN |
$615.06
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$703.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$826.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$708.39
|
| Rate for Payer: Heritage Provider Network Senior |
$708.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$765.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$765.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$765.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$382.50
|
| Rate for Payer: Multiplan Commercial |
$1,147.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$552.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$506.58
|
|
|
HC GDC STANDARD
|
Facility
|
IP
|
$4,347.50
|
|
| Hospital Charge Code |
909081815
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$869.50 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$869.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,799.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,747.69
|
| Rate for Payer: Blue Shield of California EPN |
$1,747.69
|
| Rate for Payer: Cash Price |
$1,956.38
|
| Rate for Payer: Cash Price |
$1,956.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,999.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,347.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,012.89
|
| Rate for Payer: Heritage Provider Network Senior |
$2,012.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,173.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,173.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,173.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,086.88
|
| Rate for Payer: Multiplan Commercial |
$3,260.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,570.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,439.46
|
|
|
HC GDC STANDARD
|
Facility
|
OP
|
$4,347.50
|
|
| Hospital Charge Code |
909081815
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$869.50 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$869.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,686.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,695.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,391.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,260.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,747.69
|
| Rate for Payer: Blue Shield of California EPN |
$1,747.69
|
| Rate for Payer: Cash Price |
$1,956.38
|
| Rate for Payer: Cash Price |
$1,956.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,999.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,695.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,695.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,695.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,782.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,012.89
|
| Rate for Payer: Heritage Provider Network Senior |
$2,012.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,173.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,173.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,173.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,086.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,043.25
|
| Rate for Payer: Multiplan Commercial |
$3,260.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,570.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,439.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,695.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,695.38
|
| Rate for Payer: Vantage Medical Group Senior |
$3,695.38
|
|
|
HC GDC STRETCH RESISTANT
|
Facility
|
OP
|
$1,536.00
|
|
| Hospital Charge Code |
909081816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$278.02 |
| Max. Negotiated Rate |
$1,305.60 |
| Rate for Payer: Adventist Health Commercial |
$307.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$949.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,305.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$844.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,152.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$768.31
|
| Rate for Payer: Blue Shield of California Commercial |
$936.96
|
| Rate for Payer: Blue Shield of California EPN |
$749.57
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$998.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,305.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,305.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,305.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$906.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$950.78
|
| Rate for Payer: Heritage Provider Network Senior |
$950.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$732.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$278.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,075.20
|
| Rate for Payer: Multiplan Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$768.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$768.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,305.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,305.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,305.60
|
|
|
HC GDC STRETCH RESISTANT
|
Facility
|
IP
|
$1,536.00
|
|
| Hospital Charge Code |
909081816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$278.02 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Adventist Health Commercial |
$307.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$989.18
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,039.87
|
| Rate for Payer: Heritage Provider Network Senior |
$1,039.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$278.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.00
|
| Rate for Payer: Multiplan Commercial |
$1,152.00
|
|
|
HC GENTAMICIN
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
900910406
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.46 |
| Max. Negotiated Rate |
$163.50 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$140.39
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$147.59
|
| Rate for Payer: Heritage Provider Network Senior |
$147.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.50
|
| Rate for Payer: Multiplan Commercial |
$163.50
|
|
|
HC GENTAMICIN
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
900910406
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.87 |
| Max. Negotiated Rate |
$140.95 |
| Rate for Payer: Adventist Health Commercial |
$9.80
|
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$134.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$140.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$140.95
|
| Rate for Payer: Blue Shield of California Commercial |
$131.90
|
| Rate for Payer: Blue Shield of California Commercial |
$131.90
|
| Rate for Payer: Blue Shield of California EPN |
$105.80
|
| Rate for Payer: Blue Shield of California EPN |
$105.80
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$141.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$31.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.62
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.38
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$134.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.33
|
| Rate for Payer: Heritage Provider Network Senior |
$134.94
|
| Rate for Payer: Heritage Provider Network Senior |
$30.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$103.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$23.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.95
|
| Rate for Payer: Multiplan Commercial |
$163.50
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.38
