|
HC EGD W/BAND/LIG SCLE
|
Facility
|
OP
|
$5,862.00
|
|
|
Service Code
|
CPT 43244
|
| Hospital Charge Code |
906743244
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$408.16 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,517.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,612.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,351.09
|
| Rate for Payer: Cash Price |
$2,637.90
|
| Rate for Payer: Cash Price |
$2,637.90
|
| Rate for Payer: Cigna of CA PPO |
$4,337.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Media |
$2,377.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Galaxy Health WC |
$4,982.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,517.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,396.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,899.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,899.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,851.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,851.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,909.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$408.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,406.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Multiplan Commercial |
$4,689.60
|
| Rate for Payer: Networks By Design Commercial |
$3,810.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,982.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,517.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,852.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC EGD W/BAND/LIG SCLE
|
Facility
|
IP
|
$8,771.00
|
|
|
Service Code
|
CPT 43244
|
| Hospital Charge Code |
906743244
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,105.04 |
| Max. Negotiated Rate |
$7,455.35 |
| Rate for Payer: Cash Price |
$3,946.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,508.40
|
| Rate for Payer: Galaxy Health WC |
$7,455.35
|
| Rate for Payer: Global Benefits Group Commercial |
$5,262.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,850.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,341.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,105.04
|
| Rate for Payer: Multiplan Commercial |
$7,016.80
|
| Rate for Payer: Networks By Design Commercial |
$5,701.15
|
| Rate for Payer: Prime Health Services Commercial |
$7,455.35
|
|
|
HC EGD W BLLN DLTN ESO
|
Facility
|
IP
|
$5,318.00
|
|
|
Service Code
|
CPT 43249
|
| Hospital Charge Code |
906743249
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,276.32 |
| Max. Negotiated Rate |
$4,520.30 |
| Rate for Payer: Cash Price |
$2,393.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,127.20
|
| Rate for Payer: Galaxy Health WC |
$4,520.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,190.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,547.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,026.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,276.32
|
| Rate for Payer: Multiplan Commercial |
$4,254.40
|
| Rate for Payer: Networks By Design Commercial |
$3,456.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,520.30
|
|
|
HC EGD W BLLN DLTN ESO
|
Facility
|
OP
|
$3,553.00
|
|
|
Service Code
|
CPT 43249
|
| Hospital Charge Code |
906743249
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$423.72 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,131.80
|
| Rate for Payer: Cash Price |
$1,598.85
|
| Rate for Payer: Cash Price |
$1,598.85
|
| Rate for Payer: Cash Price |
$1,598.85
|
| Rate for Payer: Cigna of CA PPO |
$2,629.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Media |
$2,377.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Galaxy Health WC |
$3,020.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,131.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,664.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,899.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,899.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,369.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$423.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$852.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Multiplan Commercial |
$2,842.40
|
| Rate for Payer: Networks By Design Commercial |
$2,309.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,020.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,131.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,776.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,776.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,776.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,776.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC EGD W BLLN DLTN ESO
|
Facility
|
OP
|
$3,553.00
|
|
|
Service Code
|
CPT 43249
|
| Hospital Charge Code |
906743249
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$423.72 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,131.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,612.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,351.09
|
| Rate for Payer: Cash Price |
$1,598.85
|
| Rate for Payer: Cash Price |
$1,598.85
|
| Rate for Payer: Cigna of CA PPO |
$2,629.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Media |
$2,377.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Galaxy Health WC |
$3,020.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,131.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,664.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,899.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,899.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,851.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,851.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,369.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$423.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$852.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Multiplan Commercial |
$2,842.40
|
| Rate for Payer: Networks By Design Commercial |
$2,309.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,020.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,131.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,852.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC EGD W BLLN DLTN ESO
|
Facility
|
IP
|
$5,318.00
|
|
|
Service Code
|
CPT 43249
|
| Hospital Charge Code |
906743249
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,276.32 |
| Max. Negotiated Rate |
$4,520.30 |
| Rate for Payer: Cash Price |
$2,393.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,127.20
|
| Rate for Payer: Galaxy Health WC |
$4,520.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,190.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,547.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,026.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,276.32
|
| Rate for Payer: Multiplan Commercial |
$4,254.40
|
| Rate for Payer: Networks By Design Commercial |
$3,456.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,520.30
|
|
|
HC EGD W BX SNGL OR MULTI
|
Facility
|
OP
|
$3,845.00
|
|
|
Service Code
|
CPT 43239
|
| Hospital Charge Code |
906743239
