|
HC EGD DIAG W/SUBMUC INJ ANY SUBSTANCE
|
Facility
|
OP
|
$4,487.00
|
|
|
Service Code
|
CPT 43236
|
| Hospital Charge Code |
906743236
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$408.42 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$897.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| 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 |
$2,470.08
|
| 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 |
$408.42
|
| 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 |
$461.91
|
| 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/SUBMUC INJ ANY SUBSTANCE
|
Facility
|
IP
|
$4,487.00
|
|
|
Service Code
|
CPT 43236
|
| Hospital Charge Code |
906743236
|
|
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 WO COLLECTION
|
Facility
|
OP
|
$4,723.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
900501432
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$425.83 |
| Max. Negotiated Rate |
$6,427.00 |
| Rate for Payer: Adventist Health Commercial |
$944.60
|
| 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 |
$2,597.65
|
| Rate for Payer: Cash Price |
$2,597.65
|
| Rate for Payer: Cash Price |
$2,597.65
|
| Rate for Payer: Cigna of CA HMO |
$3,022.72
|
| Rate for Payer: Cigna of CA PPO |
$3,495.02
|
| 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 |
$4,014.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,833.80
|
| 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 |
$3,150.24
|
| 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 |
$1,133.52
|
| 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 |
$3,778.40
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Networks By Design Commercial |
$3,069.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,014.55
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,833.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,361.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,361.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,361.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,361.50
|
| 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
|
|
|
HC EGD DIAG W WO COLLECTION
|
Facility
|
IP
|
$4,723.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
900501432
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$944.60 |
| Max. Negotiated Rate |
$4,014.55 |
| Rate for Payer: Adventist Health Commercial |
$944.60
|
| Rate for Payer: Cash Price |
$2,597.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,889.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,889.20
|
| Rate for Payer: Galaxy Health WC |
$4,014.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,833.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,150.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,799.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,923.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,133.52
|
| Rate for Payer: Multiplan Commercial |
$3,778.40
|
| Rate for Payer: Networks By Design Commercial |
$3,069.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,014.55
|
|
|
HC EGD ENDO STENT PLACEMENT
|
Facility
|
IP
|
$6,873.00
|
|
|
Service Code
|
CPT 43266
|
| Hospital Charge Code |
900100017
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,374.60 |
| Max. Negotiated Rate |
$5,842.05 |
| Rate for Payer: Adventist Health Commercial |
$1,374.60
|
| Rate for Payer: Cash Price |
$3,780.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,749.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,749.20
|
| Rate for Payer: Galaxy Health WC |
$5,842.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,123.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,584.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,618.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,254.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,649.52
|
| Rate for Payer: Multiplan Commercial |
$5,498.40
|
| Rate for Payer: Networks By Design Commercial |
$4,467.45
|
| Rate for Payer: Prime Health Services Commercial |
$5,842.05
|
|
|
HC EGD ENDO STENT PLACEMENT
|
Facility
|
OP
|
$6,873.00
|
|
|
Service Code
|
CPT 43266
|
| Hospital Charge Code |
900100017
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$336.50 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$1,374.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,345.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,320.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,563.64
|
| 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 |
$2,470.08
|
| Rate for Payer: Cash Price |
$3,780.15
|
| Rate for Payer: Cash Price |
$3,780.15
|
| Rate for Payer: Cash Price |
$3,780.15
|
| Rate for Payer: Cigna of CA HMO |
$4,398.72
|
| Rate for Payer: Cigna of CA PPO |
$5,086.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,345.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,320.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,563.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,210.91
|
| Rate for Payer: EPIC Health Plan Senior |
$7,563.64
|
| Rate for Payer: Galaxy Health WC |
$5,842.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,123.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,404.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$336.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,563.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,584.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$380.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,563.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,649.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,530.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,135.28
|
| Rate for Payer: Multiplan Commercial |
$5,498.40
|
| Rate for Payer: Networks By Design Commercial |
$4,467.45
|
| Rate for Payer: Prime Health Services Commercial |
$5,842.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,123.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,076.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,563.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,345.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,320.00
|
| Rate for Payer: Vantage Medical Group Senior |
$7,563.64
|
|
|
HC EGD INTRMURAL US NDL ASPIRATE BIOPSY ESOPHAGS
|
Facility
|
IP
|
$3,325.00
|
|
|
Service Code
|
CPT 43238
|
| Hospital Charge Code |
906703238
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$665.00 |
| Max. Negotiated Rate |
$2,826.25 |
| Rate for Payer: Adventist Health Commercial |
$665.00
|
| Rate for Payer: Cash Price |
$1,828.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,330.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,330.00
