|
HC EEG W/O VID EA 12-26HR CNT MNR
|
Facility
|
OP
|
$1,812.00
|
|
|
Service Code
|
CPT 95710
|
| Hospital Charge Code |
900605710
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$362.40 |
| Max. Negotiated Rate |
$5,833.82 |
| Rate for Payer: Adventist Health Medi-Cal |
$669.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5,833.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$736.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$669.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,242.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,070.53
|
| Rate for Payer: Blue Distinction Transplant |
$1,087.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,119.82
|
| Rate for Payer: Blue Shield of California EPN |
$880.63
|
| Rate for Payer: Caremore Medicare Advantage |
$669.68
|
| Rate for Payer: Cash Price |
$815.40
|
| Rate for Payer: Cash Price |
$815.40
|
| Rate for Payer: Cash Price |
$815.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,449.60
|
| Rate for Payer: Cigna of CA HMO |
$1,159.68
|
| Rate for Payer: Cigna of CA PPO |
$1,340.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Dignity Health Media |
$669.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$736.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$904.07
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$669.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$669.68
|
| Rate for Payer: Galaxy Health WC |
$1,540.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,087.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,630.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,359.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,098.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,104.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$669.68
|
| Rate for Payer: InnovAge PACE Commercial |
$1,004.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,208.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,944.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$669.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$362.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$897.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$897.37
|
| Rate for Payer: Multiplan Commercial |
$1,359.00
|
| Rate for Payer: Networks By Design Commercial |
$1,177.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,540.20
|
| Rate for Payer: Prime Health Services Medicare |
$709.86
|
| Rate for Payer: Riverside University Health System MISP |
$736.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,087.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,087.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,935.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,806.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,323.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$736.65
|
| Rate for Payer: Vantage Medical Group Senior |
$669.68
|
|
|
HC EEG W/O VID EA 12-26HR CNT MNR
|
Facility
|
IP
|
$1,812.00
|
|
|
Service Code
|
CPT 95710
|
| Hospital Charge Code |
900605710
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$362.40 |
| Max. Negotiated Rate |
$1,630.80 |
| Rate for Payer: Cash Price |
$815.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,449.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$724.80
|
| Rate for Payer: Galaxy Health WC |
$1,540.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,087.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,630.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,208.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$690.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$362.40
|
| Rate for Payer: Multiplan Commercial |
$1,359.00
|
| Rate for Payer: Networks By Design Commercial |
$1,177.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,540.20
|
|
|
HC EEG W/O VID EA 12-26HR INT MNR
|
Facility
|
OP
|
$1,812.00
|
|
|
Service Code
|
CPT 95709
|
| Hospital Charge Code |
900605709
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$362.40 |
| Max. Negotiated Rate |
$4,666.08 |
| Rate for Payer: Adventist Health Medi-Cal |
$669.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,666.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$736.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$669.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,209.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,070.53
|
| Rate for Payer: Blue Distinction Transplant |
$1,087.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,119.82
|
| Rate for Payer: Blue Shield of California EPN |
$880.63
|
| Rate for Payer: Caremore Medicare Advantage |
$669.68
|
| Rate for Payer: Cash Price |
$815.40
|
| Rate for Payer: Cash Price |
$815.40
|
| Rate for Payer: Cash Price |
$815.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,449.60
|
| Rate for Payer: Cigna of CA HMO |
$1,159.68
|
| Rate for Payer: Cigna of CA PPO |
$1,340.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Dignity Health Media |
$669.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$736.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$904.07
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$669.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$669.68
|
| Rate for Payer: Galaxy Health WC |
$1,540.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,087.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,630.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,359.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,098.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,104.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$669.68
|
| Rate for Payer: InnovAge PACE Commercial |
$1,004.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,208.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,118.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$669.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$362.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$897.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$897.37
|
| Rate for Payer: Multiplan Commercial |
$1,359.00
|
| Rate for Payer: Networks By Design Commercial |
