|
HC EEG SLEEP ONLY
|
Facility
|
IP
|
$3,083.00
|
|
|
Service Code
|
CPT 95822
|
| Hospital Charge Code |
900600203
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$616.60 |
| Max. Negotiated Rate |
$2,620.55 |
| Rate for Payer: Adventist Health Commercial |
$616.60
|
| Rate for Payer: Cash Price |
$1,695.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,233.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,233.20
|
| Rate for Payer: Galaxy Health WC |
$2,620.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,849.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,056.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,174.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,908.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$739.92
|
| Rate for Payer: Multiplan Commercial |
$2,466.40
|
| Rate for Payer: Networks By Design Commercial |
$2,003.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,620.55
|
|
|
HC EEG VIDEO 16+ CHAN 12HR
|
Facility
|
IP
|
$11,772.00
|
|
|
Service Code
|
CPT 95951 52
|
| Hospital Charge Code |
900600621
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$2,354.40 |
| Max. Negotiated Rate |
$10,006.20 |
| Rate for Payer: Adventist Health Commercial |
$2,354.40
|
| Rate for Payer: Cash Price |
$6,474.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,708.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,708.80
|
| Rate for Payer: Galaxy Health WC |
$10,006.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7,063.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,851.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,485.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,286.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,825.28
|
| Rate for Payer: Multiplan Commercial |
$9,417.60
|
| Rate for Payer: Networks By Design Commercial |
$7,651.80
|
| Rate for Payer: Prime Health Services Commercial |
$10,006.20
|
|
|
HC EEG VIDEO 16+ CHAN 12HR
|
Facility
|
OP
|
$11,772.00
|
|
|
Service Code
|
CPT 95951 52
|
| Hospital Charge Code |
900600621
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,272.00 |
| Max. Negotiated Rate |
$10,006.20 |
| Rate for Payer: Adventist Health Commercial |
$2,354.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,721.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,006.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,474.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,829.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,229.19
|
| Rate for Payer: Blue Shield of California Commercial |
$7,204.46
|
| Rate for Payer: Blue Shield of California EPN |
$4,755.89
|
| Rate for Payer: Cash Price |
$6,474.60
|
| Rate for Payer: Cash Price |
$6,474.60
|
| Rate for Payer: Cigna of CA HMO |
$7,534.08
|
| Rate for Payer: Cigna of CA PPO |
$8,711.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,006.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,006.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,006.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,708.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,708.80
|
| Rate for Payer: Galaxy Health WC |
$10,006.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7,063.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,851.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,485.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,286.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,825.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,240.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,240.40
|
| Rate for Payer: Multiplan Commercial |
$9,417.60
|
| Rate for Payer: Networks By Design Commercial |
$7,651.80
|
| Rate for Payer: Prime Health Services Commercial |
$10,006.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,063.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,063.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,039.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,896.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,389.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,272.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,006.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,006.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10,006.20
|
|
|
HC EEG VIDEO 16+ CHAN 24HR
|
Facility
|
IP
|
$11,772.00
|
|
|
Service Code
|
CPT 95951
|
| Hospital Charge Code |
900600620
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$2,354.40 |
| Max. Negotiated Rate |
$10,006.20 |
| Rate for Payer: Adventist Health Commercial |
$2,354.40
|
| Rate for Payer: Cash Price |
$6,474.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,708.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,708.80
|
| Rate for Payer: Galaxy Health WC |
$10,006.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7,063.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,851.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,485.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,286.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,825.28
|
| Rate for Payer: Multiplan Commercial |
$9,417.60
|
| Rate for Payer: Networks By Design Commercial |
$7,651.80
|
| Rate for Payer: Prime Health Services Commercial |
$10,006.20
|
|
|
HC EEG VIDEO 16+ CHAN 24HR
|
Facility
|
OP
|
$11,772.00
|
|
|
Service Code
|
CPT 95951
|
| Hospital Charge Code |
900600620
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,272.00 |
| Max. Negotiated Rate |
$10,006.20 |
| Rate for Payer: Adventist Health Commercial |
$2,354.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,721.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,006.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,474.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,829.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,229.19
|
| Rate for Payer: Blue Shield of California Commercial |
$7,204.46
|
| Rate for Payer: Blue Shield of California EPN |
$4,755.89
|
| Rate for Payer: Cash Price |
$6,474.60
|
| Rate for Payer: Cash Price |
$6,474.60
|
| Rate for Payer: Cigna of CA HMO |
$7,534.08
|