|
| Rate for Payer: Galaxy Health WC |
$2,826.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,995.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,217.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,266.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$798.00
|
| Rate for Payer: Multiplan Commercial |
$2,660.00
|
| Rate for Payer: Networks By Design Commercial |
$2,161.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,826.25
|
|
|
HC EGD INTRMURAL US NDL ASPIRATE BIOPSY ESOPHAGS
|
Facility
|
OP
|
$3,325.00
|
|
|
Service Code
|
CPT 43238
|
| Hospital Charge Code |
906703238
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$665.00 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$665.00
|
| 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 |
$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 |
$1,828.75
|
| Rate for Payer: Cash Price |
$1,828.75
|
| Rate for Payer: Cash Price |
$1,828.75
|
| Rate for Payer: Cigna of CA HMO |
$2,128.00
|
| Rate for Payer: Cigna of CA PPO |
$2,460.50
|
| 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 |
$2,826.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,995.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,217.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,266.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$798.00
|
| 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 |
$2,660.00
|
| Rate for Payer: Networks By Design Commercial |
$2,161.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,826.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,995.00
|
| 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 LESION ABLATION
|
Facility
|
OP
|
$4,962.00
|
|
|
Service Code
|
CPT 43270
|
| Hospital Charge Code |
900100018
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$354.01 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$992.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| 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 |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$2,729.10
|
| Rate for Payer: Cash Price |
$2,729.10
|
| Rate for Payer: Cash Price |
$2,729.10
|
| Rate for Payer: Cigna of CA HMO |
$3,175.68
|
| Rate for Payer: Cigna of CA PPO |
$3,671.88
|
| 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 |
$4,217.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,977.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$354.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,309.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$400.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,190.88
|
| 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 |
$3,969.60
|
| Rate for Payer: Networks By Design Commercial |
$3,225.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,217.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,977.20
|
| 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 LESION ABLATION
|
Facility
|
IP
|
$4,962.00
|
|
|
Service Code
|
CPT 43270
|
| Hospital Charge Code |
900100018
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$992.40 |
| Max. Negotiated Rate |
$4,217.70 |
| Rate for Payer: Adventist Health Commercial |
$992.40
|
| Rate for Payer: Cash Price |
$2,729.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,984.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,984.80
|
| Rate for Payer: Galaxy Health WC |
$4,217.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,977.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,309.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,890.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,071.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,190.88
|
| Rate for Payer: Multiplan Commercial |
$3,969.60
|
| Rate for Payer: Networks By Design Commercial |
$3,225.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,217.70
|
|
|
HC EGD & POLYPECTOMY
|
Facility
|
IP
|
$3,358.00
|
|
|
Service Code
|
CPT 43250
|
| Hospital Charge Code |
906743250
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$671.60 |
| Max. Negotiated Rate |
$2,854.30 |
| Rate for Payer: Adventist Health Commercial |
$671.60
|
| Rate for Payer: Cash Price |
$1,846.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,343.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,343.20
|
| Rate for Payer: Galaxy Health WC |
$2,854.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,014.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,239.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,279.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,078.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$805.92
|
| Rate for Payer: Multiplan Commercial |
$2,686.40
|
| Rate for Payer: Networks By Design Commercial |
$2,182.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,854.30
|
|
|
HC EGD & POLYPECTOMY
|
Facility
|
OP
|
$3,358.00
|
|
|
Service Code
|
CPT 43250
|
| Hospital Charge Code |
906743250
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$411.55 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$671.60
|
| 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 |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$1,846.90
|
| Rate for Payer: Cash Price |
$1,846.90
|
| Rate for Payer: Cash Price |
$1,846.90
|
| Rate for Payer: Cigna of CA HMO |
$2,149.12
|
| Rate for Payer: Cigna of CA PPO |
$2,484.92
|
| 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 |
$2,854.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,014.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$411.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,239.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$465.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$805.92
|
| 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 |
$2,686.40
|
| Rate for Payer: Networks By Design Commercial |
$2,182.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,854.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,014.80
|
| 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 US TRANSMURAL INJECT MARKER
|
Facility
|
OP
|
$4,216.00
|
|
|
Service Code
|
CPT 43253
|
| Hospital Charge Code |
906743253
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$392.16 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$843.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| 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 |
$392.16
|
| 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 |
$443.52
|
| 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 US TRANSMURAL INJECT MARKER
|
Facility
|
IP
|
$4,216.00
|
|
|