$1,177.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,540.20
|
| Rate for Payer: Prime Health Services Medicare |
$709.86
|
| Rate for Payer: Riverside University Health System MISP |
$736.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,087.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,087.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,935.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,806.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,323.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$736.65
|
| Rate for Payer: Vantage Medical Group Senior |
$669.68
|
|
|
HC EEG W/O VID EA 12-26HR INT MNR
|
Facility
|
IP
|
$1,812.00
|
|
|
Service Code
|
CPT 95709
|
| Hospital Charge Code |
900605709
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$362.40 |
| Max. Negotiated Rate |
$1,630.80 |
| Rate for Payer: Cash Price |
$815.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,449.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$724.80
|
| Rate for Payer: Galaxy Health WC |
$1,540.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,087.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,630.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,208.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$690.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$362.40
|
| Rate for Payer: Multiplan Commercial |
$1,359.00
|
| Rate for Payer: Networks By Design Commercial |
$1,177.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,540.20
|
|
|
HC EEG W/O VID EA 12-26HR UNMNTRD
|
Facility
|
OP
|
$1,812.00
|
|
|
Service Code
|
CPT 95708
|
| Hospital Charge Code |
900605708
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$362.40 |
| Max. Negotiated Rate |
$3,209.17 |
| Rate for Payer: Adventist Health Medi-Cal |
$669.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$839.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$736.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$669.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,209.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,070.53
|
| Rate for Payer: Blue Distinction Transplant |
$1,087.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,119.82
|
| Rate for Payer: Blue Shield of California EPN |
$880.63
|
| Rate for Payer: Caremore Medicare Advantage |
$669.68
|
| Rate for Payer: Cash Price |
$815.40
|
| Rate for Payer: Cash Price |
$815.40
|
| Rate for Payer: Cash Price |
$815.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,449.60
|
| Rate for Payer: Cigna of CA HMO |
$1,159.68
|
| Rate for Payer: Cigna of CA PPO |
$1,340.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Dignity Health Media |
$669.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$736.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$904.07
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$669.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$669.68
|
| Rate for Payer: Galaxy Health WC |
$1,540.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,087.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,630.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,359.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,098.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,104.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$669.68
|
| Rate for Payer: InnovAge PACE Commercial |
$1,004.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,208.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$503.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$669.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$362.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$897.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$897.37
|
| Rate for Payer: Multiplan Commercial |
$1,359.00
|
| Rate for Payer: Networks By Design Commercial |
$1,177.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,540.20
|
| Rate for Payer: Prime Health Services Medicare |
$709.86
|
| Rate for Payer: Riverside University Health System MISP |
$736.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,087.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,087.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,935.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,806.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,323.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$736.65
|
| Rate for Payer: Vantage Medical Group Senior |
$669.68
|
|
|
HC EEG W/O VID EA 12-26HR UNMNTRD
|
Facility
|
IP
|
$1,812.00
|
|
|
Service Code
|
CPT 95708
|
| Hospital Charge Code |
900605708
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$362.40 |
| Max. Negotiated Rate |
$1,630.80 |
| Rate for Payer: Cash Price |
$815.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,449.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$724.80
|
| Rate for Payer: Galaxy Health WC |
$1,540.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,087.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,630.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,208.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$690.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$362.40
|
| Rate for Payer: Multiplan Commercial |
$1,359.00
|
| Rate for Payer: Networks By Design Commercial |
$1,177.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,540.20
|
|
|
HC EF SPEC METABOLIC NONINHERIT
|
Facility
|
OP
|
$1.63
|
|
|
Service Code
|
CPT B4154
|
| Hospital Charge Code |
900541540
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$3.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.96
|
| Rate for Payer: Blue Distinction Transplant |
$0.98
|
| Rate for Payer: Blue Shield of California Commercial |
$1.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.80
|
| Rate for Payer: Cash Price |
$0.73
|
| Rate for Payer: Cash Price |
$0.73
|
| Rate for Payer: Central Health Plan Commercial |
$1.30
|
| Rate for Payer: Cigna of CA HMO |
$1.04
|
| Rate for Payer: Cigna of CA PPO |
$1.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.39
|
| Rate for Payer: Dignity Health Media |
$1.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.65
