|
HC EGD INTRMURAL US NDL ASPIRATE BIOPSY ESOPHAGS
|
Facility
|
OP
|
$4,118.00
|
|
|
Service Code
|
CPT 43238
|
| Hospital Charge Code |
906703238
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$823.60 |
| 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 |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,470.80
|
| 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 |
$2,377.45
|
| Rate for Payer: Cash Price |
$1,853.10
|
| Rate for Payer: Cash Price |
$1,853.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,294.40
|
| Rate for Payer: Cigna of CA PPO |
$3,047.32
|
| 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 |
$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: Health Plan of Nevada (Sierra) Other |
$3,088.50
|
| 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 |
$2,746.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,568.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$823.60
|
| 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 |
$3,088.50
|
| Rate for Payer: Networks By Design Commercial |
$2,676.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,500.30
|
| 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 |
$2,470.80
|
| 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 LESION ABLATION
|
Facility
|
IP
|
$6,146.00
|
|
|
Service Code
|
CPT 43270
|
| Hospital Charge Code |
900100018
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,229.20 |
| Max. Negotiated Rate |
$5,531.40 |
| Rate for Payer: Cash Price |
$2,765.70
|
| Rate for Payer: Central Health Plan Commercial |
$4,916.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,458.40
|
| Rate for Payer: Galaxy Health WC |
$5,224.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,687.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,531.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,099.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,341.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,229.20
|
| Rate for Payer: Multiplan Commercial |
$4,609.50
|
| Rate for Payer: Networks By Design Commercial |
$3,994.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,224.10
|
|
|
HC EGD LESION ABLATION
|
Facility
|
OP
|
$3,571.00
|
|
|
Service Code
|
CPT 43270
|
| Hospital Charge Code |
900100018
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$400.37 |
| 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 |
$2,142.60
|
| 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 |
$2,377.45
|
| Rate for Payer: Cash Price |
$1,606.95
|
| Rate for Payer: Cash Price |
$1,606.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,856.80
|
| Rate for Payer: Cigna of CA PPO |
$2,642.54
|
| 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 |
$3,035.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,142.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,213.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,678.25
|
| 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 |
$2,381.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$400.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$714.20
|
| 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 |
$2,678.25
|
| Rate for Payer: Networks By Design Commercial |
$2,321.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,035.35
|
| 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 |
$2,142.60
|
| 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 & POLYPECTOMY
|
Facility
|
IP
|
$4,159.00
|
|
|
Service Code
|
CPT 43250
|
| Hospital Charge Code |
906743250
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$831.80 |
| Max. Negotiated Rate |
$3,743.10 |
| Rate for Payer: Cash Price |
$1,871.55
|
| Rate for Payer: Central Health Plan Commercial |
$3,327.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,663.60
|
| Rate for Payer: Galaxy Health WC |
$3,535.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,495.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,743.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,774.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,584.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$831.80
|
| Rate for Payer: Multiplan Commercial |
$3,119.25
|
| Rate for Payer: Networks By Design Commercial |
$2,703.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,535.15
|
|
|
HC EGD & POLYPECTOMY
|
Facility
|
OP
|
$2,780.00
|
|
|
Service Code
|
CPT 43250
|
| Hospital Charge Code |
906743250
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$465.44 |
| 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 |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,668.00
|
| 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 |
$2,377.45
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,224.00
|
| Rate for Payer: Cigna of CA PPO |
$2,057.20
|
| 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 |
$2,363.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,668.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,502.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,085.00
|
| 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 |
$1,854.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$465.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$556.00
|
| 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 |
$2,085.00
|
| Rate for Payer: Networks By Design Commercial |
$1,807.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,363.00
|
| 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 |
$1,668.00
|
| 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 US TRANSMURAL INJECT MARKER
|
Facility
|
IP
|
$5,222.00
|
|
|
Service Code
|
CPT 43253
|
| Hospital Charge Code |
906743253
|
|
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 US TRANSMURAL INJECT MARKER
|
Facility
|
OP
|
$2,791.00
|
|
|
Service Code
|
CPT 43253
|
| Hospital Charge Code |
906743253
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$443.52 |
| 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 |
$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 |
$443.52
|
| 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 W/BAND/LIG SCLE
|
Facility
|
OP
|
$5,862.00
|
|
|
Service Code
|
CPT 43244
|
| Hospital Charge Code |
906743244
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$408.16 |
| 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 |
$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 |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| 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: 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 Medi-Cal |
