|
HC EGD W/ENDO US EXAM
|
Facility
|
IP
|
$5,149.00
|
|
|
Service Code
|
CPT 43259
|
| Hospital Charge Code |
906743259
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,029.80 |
| Max. Negotiated Rate |
$4,376.65 |
| Rate for Payer: Adventist Health Commercial |
$1,029.80
|
| Rate for Payer: Cash Price |
$2,317.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,059.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,059.60
|
| Rate for Payer: Galaxy Health WC |
$4,376.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,089.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,434.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,961.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,187.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,235.76
|
| Rate for Payer: Multiplan Commercial |
$4,119.20
|
| Rate for Payer: Networks By Design Commercial |
$3,346.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,376.65
|
|
|
HC EGD W/ENDO US EXAM
|
Facility
|
OP
|
$3,438.00
|
|
|
Service Code
|
CPT 43259
|
| Hospital Charge Code |
906743259
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$349.00 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$687.60
|
| 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 |
$2,822.94
|
| Rate for Payer: Cash Price |
$1,547.10
|
| Rate for Payer: Cash Price |
$1,547.10
|
| Rate for Payer: Cash Price |
$1,547.10
|
| Rate for Payer: Cigna of CA HMO |
$2,200.32
|
| Rate for Payer: Cigna of CA PPO |
$2,544.12
|
| 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 |
$2,922.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,062.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$349.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,293.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$394.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$825.12
|
| 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 |
$2,750.40
|
| Rate for Payer: Networks By Design Commercial |
$2,234.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,922.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,062.80
|
| 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 W INJ SCLER ESO
|
Facility
|
OP
|
$3,127.00
|
|
|
Service Code
|
CPT 43243
|
| Hospital Charge Code |
906743243
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$580.05 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$625.40
|
| 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: Cash Price |
$1,407.15
|
| Rate for Payer: Cash Price |
$1,407.15
|
| Rate for Payer: Cash Price |
$1,407.15
|
| Rate for Payer: Cigna of CA HMO |
$2,001.28
|
| Rate for Payer: Cigna of CA PPO |
$2,313.98
|
| 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 |
$2,657.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,876.20
|
| 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 |
$2,085.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$580.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$750.48
|
| 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 |
$2,501.60
|
| Rate for Payer: Multiplan WC |
$3,840.40
|
| Rate for Payer: Networks By Design Commercial |
$2,032.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,657.95
|
| Rate for Payer: Prime Health Services WC |
$3,801.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,876.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,563.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,563.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,563.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,563.50
|
| 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 INJ SCLER ESO
|
Facility
|
IP
|
$4,678.00
|
|
|
Service Code
|
CPT 43243
|
| Hospital Charge Code |
906743243
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$935.60 |
| Max. Negotiated Rate |
$3,976.30 |
| Rate for Payer: Adventist Health Commercial |
$935.60
|
| Rate for Payer: Cash Price |
$2,105.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,871.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,871.20
|
| Rate for Payer: Galaxy Health WC |
$3,976.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,806.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,120.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,782.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,895.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,122.72
|
| Rate for Payer: Multiplan Commercial |
$3,742.40
|
| Rate for Payer: Networks By Design Commercial |
$3,040.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,976.30
|
|
|
HC EGD W INJ SCLER ESO
|
Facility
|
IP
|
$4,678.00
|
|
|
Service Code
|
CPT 43243
|
| Hospital Charge Code |
906743243
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$935.60 |
| Max. Negotiated Rate |
$3,976.30 |
| Rate for Payer: Adventist Health Commercial |
$935.60
|
| Rate for Payer: Cash Price |
$2,105.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,871.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,871.20
|
| Rate for Payer: Galaxy Health WC |
$3,976.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,806.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,120.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,782.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,895.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,122.72
|
| Rate for Payer: Multiplan Commercial |
$3,742.40
|
| Rate for Payer: Networks By Design Commercial |
$3,040.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,976.30
|
|
|
HC EGD W INJ SCLER ESO
|
Facility
|
OP
|
$3,127.00
|
|
|
Service Code
|
CPT 43243
|
| Hospital Charge Code |
906743243
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$512.89 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$625.40