Service Code
|
CPT 43253
|
| Hospital Charge Code |
906743253
|
|
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 W/ABLTN TUMOR/POLYP/LESION
|
Facility
|
OP
|
$2,977.00
|
|
|
Service Code
|
CPT 43258
|
| Hospital Charge Code |
906743258
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$595.40 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$595.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,530.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,637.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,232.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,828.18
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$1,637.35
|
| Rate for Payer: Cash Price |
$1,637.35
|
| Rate for Payer: Cigna of CA HMO |
$1,905.28
|
| Rate for Payer: Cigna of CA PPO |
$2,202.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,530.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,530.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,530.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,190.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,190.80
|
| Rate for Payer: Galaxy Health WC |
$2,530.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,786.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,985.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,134.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,842.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$714.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,083.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,083.90
|
| Rate for Payer: Multiplan Commercial |
$2,381.60
|
| Rate for Payer: Networks By Design Commercial |
$1,935.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,530.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,786.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,786.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,488.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,488.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,488.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,488.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,530.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,530.45
|
| Rate for Payer: Vantage Medical Group Senior |
$2,530.45
|
|
|
HC EGD W/ABLTN TUMOR/POLYP/LESION
|
Facility
|
IP
|
$2,977.00
|
|
|
Service Code
|
CPT 43258
|
| Hospital Charge Code |
906743258
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$595.40 |
| Max. Negotiated Rate |
$2,530.45 |
| Rate for Payer: Adventist Health Commercial |
$595.40
|
| Rate for Payer: Cash Price |
$1,637.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,190.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,190.80
|
| Rate for Payer: Galaxy Health WC |
$2,530.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,786.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,985.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,134.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,842.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$714.48
|
| Rate for Payer: Multiplan Commercial |
$2,381.60
|
| Rate for Payer: Networks By Design Commercial |
$1,935.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,530.45
|
|
|
HC EGD W/BAND/LIG SCLE
|
Facility
|
IP
|
$7,082.00
|
|
|
Service Code
|
CPT 43244
|
| Hospital Charge Code |
906743244
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,416.40 |
| Max. Negotiated Rate |
$6,019.70 |
| Rate for Payer: Adventist Health Commercial |
$1,416.40
|
| Rate for Payer: Cash Price |
$3,895.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,832.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,832.80
|
| Rate for Payer: Galaxy Health WC |
$6,019.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,249.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,723.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,698.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,383.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,699.68
|
| Rate for Payer: Multiplan Commercial |
$5,665.60
|
| Rate for Payer: Networks By Design Commercial |
$4,603.30
|
| Rate for Payer: Prime Health Services Commercial |
$6,019.70
|
|
|
HC EGD W/BAND/LIG SCLE
|
Facility
|
OP
|
$7,082.00
|
|
|
Service Code
|
CPT 43244
|
| Hospital Charge Code |
906743244
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$360.90 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$1,416.40
|
| 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 |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$3,895.10
|
| Rate for Payer: Cash Price |
$3,895.10
|
| Rate for Payer: Cash Price |
$3,895.10
|
| Rate for Payer: Cigna of CA HMO |
$4,532.48
|
| Rate for Payer: Cigna of CA PPO |
$5,240.68
|
| 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 |
$6,019.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,249.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$360.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,723.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$408.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,699.68
|
| 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 |
$5,665.60
|
| Rate for Payer: Networks By Design Commercial |
$4,603.30
|
| Rate for Payer: Prime Health Services Commercial |
$6,019.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,249.20
|
| 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 W BLLN DLTN ESO
|
Facility
|
OP
|
$4,294.00
|
|
|
Service Code
|
CPT 43249
|
| Hospital Charge Code |
906743249
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$374.66 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$858.80
|
| 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 |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$2,361.70
|
| Rate for Payer: Cash Price |
$2,361.70
|
| Rate for Payer: Cash Price |
$2,361.70
|
| Rate for Payer: Cigna of CA HMO |
$2,748.16
|
| Rate for Payer: Cigna of CA PPO |
$3,177.56
|
| 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 |
$3,649.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,576.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$374.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,864.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$423.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,030.56
|
| 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 |
$3,435.20
|
| Rate for Payer: Networks By Design Commercial |
$2,791.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,649.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,576.40
|
| 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 W BLLN DLTN ESO
