|
HC UNLSTD DIAG GASTROENTEROLOGY
|
Facility
|
IP
|
$1,559.00
|
|
|
Service Code
|
CPT 91299
|
| Hospital Charge Code |
906791299
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$282.18 |
| Max. Negotiated Rate |
$1,169.25 |
| Rate for Payer: Adventist Health Commercial |
$311.80
|
| Rate for Payer: Cash Price |
$857.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,055.44
|
| Rate for Payer: Heritage Provider Network Senior |
$1,055.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$282.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$389.75
|
| Rate for Payer: Multiplan Commercial |
$1,169.25
|
|
|
HC UNLSTD DIAG GASTROENTEROLOGY
|
Facility
|
IP
|
$1,559.00
|
|
|
Service Code
|
CPT 91299
|
| Hospital Charge Code |
906791299
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$282.18 |
| Max. Negotiated Rate |
$1,169.25 |
| Rate for Payer: Adventist Health Commercial |
$311.80
|
| Rate for Payer: Cash Price |
$857.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,055.44
|
| Rate for Payer: Heritage Provider Network Senior |
$1,055.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$282.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$389.75
|
| Rate for Payer: Multiplan Commercial |
$1,169.25
|
|
|
HC UNLSTD MALE GENITAL SURG PROC
|
Facility
|
IP
|
$503.00
|
|
|
Service Code
|
CPT 55899
|
| Hospital Charge Code |
900501624
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$91.04 |
| Max. Negotiated Rate |
$377.25 |
| Rate for Payer: Adventist Health Commercial |
$100.60
|
| Rate for Payer: Cash Price |
$276.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$340.53
|
| Rate for Payer: Heritage Provider Network Senior |
$340.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.75
|
| Rate for Payer: Multiplan Commercial |
$377.25
|
|
|
HC UNLSTD MALE GENITAL SURG PROC
|
Facility
|
OP
|
$503.00
|
|
|
Service Code
|
CPT 55899
|
| Hospital Charge Code |
900501624
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$100.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$345.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,915.00
|
| Rate for Payer: Cash Price |
$276.65
|
| Rate for Payer: Cash Price |
$276.65
|
| Rate for Payer: Cash Price |
$276.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$326.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.92
|
| Rate for Payer: Dignity Health Senior |
$309.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$309.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$340.53
|
| Rate for Payer: Heritage Provider Network Senior |
$340.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$309.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$239.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$355.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$389.37
|
| Rate for Payer: Multiplan Commercial |
$377.25
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$180.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$166.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Vantage Medical Group Senior |
$309.02
|
|
|
HC UNLSTD PROCEDURE TRACHEA BRONC
|
Facility
|
IP
|
$3,367.00
|
|
|
Service Code
|
CPT 31899
|
| Hospital Charge Code |
900501511
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$609.43 |
| Max. Negotiated Rate |
$2,525.25 |
| Rate for Payer: Adventist Health Commercial |
$673.40
|
| Rate for Payer: Cash Price |
$1,851.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,279.46
|
| Rate for Payer: Heritage Provider Network Senior |
$2,279.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$609.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$841.75
|
| Rate for Payer: Multiplan Commercial |
$2,525.25
|
|
|
HC UNLSTD PROCEDURE TRACHEA BRONC
|
Facility
|
OP
|
$3,367.00
|
|
|
Service Code
|
CPT 31899
|
| Hospital Charge Code |
900501511
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$673.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,313.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$370.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$271.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$246.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,915.00
|
| Rate for Payer: Cash Price |
$1,851.85
|
| Rate for Payer: Cash Price |
$1,851.85
|
| Rate for Payer: Cash Price |
$1,851.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,188.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$370.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$271.34
|
| Rate for Payer: Dignity Health Senior |
$246.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$246.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,279.46
|
| Rate for Payer: Heritage Provider Network Senior |
$2,279.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$246.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,606.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$609.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$283.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$841.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$310.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$310.80
|
| Rate for Payer: Multiplan Commercial |
$2,525.25
|
| Rate for Payer: Multiplan WC |
$393.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,211.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,114.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$370.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$271.34
|
| Rate for Payer: Vantage Medical Group Senior |
$246.67
|
|
|
HC UNLSTD PROC PALATE/UVULA
|
Facility
|
IP
|
$413.00
|
|
|
Service Code
|
CPT 42299
|
| Hospital Charge Code |
900501745
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$74.75 |
| Max. Negotiated Rate |
$309.75 |
| Rate for Payer: Adventist Health Commercial |
$82.60
|
| Rate for Payer: Cash Price |
$227.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$279.60
|
| Rate for Payer: Heritage Provider Network Senior |
$279.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.25
|
| Rate for Payer: Multiplan Commercial |
$309.75
|
|
|
HC UNLSTD PROC PALATE/UVULA
|
Facility
|
OP
|
$413.00
|
|
|
Service Code
|
CPT 42299
|
| Hospital Charge Code |
900501745
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$74.75 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$82.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$220.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$283.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$295.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,915.00
