|
HC EGD W BX SNGL OR MULTI
|
Facility
|
OP
|
$5,808.00
|
|
|
Service Code
|
CPT 43239
|
| Hospital Charge Code |
906743239
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$393.42 |
| Max. Negotiated Rate |
$11,230.65 |
| 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: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$3,194.40
|
| 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 |
$393.42
|
| 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: Networks By Design Commercial |
$3,775.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,936.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,484.80
|
| 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/CNTRL BLEEDNG ANY METHOD
|
Facility
|
OP
|
$6,219.00
|
|
|
Service Code
|
CPT 43255
|
| Hospital Charge Code |
906743255
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$483.49 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$1,243.80
|
| 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 |
$3,420.45
|
| Rate for Payer: Cash Price |
$3,420.45
|
| Rate for Payer: Cash Price |
$3,420.45
|
| Rate for Payer: Cigna of CA HMO |
$3,980.16
|
| Rate for Payer: Cigna of CA PPO |
$4,602.06
|
| 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 |
$5,286.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,731.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$483.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,148.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$546.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,492.56
|
| 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 |
$4,975.20
|
| Rate for Payer: Networks By Design Commercial |
$4,042.35
|
| Rate for Payer: Prime Health Services Commercial |
$5,286.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,731.40
|
| 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/CNTRL BLEEDNG ANY METHOD
|
Facility
|
IP
|
$6,219.00
|
|
|
Service Code
|
CPT 43255
|
| Hospital Charge Code |
906743255
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,243.80 |
| Max. Negotiated Rate |
$5,286.15 |
| Rate for Payer: Adventist Health Commercial |
$1,243.80
|
| Rate for Payer: Cash Price |
$3,420.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,487.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,487.60
|
| Rate for Payer: Galaxy Health WC |
$5,286.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,731.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,148.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,369.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,849.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,492.56
|
| Rate for Payer: Multiplan Commercial |
$4,975.20
|
| Rate for Payer: Networks By Design Commercial |
$4,042.35
|
| Rate for Payer: Prime Health Services Commercial |
$5,286.15
|
|
|
HC EGD W/DILATION OF GASTRIC OUTL
|
Facility
|
IP
|
$5,547.00
|
|
|
Service Code
|
CPT 43245
|
| Hospital Charge Code |
906743245
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,109.40 |
| Max. Negotiated Rate |
$4,714.95 |
| Rate for Payer: Adventist Health Commercial |
$1,109.40
|
| Rate for Payer: Cash Price |
$3,050.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,218.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,218.80
|
| Rate for Payer: Galaxy Health WC |
$4,714.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,328.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,699.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,113.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,433.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,331.28
|
| Rate for Payer: Multiplan Commercial |
$4,437.60
|
| Rate for Payer: Networks By Design Commercial |
$3,605.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,714.95
|
|
|
HC EGD W/DILATION OF GASTRIC OUTL
|
Facility
|
OP
|
$5,547.00
|
|
|
Service Code
|
CPT 43245
|
| Hospital Charge Code |
906743245
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$406.56 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$1,109.40
|
| 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 |
$3,050.85
|
| Rate for Payer: Cash Price |
$3,050.85
|
| Rate for Payer: Cash Price |
$3,050.85
|
| Rate for Payer: Cigna of CA HMO |
$3,550.08
|
| Rate for Payer: Cigna of CA PPO |
$4,104.78
|
| 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 |
$4,714.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,328.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$406.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,699.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$459.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,331.28
|
| 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 |
$4,437.60
|
| Rate for Payer: Networks By Design Commercial |
$3,605.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,714.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,328.20
|
| 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/DRCTD PLCMT PERCUT GAST
|
Facility
|
OP
|
$4,221.00
|
|
|
Service Code
|
CPT 43246
|
| Hospital Charge Code |
906743246
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$406.56 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$844.20
|
| 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 |
$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 |
$2,321.55
|
| Rate for Payer: Cash Price |
$2,321.55
|
| Rate for Payer: Cash Price |
$2,321.55
|
| Rate for Payer: Cigna of CA HMO |
$2,701.44
|
| Rate for Payer: Cigna of CA PPO |
$3,123.54
|
| 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 |
$3,587.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,532.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$406.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,815.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$459.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,013.04
|
| 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 |
$3,376.80
|
| Rate for Payer: Networks By Design Commercial |