$408.16
|
| 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 W/BAND/LIG SCLE
|
Facility
|
IP
|
$8,771.00
|
|
|
Service Code
|
CPT 43244
|
| Hospital Charge Code |
906743244
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,754.20 |
| Max. Negotiated Rate |
$7,893.90 |
| Rate for Payer: Cash Price |
$3,946.95
|
| Rate for Payer: Central Health Plan Commercial |
$7,016.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,508.40
|
| Rate for Payer: Galaxy Health WC |
$7,455.35
|
| Rate for Payer: Global Benefits Group Commercial |
$5,262.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,893.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,850.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,341.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,754.20
|
| Rate for Payer: Multiplan Commercial |
$6,578.25
|
| Rate for Payer: Networks By Design Commercial |
$5,701.15
|
| Rate for Payer: Prime Health Services Commercial |
$7,455.35
|
|
|
HC EGD W BLLN DLTN ESO
|
Facility
|
OP
|
$3,553.00
|
|
|
Service Code
|
CPT 43249
|
| Hospital Charge Code |
906743249
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| 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 |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,131.80
|
| Rate for Payer: Caremore Medicare Advantage |
$2,377.45
|
| Rate for Payer: Cash Price |
$1,598.85
|
| Rate for Payer: Cash Price |
$1,598.85
|
| Rate for Payer: Cash Price |
$1,598.85
|
| Rate for Payer: Cash Price |
$1,598.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,842.40
|
| Rate for Payer: Cigna of CA PPO |
$2,629.22
|
| 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 |
$3,020.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,131.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,197.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,664.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,899.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| 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 |
$2,369.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$423.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$710.60
|
| 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 |
$2,664.75
|
| Rate for Payer: Networks By Design Commercial |
$2,309.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,020.05
|
| 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 |
$2,131.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,776.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,776.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,776.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,776.50
|
| 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 W BLLN DLTN ESO
|
Facility
|
OP
|
$3,553.00
|
|
|
Service Code
|
CPT 43249
|
| Hospital Charge Code |
906743249
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$423.72 |
| 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 |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,131.80
|
| 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 |
$2,377.45
|
| Rate for Payer: Cash Price |
$1,598.85
|
| Rate for Payer: Cash Price |
$1,598.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,842.40
|
| Rate for Payer: Cigna of CA PPO |
$2,629.22
|
| 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 |
$3,020.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,131.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,197.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,664.75
|
| 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 |
$2,369.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$423.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$710.60
|
| 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 |
$2,664.75
|
| Rate for Payer: Networks By Design Commercial |
$2,309.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,020.05
|
| 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 |
$2,131.80
|
| 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 W BLLN DLTN ESO
|
Facility
|
IP
|
$5,318.00
|
|
|
Service Code
|
CPT 43249
|
| Hospital Charge Code |
906743249
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,063.60 |
| Max. Negotiated Rate |
$4,786.20 |
| Rate for Payer: Cash Price |
$2,393.10
|
| Rate for Payer: Central Health Plan Commercial |
$4,254.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,127.20
|
| Rate for Payer: Galaxy Health WC |
$4,520.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,190.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,786.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,547.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,026.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,063.60
|
| Rate for Payer: Multiplan Commercial |
$3,988.50
|
| Rate for Payer: Networks By Design Commercial |
$3,456.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,520.30
|
|
|
HC EGD W BLLN DLTN ESO
|
Facility
|
IP
|
$5,318.00
|
|
|
Service Code
|
CPT 43249
|
| Hospital Charge Code |
906743249
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,063.60 |
| Max. Negotiated Rate |
$4,786.20 |
| Rate for Payer: Cash Price |
$2,393.10
|
| Rate for Payer: Central Health Plan Commercial |
$4,254.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,127.20
|
| Rate for Payer: Galaxy Health WC |
$4,520.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,190.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,786.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,547.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,026.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,063.60
|
| Rate for Payer: Multiplan Commercial |
$3,988.50
|
| Rate for Payer: Networks By Design Commercial |
$3,456.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,520.30
|
|
|
HC EGD W BX SNGL OR MULTI
|
Facility
|
IP
|
$7,193.00
|
|
|
Service Code
|
CPT 43239
|
| Hospital Charge Code |
906743239
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,438.60 |
| Max. Negotiated Rate |
$6,473.70 |
| Rate for Payer: Cash Price |
$3,236.85
|
| Rate for Payer: Central Health Plan Commercial |
$5,754.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,877.20
|
| Rate for Payer: Galaxy Health WC |