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.65
|
| Rate for Payer: Galaxy Health WC |
$1.39
|
| Rate for Payer: Global Benefits Group Commercial |
$0.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.47
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: Multiplan Commercial |
$1.22
|
| Rate for Payer: Networks By Design Commercial |
$1.06
|
| Rate for Payer: Prime Health Services Commercial |
$1.39
|
| Rate for Payer: Riverside University Health System MISP |
$0.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.82
|
| Rate for Payer: United Healthcare All Other HMO |
$0.82
|
| Rate for Payer: United Healthcare HMO Rider |
$0.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1.39
|
|
|
HC EF SPEC METABOLIC NONINHERIT
|
Facility
|
IP
|
$1.63
|
|
|
Service Code
|
CPT B4154
|
| Hospital Charge Code |
900541540
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.47 |
| Rate for Payer: Cash Price |
$0.73
|
| Rate for Payer: Central Health Plan Commercial |
$1.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.65
|
| Rate for Payer: Galaxy Health WC |
$1.39
|
| Rate for Payer: Global Benefits Group Commercial |
$0.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: Multiplan Commercial |
$1.22
|
| Rate for Payer: Networks By Design Commercial |
$1.06
|
| Rate for Payer: Prime Health Services Commercial |
$1.39
|
|
|
HC EGD BLLN DILA ESOPH 30MM OR GT
|
Facility
|
OP
|
$2,791.00
|
|
|
Service Code
|
CPT 43233
|
| Hospital Charge Code |
906743233
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$382.68 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,377.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,674.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$2,377.45
|
| Rate for Payer: Cash Price |
$1,255.95
|
| Rate for Payer: Cash Price |
$1,255.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,232.80
|
| Rate for Payer: Cigna of CA PPO |
$2,065.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Media |
$2,377.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Galaxy Health WC |
$2,372.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,674.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,511.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,093.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,899.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,922.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,377.45
|
| Rate for Payer: InnovAge PACE Commercial |
$3,566.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,861.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$382.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$558.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,185.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Multiplan Commercial |
$2,093.25
|
| Rate for Payer: Networks By Design Commercial |
$1,814.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,372.35
|
| Rate for Payer: Prime Health Services Medicare |
$2,520.10
|
| Rate for Payer: Riverside University Health System MISP |
$2,615.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,674.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,852.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC EGD BLLN DILA ESOPH 30MM OR GT
|
Facility
|
IP
|
$5,222.00
|
|
|
Service Code
|
CPT 43233
|
| Hospital Charge Code |
906743233
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,044.40 |
| Max. Negotiated Rate |
$4,699.80 |
| Rate for Payer: Cash Price |
$2,349.90
|
| Rate for Payer: Central Health Plan Commercial |
$4,177.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,088.80
|
| Rate for Payer: Galaxy Health WC |
$4,438.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,133.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,699.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,483.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,989.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,044.40
|
| Rate for Payer: Multiplan Commercial |
$3,916.50
|
| Rate for Payer: Networks By Design Commercial |
$3,394.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,438.70
|
|
|
HC EGD DIAG W/ OR W/O COLLECTION
|
Facility
|
OP
|
$5,557.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
902100084
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$5,779.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,334.20
|
| Rate for Payer: Caremore Medicare Advantage |
$1,132.59
|
| Rate for Payer: Cash Price |
$2,500.65
|
| Rate for Payer: Cash Price |
$2,500.65
|
| Rate for Payer: Cash Price |
$2,500.65
|
| Rate for Payer: Cash Price |
$2,500.65
|
| Rate for Payer: Central Health Plan Commercial |
$4,445.60
|
| Rate for Payer: Cigna of CA PPO |
$4,112.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$4,723.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,334.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,001.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,167.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,857.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: InnovAge PACE Commercial |
$1,698.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,706.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$425.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,111.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,517.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$4,167.75
|
| Rate for Payer: Networks By Design Commercial |
$3,612.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,723.45
|
| Rate for Payer: Prime Health Services Medicare |
$1,200.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,245.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,334.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,778.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,778.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,778.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,778.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC EGD DIAG W/ OR W/O COLLECTION
|
Facility
|
OP
|
$3,713.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
906743235