| Rate for Payer: Cigna of CA PPO |
$8,711.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,006.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,006.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,006.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,708.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,708.80
|
| Rate for Payer: Galaxy Health WC |
$10,006.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7,063.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,851.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,485.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,286.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,825.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,240.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,240.40
|
| Rate for Payer: Multiplan Commercial |
$9,417.60
|
| Rate for Payer: Networks By Design Commercial |
$7,651.80
|
| Rate for Payer: Prime Health Services Commercial |
$10,006.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,063.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,063.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,039.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,896.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,389.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,272.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,006.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,006.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10,006.20
|
|
|
HC EEG W/O VID 2-12HR CONT MNTR
|
Facility
|
OP
|
$923.00
|
|
|
Service Code
|
CPT 95707
|
| Hospital Charge Code |
900605707
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$184.60 |
| Max. Negotiated Rate |
$2,039.00 |
| Rate for Payer: Adventist Health Commercial |
$184.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$605.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$395.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$566.81
|
| Rate for Payer: Blue Shield of California Commercial |
$564.88
|
| Rate for Payer: Blue Shield of California EPN |
$372.89
|
| Rate for Payer: Cash Price |
$507.65
|
| Rate for Payer: Cash Price |
$507.65
|
| Rate for Payer: Cash Price |
$507.65
|
| Rate for Payer: Cigna of CA HMO |
$590.72
|
| Rate for Payer: Cigna of CA PPO |
$683.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$435.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$395.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$534.14
|
| Rate for Payer: EPIC Health Plan Senior |
$395.66
|
| Rate for Payer: Galaxy Health WC |
$784.55
|
| Rate for Payer: Global Benefits Group Commercial |
$553.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$648.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,075.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$395.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$615.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,215.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$395.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$498.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$530.18
|
| Rate for Payer: Multiplan Commercial |
$738.40
|
| Rate for Payer: Networks By Design Commercial |
$599.95
|
| Rate for Payer: Prime Health Services Commercial |
$784.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$553.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$553.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,039.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,896.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,389.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,272.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$395.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Vantage Medical Group Senior |
$395.66
|
|
|
HC EEG W/O VID 2-12HR CONT MNTR
|
Facility
|
IP
|
$923.00
|
|
|
Service Code
|
CPT 95707
|
| Hospital Charge Code |
900605707
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$184.60 |
| Max. Negotiated Rate |
$784.55 |
| Rate for Payer: Adventist Health Commercial |
$184.60
|
| Rate for Payer: Cash Price |
$507.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$369.20
|
| Rate for Payer: EPIC Health Plan Senior |
$369.20
|
| Rate for Payer: Galaxy Health WC |
$784.55
|
| Rate for Payer: Global Benefits Group Commercial |
$553.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$615.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$351.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$571.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.52
|
| Rate for Payer: Multiplan Commercial |
$738.40
|
| Rate for Payer: Networks By Design Commercial |
$599.95
|
| Rate for Payer: Prime Health Services Commercial |
$784.55
|
|
|
HC EEG W/O VID 2-12HR INTMT MNTRD
|
Facility
|
OP
|
$923.00
|
|
|
Service Code
|
CPT 95706
|
| Hospital Charge Code |
900605706
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$184.60 |
| Max. Negotiated Rate |
$2,039.00 |
| Rate for Payer: Adventist Health Commercial |
$184.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$605.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$395.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$566.81
|
| Rate for Payer: Blue Shield of California Commercial |
$564.88
|
| Rate for Payer: Blue Shield of California EPN |
$372.89
|
| Rate for Payer: Cash Price |
$507.65
|
| Rate for Payer: Cash Price |
$507.65
|
| Rate for Payer: Cash Price |
$507.65
|
| Rate for Payer: Cigna of CA HMO |
$590.72
|
| Rate for Payer: Cigna of CA PPO |
$683.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$435.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$395.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$534.14
|
| Rate for Payer: EPIC Health Plan Senior |
$395.66
|
| Rate for Payer: Galaxy Health WC |
$784.55
|
| Rate for Payer: Global Benefits Group Commercial |
$553.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$648.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$554.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$395.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$615.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$626.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$395.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$498.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$530.18
