|
HC EGD W/ENDO US EXAM
|
Facility
|
IP
|
$6,377.00
|
|
|
Service Code
|
CPT 43259
|
| Hospital Charge Code |
906743259
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,275.40 |
| Max. Negotiated Rate |
$5,739.30 |
| Rate for Payer: Cash Price |
$2,869.65
|
| Rate for Payer: Central Health Plan Commercial |
$5,101.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,550.80
|
| Rate for Payer: Galaxy Health WC |
$5,420.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,826.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,739.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,253.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,429.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,275.40
|
| Rate for Payer: Multiplan Commercial |
$4,782.75
|
| Rate for Payer: Networks By Design Commercial |
$4,145.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,420.45
|
|
|
HC EGD W/ENDO US EXAM
|
Facility
|
OP
|
$4,258.00
|
|
|
Service Code
|
CPT 43259
|
| Hospital Charge Code |
906743259
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$394.71 |
| 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 |
$2,554.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$2,377.45
|
| Rate for Payer: Cash Price |
$1,916.10
|
| Rate for Payer: Cash Price |
$1,916.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,406.40
|
| Rate for Payer: Cigna of CA PPO |
$3,150.92
|
| 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 |
$3,619.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,554.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,832.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,193.50
|
| 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 |
$2,840.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$394.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$851.60
|
| 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 |
$3,193.50
|
| Rate for Payer: Networks By Design Commercial |
$2,767.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,619.30
|
| 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 |
$2,554.80
|
| 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 ESPHGSTRC FNDOPLSTY
|
Facility
|
OP
|
$19,901.00
|
|
|
Service Code
|
CPT 43210
|
| Hospital Charge Code |
906743210
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$708.40 |
| Max. Negotiated Rate |
$21,221.16 |
| Rate for Payer: Adventist Health Medi-Cal |
$12,861.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,291.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,147.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,861.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Distinction Transplant |
$11,940.60
|
| 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 |
$12,861.31
|
| Rate for Payer: Cash Price |
$8,955.45
|
| Rate for Payer: Cash Price |
$8,955.45
|
| Rate for Payer: Central Health Plan Commercial |
$15,920.80
|
| Rate for Payer: Cigna of CA PPO |
$14,726.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,291.96
|
| Rate for Payer: Dignity Health Media |
$12,861.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,147.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,362.77
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12,861.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$12,861.31
|
| Rate for Payer: Galaxy Health WC |
$16,915.85
|
| Rate for Payer: Global Benefits Group Commercial |
$11,940.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,910.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$14,925.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21,092.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21,221.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12,861.31
|
| Rate for Payer: InnovAge PACE Commercial |
$19,291.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,273.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$708.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,861.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,980.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,234.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,234.16
|
| Rate for Payer: Multiplan Commercial |
$14,925.75
|
| Rate for Payer: Networks By Design Commercial |
$12,935.65
|
| Rate for Payer: Prime Health Services Commercial |
$16,915.85
|
| Rate for Payer: Prime Health Services Medicare |
$13,632.99
|
| Rate for Payer: Riverside University Health System MISP |
$14,147.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,940.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,433.57
|
| 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 |
$19,291.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,147.44
|
| Rate for Payer: Vantage Medical Group Senior |
$12,861.31
|
|
|
HC EGD W ESPHGSTRC FNDOPLSTY
|
Facility
|
IP
|
$19,901.00
|
|
|
Service Code
|
CPT 43210
|
| Hospital Charge Code |
906743210
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$3,980.20 |
| Max. Negotiated Rate |
$17,910.90 |
| Rate for Payer: Cash Price |
$8,955.45
|
| Rate for Payer: Central Health Plan Commercial |
$15,920.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,960.40
|
| Rate for Payer: Galaxy Health WC |
$16,915.85
|
| Rate for Payer: Global Benefits Group Commercial |
$11,940.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,910.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,273.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,582.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,980.20
|
| Rate for Payer: Multiplan Commercial |
$14,925.75
|
| Rate for Payer: Networks By Design Commercial |
$12,935.65
|
| Rate for Payer: Prime Health Services Commercial |
$16,915.85
|
|
|
HC EGD W INJ SCLER ESO
|
Facility
|
IP
|
$5,794.00
|
|
|
Service Code
|
CPT 43243
|
| Hospital Charge Code |
906743243
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,158.80 |
| Max. Negotiated Rate |
$5,214.60 |
| Rate for Payer: Cash Price |
$2,607.30
|
| Rate for Payer: Central Health Plan Commercial |
$4,635.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,317.60
|
| Rate for Payer: Galaxy Health WC |
$4,924.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,476.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,214.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,864.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,207.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,158.80
|
| Rate for Payer: Multiplan Commercial |
$4,345.50
|
| Rate for Payer: Networks By Design Commercial |
$3,766.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,924.90
|
|
|
HC EGD W INJ SCLER ESO
|
Facility
|
IP
|
$5,794.00
|
|
|
Service Code
|
CPT 43243
|
| Hospital Charge Code |
906743243
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,158.80 |
| Max. Negotiated Rate |
$5,214.60 |
| Rate for Payer: Cash Price |
$2,607.30
|
| Rate for Payer: Central Health Plan Commercial |
$4,635.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,317.60
|
| Rate for Payer: Galaxy Health WC |
$4,924.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,476.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,214.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,864.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,207.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,158.80
|
| Rate for Payer: Multiplan Commercial |
$4,345.50
|
| Rate for Payer: Networks By Design Commercial |
$3,766.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,924.90
|
|
|
HC EGD W INJ SCLER ESO
|
Facility
|
OP
|
$3,873.00
|
|
|
Service Code
|
CPT 43243
|
| Hospital Charge Code |
906743243
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$580.05 |
| 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 |
