|
HC EEG W/O VID EA 12-26HR UNMNTRD
|
Facility
IP
|
$1,812.00
|
|
|
Service Code
|
CPT 95708
|
| Hospital Charge Code |
900605708
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$434.88 |
| Max. Negotiated Rate |
$1,540.20 |
| Rate for Payer: Cash Price |
$815.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$724.80
|
| Rate for Payer: Galaxy Health WC |
$1,540.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,087.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,208.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$690.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$434.88
|
| Rate for Payer: Multiplan Commercial |
$1,449.60
|
| Rate for Payer: Networks By Design Commercial |
$1,177.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,540.20
|
|
|
HC EEG W/O VID EA 12-26HR UNMNTRD
|
Facility
OP
|
$1,812.00
|
|
|
Service Code
|
CPT 95708
|
| Hospital Charge Code |
900605708
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$434.88 |
| Max. Negotiated Rate |
$1,935.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$951.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,004.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$736.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$669.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,079.59
|
| Rate for Payer: BCBS Transplant Transplant |
$1,087.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,070.89
|
| Rate for Payer: Blue Shield of California EPN |
$849.83
|
| Rate for Payer: Cash Price |
$815.40
|
| Rate for Payer: Cash Price |
$815.40
|
| Rate for Payer: Cash Price |
$815.40
|
| Rate for Payer: Cigna of CA HMO |
$1,159.68
|
| Rate for Payer: Cigna of CA PPO |
$1,340.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Dignity Health Media |
$669.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$736.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$904.07
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$669.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$669.68
|
| Rate for Payer: Galaxy Health WC |
$1,540.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,087.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,359.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,098.28
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,098.28
|
| Rate for Payer: IEHP Medi-Cal |
$1,084.88
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$1,084.88
|
| Rate for Payer: IEHP Medicare Advantage |
$669.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,208.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$503.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$669.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$434.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$843.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$897.37
|
| Rate for Payer: Multiplan Commercial |
$1,449.60
|
| Rate for Payer: Networks By Design Commercial |
$1,177.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,540.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,087.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,087.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,087.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,935.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,806.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,323.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$736.65
|
| Rate for Payer: Vantage Medical Group Senior |
$669.68
|
|
|
HC EGD BLLN DILA ESOPH 30MM OR GT
|
Facility
OP
|
$2,791.00
|
|
|
Service Code
|
CPT 43233
|
| Hospital Charge Code |
906743233
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$382.68 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,674.60
|
| 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 |
$1,255.95
|
| Rate for Payer: Cash Price |
$1,255.95
|
| Rate for Payer: Cigna of CA PPO |
$2,065.34
|
| 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 |
$2,372.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,674.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,093.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,899.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,899.02
|
| Rate for Payer: IEHP Medi-Cal |
$3,851.47
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3,851.47
|
| Rate for Payer: IEHP Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,861.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$382.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$669.84
|
| 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 |
$2,232.80
|
| Rate for Payer: Networks By Design Commercial |
$1,814.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,372.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,615.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,674.60
|
| 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 BLLN DILA ESOPH 30MM OR GT
|
Facility
IP
|
$5,222.00
|
|
|
Service Code
|
CPT 43233
|
| Hospital Charge Code |
906743233
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,253.28 |
| Max. Negotiated Rate |
$4,438.70 |
| Rate for Payer: Cash Price |
$2,349.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,088.80
|
| Rate for Payer: Galaxy Health WC |
$4,438.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,133.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,483.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,989.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,253.28
|
| Rate for Payer: Multiplan Commercial |
$4,177.60
|
| Rate for Payer: Networks By Design Commercial |
$3,394.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,438.70
|
|
|
HC EGD DIAG W/ OR W/O COLLECTION
|
Facility
OP
|
$3,713.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
906743235
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.83 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: AlphaCare 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: BCBS Transplant Transplant |
$2,227.80
|
| 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 |
$1,670.85
|
| Rate for Payer: Cash Price |
$1,670.85
|
| Rate for Payer: Cigna of CA PPO |
$2,747.62
|
| 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 |
$3,156.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,227.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,784.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,857.45
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,857.45
|
| Rate for Payer: IEHP Medi-Cal |
$1,834.80
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$1,834.80
|
| Rate for Payer: IEHP Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,476.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$425.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$891.12
|
| 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 |
$2,970.40
|
| Rate for Payer: Networks By Design Commercial |
$2,413.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,156.05
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,245.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,227.80