|
| Rate for Payer: Multiplan Commercial |
$738.40
|
| Rate for Payer: Networks By Design Commercial |
$599.95
|
| Rate for Payer: Prime Health Services Commercial |
$784.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$553.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$553.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,039.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,896.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,389.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,272.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$395.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Vantage Medical Group Senior |
$395.66
|
|
|
HC EEG W/O VID 2-12HR INTMT MNTRD
|
Facility
|
IP
|
$923.00
|
|
|
Service Code
|
CPT 95706
|
| Hospital Charge Code |
900605706
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$184.60 |
| Max. Negotiated Rate |
$784.55 |
| Rate for Payer: Adventist Health Commercial |
$184.60
|
| Rate for Payer: Cash Price |
$507.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$369.20
|
| Rate for Payer: EPIC Health Plan Senior |
$369.20
|
| Rate for Payer: Galaxy Health WC |
$784.55
|
| Rate for Payer: Global Benefits Group Commercial |
$553.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$615.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$351.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$571.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.52
|
| Rate for Payer: Multiplan Commercial |
$738.40
|
| Rate for Payer: Networks By Design Commercial |
$599.95
|
| Rate for Payer: Prime Health Services Commercial |
$784.55
|
|
|
HC EEG W/O VID 2-12HR UNMNTRD
|
Facility
|
OP
|
$923.00
|
|
|
Service Code
|
CPT 95705
|
| Hospital Charge Code |
900605705
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$184.60 |
| Max. Negotiated Rate |
$2,039.00 |
| Rate for Payer: Adventist Health Commercial |
$184.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$605.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$395.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$566.81
|
| Rate for Payer: Blue Shield of California Commercial |
$564.88
|
| Rate for Payer: Blue Shield of California EPN |
$372.89
|
| Rate for Payer: Cash Price |
$507.65
|
| Rate for Payer: Cash Price |
$507.65
|
| Rate for Payer: Cash Price |
$507.65
|
| Rate for Payer: Cigna of CA HMO |
$590.72
|
| Rate for Payer: Cigna of CA PPO |
$683.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$435.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$395.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$534.14
|
| Rate for Payer: EPIC Health Plan Senior |
$395.66
|
| Rate for Payer: Galaxy Health WC |
$784.55
|
| Rate for Payer: Global Benefits Group Commercial |
$553.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$648.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$372.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$395.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$615.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$421.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$395.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$498.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$530.18
|
| Rate for Payer: Multiplan Commercial |
$738.40
|
| Rate for Payer: Networks By Design Commercial |
$599.95
|
| Rate for Payer: Prime Health Services Commercial |
$784.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$553.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$553.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,039.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,896.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,389.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,272.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$395.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Vantage Medical Group Senior |
$395.66
|
|
|
HC EEG W/O VID 2-12HR UNMNTRD
|
Facility
|
IP
|
$923.00
|
|
|
Service Code
|
CPT 95705
|
| Hospital Charge Code |
900605705
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$184.60 |
| Max. Negotiated Rate |
$784.55 |
| Rate for Payer: Adventist Health Commercial |
$184.60
|
| Rate for Payer: Cash Price |
$507.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$369.20
|
| Rate for Payer: EPIC Health Plan Senior |
$369.20
|
| Rate for Payer: Galaxy Health WC |
$784.55
|
| Rate for Payer: Global Benefits Group Commercial |
$553.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$615.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$351.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$571.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.52
|
| Rate for Payer: Multiplan Commercial |
$738.40
|
| Rate for Payer: Networks By Design Commercial |
$599.95
|
| Rate for Payer: Prime Health Services Commercial |
$784.55
|
|
|
HC EEG W/O VID EA 12-26HR CNT MNR
|
Facility
|
OP
|
$1,771.00
|
|
|
Service Code
|
CPT 95710
|
| Hospital Charge Code |
900605710
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$354.20 |
| Max. Negotiated Rate |
$2,039.00 |
| Rate for Payer: Adventist Health Commercial |
$354.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,161.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$741.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$674.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,087.57
|
| Rate for Payer: Blue Shield of California Commercial |
$1,083.85
|
| Rate for Payer: Blue Shield of California EPN |
$715.48
|
| Rate for Payer: Cash Price |
$974.05
|
| Rate for Payer: Cash Price |
$974.05
|
| Rate for Payer: Cash Price |
$974.05
|
| Rate for Payer: Cigna of CA HMO |
$1,133.44
|
| Rate for Payer: Cigna of CA PPO |
$1,310.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$741.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$674.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$910.14