|
| 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 |
$1,407.15
|
| Rate for Payer: Cash Price |
$1,407.15
|
| Rate for Payer: Cash Price |
$1,407.15
|
| Rate for Payer: Cigna of CA HMO |
$2,001.28
|
| Rate for Payer: Cigna of CA PPO |
$2,313.98
|
| 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 |
$2,657.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,876.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$512.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,085.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$580.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$750.48
|
| 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 |
$2,501.60
|
| Rate for Payer: Networks By Design Commercial |
$2,032.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,657.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,876.20
|
| 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/INSRT GIDE WIRE
|
Facility
|
IP
|
$3,955.00
|
|
|
Service Code
|
CPT 43248
|
| Hospital Charge Code |
906743248
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$791.00 |
| Max. Negotiated Rate |
$3,361.75 |
| Rate for Payer: Adventist Health Commercial |
$791.00
|
| Rate for Payer: Cash Price |
$1,779.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,582.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,582.00
|
| Rate for Payer: Galaxy Health WC |
$3,361.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,373.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,637.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,506.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,448.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$949.20
|
| Rate for Payer: Multiplan Commercial |
$3,164.00
|
| Rate for Payer: Networks By Design Commercial |
$2,570.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,361.75
|
|
|
HC EGD W/INSRT GIDE WIRE
|
Facility
|
OP
|
$2,644.00
|
|
|
Service Code
|
CPT 43248
|
| Hospital Charge Code |
906743248
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$248.30 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$528.80
|
| 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 |
$1,189.80
|
| Rate for Payer: Cash Price |
$1,189.80
|
| Rate for Payer: Cash Price |
$1,189.80
|
| Rate for Payer: Cigna of CA HMO |
$1,692.16
|
| Rate for Payer: Cigna of CA PPO |
$1,956.56
|
| 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 |
$2,247.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,586.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$248.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,763.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$280.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$634.56
|
| 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 |
$2,115.20
|
| Rate for Payer: Networks By Design Commercial |
$1,718.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,247.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,586.40
|
| 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 W/INSRT STENT
|
Facility
|
OP
|
$4,268.00
|
|
|
Service Code
|
CPT 43256
|
| Hospital Charge Code |
906743256
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$853.60 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$853.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,627.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,347.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,201.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,620.98
|
| 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 |
$1,920.60
|
| Rate for Payer: Cash Price |
$1,920.60
|
| Rate for Payer: Cigna of CA HMO |
$2,731.52
|
| Rate for Payer: Cigna of CA PPO |
$3,158.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,627.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,627.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,627.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,707.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,707.20
|
| Rate for Payer: Galaxy Health WC |
$3,627.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,560.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,846.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,626.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,641.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,024.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,987.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,987.60
|
| Rate for Payer: Multiplan Commercial |
$3,414.40
|
| Rate for Payer: Networks By Design Commercial |
$2,774.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,627.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,560.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,560.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,134.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,134.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,134.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,134.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,627.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,627.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,627.80
|
|
|
HC EGD W/REMOVAL FOREIGN BODY
|
Facility
|
OP
|
$2,954.00
|
|
|
Service Code
|
CPT 43247
|
| Hospital Charge Code |
906743247
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$429.07 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$590.80
|
| 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 |
$1,329.30
|
| Rate for Payer: Cash Price |
$1,329.30
|
| Rate for Payer: Cash Price |
$1,329.30
|
| Rate for Payer: Cigna of CA HMO |
$1,890.56
|
| Rate for Payer: Cigna of CA PPO |
$2,185.96
|
| 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 |