|
| 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 DIAG W/ OR W/O COLLECTION
|
Facility
IP
|
$5,557.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
902100084
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,333.68 |
| Max. Negotiated Rate |
$4,723.45 |
| Rate for Payer: Cash Price |
$2,500.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,222.80
|
| Rate for Payer: Galaxy Health WC |
$4,723.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,334.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,706.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,117.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,333.68
|
| Rate for Payer: Multiplan Commercial |
$4,445.60
|
| Rate for Payer: Networks By Design Commercial |
$3,612.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,723.45
|
|
|
HC EGD DIAG W/ OR W/O COLLECTION
|
Facility
IP
|
$5,557.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
906743235
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,333.68 |
| Max. Negotiated Rate |
$4,723.45 |
| Rate for Payer: Cash Price |
$2,500.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,222.80
|
| Rate for Payer: Galaxy Health WC |
$4,723.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,334.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,706.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,117.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,333.68
|
| Rate for Payer: Multiplan Commercial |
$4,445.60
|
| Rate for Payer: Networks By Design Commercial |
$3,612.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,723.45
|
|
|
HC EGD DIAG W/ OR W/O COLLECTION
|
Facility
OP
|
$5,557.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
902100084
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$425.83 |
| Max. Negotiated Rate |
$5,938.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: AlphaCare 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: BCBS Transplant Transplant |
$3,334.20
|
| Rate for Payer: Cash Price |
$2,500.65
|
| Rate for Payer: Cash Price |
$2,500.65
|
| Rate for Payer: Cash Price |
$2,500.65
|
| Rate for Payer: Cigna of CA PPO |
$4,112.18
|
| 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 |
$4,723.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,334.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,167.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,857.45
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,857.45
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,706.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$425.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,333.68
|
| 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 |
$4,445.60
|
| Rate for Payer: Networks By Design Commercial |
$3,612.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,723.45
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3,334.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,334.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,778.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,778.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,778.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,778.50
|
| 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 DIAG W/SUBMUC INJ ANY SUBSTANCE
|
Facility
OP
|
$3,713.00
|
|
|
Service Code
|
CPT 43236
|
| Hospital Charge Code |
906743236
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$462.04 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: AlphaCare 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: BCBS Transplant Transplant |
$2,227.80
|
| 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 |
$1,670.85
|
| Rate for Payer: Cash Price |
$1,670.85
|
| Rate for Payer: Cigna of CA PPO |
$2,747.62
|
| 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 |
$3,156.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,227.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,784.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,857.45
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,857.45
|
| Rate for Payer: IEHP Medi-Cal |
$1,834.80
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$1,834.80
|
| Rate for Payer: IEHP Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,476.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$462.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$891.12
|
| 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 |
$2,970.40
|
| Rate for Payer: Networks By Design Commercial |
$2,413.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,156.05
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,245.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,227.80
|
| 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 DIAG W/SUBMUC INJ ANY SUBSTANCE
|
Facility
IP
|
$5,557.00
|
|
|
Service Code
|
CPT 43236
|
| Hospital Charge Code |
906743236
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,333.68 |
| Max. Negotiated Rate |
$4,723.45 |
| Rate for Payer: Cash Price |
$2,500.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,222.80
|
| Rate for Payer: Galaxy Health WC |
$4,723.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,334.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,706.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,117.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,333.68
|
| Rate for Payer: Multiplan Commercial |
$4,445.60
|
| Rate for Payer: Networks By Design Commercial |
$3,612.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,723.45
|
|
|
HC EGD DIAG W WO COLLECTION
|
Facility
OP
|
$5,557.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
900501432
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$425.83 |
| Max. Negotiated Rate |
$5,938.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: AlphaCare 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: BCBS Transplant Transplant |
$3,334.20
|
| Rate for Payer: Cash Price |
$2,500.65
|
| Rate for Payer: Cash Price |
$2,500.65
|
| Rate for Payer: Cash Price |
$2,500.65
|
| Rate for Payer: Cigna of CA PPO |
$4,112.18
|
| 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 |
$4,723.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,334.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,167.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,857.45
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,857.45
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,706.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$425.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,333.68
|
| 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 |
$4,445.60
|
| Rate for Payer: Networks By Design Commercial |
$3,612.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,723.45
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3,334.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,334.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,778.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,778.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,778.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,778.50