|
| Rate for Payer: EPIC Health Plan Senior |
$674.18
|
| Rate for Payer: Galaxy Health WC |
$1,505.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,062.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,105.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,718.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$674.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,181.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,944.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$674.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$849.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$903.40
|
| Rate for Payer: Multiplan Commercial |
$1,416.80
|
| Rate for Payer: Networks By Design Commercial |
$1,151.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,505.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,062.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,062.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,039.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,896.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,389.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,272.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$674.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$741.60
|
| Rate for Payer: Vantage Medical Group Senior |
$674.18
|
|
|
HC EEG W/O VID EA 12-26HR CNT MNR
|
Facility
|
IP
|
$1,771.00
|
|
|
Service Code
|
CPT 95710
|
| Hospital Charge Code |
900605710
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$354.20 |
| Max. Negotiated Rate |
$1,505.35 |
| Rate for Payer: Adventist Health Commercial |
$354.20
|
| Rate for Payer: Cash Price |
$974.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$708.40
|
| Rate for Payer: EPIC Health Plan Senior |
$708.40
|
| Rate for Payer: Galaxy Health WC |
$1,505.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,062.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,181.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$674.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,096.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.04
|
| Rate for Payer: Multiplan Commercial |
$1,416.80
|
| Rate for Payer: Networks By Design Commercial |
$1,151.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,505.35
|
|
|
HC EEG W/O VID EA 12-26HR INT MNR
|
Facility
|
OP
|
$1,771.00
|
|
|
Service Code
|
CPT 95709
|
| Hospital Charge Code |
900605709
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$354.20 |
| Max. Negotiated Rate |
$2,039.00 |
| Rate for Payer: Adventist Health Commercial |
$354.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,161.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$741.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$674.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,087.57
|
| Rate for Payer: Blue Shield of California Commercial |
$1,083.85
|
| Rate for Payer: Blue Shield of California EPN |
$715.48
|
| Rate for Payer: Cash Price |
$974.05
|
| Rate for Payer: Cash Price |
$974.05
|
| Rate for Payer: Cash Price |
$974.05
|
| Rate for Payer: Cigna of CA HMO |
$1,133.44
|
| Rate for Payer: Cigna of CA PPO |
$1,310.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$741.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$674.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$910.14
|
| Rate for Payer: EPIC Health Plan Senior |
$674.18
|
| Rate for Payer: Galaxy Health WC |
$1,505.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,062.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,105.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$989.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$674.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,181.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,118.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$674.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$849.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$903.40
|
| Rate for Payer: Multiplan Commercial |
$1,416.80
|
| Rate for Payer: Networks By Design Commercial |
$1,151.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,505.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,062.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,062.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,039.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,896.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,389.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,272.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$674.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$741.60
|
| Rate for Payer: Vantage Medical Group Senior |
$674.18
|
|
|
HC EEG W/O VID EA 12-26HR INT MNR
|
Facility
|
IP
|
$1,771.00
|
|
|
Service Code
|
CPT 95709
|
| Hospital Charge Code |
900605709
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$354.20 |
| Max. Negotiated Rate |
$1,505.35 |
| Rate for Payer: Adventist Health Commercial |
$354.20
|
| Rate for Payer: Cash Price |
$974.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$708.40
|
| Rate for Payer: EPIC Health Plan Senior |
$708.40
|
| Rate for Payer: Galaxy Health WC |
$1,505.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,062.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,181.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$674.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,096.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.04
|
| Rate for Payer: Multiplan Commercial |
$1,416.80
|
| Rate for Payer: Networks By Design Commercial |
$1,151.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,505.35
|
|
|
HC EEG W/O VID EA 12-26HR UNMNTRD
|
Facility
|
IP
|
$1,771.00
|
|
|
Service Code
|
CPT 95708
|
| Hospital Charge Code |
900605708
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$354.20 |
| Max. Negotiated Rate |
$1,505.35 |
| Rate for Payer: Adventist Health Commercial |
$354.20
|
| Rate for Payer: Cash Price |
$974.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$708.40
|
| Rate for Payer: EPIC Health Plan Senior |
$708.40
|
| Rate for Payer: Galaxy Health WC |