|
| Rate for Payer: Cash Price |
$227.15
|
| Rate for Payer: Cash Price |
$227.15
|
| Rate for Payer: Cash Price |
$227.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$268.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.57
|
| Rate for Payer: Dignity Health Senior |
$295.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$295.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$279.60
|
| Rate for Payer: Heritage Provider Network Senior |
$279.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$295.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$197.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$339.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$371.78
|
| Rate for Payer: Multiplan Commercial |
$309.75
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$148.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$136.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Vantage Medical Group Senior |
$295.06
|
|
|
HC UNLSTD TEAR DUCT SYSTEM SURGRY
|
Facility
|
OP
|
$1,037.00
|
|
|
Service Code
|
CPT 68899
|
| Hospital Charge Code |
900501716
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$187.70 |
| Max. Negotiated Rate |
$1,915.00 |
| Rate for Payer: Adventist Health Commercial |
$207.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$554.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$712.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$569.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$417.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$379.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,915.00
|
| Rate for Payer: Cash Price |
$570.35
|
| Rate for Payer: Cash Price |
$570.35
|
| Rate for Payer: Cash Price |
$570.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$674.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$569.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$417.80
|
| Rate for Payer: Dignity Health Senior |
$379.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$674.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$379.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$702.05
|
| Rate for Payer: Heritage Provider Network Senior |
$702.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$379.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$494.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$187.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$436.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$478.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$478.57
|
| Rate for Payer: Multiplan Commercial |
$777.75
|
| Rate for Payer: Multiplan WC |
$605.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$373.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$343.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$569.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$417.80
|
| Rate for Payer: Vantage Medical Group Senior |
$379.82
|
|
|
HC UNLSTD TEAR DUCT SYSTEM SURGRY
|
Facility
|
IP
|
$1,037.00
|
|
|
Service Code
|
CPT 68899
|
| Hospital Charge Code |
900501716
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$187.70 |
| Max. Negotiated Rate |
$777.75 |
| Rate for Payer: Adventist Health Commercial |
$207.40
|
| Rate for Payer: Cash Price |
$570.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$702.05
|
| Rate for Payer: Heritage Provider Network Senior |
$702.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$187.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.25
|
| Rate for Payer: Multiplan Commercial |
$777.75
|
|
|
HC UNLST PROC CASTING/STRAPPING
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 29799
|
| Hospital Charge Code |
900501651
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$59.73 |
| Max. Negotiated Rate |
$247.50 |
| Rate for Payer: Adventist Health Commercial |
$66.00
|
| Rate for Payer: Cash Price |
$181.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$223.41
|
| Rate for Payer: Heritage Provider Network Senior |
$223.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.50
|
| Rate for Payer: Multiplan Commercial |
$247.50
|
|
|
HC UNLST PROC CASTING/STRAPPING
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 29799
|
| Hospital Charge Code |
900501651
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$59.73 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$66.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$176.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$226.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$300.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$220.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$200.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,915.00
|
| Rate for Payer: Cash Price |
$181.50
|
| Rate for Payer: Cash Price |
$181.50
|
| Rate for Payer: Cash Price |
$181.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$214.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$300.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$220.54
|
| Rate for Payer: Dignity Health Senior |
$200.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$200.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$223.41
|
| Rate for Payer: Heritage Provider Network Senior |
$223.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$200.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$157.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$230.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$252.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$252.62
|
| Rate for Payer: Multiplan Commercial |
$247.50
|
| Rate for Payer: Multiplan WC |
$319.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$118.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$109.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$300.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$220.54
|
| Rate for Payer: Vantage Medical Group Senior |
$200.49
|
|
|
HC UNLST PROC TONGUE FLOOR OF MOUTH
|
Facility
|
IP
|
$480.00
|
|
|
Service Code
|
CPT 41599
|
| Hospital Charge Code |
900501220
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$86.88 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Adventist Health Commercial |
$96.00
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$324.96
|
| Rate for Payer: Heritage Provider Network Senior |