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.38
|
| Rate for Payer: TriValley Medical Group Senior |
$16.38
|
| Rate for Payer: TriValley Medical Group Senior |
$16.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.69
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.69
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.69
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.02
|
| Rate for Payer: Vantage Medical Group Senior |
$16.38
|
| Rate for Payer: Vantage Medical Group Senior |
$16.38
|
|
|
HC GENTAMICIN LEVEL PEAK
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
900912234
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.30 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$193.20
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$203.10
|
| Rate for Payer: Heritage Provider Network Senior |
$203.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
|
|
HC GENTAMICIN LEVEL PEAK
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
900912234
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.38 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$185.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$140.95
|
| Rate for Payer: Blue Shield of California Commercial |
$131.90
|
| Rate for Payer: Blue Shield of California EPN |
$105.80
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$195.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$177.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$185.70
|
| Rate for Payer: Heritage Provider Network Senior |
$185.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$143.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.95
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.38
|
| Rate for Payer: TriValley Medical Group Senior |
$16.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.69
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.02
|
| Rate for Payer: Vantage Medical Group Senior |
$16.38
|
|
|
HC GI BLEED SCAN
|
Facility
|
OP
|
$2,394.00
|
|
|
Service Code
|
CPT 78278
|
| Hospital Charge Code |
909301360
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$433.31 |
| Max. Negotiated Rate |
$1,795.50 |
| Rate for Payer: Adventist Health Commercial |
$478.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,479.49
|
| 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 |
$1,197.48
|
| Rate for Payer: Blue Shield of California Commercial |
$1,023.89
|
| Rate for Payer: Blue Shield of California EPN |
$823.38
|
| Rate for Payer: Cash Price |
$1,077.30
|
| Rate for Payer: Cash Price |
$1,077.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,556.10
|
| 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 |
$1,556.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$514.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,481.89
|
| Rate for Payer: Heritage Provider Network Senior |
$1,481.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$514.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,141.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$433.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$591.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$598.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$688.99
|
| Rate for Payer: Multiplan Commercial |
$1,795.50
|
| 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 |
$1,197.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,197.00
|
| 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 GI BLEED SCAN
|
Facility
|
IP
|
$2,394.00
|
|
|
Service Code
|
CPT 78278
|
| Hospital Charge Code |
909301360
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$433.31 |
| Max. Negotiated Rate |
$1,795.50 |
| Rate for Payer: Adventist Health Commercial |
$478.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,541.74
|
| Rate for Payer: Cash Price |
$1,077.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,620.74
|
| Rate for Payer: Heritage Provider Network Senior |
$1,620.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$433.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$598.50
|
| Rate for Payer: Multiplan Commercial |
$1,795.50
|
|
|
HC GI ENDOSCOPIC ULTRASOUND
|
Facility
|
OP
|
$1,355.00
|
|
|
Service Code
|
CPT 76975
|
| Hospital Charge Code |
906776975
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$243.41 |
| Max. Negotiated Rate |
$1,016.25 |
| Rate for Payer: Adventist Health Commercial |
$271.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$837.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$677.77
|
| Rate for Payer: Blue Shield of California Commercial |
$321.50
|
| Rate for Payer: Blue Shield of California EPN |
$258.54
|
| Rate for Payer: Cash Price |
$609.75
|
| Rate for Payer: Cash Price |
$609.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$880.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$799.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$838.75
|
| Rate for Payer: Heritage Provider Network Senior |
$838.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$646.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$245.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$352.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$338.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$1,016.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$306.88
|
| Rate for Payer: TriValley Medical Group Senior |
$306.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$243.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$243.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC GI ENDOSCOPIC ULTRASOUND
|
Facility
|
IP
|
$1,355.00
|
|
|
Service Code
|
CPT 76975
|
| Hospital Charge Code |
906776975
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$245.25 |
| Max. Negotiated Rate |
$1,016.25 |
| Rate for Payer: Adventist Health Commercial |
$271.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$872.62
|
| Rate for Payer: Cash Price |
$609.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$917.34
|
| Rate for Payer: Heritage Provider Network Senior |
$917.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$245.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$338.75
|
| Rate for Payer: Multiplan Commercial |
$1,016.25
|
|
|
HC GI INJ TREATMENT NR
|
Facility
|
OP
|
$1,961.00
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
906764640
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$354.94 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$392.20
|
| Rate for Payer: Adventist Health Commercial |
$361.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,116.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,211.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,137.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,137.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$882.45
|
| Rate for Payer: Cash Price |
$812.70
|
| Rate for Payer: Cash Price |
$882.45
|
| Rate for Payer: Cash Price |
$812.70
|
| Rate for Payer: Cash Price |
$882.45
|
| Rate for Payer: Cash Price |
$812.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,173.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,274.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,251.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,251.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,137.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,137.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,083.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,176.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,137.58