$6,114.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,315.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,473.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,797.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,740.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,438.60
|
| Rate for Payer: Multiplan Commercial |
$5,394.75
|
| Rate for Payer: Networks By Design Commercial |
$4,675.45
|
| Rate for Payer: Prime Health Services Commercial |
$6,114.05
|
|
|
HC EGD W BX SNGL OR MULTI
|
Facility
|
IP
|
$7,193.00
|
|
|
Service Code
|
CPT 43239
|
| Hospital Charge Code |
906743239
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,438.60 |
| Max. Negotiated Rate |
$6,473.70 |
| Rate for Payer: Cash Price |
$3,236.85
|
| Rate for Payer: Central Health Plan Commercial |
$5,754.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,877.20
|
| Rate for Payer: Galaxy Health WC |
$6,114.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,315.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,473.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,797.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,740.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,438.60
|
| Rate for Payer: Multiplan Commercial |
$5,394.75
|
| Rate for Payer: Networks By Design Commercial |
$4,675.45
|
| Rate for Payer: Prime Health Services Commercial |
$6,114.05
|
|
|
HC EGD W BX SNGL OR MULTI
|
Facility
|
OP
|
$3,845.00
|
|
|
Service Code
|
CPT 43239
|
| Hospital Charge Code |
906743239
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$444.94 |
| 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 |
$2,307.00
|
| 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 |
$1,730.25
|
| Rate for Payer: Cash Price |
$1,730.25
|
| Rate for Payer: Central Health Plan Commercial |
$3,076.00
|
| Rate for Payer: Cigna of CA PPO |
$2,845.30
|
| 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 |
$3,268.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,307.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,460.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,883.75
|
| 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 |
$2,564.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$444.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$769.00
|
| 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 |
$2,883.75
|
| Rate for Payer: Networks By Design Commercial |
$2,499.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,268.25
|
| 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 |
$2,307.00
|
| 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 W BX SNGL OR MULTI
|
Facility
|
OP
|
$3,845.00
|
|
|
Service Code
|
CPT 43239
|
| Hospital Charge Code |
906743239
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| 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 |
$2,307.00
|
| Rate for Payer: Caremore Medicare Advantage |
$1,132.59
|
| Rate for Payer: Cash Price |
$1,730.25
|
| Rate for Payer: Cash Price |
$1,730.25
|
| Rate for Payer: Cash Price |
$1,730.25
|
| Rate for Payer: Cash Price |
$1,730.25
|
| Rate for Payer: Central Health Plan Commercial |
$3,076.00
|
| Rate for Payer: Cigna of CA PPO |
$2,845.30
|
| 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 |
$3,268.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,307.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,460.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,883.75
|
| 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 |
$2,564.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$444.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$769.00
|
| 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 |
$2,883.75
|
| Rate for Payer: Networks By Design Commercial |
$2,499.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,268.25
|
| 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 |
$2,307.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,922.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,922.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,922.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,922.50
|
| 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 W/CNTRL BLEEDNG ANY METHOD
|
Facility
|
OP
|
$5,146.00
|
|
|
Service Code
|
CPT 43255
|
| Hospital Charge Code |
906743255
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$546.80 |
| 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 |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,087.60
|
| 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 |
$2,377.45
|
| Rate for Payer: Cash Price |
$2,315.70
|
| Rate for Payer: Cash Price |
$2,315.70
|
| Rate for Payer: Central Health Plan Commercial |
$4,116.80
|
| Rate for Payer: Cigna of CA PPO |
$3,808.04
|
| 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 |
$4,374.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,087.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,631.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,859.50
|
| 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 |
$3,432.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$546.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,029.20
|
| 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 |
$3,859.50
|
| Rate for Payer: Networks By Design Commercial |
$3,344.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,374.10
|
| 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 |
$3,087.60
|
| 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 W/CNTRL BLEEDNG ANY METHOD
|
Facility
|
IP
|
$7,702.00
|
|
|
Service Code
|
CPT 43255
|
| Hospital Charge Code |
906743255
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,540.40 |
| Max. Negotiated Rate |
$6,931.80 |
| Rate for Payer: Cash Price |
$3,465.90
|
| Rate for Payer: Central Health Plan Commercial |
$6,161.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,080.80
|
| Rate for Payer: Galaxy Health WC |
$6,546.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,621.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,931.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,137.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,934.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,540.40
|
| Rate for Payer: Multiplan Commercial |
$5,776.50
|
| Rate for Payer: Networks By Design Commercial |
$5,006.30
|
| Rate for Payer: Prime Health Services Commercial |
$6,546.70
|
|
|
HC EGD W/DILATION OF GASTRIC OUTL
|
Facility
|
IP
|
$6,870.00
|
|
|
Service Code
|
CPT 43245
|
| Hospital Charge Code |
906743245