$2,510.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,772.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$429.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,970.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$485.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$708.96
|
| 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 |
$2,363.20
|
| Rate for Payer: Networks By Design Commercial |
$1,920.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,510.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,772.40
|
| 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 W/REMOVAL FOREIGN BODY
|
Facility
|
IP
|
$4,421.00
|
|
|
Service Code
|
CPT 43247
|
| Hospital Charge Code |
906743247
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$884.20 |
| Max. Negotiated Rate |
$3,757.85 |
| Rate for Payer: Adventist Health Commercial |
$884.20
|
| Rate for Payer: Cash Price |
$1,989.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,768.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,768.40
|
| Rate for Payer: Galaxy Health WC |
$3,757.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,652.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,948.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,684.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,736.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,061.04
|
| Rate for Payer: Multiplan Commercial |
$3,536.80
|
| Rate for Payer: Networks By Design Commercial |
$2,873.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,757.85
|
|
|
HC EGD W/REMOV TUMOR/POLYP/LESION
|
Facility
|
IP
|
$3,551.00
|
|
|
Service Code
|
CPT 43251
|
| Hospital Charge Code |
906743251
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$710.20 |
| Max. Negotiated Rate |
$3,018.35 |
| Rate for Payer: Adventist Health Commercial |
$710.20
|
| Rate for Payer: Cash Price |
$1,597.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,420.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,420.40
|
| Rate for Payer: Galaxy Health WC |
$3,018.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,130.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,368.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,352.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,198.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$852.24
|
| Rate for Payer: Multiplan Commercial |
$2,840.80
|
| Rate for Payer: Networks By Design Commercial |
$2,308.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,018.35
|
|
|
HC EGD W/REMOV TUMOR/POLYP/LESION
|
Facility
|
OP
|
$1,898.00
|
|
|
Service Code
|
CPT 43251
|
| Hospital Charge Code |
906743251
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$379.60 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$379.60
|
| 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 |
$854.10
|
| Rate for Payer: Cash Price |
$854.10
|
| Rate for Payer: Cash Price |
$854.10
|
| Rate for Payer: Cigna of CA HMO |
$1,214.72
|
| Rate for Payer: Cigna of CA PPO |
$1,404.52
|
| 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 |
$1,613.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,138.80
|
| 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 |
$1,265.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$455.52
|
| 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 |
$1,518.40
|
| Rate for Payer: Networks By Design Commercial |
$1,233.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,613.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,138.80
|
| 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 W/TRANSENDO TUBE/CATH PLAC
|
Facility
|
IP
|
$5,091.00
|
|
|
Service Code
|
CPT 43241
|
| Hospital Charge Code |
906743241
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,018.20 |
| Max. Negotiated Rate |
$4,327.35 |
| Rate for Payer: Adventist Health Commercial |
$1,018.20
|
| Rate for Payer: Cash Price |
$2,290.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,036.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,036.40
|
| Rate for Payer: Galaxy Health WC |
$4,327.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,054.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,395.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,939.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,151.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,221.84
|
| Rate for Payer: Multiplan Commercial |
$4,072.80
|
| Rate for Payer: Networks By Design Commercial |
$3,309.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,327.35
|
|
|
HC EGD W/TRANSENDO TUBE/CATH PLAC
|
Facility
|
OP
|
$2,869.00
|
|
|
Service Code
|
CPT 43241
|
| Hospital Charge Code |
906743241
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$573.80 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$573.80
|
| 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 |
$1,291.05
|
| Rate for Payer: Cash Price |
$1,291.05
|
| Rate for Payer: Cash Price |
$1,291.05
|
| Rate for Payer: Cigna of CA HMO |
$1,836.16
|
| Rate for Payer: Cigna of CA PPO |
$2,123.06
|
| 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 |
$2,438.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,721.40
|
| 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 |
$1,913.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$688.56
|
| 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 |
$2,295.20
|
| Rate for Payer: Networks By Design Commercial |
$1,864.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,438.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,721.40
|
| 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/TRNSMRL DRNG/ PSEUDOCYST
|
Facility
|
OP
|
$3,096.00
|
|
|
Service Code
|
CPT 43240
|
| Hospital Charge Code |
906743240