$2,743.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,587.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,532.60
|
| 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/DRCTD PLCMT PERCUT GAST
|
Facility
|
IP
|
$4,221.00
|
|
|
Service Code
|
CPT 43246
|
| Hospital Charge Code |
906743246
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$844.20 |
| Max. Negotiated Rate |
$3,587.85 |
| Rate for Payer: Adventist Health Commercial |
$844.20
|
| Rate for Payer: Cash Price |
$2,321.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,688.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,688.40
|
| Rate for Payer: Galaxy Health WC |
$3,587.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,532.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,815.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,608.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,612.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,013.04
|
| Rate for Payer: Multiplan Commercial |
$3,376.80
|
| Rate for Payer: Networks By Design Commercial |
$2,743.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,587.85
|
|
|
HC EGD W ENDO MUCOSAL RESECTION
|
Facility
|
IP
|
$2,791.00
|
|
|
Service Code
|
CPT 43254
|
| Hospital Charge Code |
906743254
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$558.20 |
| Max. Negotiated Rate |
$2,372.35 |
| Rate for Payer: Adventist Health Commercial |
$558.20
|
| Rate for Payer: Cash Price |
$1,535.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,116.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,116.40
|
| Rate for Payer: Galaxy Health WC |
$2,372.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,674.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,861.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,063.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,727.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$669.84
|
| Rate for Payer: Multiplan Commercial |
$2,232.80
|
| Rate for Payer: Networks By Design Commercial |
$1,814.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,372.35
|
|
|
HC EGD W ENDO MUCOSAL RESECTION
|
Facility
|
OP
|
$2,791.00
|
|
|
Service Code
|
CPT 43254
|
| Hospital Charge Code |
906743254
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$406.56 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$558.20
|
| 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 |
$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 |
$1,535.05
|
| Rate for Payer: Cash Price |
$1,535.05
|
| Rate for Payer: Cash Price |
$1,535.05
|
| Rate for Payer: Cigna of CA HMO |
$1,786.24
|
| Rate for Payer: Cigna of CA PPO |
$2,065.34
|
| 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 |
$2,372.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,674.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$406.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,861.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$459.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$669.84
|
| 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 |
$2,232.80
|
| Rate for Payer: Networks By Design Commercial |
$1,814.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,372.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,674.60
|
| 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/ENDO US EXAM
|
Facility
|
OP
|
$5,149.00
|
|
|
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 |
$1,029.80
|
| 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 |
$2,831.95
|
| Rate for Payer: Cash Price |
$2,831.95
|
| Rate for Payer: Cash Price |
$2,831.95
|
| Rate for Payer: Cigna of CA HMO |
$3,295.36
|
| Rate for Payer: Cigna of CA PPO |
$3,810.26
|
| 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 |
$4,376.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,089.40
|
| 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 |
$3,434.38
|
| 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 |
$1,235.76
|
| 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 |
$4,119.20
|
| Rate for Payer: Networks By Design Commercial |
$3,346.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,376.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,089.40
|
| 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/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 |
$2,831.95
|
| 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 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 |
$2,572.90
|
| 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
|
$4,678.00
|
|
|
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 |
$935.60
|
| 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: Cash Price |
$2,572.90
|
| Rate for Payer: Cash Price |
$2,572.90
|
| Rate for Payer: Cash Price |
$2,572.90
|
| Rate for Payer: Cigna of CA HMO |
$2,993.92
|
| Rate for Payer: Cigna of CA PPO |
$3,461.72
|
| 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 |
$3,976.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,806.80
|
| 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 |
$3,120.23
|
| 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 |
$1,122.72
|
| 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 |
$3,742.40
|
| Rate for Payer: Multiplan WC |
$3,840.40
|
| Rate for Payer: Networks By Design Commercial |
$3,040.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,976.30
|
| Rate for Payer: Prime Health Services WC |
$3,801.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,806.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,339.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,339.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,339.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,339.00
|
| 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
|
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 |
$2,572.90
|
| 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
|
$4,678.00
|
|
|
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 |