$324.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.00
|
| Rate for Payer: Multiplan Commercial |
$360.00
|
|
|
HC UNLST PROC TONGUE FLOOR OF MOUTH
|
Facility
|
OP
|
$480.00
|
|
|
Service Code
|
CPT 41599
|
| Hospital Charge Code |
900501220
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$86.88 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$96.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$256.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$329.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$295.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,915.00
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$312.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.57
|
| Rate for Payer: Dignity Health Senior |
$295.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$295.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$324.96
|
| Rate for Payer: Heritage Provider Network Senior |
$324.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$295.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$228.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$339.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$371.78
|
| Rate for Payer: Multiplan Commercial |
$360.00
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$172.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$158.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Vantage Medical Group Senior |
$295.06
|
|
|
HC UPPER GI ENDOSCOPY W OPTCL END
|
Facility
|
OP
|
$2,041.00
|
|
|
Service Code
|
CPT 43252
|
| Hospital Charge Code |
906743252
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$408.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,402.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,410.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| 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 |
$1,122.55
|
| Rate for Payer: Cash Price |
$1,122.55
|
| Rate for Payer: Cash Price |
$1,122.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,326.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,651.35
|
| Rate for Payer: Dignity Health Senior |
$2,410.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,410.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,263.38
|
| Rate for Payer: Heritage Provider Network Senior |
$2,964.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$973.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$369.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,771.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$510.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,037.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,037.00
|
| Rate for Payer: Multiplan Commercial |
$1,530.75
|
| 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 |
$3,615.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,410.32
|
|
|
HC UPPER GI ENDOSCOPY W OPTCL END
|
Facility
|
IP
|
$2,041.00
|
|
|
Service Code
|
CPT 43252
|
| Hospital Charge Code |
906743252
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$369.42 |
| Max. Negotiated Rate |
$1,530.75 |
| Rate for Payer: Adventist Health Commercial |
$408.20
|
| Rate for Payer: Cash Price |
$1,122.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,381.76
|
| Rate for Payer: Heritage Provider Network Senior |
$1,381.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$369.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$510.25
|
| Rate for Payer: Multiplan Commercial |
$1,530.75
|
|
|
HC UPPER GI ENDOSCOPY W/RMVL FB
|
Facility
|
IP
|
$3,240.00
|
|
|
Service Code
|
CPT 43247
|
| Hospital Charge Code |
900501341
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$586.44 |
| Max. Negotiated Rate |
$2,430.00 |
| Rate for Payer: Adventist Health Commercial |
$648.00
|
| Rate for Payer: Cash Price |
$1,782.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,193.48
|
| Rate for Payer: Heritage Provider Network Senior |
$2,193.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$586.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$810.00
|
| Rate for Payer: Multiplan Commercial |
$2,430.00
|
|
|
HC UPPER GI ENDOSCOPY W/RMVL FB
|
Facility
|
OP
|
$3,240.00
|
|
|
Service Code
|
CPT 43247
|
| Hospital Charge Code |
900501341
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$648.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,225.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Cash Price |
$1,782.00
|
| Rate for Payer: Cash Price |
$1,782.00
|
| Rate for Payer: Cash Price |
$1,782.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,106.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Senior |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,191.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,193.48
|
| Rate for Payer: Heritage Provider Network Senior |
$2,193.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,545.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$586.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,369.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$810.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,500.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,500.99
|
| Rate for Payer: Multiplan Commercial |
$2,430.00
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,165.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,072.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC UPPER GI SCOPE W/THRMAL ENERGY
|
Facility
|
IP
|
$4,134.00
|
|
|
Service Code
|
CPT 43257
|
| Hospital Charge Code |
906743257
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$748.25 |
| Max. Negotiated Rate |
$3,100.50 |
| Rate for Payer: Adventist Health Commercial |
$826.80
|
| Rate for Payer: Cash Price |
$2,273.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,798.72
|
| Rate for Payer: Heritage Provider Network Senior |
$2,798.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$748.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,033.50
|
| Rate for Payer: Multiplan Commercial |
$3,100.50
|
|
|
HC UPPER GI SCOPE W/THRMAL ENERGY
|
Facility
|
OP
|
$4,134.00
|
|
|
Service Code
|
CPT 43257
|
| Hospital Charge Code |
906743257
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$826.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,840.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,251.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,317.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,834.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| 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 |