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$444.94 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,307.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,612.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,351.09
|
| Rate for Payer: Cash Price |
$1,730.25
|
| Rate for Payer: Cash Price |
$1,730.25
|
| Rate for Payer: Cigna of CA PPO |
$2,845.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$3,268.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,307.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,883.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,857.45
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,857.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,834.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,834.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,564.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$444.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$922.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$3,076.00
|
| Rate for Payer: Networks By Design Commercial |
$2,499.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,268.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,307.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,359.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC EGD W BX SNGL OR MULTI
|
Facility
|
IP
|
$7,193.00
|
|
|
Service Code
|
CPT 43239
|
| Hospital Charge Code |
906743239
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,726.32 |
| Max. Negotiated Rate |
$6,114.05 |
| Rate for Payer: Cash Price |
$3,236.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,877.20
|
| Rate for Payer: Galaxy Health WC |
$6,114.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,315.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,797.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,740.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,726.32
|
| Rate for Payer: Multiplan Commercial |
$5,754.40
|
| Rate for Payer: Networks By Design Commercial |
$4,675.45
|
| Rate for Payer: Prime Health Services Commercial |
$6,114.05
|
|
|
HC EGD W BX SNGL OR MULTI
|
Facility
|
OP
|
$3,845.00
|
|
|
Service Code
|
CPT 43239
|
| Hospital Charge Code |
906743239
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$444.94 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,307.00
|
| Rate for Payer: Cash Price |
$1,730.25
|
| Rate for Payer: Cash Price |
$1,730.25
|
| Rate for Payer: Cash Price |
$1,730.25
|
| Rate for Payer: Cigna of CA PPO |
$2,845.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$3,268.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,307.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,883.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,857.45
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,857.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,564.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$444.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$922.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$3,076.00
|
| Rate for Payer: Networks By Design Commercial |
$2,499.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,268.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,307.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,922.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,922.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,922.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,922.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC EGD W BX SNGL OR MULTI
|
Facility
|
IP
|
$7,193.00
|
|
|
Service Code
|
CPT 43239
|
| Hospital Charge Code |
906743239
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,726.32 |
| Max. Negotiated Rate |
$6,114.05 |
| Rate for Payer: Cash Price |
$3,236.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,877.20
|
| Rate for Payer: Galaxy Health WC |
$6,114.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,315.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,797.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,740.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,726.32
|
| Rate for Payer: Multiplan Commercial |
$5,754.40
|
| Rate for Payer: Networks By Design Commercial |
$4,675.45
|
| Rate for Payer: Prime Health Services Commercial |
$6,114.05
|
|
|
HC EGD W/CNTRL BLEEDNG ANY METHOD
|
Facility
|
OP
|
$5,146.00
|
|
|
Service Code
|
CPT 43255
|
| Hospital Charge Code |
906743255
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$546.80 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,087.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,612.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,351.09
|
| Rate for Payer: Cash Price |
$2,315.70
|
| Rate for Payer: Cash Price |
$2,315.70
|
| Rate for Payer: Cigna of CA PPO |
$3,808.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Media |
$2,377.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Galaxy Health WC |
$4,374.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,087.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,859.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,899.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,899.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,851.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,851.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,432.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$546.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,235.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Multiplan Commercial |
$4,116.80
|
| Rate for Payer: Networks By Design Commercial |
$3,344.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,374.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,087.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,852.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC EGD W/CNTRL BLEEDNG ANY METHOD
|
Facility
|
IP
|
$7,702.00
|
|
|
Service Code
|
CPT 43255
|
| Hospital Charge Code |
906743255
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,848.48 |
| Max. Negotiated Rate |
$6,546.70 |
| Rate for Payer: Cash Price |
$3,465.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,080.80
|
| Rate for Payer: Galaxy Health WC |
$6,546.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,621.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,137.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,934.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,848.48
|
| Rate for Payer: Multiplan Commercial |
$6,161.60
|
| Rate for Payer: Networks By Design Commercial |
$5,006.30
|
| Rate for Payer: Prime Health Services Commercial |
$6,546.70
|
|
|
HC EGD W/DILATION OF GASTRIC OUTL
|
Facility
|
IP
|
$6,870.00
|
|
|
Service Code
|
CPT 43245
|
| Hospital Charge Code |
906743245
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,648.80 |
| Max. Negotiated Rate |
$5,839.50 |
| Rate for Payer: Cash Price |
$3,091.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,748.00
|
| Rate for Payer: Galaxy Health WC |