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$587.93 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$619.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| 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 |
$1,393.20
|
| Rate for Payer: Cash Price |
$1,393.20
|
| Rate for Payer: Cash Price |
$1,393.20
|
| Rate for Payer: Cigna of CA HMO |
$1,981.44
|
| Rate for Payer: Cigna of CA PPO |
$2,291.04
|
| 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 |
$2,631.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,857.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,404.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$587.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,563.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,065.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$664.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,563.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$743.04
|
| 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 |
$2,476.80
|
| Rate for Payer: Networks By Design Commercial |
$2,012.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,631.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,857.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,076.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| 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 W/TRNSMRL DRNG/ PSEUDOCYST
|
Facility
|
IP
|
$5,728.00
|
|
|
Service Code
|
CPT 43240
|
| Hospital Charge Code |
906743240
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,145.60 |
| Max. Negotiated Rate |
$4,868.80 |
| Rate for Payer: Adventist Health Commercial |
$1,145.60
|
| Rate for Payer: Cash Price |
$2,577.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,291.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,291.20
|
| Rate for Payer: Galaxy Health WC |
$4,868.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,436.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,820.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,182.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,545.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,374.72
|
| Rate for Payer: Multiplan Commercial |
$4,582.40
|
| Rate for Payer: Networks By Design Commercial |
$3,723.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,868.80
|
|
|
HC EGD W/US GUID INTRMRL
|
Facility
|
OP
|
$3,566.00
|
|
|
Service Code
|
CPT 43242
|
| Hospital Charge Code |
906743242
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$421.56 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$713.20
|
| 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 |
$2,470.08
|
| Rate for Payer: Cash Price |
$1,604.70
|
| Rate for Payer: Cash Price |
$1,604.70
|
| Rate for Payer: Cash Price |
$1,604.70
|
| Rate for Payer: Cigna of CA HMO |
$2,282.24
|
| Rate for Payer: Cigna of CA PPO |
$2,638.84
|
| 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 |
$3,031.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,139.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$421.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,378.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$476.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$855.84
|
| 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 |
$2,852.80
|
| Rate for Payer: Networks By Design Commercial |
$2,317.90
|
| Rate for Payer: Prime Health Services Commercial |
$3,031.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,139.60
|
| 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 W/US GUID INTRMRL
|
Facility
|
IP
|
$5,335.00
|
|
|
Service Code
|
CPT 43242
|
| Hospital Charge Code |
906743242
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,067.00 |
| Max. Negotiated Rate |
$4,534.75 |
| Rate for Payer: Adventist Health Commercial |
$1,067.00
|
| Rate for Payer: Cash Price |
$2,400.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,134.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,134.00
|
| Rate for Payer: Galaxy Health WC |
$4,534.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,201.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,558.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,032.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,302.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,280.40
|
| Rate for Payer: Multiplan Commercial |
$4,268.00
|
| Rate for Payer: Networks By Design Commercial |
$3,467.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,534.75
|
|
|
HC EKOS THROMLYSIS CATH
|
Facility
|
OP
|
$6,704.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,340.80 |
| Max. Negotiated Rate |
$5,698.40 |
| Rate for Payer: Adventist Health Commercial |
$1,340.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,698.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,687.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,028.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,882.96
|
| Rate for Payer: Blue Shield of California Commercial |
$4,947.55
|
| Rate for Payer: Blue Shield of California EPN |
$3,258.14
|
| Rate for Payer: Cash Price |
$3,016.80
|
| Rate for Payer: Cigna of CA HMO |
$4,692.80
|
| Rate for Payer: Cigna of CA PPO |
$4,692.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,698.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,698.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,698.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,681.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,681.60
|
| Rate for Payer: Galaxy Health WC |
$5,698.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,022.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,471.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,554.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,149.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,608.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,692.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,692.80