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,374.00 |
| Max. Negotiated Rate |
$6,183.00 |
| Rate for Payer: Cash Price |
$3,091.50
|
| Rate for Payer: Central Health Plan Commercial |
$5,496.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,748.00
|
| Rate for Payer: Galaxy Health WC |
$5,839.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,122.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,183.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,582.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,617.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,374.00
|
| Rate for Payer: Multiplan Commercial |
$5,152.50
|
| Rate for Payer: Networks By Design Commercial |
$4,465.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,839.50
|
|
|
HC EGD W/DILATION OF GASTRIC OUTL
|
Facility
|
OP
|
$4,592.00
|
|
|
Service Code
|
CPT 43245
|
| Hospital Charge Code |
906743245
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$459.80 |
| 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 |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,755.20
|
| 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 |
$2,377.45
|
| Rate for Payer: Cash Price |
$2,066.40
|
| Rate for Payer: Cash Price |
$2,066.40
|
| Rate for Payer: Central Health Plan Commercial |
$3,673.60
|
| Rate for Payer: Cigna of CA PPO |
$3,398.08
|
| 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 |
$3,903.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,755.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,132.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,444.00
|
| 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 |
$3,062.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$459.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$918.40
|
| 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 |
$3,444.00
|
| Rate for Payer: Networks By Design Commercial |
$2,984.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,903.20
|
| 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 |
$2,755.20
|
| 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 W/DRCTD PLCMT PERCUT GAST
|
Facility
|
OP
|
$3,449.00
|
|
|
Service Code
|
CPT 43246
|
| Hospital Charge Code |
906743246
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$459.80 |
| 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 |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,069.40
|
| 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 |
$2,377.45
|
| Rate for Payer: Cash Price |
$1,552.05
|
| Rate for Payer: Cash Price |
$1,552.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,759.20
|
| Rate for Payer: Cigna of CA PPO |
$2,552.26
|
| 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 |
$2,931.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,069.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,104.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,586.75
|
| 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 |
$2,300.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$459.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$689.80
|
| 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 |
$2,586.75
|
| Rate for Payer: Networks By Design Commercial |
$2,241.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,931.65
|
| 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 |
$2,069.40
|
| 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 W/DRCTD PLCMT PERCUT GAST
|
Facility
|
IP
|
$5,228.00
|
|
|
Service Code
|
CPT 43246
|
| Hospital Charge Code |
906743246
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,045.60 |
| Max. Negotiated Rate |
$4,705.20 |
| Rate for Payer: Cash Price |
$2,352.60
|
| Rate for Payer: Central Health Plan Commercial |
$4,182.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,091.20
|
| Rate for Payer: Galaxy Health WC |
$4,443.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,136.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,705.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,487.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,991.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,045.60
|
| Rate for Payer: Multiplan Commercial |
$3,921.00
|
| Rate for Payer: Networks By Design Commercial |
$3,398.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,443.80
|
|
|
HC EGD W ENDO MUCOSAL RESECTION
|
Facility
|
OP
|
$1,847.00
|
|
|
Service Code
|
CPT 43254
|
| Hospital Charge Code |
906743254
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$369.40 |
| 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 |
$1,108.20
|
| 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 |
$831.15
|
| Rate for Payer: Cash Price |
$831.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,477.60
|
| Rate for Payer: Cigna of CA PPO |
$1,366.78
|
| 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 |
$1,569.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,108.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,662.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,385.25
|
| 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 |
$1,231.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$459.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$369.40
|
| 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 |
$1,385.25
|
| Rate for Payer: Networks By Design Commercial |
$1,200.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,569.95
|
| 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 |
$1,108.20
|
| 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 W ENDO MUCOSAL RESECTION
|
Facility
|
IP
|
$3,456.00
|
|
|
Service Code
|
CPT 43254
|
| Hospital Charge Code |
906743254
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$691.20 |
| Max. Negotiated Rate |
$3,110.40 |
| Rate for Payer: Cash Price |
$1,555.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,764.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,382.40
|
| Rate for Payer: Galaxy Health WC |
$2,937.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,073.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,110.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,305.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,316.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$691.20
|
| Rate for Payer: Multiplan Commercial |
$2,592.00
|
| Rate for Payer: Networks By Design Commercial |
$2,246.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,937.60
|
|