|
| 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 DIAG W WO COLLECTION
|
Facility
IP
|
$5,557.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
900501432
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,333.68 |
| Max. Negotiated Rate |
$4,723.45 |
| Rate for Payer: Cash Price |
$2,500.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,222.80
|
| Rate for Payer: Galaxy Health WC |
$4,723.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,334.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,706.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,117.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,333.68
|
| Rate for Payer: Multiplan Commercial |
$4,445.60
|
| Rate for Payer: Networks By Design Commercial |
$3,612.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,723.45
|
|
|
HC EGD ENDO STENT PLACEMENT
|
Facility
IP
|
$8,512.00
|
|
|
Service Code
|
CPT 43266
|
| Hospital Charge Code |
900100017
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,042.88 |
| Max. Negotiated Rate |
$7,235.20 |
| Rate for Payer: Cash Price |
$3,830.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,404.80
|
| Rate for Payer: Galaxy Health WC |
$7,235.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,107.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,677.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,243.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,042.88
|
| Rate for Payer: Multiplan Commercial |
$6,809.60
|
| Rate for Payer: Networks By Design Commercial |
$5,532.80
|
| Rate for Payer: Prime Health Services Commercial |
$7,235.20
|
|
|
HC EGD ENDO STENT PLACEMENT
|
Facility
OP
|
$5,688.00
|
|
|
Service Code
|
CPT 43266
|
| Hospital Charge Code |
900100017
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$380.57 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,681.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,832.91
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,120.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$3,412.80
|
| 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 |
$2,559.60
|
| Rate for Payer: Cash Price |
$2,559.60
|
| Rate for Payer: Cigna of CA PPO |
$4,209.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,681.24
|
| Rate for Payer: Dignity Health Media |
$7,120.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,832.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,613.12
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,120.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,120.83
|
| Rate for Payer: Galaxy Health WC |
$4,834.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,412.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,266.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,678.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$11,678.16
|
| Rate for Payer: IEHP Medi-Cal |
$11,535.74
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$11,535.74
|
| Rate for Payer: IEHP Medicare Advantage |
$7,120.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,793.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$380.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,120.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,365.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,972.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,541.91
|
| Rate for Payer: Multiplan Commercial |
$4,550.40
|
| Rate for Payer: Networks By Design Commercial |
$3,697.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,834.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7,832.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,412.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,545.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,681.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,832.91
|
| Rate for Payer: Vantage Medical Group Senior |
$7,120.83
|
|
|
HC EGD INTRMURAL US NDL ASPIRATE BIOPSY ESOPHAGS
|
Facility
OP
|
$4,118.00
|
|
|
Service Code
|
CPT 43238
|
| Hospital Charge Code |
906703238
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$988.32 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: AlphaCare 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: BCBS Transplant Transplant |
$2,470.80
|
| 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 |
$1,853.10
|
| Rate for Payer: Cash Price |
$1,853.10
|
| Rate for Payer: Cigna of CA PPO |
$3,047.32
|
| 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 |
$3,500.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,470.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,088.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,899.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,899.02
|
| Rate for Payer: IEHP Medi-Cal |
$3,851.47
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3,851.47
|
| Rate for Payer: IEHP Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,746.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,568.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$988.32
|
| 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 |
$3,294.40
|
| Rate for Payer: Networks By Design Commercial |
$2,676.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,500.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,615.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,470.80
|
| 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 INTRMURAL US NDL ASPIRATE BIOPSY ESOPHAGS
|
Facility
IP
|
$4,118.00
|
|
|
Service Code
|
CPT 43238
|
| Hospital Charge Code |
906703238
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$988.32 |
| Max. Negotiated Rate |
$3,500.30 |
| Rate for Payer: Cash Price |
$1,853.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,647.20
|
| Rate for Payer: Galaxy Health WC |
$3,500.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,470.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,746.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,568.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$988.32
|
| Rate for Payer: Multiplan Commercial |
$3,294.40
|
| Rate for Payer: Networks By Design Commercial |
$2,676.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,500.30
|
|
|
HC EGD LESION ABLATION
|
Facility
IP
|
$6,146.00
|
|
|
Service Code
|
CPT 43270
|
| Hospital Charge Code |
900100018
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,475.04 |
| Max. Negotiated Rate |
$5,224.10 |
| Rate for Payer: Cash Price |
$2,765.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,458.40
|
| Rate for Payer: Galaxy Health WC |
$5,224.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,687.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,099.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,341.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,475.04
|
| Rate for Payer: Multiplan Commercial |
$4,916.80
|
| Rate for Payer: Networks By Design Commercial |
$3,994.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,224.10
|
|