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.83 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,132.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,227.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$1,132.59
|
| Rate for Payer: Cash Price |
$1,670.85
|
| Rate for Payer: Cash Price |
$1,670.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,970.40
|
| Rate for Payer: Cigna of CA PPO |
$2,747.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$3,156.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,227.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,341.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,784.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,857.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,868.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: InnovAge PACE Commercial |
$1,698.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,476.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$425.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$742.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,517.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$2,784.75
|
| Rate for Payer: Networks By Design Commercial |
$2,413.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,156.05
|
| Rate for Payer: Prime Health Services Medicare |
$1,200.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,245.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,227.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,359.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC EGD DIAG W/ OR W/O COLLECTION
|
Facility
|
IP
|
$5,557.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
902100084
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,111.40 |
| Max. Negotiated Rate |
$5,001.30 |
| Rate for Payer: Cash Price |
$2,500.65
|
| Rate for Payer: Central Health Plan Commercial |
$4,445.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,222.80
|
| Rate for Payer: Galaxy Health WC |
$4,723.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,334.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,001.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,706.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,117.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,111.40
|
| Rate for Payer: Multiplan Commercial |
$4,167.75
|
| Rate for Payer: Networks By Design Commercial |
$3,612.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,723.45
|
|
|
HC EGD DIAG W/ OR W/O COLLECTION
|
Facility
|
IP
|
$5,557.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
906743235
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,111.40 |
| Max. Negotiated Rate |
$5,001.30 |
| Rate for Payer: Cash Price |
$2,500.65
|
| Rate for Payer: Central Health Plan Commercial |
$4,445.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,222.80
|
| Rate for Payer: Galaxy Health WC |
$4,723.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,334.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,001.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,706.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,117.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,111.40
|
| Rate for Payer: Multiplan Commercial |
$4,167.75
|
| Rate for Payer: Networks By Design Commercial |
$3,612.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,723.45
|
|
|
HC EGD DIAG W/SUBMUC INJ ANY SUBSTANCE
|
Facility
|
IP
|
$5,557.00
|
|
|
Service Code
|
CPT 43236
|
| Hospital Charge Code |
906743236
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,111.40 |
| Max. Negotiated Rate |
$5,001.30 |
| Rate for Payer: Cash Price |
$2,500.65
|
| Rate for Payer: Central Health Plan Commercial |
$4,445.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,222.80
|
| Rate for Payer: Galaxy Health WC |
$4,723.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,334.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,001.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,706.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,117.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,111.40
|
| Rate for Payer: Multiplan Commercial |
$4,167.75
|
| Rate for Payer: Networks By Design Commercial |
$3,612.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,723.45
|
|
|
HC EGD DIAG W/SUBMUC INJ ANY SUBSTANCE
|
Facility
|
OP
|
$3,713.00
|
|
|
Service Code
|
CPT 43236
|
| Hospital Charge Code |
906743236
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$462.04 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,132.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,227.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$1,132.59
|
| Rate for Payer: Cash Price |
$1,670.85
|
| Rate for Payer: Cash Price |
$1,670.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,970.40
|
| Rate for Payer: Cigna of CA PPO |
$2,747.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$3,156.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,227.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,341.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,784.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,857.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,868.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: InnovAge PACE Commercial |
$1,698.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,476.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$462.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$742.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,517.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$2,784.75
|
| Rate for Payer: Networks By Design Commercial |
$2,413.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,156.05
|
| Rate for Payer: Prime Health Services Medicare |
$1,200.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,245.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,227.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,359.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC EGD DIAG W WO COLLECTION
|
Facility
|
OP
|
$5,557.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
900501432
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$5,779.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,334.20