$1,505.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,062.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,181.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$674.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,096.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.04
|
| Rate for Payer: Multiplan Commercial |
$1,416.80
|
| Rate for Payer: Networks By Design Commercial |
$1,151.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,505.35
|
|
|
HC EEG W/O VID EA 12-26HR UNMNTRD
|
Facility
|
OP
|
$1,771.00
|
|
|
Service Code
|
CPT 95708
|
| Hospital Charge Code |
900605708
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$354.20 |
| Max. Negotiated Rate |
$2,039.00 |
| Rate for Payer: Adventist Health Commercial |
$354.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,161.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$741.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$674.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,087.57
|
| Rate for Payer: Blue Shield of California Commercial |
$1,083.85
|
| Rate for Payer: Blue Shield of California EPN |
$715.48
|
| Rate for Payer: Cash Price |
$974.05
|
| Rate for Payer: Cash Price |
$974.05
|
| Rate for Payer: Cash Price |
$974.05
|
| Rate for Payer: Cigna of CA HMO |
$1,133.44
|
| Rate for Payer: Cigna of CA PPO |
$1,310.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$741.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$674.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$910.14
|
| Rate for Payer: EPIC Health Plan Senior |
$674.18
|
| Rate for Payer: Galaxy Health WC |
$1,505.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,062.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,105.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$445.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$674.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,181.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$503.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$674.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$849.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$903.40
|
| Rate for Payer: Multiplan Commercial |
$1,416.80
|
| Rate for Payer: Networks By Design Commercial |
$1,151.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,505.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,062.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,062.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,039.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,896.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,389.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,272.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$674.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$741.60
|
| Rate for Payer: Vantage Medical Group Senior |
$674.18
|
|
|
HC EF SPEC METABOLIC NONINHERIT
|
Facility
|
OP
|
$1.63
|
|
|
Service Code
|
CPT B4154
|
| Hospital Charge Code |
900541540
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.39 |
| Rate for Payer: Adventist Health Commercial |
$0.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.00
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna of CA HMO |
$1.04
|
| Rate for Payer: Cigna of CA PPO |
$1.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.65
|
| Rate for Payer: EPIC Health Plan Senior |
$0.65
|
| Rate for Payer: Galaxy Health WC |
$1.39
|
| Rate for Payer: Global Benefits Group Commercial |
$0.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.14
|
| Rate for Payer: Multiplan Commercial |
$1.30
|
| Rate for Payer: Networks By Design Commercial |
$1.06
|
| Rate for Payer: Prime Health Services Commercial |
$1.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.82
|
| Rate for Payer: United Healthcare All Other HMO |
$0.82
|
| Rate for Payer: United Healthcare HMO Rider |
$0.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1.39
|
|
|
HC EF SPEC METABOLIC NONINHERIT
|
Facility
|
IP
|
$1.63
|
|
|
Service Code
|
CPT B4154
|
| Hospital Charge Code |
900541540
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.39 |
| Rate for Payer: Adventist Health Commercial |
$0.33
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.65
|
| Rate for Payer: EPIC Health Plan Senior |
$0.65
|
| Rate for Payer: Galaxy Health WC |
$1.39
|
| Rate for Payer: Global Benefits Group Commercial |
$0.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Multiplan Commercial |
$1.30
|
| Rate for Payer: Networks By Design Commercial |
$1.06
|
| Rate for Payer: Prime Health Services Commercial |
$1.39
|
|
|
HC EGD BLLN DILA ESOPH 30MM OR GT
|
Facility
|
OP
|
$4,216.00
|
|
|
Service Code
|
CPT 43233
|
| Hospital Charge Code |
906743233
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$338.37 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$843.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,410.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$2,318.80
|
| Rate for Payer: Cash Price |
$2,318.80
|
| Rate for Payer: Cash Price |
$2,318.80
|
| Rate for Payer: Cigna of CA HMO |
$2,698.24
|
| Rate for Payer: Cigna of CA PPO |
$3,119.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,651.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,410.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,253.93
|
| Rate for Payer: EPIC Health Plan Senior |
$2,410.32
|
| Rate for Payer: Galaxy Health WC |
$3,583.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,529.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$338.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,812.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$382.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,011.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,037.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,229.83
|
| Rate for Payer: Multiplan Commercial |
$3,372.80
|
| Rate for Payer: Networks By Design Commercial |
$2,740.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,583.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,529.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,892.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,410.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,410.32