$935.60
|
| 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 |
$2,572.90
|
| Rate for Payer: Cash Price |
$2,572.90
|
| Rate for Payer: Cash Price |
$2,572.90
|
| Rate for Payer: Cigna of CA HMO |
$2,993.92
|
| Rate for Payer: Cigna of CA PPO |
$3,461.72
|
| 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 |
$3,976.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,806.80
|
| 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 |
$3,120.23
|
| 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 |
$1,122.72
|
| 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 |
$3,742.40
|
| Rate for Payer: Networks By Design Commercial |
$3,040.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,976.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,806.80
|
| 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/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 |
$2,175.25
|
| 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
|
$3,955.00
|
|
|
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 |
$791.00
|
| 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 |
$2,175.25
|
| Rate for Payer: Cash Price |
$2,175.25
|
| Rate for Payer: Cash Price |
$2,175.25
|
| Rate for Payer: Cigna of CA HMO |
$2,531.20
|
| Rate for Payer: Cigna of CA PPO |
$2,926.70
|
| 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 |
$3,361.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,373.00
|
| 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 |
$2,637.99
|
| 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 |
$949.20
|
| 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 |
$3,164.00
|
| Rate for Payer: Networks By Design Commercial |
$2,570.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,361.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,373.00
|
| 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
|
IP
|
$4,268.00
|
|
|
Service Code
|
CPT 43256
|
| Hospital Charge Code |
906743256
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$853.60 |
| Max. Negotiated Rate |
$3,627.80 |
| Rate for Payer: Adventist Health Commercial |
$853.60
|
| Rate for Payer: Cash Price |
$2,347.40
|
| 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: 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
|
|
|
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 |
$2,347.40
|
| Rate for Payer: Cash Price |
$2,347.40
|
| 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
|
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 |
$2,431.55
|
| 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/REMOVAL FOREIGN BODY
|
Facility
|
OP
|
$4,421.00
|
|
|
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 |
$884.20
|
| 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 |
$2,431.55
|
| Rate for Payer: Cash Price |
$2,431.55
|
| Rate for Payer: Cash Price |
$2,431.55
|
| Rate for Payer: Cigna of CA HMO |
$2,829.44
|
| Rate for Payer: Cigna of CA PPO |
$3,271.54
|
| 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 |
$3,757.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,652.60
|
| 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 |
$2,948.81
|
| 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 |
$1,061.04
|
| 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 |
$3,536.80
|
| Rate for Payer: Networks By Design Commercial |
$2,873.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,757.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,652.60
|
| 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/REMOV TUMOR/POLYP/LESION
|
Facility
|
OP
|
$3,551.00
|
|
|
Service Code
|
CPT 43251
|
| Hospital Charge Code |
906743251
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$710.20 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$710.20
|
| 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 |
$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 |
$1,953.05
|
| Rate for Payer: Cash Price |
$1,953.05
|
| Rate for Payer: Cash Price |
$1,953.05
|
| Rate for Payer: Cigna of CA HMO |
$2,272.64
|
| Rate for Payer: Cigna of CA PPO |
$2,627.74
|
| 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 |
$3,018.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,130.60
|
| 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 |
$2,368.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$852.24
|
| 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 |
$2,840.80
|
| Rate for Payer: Networks By Design Commercial |
$2,308.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,018.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,130.60
|
| 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/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 |
$1,953.05
|
| 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/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 |
$2,800.05
|
| 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
|
$5,091.00
|
|
|
Service Code
|
CPT 43241
|
| Hospital Charge Code |
906743241
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,018.20 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$1,018.20
|
| 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 |
$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 |
$2,800.05
|
| Rate for Payer: Cash Price |
$2,800.05
|
| Rate for Payer: Cash Price |
$2,800.05
|
| Rate for Payer: Cigna of CA HMO |
$3,258.24
|
| Rate for Payer: Cigna of CA PPO |
$3,767.34
|
| 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 |
$4,327.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,054.60
|
| 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 |
$3,395.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,221.84
|
| 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 |
$4,072.80
|
| Rate for Payer: Networks By Design Commercial |
$3,309.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,327.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,054.60
|
| 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
|
|