|
| Rate for Payer: Caremore Medicare Advantage |
$1,132.59
|
| Rate for Payer: Cash Price |
$2,500.65
|
| Rate for Payer: Cash Price |
$2,500.65
|
| Rate for Payer: Cash Price |
$2,500.65
|
| Rate for Payer: Cash Price |
$2,500.65
|
| Rate for Payer: Central Health Plan Commercial |
$4,445.60
|
| Rate for Payer: Cigna of CA PPO |
$4,112.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$4,723.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,334.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,001.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,167.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,857.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: InnovAge PACE Commercial |
$1,698.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,706.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$425.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,111.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,517.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$4,167.75
|
| Rate for Payer: Networks By Design Commercial |
$3,612.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,723.45
|
| Rate for Payer: Prime Health Services Medicare |
$1,200.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,245.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,334.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,778.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,778.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,778.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,778.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC EGD DIAG W WO COLLECTION
|
Facility
|
IP
|
$5,557.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
900501432
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,111.40 |
| Max. Negotiated Rate |
$5,001.30 |
| Rate for Payer: Cash Price |
$2,500.65
|
| Rate for Payer: Central Health Plan Commercial |
$4,445.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,222.80
|
| Rate for Payer: Galaxy Health WC |
$4,723.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,334.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,001.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,706.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,117.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,111.40
|
| Rate for Payer: Multiplan Commercial |
$4,167.75
|
| Rate for Payer: Networks By Design Commercial |
$3,612.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,723.45
|
|
|
HC EGD ENDO STENT PLACEMENT
|
Facility
|
IP
|
$8,512.00
|
|
|
Service Code
|
CPT 43266
|
| Hospital Charge Code |
900100017
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,702.40 |
| Max. Negotiated Rate |
$7,660.80 |
| Rate for Payer: Cash Price |
$3,830.40
|
| Rate for Payer: Central Health Plan Commercial |
$6,809.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,404.80
|
| Rate for Payer: Galaxy Health WC |
$7,235.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,107.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,660.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,677.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,243.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,702.40
|
| Rate for Payer: Multiplan Commercial |
$6,384.00
|
| Rate for Payer: Networks By Design Commercial |
$5,532.80
|
| Rate for Payer: Prime Health Services Commercial |
$7,235.20
|
|
|
HC EGD ENDO STENT PLACEMENT
|
Facility
|
OP
|
$5,688.00
|
|
|
Service Code
|
CPT 43266
|
| Hospital Charge Code |
900100017
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$380.57 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,120.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,681.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,832.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,120.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,412.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$7,120.83
|
| Rate for Payer: Cash Price |
$2,559.60
|
| Rate for Payer: Cash Price |
$2,559.60
|
| Rate for Payer: Central Health Plan Commercial |
$4,550.40
|
| Rate for Payer: Cigna of CA PPO |
$4,209.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,681.24
|
| Rate for Payer: Dignity Health Media |
$7,120.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,832.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,613.12
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,120.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,120.83
|
| Rate for Payer: Galaxy Health WC |
$4,834.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,412.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,119.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,266.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,678.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11,749.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,120.83
|
| Rate for Payer: InnovAge PACE Commercial |
$10,681.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,793.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$380.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,120.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,137.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,541.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,541.91
|
| Rate for Payer: Multiplan Commercial |
$4,266.00
|
| Rate for Payer: Networks By Design Commercial |
$3,697.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,834.80
|
| Rate for Payer: Prime Health Services Medicare |
$7,548.08
|
| Rate for Payer: Riverside University Health System MISP |
$7,832.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,412.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,545.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,681.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,832.91
|
| Rate for Payer: Vantage Medical Group Senior |
$7,120.83
|
|
|
HC EGD FLXBL TRNSORL W DPLMNT OF IG BRTRC BLLN
|
Facility
|
IP
|
$5,862.00
|
|
|
Service Code
|
CPT 43290
|
| Hospital Charge Code |
906743290
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,172.40 |