|
|
|
HC EGD BLLN DILA ESOPH 30MM OR GT
|
Facility
|
IP
|
$4,216.00
|
|
|
Service Code
|
CPT 43233
|
| Hospital Charge Code |
906743233
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$843.20 |
| Max. Negotiated Rate |
$3,583.60 |
| Rate for Payer: Adventist Health Commercial |
$843.20
|
| Rate for Payer: Cash Price |
$2,318.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,686.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,686.40
|
| Rate for Payer: Galaxy Health WC |
$3,583.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,529.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,812.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,606.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,609.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,011.84
|
| Rate for Payer: Multiplan Commercial |
$3,372.80
|
| Rate for Payer: Networks By Design Commercial |
$2,740.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,583.60
|
|
|
HC EGD DIAG W/ OR W/O COLLECTION
|
Facility
|
OP
|
$4,487.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
906743235
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$376.52 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$897.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$2,467.85
|
| Rate for Payer: Cash Price |
$2,467.85
|
| Rate for Payer: Cash Price |
$2,467.85
|
| Rate for Payer: Cigna of CA HMO |
$2,871.68
|
| Rate for Payer: Cigna of CA PPO |
$3,320.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,608.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,191.26
|
| Rate for Payer: Galaxy Health WC |
$3,813.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,692.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$376.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,992.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$425.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,076.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,500.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,596.29
|
| Rate for Payer: Multiplan Commercial |
$3,589.60
|
| Rate for Payer: Networks By Design Commercial |
$2,916.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,813.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,692.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,429.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,191.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC EGD DIAG W/ OR W/O COLLECTION
|
Facility
|
IP
|
$4,487.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
906743235
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$897.40 |
| Max. Negotiated Rate |
$3,813.95 |
| Rate for Payer: Adventist Health Commercial |
$897.40
|
| Rate for Payer: Cash Price |
$2,467.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,794.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,794.80
|
| Rate for Payer: Galaxy Health WC |
$3,813.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,692.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,992.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,709.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,777.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,076.88
|
| Rate for Payer: Multiplan Commercial |
$3,589.60
|
| Rate for Payer: Networks By Design Commercial |
$2,916.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,813.95
|
|
|
HC EGD DIAG W/ OR W/O COLLECTION
|
Facility
|
IP
|
$4,487.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
902100084
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$897.40 |
| Max. Negotiated Rate |
$3,813.95 |
| Rate for Payer: Adventist Health Commercial |
$897.40
|
| Rate for Payer: Cash Price |
$2,467.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,794.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,794.80
|
| Rate for Payer: Galaxy Health WC |
$3,813.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,692.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,992.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,709.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,777.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,076.88
|
| Rate for Payer: Multiplan Commercial |
$3,589.60
|
| Rate for Payer: Networks By Design Commercial |
$2,916.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,813.95
|
|
|
HC EGD DIAG W/ OR W/O COLLECTION
|
Facility
|
OP
|
$4,487.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
902100084
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$425.83 |
| Max. Negotiated Rate |
$6,427.00 |
| Rate for Payer: Adventist Health Commercial |
$897.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$2,467.85
|
| Rate for Payer: Cash Price |
$2,467.85
|
| Rate for Payer: Cash Price |
$2,467.85
|
| Rate for Payer: Cigna of CA HMO |
$2,871.68
|
| Rate for Payer: Cigna of CA PPO |
$3,320.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,608.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,191.26
|
| Rate for Payer: Galaxy Health WC |
$3,813.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,692.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,992.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$425.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,076.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,500.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,596.29
|
| Rate for Payer: Multiplan Commercial |
$3,589.60
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Networks By Design Commercial |
$2,916.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,813.95
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,692.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,243.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,243.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,243.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,243.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,191.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