|
HC EGD LESION ABLATION
|
Facility
OP
|
$3,571.00
|
|
|
Service Code
|
CPT 43270
|
| Hospital Charge Code |
900100018
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$400.37 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: AlphaCare 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: BCBS Transplant Transplant |
$2,142.60
|
| 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 |
$1,606.95
|
| Rate for Payer: Cash Price |
$1,606.95
|
| Rate for Payer: Cigna of CA PPO |
$2,642.54
|
| 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 |
$3,035.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,142.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,678.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,899.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,899.02
|
| Rate for Payer: IEHP Medi-Cal |
$3,851.47
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3,851.47
|
| Rate for Payer: IEHP Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,381.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$400.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$857.04
|
| 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 |
$2,856.80
|
| Rate for Payer: Networks By Design Commercial |
$2,321.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,035.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,615.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,142.60
|
| 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 & POLYPECTOMY
|
Facility
IP
|
$4,159.00
|
|
|
Service Code
|
CPT 43250
|
| Hospital Charge Code |
906743250
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$998.16 |
| Max. Negotiated Rate |
$3,535.15 |
| Rate for Payer: Cash Price |
$1,871.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,663.60
|
| Rate for Payer: Galaxy Health WC |
$3,535.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,495.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,774.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,584.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$998.16
|
| Rate for Payer: Multiplan Commercial |
$3,327.20
|
| Rate for Payer: Networks By Design Commercial |
$2,703.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,535.15
|
|
|
HC EGD & POLYPECTOMY
|
Facility
OP
|
$2,780.00
|
|
|
Service Code
|
CPT 43250
|
| Hospital Charge Code |
906743250
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$465.44 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: AlphaCare 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: BCBS Transplant Transplant |
$1,668.00
|
| 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 |
$1,251.00
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna of CA PPO |
$2,057.20
|
| 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 |
$2,363.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,668.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,085.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,899.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,899.02
|
| Rate for Payer: IEHP Medi-Cal |
$3,851.47
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3,851.47
|
| Rate for Payer: IEHP Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,854.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$465.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$667.20
|
| 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 |
$2,224.00
|
| Rate for Payer: Networks By Design Commercial |
$1,807.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,363.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,615.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,668.00
|
| 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 US TRANSMURAL INJECT MARKER
|
Facility
IP
|
$5,222.00
|
|
|
Service Code
|
CPT 43253
|
| Hospital Charge Code |
906743253
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,253.28 |
| Max. Negotiated Rate |
$4,438.70 |
| Rate for Payer: Cash Price |
$2,349.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,088.80
|
| Rate for Payer: Galaxy Health WC |
$4,438.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,133.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,483.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,989.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,253.28
|
| Rate for Payer: Multiplan Commercial |
$4,177.60
|
| Rate for Payer: Networks By Design Commercial |
$3,394.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,438.70
|
|
|
HC EGD US TRANSMURAL INJECT MARKER
|
Facility
OP
|
$2,791.00
|
|
|
Service Code
|
CPT 43253
|
| Hospital Charge Code |
906743253
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$443.52 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,674.60
|
| 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 |
$1,255.95
|
| Rate for Payer: Cash Price |
$1,255.95
|
| Rate for Payer: Cigna of CA PPO |
$2,065.34
|
| 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 |
$2,372.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,674.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,093.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,899.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,899.02
|
| Rate for Payer: IEHP Medi-Cal |
$3,851.47
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3,851.47
|
| Rate for Payer: IEHP Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,861.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$443.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$669.84
|
| 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 |
$2,232.80
|
| Rate for Payer: Networks By Design Commercial |
$1,814.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,372.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,615.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,674.60
|
| 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/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: AlphaCare Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: AlphaCare 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: BCBS Transplant 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 Transplant 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: IEHP Medi-Cal |
$3,851.47
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3,851.47
|
| Rate for Payer: 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: Redlands Yucaipa Medical Group Commercial/Senior |
$2,615.20
|
| 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
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: AlphaCare Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: AlphaCare 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: BCBS Transplant 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 Transplant 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: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: 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: Redlands Yucaipa Medical Group Commercial/Senior |
$2,131.80
|
| 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
|
|