| Max. Negotiated Rate |
$5,275.80 |
| Rate for Payer: Cash Price |
$2,637.90
|
| Rate for Payer: Central Health Plan Commercial |
$4,689.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,344.80
|
| Rate for Payer: Galaxy Health WC |
$4,982.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,517.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,275.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,909.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,233.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,172.40
|
| Rate for Payer: Multiplan Commercial |
$4,396.50
|
| Rate for Payer: Networks By Design Commercial |
$3,810.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,982.70
|
|
|
HC EGD FLXBL TRNSORL W DPLMNT OF IG BRTRC BLLN
|
Facility
|
OP
|
$5,862.00
|
|
|
Service Code
|
CPT 43290
|
| Hospital Charge Code |
906743290
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,172.40 |
| Max. Negotiated Rate |
$8,114.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,377.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,517.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$2,377.45
|
| Rate for Payer: Cash Price |
$2,637.90
|
| Rate for Payer: Cash Price |
$2,637.90
|
| Rate for Payer: Cash Price |
$2,637.90
|
| Rate for Payer: Central Health Plan Commercial |
$4,689.60
|
| Rate for Payer: Cigna of CA PPO |
$4,337.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Media |
$2,377.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Galaxy Health WC |
$4,982.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,517.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,275.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,396.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,899.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,922.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,377.45
|
| Rate for Payer: InnovAge PACE Commercial |
$3,566.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,909.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,172.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,185.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Multiplan Commercial |
$4,396.50
|
| Rate for Payer: Networks By Design Commercial |
$3,810.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,982.70
|
| Rate for Payer: Prime Health Services Medicare |
$2,520.10
|
| Rate for Payer: Riverside University Health System MISP |
$2,615.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,517.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,852.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC EGD FLXBL TRNSORL W RMVL OF IG BRTRC BLLN
|
Facility
|
OP
|
$2,778.00
|
|
|
Service Code
|
CPT 43291
|
| Hospital Charge Code |
906743291
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$555.60 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,132.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,666.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$1,132.59
|
| Rate for Payer: Cash Price |
$1,250.10
|
| Rate for Payer: Cash Price |
$1,250.10
|
| Rate for Payer: Cash Price |
$1,250.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,222.40
|
| Rate for Payer: Cigna of CA PPO |
$2,055.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$2,361.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,666.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,500.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,083.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,857.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,868.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: InnovAge PACE Commercial |
$1,698.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,852.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$555.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,517.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$2,083.50
|
| Rate for Payer: Networks By Design Commercial |
$1,805.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,361.30
|
| Rate for Payer: Prime Health Services Medicare |
$1,200.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,245.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,666.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,359.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC EGD FLXBL TRNSORL W RMVL OF IG BRTRC BLLN
|
Facility
|
IP
|
$2,778.00
|
|
|
Service Code
|
CPT 43291
|
| Hospital Charge Code |
906743291
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$555.60 |
| Max. Negotiated Rate |
$2,500.20 |
| Rate for Payer: Cash Price |
$1,250.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,222.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,111.20
|
| Rate for Payer: Galaxy Health WC |
$2,361.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,666.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,500.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,852.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,058.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$555.60
|
| Rate for Payer: Multiplan Commercial |
$2,083.50
|
| Rate for Payer: Networks By Design Commercial |
$1,805.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,361.30
|
|
|
HC EGD INTRMURAL US NDL ASPIRATE BIOPSY ESOPHAGS
|
Facility
|
IP
|
$4,118.00
|
|
|
Service Code
|
CPT 43238
|
| Hospital Charge Code |
906703238
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$823.60 |
| Max. Negotiated Rate |
$3,706.20 |
| Rate for Payer: Cash Price |
$1,853.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,294.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,647.20
|
| Rate for Payer: Galaxy Health WC |
$3,500.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,470.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,706.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,746.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,568.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$823.60
|
| Rate for Payer: Multiplan Commercial |
$3,088.50
|
| Rate for Payer: Networks By Design Commercial |
$2,676.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,500.30
|
|