$2,273.70
|
| Rate for Payer: Cash Price |
$2,273.70
|
| Rate for Payer: Cash Price |
$2,273.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,687.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,251.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,317.44
|
| Rate for Payer: Dignity Health Senior |
$4,834.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,834.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,558.95
|
| Rate for Payer: Heritage Provider Network Senior |
$5,945.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$58.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,834.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,971.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$748.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,559.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,033.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,090.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,090.89
|
| Rate for Payer: Multiplan Commercial |
$3,100.50
|
| 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 |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,251.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,317.44
|
| Rate for Payer: Vantage Medical Group Senior |
$4,834.04
|
|
|
HC UREA NITROGEN, UR
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
900910460
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.91 |
| Max. Negotiated Rate |
$161.25 |
| Rate for Payer: Adventist Health Commercial |
$43.00
|
| Rate for Payer: Cash Price |
$118.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$145.56
|
| Rate for Payer: Heritage Provider Network Senior |
$145.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.75
|
| Rate for Payer: Multiplan Commercial |
$161.25
|
|
|
HC UREA NITROGEN, UR
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
900910460
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.36 |
| Max. Negotiated Rate |
$161.25 |
| Rate for Payer: Adventist Health Commercial |
$43.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$114.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$147.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.33
|
| Rate for Payer: Blue Shield of California Commercial |
$38.25
|
| Rate for Payer: Blue Shield of California EPN |
$30.68
|
| Rate for Payer: Cash Price |
$118.25
|
| Rate for Payer: Cash Price |
$118.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$139.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.12
|
| Rate for Payer: Dignity Health Senior |
$5.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$139.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$133.09
|
| Rate for Payer: Heritage Provider Network Senior |
$133.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$102.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.01
|
| Rate for Payer: Multiplan Commercial |
$161.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.56
|
| Rate for Payer: TriValley Medical Group Senior |
$5.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Vantage Medical Group Senior |
$5.56
|
|
|
HC UREA NITROGEN URINE 24 HOURS
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
900912196
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.91 |
| Max. Negotiated Rate |
$161.25 |
| Rate for Payer: Adventist Health Commercial |
$43.00
|
| Rate for Payer: Cash Price |
$118.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$145.56
|
| Rate for Payer: Heritage Provider Network Senior |
$145.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.75
|
| Rate for Payer: Multiplan Commercial |
$161.25
|
|
|
HC UREA NITROGEN URINE 24 HOURS
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
900912196
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.36 |
| Max. Negotiated Rate |
$161.25 |
| Rate for Payer: Adventist Health Commercial |
$43.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$114.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$147.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.33
|
| Rate for Payer: Blue Shield of California Commercial |
$38.25
|
| Rate for Payer: Blue Shield of California EPN |
$30.68
|
| Rate for Payer: Cash Price |
$118.25
|
| Rate for Payer: Cash Price |
$118.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$139.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.12
|
| Rate for Payer: Dignity Health Senior |
$5.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$139.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$133.09
|
| Rate for Payer: Heritage Provider Network Senior |
$133.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$102.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.01
|
| Rate for Payer: Multiplan Commercial |
$161.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.56
|
| Rate for Payer: TriValley Medical Group Senior |
$5.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Vantage Medical Group Senior |
$5.56
|
|
|
HC UREA NITROGEN URINE RANDOM
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
900912195
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.36 |
| Max. Negotiated Rate |
$161.25 |
| Rate for Payer: Adventist Health Commercial |
$43.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$114.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$147.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.33
|
| Rate for Payer: Blue Shield of California Commercial |
$38.25
|
| Rate for Payer: Blue Shield of California EPN |
$30.68
|
| Rate for Payer: Cash Price |
$118.25
|
| Rate for Payer: Cash Price |
$118.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$139.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.12
|
| Rate for Payer: Dignity Health Senior |
$5.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$139.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$133.09
|
| Rate for Payer: Heritage Provider Network Senior |
$133.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$102.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.01
|
| Rate for Payer: Multiplan Commercial |
$161.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.56
|
| Rate for Payer: TriValley Medical Group Senior |
$5.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Vantage Medical Group Senior |
$5.56
|
|