$5,839.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,122.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,582.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,617.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,648.80
|
| Rate for Payer: Multiplan Commercial |
$5,496.00
|
| Rate for Payer: Networks By Design Commercial |
$4,465.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,839.50
|
|
|
HC EGD W/DILATION OF GASTRIC OUTL
|
Facility
|
OP
|
$4,592.00
|
|
|
Service Code
|
CPT 43245
|
| Hospital Charge Code |
906743245
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$459.80 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,755.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,612.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,351.09
|
| Rate for Payer: Cash Price |
$2,066.40
|
| Rate for Payer: Cash Price |
$2,066.40
|
| Rate for Payer: Cigna of CA PPO |
$3,398.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Media |
$2,377.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Galaxy Health WC |
$3,903.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,755.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,444.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,899.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,899.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,851.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,851.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,062.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$459.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,102.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Multiplan Commercial |
$3,673.60
|
| Rate for Payer: Networks By Design Commercial |
$2,984.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,903.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,755.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,852.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC EGD W/DRCTD PLCMT PERCUT GAST
|
Facility
|
IP
|
$5,228.00
|
|
|
Service Code
|
CPT 43246
|
| Hospital Charge Code |
906743246
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,254.72 |
| Max. Negotiated Rate |
$4,443.80 |
| Rate for Payer: Cash Price |
$2,352.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,091.20
|
| Rate for Payer: Galaxy Health WC |
$4,443.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,136.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,487.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,991.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,254.72
|
| Rate for Payer: Multiplan Commercial |
$4,182.40
|
| Rate for Payer: Networks By Design Commercial |
$3,398.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,443.80
|
|
|
HC EGD W/DRCTD PLCMT PERCUT GAST
|
Facility
|
OP
|
$3,449.00
|
|
|
Service Code
|
CPT 43246
|
| Hospital Charge Code |
906743246
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$459.80 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,069.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,612.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,351.09
|
| Rate for Payer: Cash Price |
$1,552.05
|
| Rate for Payer: Cash Price |
$1,552.05
|
| Rate for Payer: Cigna of CA PPO |
$2,552.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Media |
$2,377.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Galaxy Health WC |
$2,931.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,069.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,586.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,899.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,899.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,851.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,851.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,300.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$459.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$827.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Multiplan Commercial |
$2,759.20
|
| Rate for Payer: Networks By Design Commercial |
$2,241.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,931.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,069.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,852.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC EGD W ENDO MUCOSAL RESECTION
|
Facility
|
OP
|
$1,847.00
|
|
|
Service Code
|
CPT 43254
|
| Hospital Charge Code |
906743254
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$443.28 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,108.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$831.15
|
| Rate for Payer: Cash Price |
$831.15
|
| Rate for Payer: Cigna of CA PPO |
$1,366.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Media |
$2,377.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Galaxy Health WC |
$1,569.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,108.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,385.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,899.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,899.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,851.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,851.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,231.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$459.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$443.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Multiplan Commercial |
$1,477.60
|
| Rate for Payer: Networks By Design Commercial |
$1,200.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,569.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,108.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,852.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC EGD W ENDO MUCOSAL RESECTION
|
Facility
|
IP
|
$3,456.00
|
|
|
Service Code
|
CPT 43254
|
| Hospital Charge Code |
906743254
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$829.44 |
| Max. Negotiated Rate |
$2,937.60 |
| Rate for Payer: Cash Price |
$1,555.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,382.40
|
| Rate for Payer: Galaxy Health WC |
$2,937.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,073.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,305.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,316.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$829.44
|
| Rate for Payer: Multiplan Commercial |
$2,764.80
|
| Rate for Payer: Networks By Design Commercial |
$2,246.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,937.60
|
|
|
HC EGD W/ENDO US EXAM
|
Facility
|
IP
|
$6,377.00
|
|
|
Service Code
|
CPT 43259
|
| Hospital Charge Code |
906743259
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,530.48 |
| Max. Negotiated Rate |
$5,420.45 |
| Rate for Payer: Cash Price |
$2,869.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,550.80
|
| Rate for Payer: Galaxy Health WC |
$5,420.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,826.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,253.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,429.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,530.48
|
| Rate for Payer: Multiplan Commercial |