|
| Rate for Payer: Multiplan Commercial |
$5,363.20
|
| Rate for Payer: Networks By Design Commercial |
$3,352.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,698.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,022.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,022.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,516.01
|
| Rate for Payer: United Healthcare All Other HMO |
$2,448.97
|
| Rate for Payer: United Healthcare HMO Rider |
$2,396.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,195.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,698.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,698.40
|
| Rate for Payer: Vantage Medical Group Senior |
$5,698.40
|
|
|
HC EKOS THROMLYSIS CATH
|
Facility
|
IP
|
$6,704.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,340.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,340.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,016.80
|
| Rate for Payer: Cash Price |
$3,016.80
|
| Rate for Payer: Cigna of CA HMO |
$4,692.80
|
| Rate for Payer: Cigna of CA PPO |
$4,692.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,681.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,681.60
|
| Rate for Payer: Galaxy Health WC |
$5,698.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,022.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,471.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,554.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,149.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,608.96
|
| Rate for Payer: Multiplan Commercial |
$5,363.20
|
| Rate for Payer: Networks By Design Commercial |
$3,352.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,698.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,516.01
|
| Rate for Payer: United Healthcare All Other HMO |
$2,448.97
|
| Rate for Payer: United Healthcare HMO Rider |
$2,396.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,195.56
|
|
|
HC ELASTOPLAST
|
Facility
|
OP
|
$12.00
|
|
| Hospital Charge Code |
909001032
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$10.20 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.37
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna of CA HMO |
$7.68
|
| Rate for Payer: Cigna of CA PPO |
$8.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4.80
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.40
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: Networks By Design Commercial |
$7.80
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10.20
|
|
|
HC ELASTOPLAST
|
Facility
|
IP
|
$12.00
|
|
| Hospital Charge Code |
909001032
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$10.20 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4.80
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: Networks By Design Commercial |
$7.80
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
|
|
HC ELBOW ARTHROGRAPHY INJECT
|
Facility
|
IP
|
$357.00
|
|
|
Service Code
|
CPT 24220
|
| Hospital Charge Code |
909000114
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$71.40 |
| Max. Negotiated Rate |
$303.45 |
| Rate for Payer: Adventist Health Commercial |
$71.40
|
| Rate for Payer: Cash Price |
$160.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$142.80
|
| Rate for Payer: EPIC Health Plan Senior |
$142.80
|
| Rate for Payer: Galaxy Health WC |
$303.45
|
| Rate for Payer: Global Benefits Group Commercial |
$214.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$238.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$220.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.68
|
| Rate for Payer: Multiplan Commercial |
$285.60
|
| Rate for Payer: Networks By Design Commercial |
$232.05
|
| Rate for Payer: Prime Health Services Commercial |
$303.45
|
|
|
HC ELBOW ARTHROGRAPHY INJECT
|
Facility
|
OP
|
$357.00
|
|
|
Service Code
|
CPT 24220
|
| Hospital Charge Code |
909000114
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$71.40 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$71.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$303.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$196.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| 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 |
$160.65
|
| Rate for Payer: Cash Price |
$160.65
|
| Rate for Payer: Cash Price |
$160.65
|
| Rate for Payer: Cigna of CA HMO |
$228.48
|
| Rate for Payer: Cigna of CA PPO |
$264.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$303.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$303.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$303.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$142.80
|
| Rate for Payer: EPIC Health Plan Senior |
$142.80
|
| Rate for Payer: Galaxy Health WC |
$303.45
|
| Rate for Payer: Global Benefits Group Commercial |
$214.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$343.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$238.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$388.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$220.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$249.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$249.90
|
| Rate for Payer: Multiplan Commercial |
$285.60
|
| Rate for Payer: Networks By Design Commercial |
$232.05
|
| Rate for Payer: Prime Health Services Commercial |
$303.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$214.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$303.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$303.45
|
| Rate for Payer: Vantage Medical Group Senior |
$303.45
|
|