|
Facility
|
OP
|
$4,294.00
|
|
|
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: Adventist Health Commercial |
$858.80
|
| 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 |
$6,427.00
|
| Rate for Payer: Cash Price |
$2,361.70
|
| Rate for Payer: Cash Price |
$2,361.70
|
| Rate for Payer: Cash Price |
$2,361.70
|
| Rate for Payer: Cigna of CA HMO |
$2,748.16
|
| Rate for Payer: Cigna of CA PPO |
$3,177.56
|
| 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 |
$3,649.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,576.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,864.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$423.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,030.56
|
| 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 |
$3,435.20
|
| Rate for Payer: Multiplan WC |
$3,840.40
|
| Rate for Payer: Networks By Design Commercial |
$2,791.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,649.90
|
| Rate for Payer: Prime Health Services WC |
$3,801.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,576.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,147.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,147.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,147.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,147.00
|
| 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 W BLLN DLTN ESO
|
Facility
|
IP
|
$4,294.00
|
|
|
Service Code
|
CPT 43249
|
| Hospital Charge Code |
906743249
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$858.80 |
| Max. Negotiated Rate |
$3,649.90 |
| Rate for Payer: Adventist Health Commercial |
$858.80
|
| Rate for Payer: Cash Price |
$2,361.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,717.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,717.60
|
| Rate for Payer: Galaxy Health WC |
$3,649.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,576.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,864.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,636.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,657.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,030.56
|
| Rate for Payer: Multiplan Commercial |
$3,435.20
|
| Rate for Payer: Networks By Design Commercial |
$2,791.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,649.90
|
|
|
HC EGD W BLLN DLTN ESO
|
Facility
|
IP
|
$4,294.00
|
|
|
Service Code
|
CPT 43249
|
| Hospital Charge Code |
906743249
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$858.80 |
| Max. Negotiated Rate |
$3,649.90 |
| Rate for Payer: Adventist Health Commercial |
$858.80
|
| Rate for Payer: Cash Price |
$2,361.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,717.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,717.60
|
| Rate for Payer: Galaxy Health WC |
$3,649.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,576.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,864.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,636.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,657.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,030.56
|
| Rate for Payer: Multiplan Commercial |
$3,435.20
|
| Rate for Payer: Networks By Design Commercial |
$2,791.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,649.90
|
|
|
HC EGD W BX SNGL OR MULTI
|
Facility
|
OP
|
$5,808.00
|
|
|
Service Code
|
CPT 43239
|
| Hospital Charge Code |
906743239
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$444.94 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$1,161.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| 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 |
$3,194.40
|
| Rate for Payer: Cash Price |
$3,194.40
|
| Rate for Payer: Cash Price |
$3,194.40
|
| Rate for Payer: Cigna of CA HMO |
$3,717.12
|
| Rate for Payer: Cigna of CA PPO |
$4,297.92
|
| 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 |
$4,936.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,484.80
|
| 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 |
$3,873.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$444.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,393.92
|
| 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 |
$4,646.40
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Networks By Design Commercial |
$3,775.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,936.80
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,484.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,904.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,904.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,904.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,904.00
|
| 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 W BX SNGL OR MULTI
|
Facility
|
IP
|
$5,808.00
|
|
|
Service Code
|
CPT 43239
|
| Hospital Charge Code |
906743239
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,161.60 |
| Max. Negotiated Rate |
$4,936.80 |
| Rate for Payer: Adventist Health Commercial |
$1,161.60
|
| Rate for Payer: Cash Price |
$3,194.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,323.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,323.20
|
| Rate for Payer: Galaxy Health WC |
$4,936.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,484.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,873.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,212.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,595.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,393.92
|
| Rate for Payer: Multiplan Commercial |
$4,646.40
|
| Rate for Payer: Networks By Design Commercial |
$3,775.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,936.80
|
|
|
HC EGD W BX SNGL OR MULTI
|
Facility
|
IP
|
$5,808.00
|
|
|
Service Code
|
CPT 43239
|
| Hospital Charge Code |
906743239
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,161.60 |
| Max. Negotiated Rate |
$4,936.80 |
| Rate for Payer: Adventist Health Commercial |
$1,161.60
|
| Rate for Payer: Cash Price |
$3,194.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,323.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,323.20
|
| Rate for Payer: Galaxy Health WC |
$4,936.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,484.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,873.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,212.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,595.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,393.92
|
| Rate for Payer: Multiplan Commercial |
$4,646.40
|
| Rate for Payer: Networks By Design Commercial |
$3,775.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,936.80
|
|