$5,101.60
|
| Rate for Payer: Networks By Design Commercial |
$4,145.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,420.45
|
|
|
HC EGD W/ENDO US EXAM
|
Facility
|
OP
|
$4,258.00
|
|
|
Service Code
|
CPT 43259
|
| Hospital Charge Code |
906743259
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$394.71 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,554.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,128.35
|
| Rate for Payer: Blue Shield of California EPN |
$2,686.96
|
| Rate for Payer: Cash Price |
$1,916.10
|
| Rate for Payer: Cash Price |
$1,916.10
|
| Rate for Payer: Cigna of CA PPO |
$3,150.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Media |
$2,377.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Galaxy Health WC |
$3,619.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,554.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,193.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,899.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,899.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,851.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,851.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,840.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$394.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,021.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Multiplan Commercial |
$3,406.40
|
| Rate for Payer: Networks By Design Commercial |
$2,767.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,619.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,554.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,852.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC EGD W INJ SCLER ESO
|
Facility
|
IP
|
$5,794.00
|
|
|
Service Code
|
CPT 43243
|
| Hospital Charge Code |
906743243
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,390.56 |
| Max. Negotiated Rate |
$4,924.90 |
| Rate for Payer: Cash Price |
$2,607.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,317.60
|
| Rate for Payer: Galaxy Health WC |
$4,924.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,476.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,864.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,207.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,390.56
|
| Rate for Payer: Multiplan Commercial |
$4,635.20
|
| Rate for Payer: Networks By Design Commercial |
$3,766.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,924.90
|
|
|
HC EGD W INJ SCLER ESO
|
Facility
|
OP
|
$3,873.00
|
|
|
Service Code
|
CPT 43243
|
| Hospital Charge Code |
906743243
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$580.05 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,323.80
|
| Rate for Payer: Cash Price |
$1,742.85
|
| Rate for Payer: Cash Price |
$1,742.85
|
| Rate for Payer: Cash Price |
$1,742.85
|
| Rate for Payer: Cigna of CA PPO |
$2,866.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Media |
$2,377.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Galaxy Health WC |
$3,292.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,323.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,904.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,899.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,899.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,583.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$580.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$929.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Multiplan Commercial |
$3,098.40
|
| Rate for Payer: Networks By Design Commercial |
$2,517.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,292.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,323.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,936.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,936.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,936.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,936.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC EGD W INJ SCLER ESO
|
Facility
|
IP
|
$5,794.00
|
|
|
Service Code
|
CPT 43243
|
| Hospital Charge Code |
906743243
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,390.56 |
| Max. Negotiated Rate |
$4,924.90 |
| Rate for Payer: Cash Price |
$2,607.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,317.60
|
| Rate for Payer: Galaxy Health WC |
$4,924.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,476.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,864.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,207.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,390.56
|
| Rate for Payer: Multiplan Commercial |
$4,635.20
|
| Rate for Payer: Networks By Design Commercial |
$3,766.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,924.90
|
|
|
HC EGD W INJ SCLER ESO
|
Facility
|
OP
|
$3,873.00
|
|
|
Service Code
|
CPT 43243
|
| Hospital Charge Code |
906743243
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$580.05 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,323.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,612.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,351.09
|
| Rate for Payer: Cash Price |
$1,742.85
|
| Rate for Payer: Cash Price |
$1,742.85
|
| Rate for Payer: Cigna of CA PPO |
$2,866.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Media |
$2,377.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Galaxy Health WC |
$3,292.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,323.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,904.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,899.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,899.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,851.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,851.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,583.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$580.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$929.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Multiplan Commercial |
$3,098.40
|
| Rate for Payer: Networks By Design Commercial |
$2,517.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,292.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,323.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,852.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC EGD W/INSRT GIDE WIRE
|
Facility
|
IP
|
$4,898.00
|
|
|
Service Code
|
CPT 43248
|
| Hospital Charge Code |
906743248
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,175.52 |
| Max. Negotiated Rate |
$4,163.30 |
| Rate for Payer: Cash Price |
$2,204.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,959.20
|
| Rate for Payer: Galaxy Health WC |
$4,163.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,938.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,266.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,866.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,175.52
|
| Rate for Payer: Multiplan Commercial |
$3,918.40
|
| Rate for Payer: Networks By Design Commercial |
$3,183.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,163.30
|
|