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,137.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,213.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,117.91
|
| Rate for Payer: Heritage Provider Network Senior |
$1,399.22
|
| Rate for Payer: Heritage Provider Network Senior |
$1,399.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$861.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$935.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$354.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$326.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,308.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,308.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$451.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$490.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,524.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,524.36
|
| Rate for Payer: Multiplan Commercial |
$1,470.75
|
| Rate for Payer: Multiplan Commercial |
$1,354.50
|
| 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 |
$2,731.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Vantage Medical Group Senior |
$1,137.58
|
| Rate for Payer: Vantage Medical Group Senior |
$1,137.58
|
|
|
HC GI INJ TREATMENT NR
|
Facility
|
IP
|
$1,806.00
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
906764640
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$326.89 |
| Max. Negotiated Rate |
$1,354.50 |
| Rate for Payer: Adventist Health Commercial |
$361.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,163.06
|
| Rate for Payer: Cash Price |
$812.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,222.66
|
| Rate for Payer: Heritage Provider Network Senior |
$1,222.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$326.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$451.50
|
| Rate for Payer: Multiplan Commercial |
$1,354.50
|
|
|
HC GI INJ TREATMENT NR
|
Facility
|
OP
|
$1,961.00
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
906764640
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$354.94 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$392.20
|
| Rate for Payer: Adventist Health Commercial |
$361.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,116.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,211.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,137.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,137.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$882.45
|
| Rate for Payer: Cash Price |
$812.70
|
| Rate for Payer: Cash Price |
$812.70
|
| Rate for Payer: Cash Price |
$882.45
|
| Rate for Payer: Cash Price |
$812.70
|
| Rate for Payer: Cash Price |
$882.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,173.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,274.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,251.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,251.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,137.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,137.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,083.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,176.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,137.58
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,137.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,117.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,213.86
|
| Rate for Payer: Heritage Provider Network Senior |
$1,399.22
|
| Rate for Payer: Heritage Provider Network Senior |
$1,399.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,161.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,161.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$354.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$326.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,308.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,308.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$451.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$490.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,524.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,524.36
|
| Rate for Payer: Multiplan Commercial |
$1,354.50
|
| Rate for Payer: Multiplan Commercial |
$1,470.75
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,251.34
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,251.34
|
| Rate for Payer: TriValley Medical Group Senior |
$1,251.34
|
| Rate for Payer: TriValley Medical Group Senior |
$1,251.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Vantage Medical Group Senior |
$1,137.58
|
| Rate for Payer: Vantage Medical Group Senior |
$1,137.58
|
|
|
HC GI INJ TREATMENT NR
|
Facility
|
IP
|
$1,806.00
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
906764640
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$326.89 |
| Max. Negotiated Rate |
$1,354.50 |
| Rate for Payer: Adventist Health Commercial |
$361.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,163.06
|
| Rate for Payer: Cash Price |
$812.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,222.66
|
| Rate for Payer: Heritage Provider Network Senior |
$1,222.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$326.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$451.50
|
| Rate for Payer: Multiplan Commercial |
$1,354.50
|
|
|
HC GI MYOELECTRICAL STDY, STMCH THRGH COLON
|
Facility
|
OP
|
$1,076.00
|
|
|
Service Code
|
CPT 0779T
|
| Hospital Charge Code |
906700779
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$194.76 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$215.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$664.97
|
| 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 Medicare Advantage/Dual Product |
$479.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$538.22
|
| 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 |
$484.20
|
| Rate for Payer: Cash Price |
$484.20
|
| Rate for Payer: Cash Price |
$484.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$699.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$719.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$527.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$479.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$479.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$666.04
|
| Rate for Payer: Heritage Provider Network Senior |
$590.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$479.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$513.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$194.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$551.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$269.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$643.12
|
| Rate for Payer: Multiplan Commercial |
$807.00
|
| 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 |
$538.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$538.00
|
| 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 Senior |
$479.94
|
|
|
HC GI MYOELECTRICAL STDY, STMCH THRGH COLON
|
Facility
|
IP
|
$1,076.00
|
|
|
Service Code
|
CPT 0779T
|
| Hospital Charge Code |
906700779
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$194.76 |
| Max. Negotiated Rate |
$807.00 |
| Rate for Payer: Adventist Health Commercial |
$215.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$692.94
|
| Rate for Payer: Cash Price |
$484.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$728.45
|
| Rate for Payer: Heritage Provider Network Senior |
$728.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$194.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$269.00
|
| Rate for Payer: Multiplan Commercial |
$807.00
|
|