$2,323.80
|
| 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 |
$1,742.85
|
| Rate for Payer: Cash Price |
$1,742.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,098.40
|
| Rate for Payer: Cigna of CA PPO |
$2,866.02
|
| 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 |
$3,292.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,323.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,485.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,904.75
|
| 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 |
$2,583.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$580.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$774.60
|
| 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 |
$2,904.75
|
| Rate for Payer: Networks By Design Commercial |
$2,517.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,292.05
|
| 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 |
$2,323.80
|
| 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 INJ SCLER ESO
|
Facility
|
OP
|
$3,873.00
|
|
|
Service Code
|
CPT 43243
|
| Hospital Charge Code |
906743243
|
|
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 |
$2,323.80
|
| Rate for Payer: Caremore Medicare Advantage |
$2,377.45
|
| Rate for Payer: Cash Price |
$1,742.85
|
| Rate for Payer: Cash Price |
$1,742.85
|
| Rate for Payer: Cash Price |
$1,742.85
|
| Rate for Payer: Cash Price |
$1,742.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,098.40
|
| Rate for Payer: Cigna of CA PPO |
$2,866.02
|
| 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 |
$3,292.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,323.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,485.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,904.75
|
| 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 |
$2,583.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$580.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$774.60
|
| 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 |
$2,904.75
|
| Rate for Payer: Networks By Design Commercial |
$2,517.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,292.05
|
| 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 |
$2,323.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,936.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,936.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,936.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,936.50
|
| 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/INSRT GIDE WIRE
|
Facility
|
OP
|
$3,274.00
|
|
|
Service Code
|
CPT 43248
|
| Hospital Charge Code |
906743248
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$280.82 |
| 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 |
$1,964.40
|
| 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 |
$1,132.59
|
| Rate for Payer: Cash Price |
$1,473.30
|
| Rate for Payer: Cash Price |
$1,473.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,619.20
|
| Rate for Payer: Cigna of CA PPO |
$2,422.76
|
| 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 |
$2,782.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,964.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,946.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,455.50
|
| 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 |
$2,183.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$280.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$654.80
|
| 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 |
$2,455.50
|
| Rate for Payer: Networks By Design Commercial |
$2,128.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,782.90
|
| 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 |
$1,964.40
|
| 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/INSRT GIDE WIRE
|
Facility
|
IP
|
$4,898.00
|
|
|
Service Code
|
CPT 43248
|
| Hospital Charge Code |
906743248
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$979.60 |
| Max. Negotiated Rate |
$4,408.20 |
| Rate for Payer: Cash Price |
$2,204.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,918.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,959.20
|
| Rate for Payer: Galaxy Health WC |
$4,163.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,938.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,408.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,266.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,866.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$979.60
|
| Rate for Payer: Multiplan Commercial |
$3,673.50
|
| Rate for Payer: Networks By Design Commercial |
$3,183.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,163.30
|
|
|
HC EGD W/REMOVAL FOREIGN BODY
|
Facility
|
OP
|
$3,658.00
|
|
|
Service Code
|
CPT 43247
|
| Hospital Charge Code |
906743247
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$485.26 |
| 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 |
$2,194.80
|
| 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 |
$1,646.10
|
| Rate for Payer: Cash Price |
$1,646.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,926.40
|
| Rate for Payer: Cigna of CA PPO |
$2,706.92
|
| 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 |
$3,109.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,194.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,292.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,743.50
|
| 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 |
$2,439.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$485.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$731.60
|
| 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 |
$2,743.50
|
| Rate for Payer: Networks By Design Commercial |
$2,377.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,109.30
|
| 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 |
$2,194.80
|
| 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 W/REMOVAL FOREIGN BODY
|
Facility
|
IP
|
$5,475.00
|
|
|
Service Code
|
CPT 43247
|
| Hospital Charge Code |
906743247
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,095.00 |
| Max. Negotiated Rate |
$4,927.50 |
| Rate for Payer: Cash Price |
$2,463.75
|
| Rate for Payer: Central Health Plan Commercial |
$4,380.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,190.00
|
| Rate for Payer: Galaxy Health WC |
$4,653.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,285.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,927.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,651.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,085.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,095.00
|
| Rate for Payer: Multiplan Commercial |
$4,106.25
|
| Rate for Payer: Networks By Design Commercial |
$3,558.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,653.75
|
|
|
HC EGD W/REMOV TUMOR/POLYP/LESION
|
Facility
|
IP
|
$4,398.00
|
|
|
Service Code
|
CPT 43251
|
| Hospital Charge Code |
906743251
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$879.60 |
| Max. Negotiated Rate |
$3,958.20 |
| Rate for Payer: Cash Price |
$1,979.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,518.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,759.20
|
| Rate for Payer: Galaxy Health WC |
$3,738.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,638.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,958.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,933.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,675.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$879.60
|
| Rate for Payer: Multiplan Commercial |
$3,298.50
|
| Rate for Payer: Networks By Design Commercial |
$2,858.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,738.30
|
|
|
HC EGD W/REMOV TUMOR/POLYP/LESION
|
Facility
|
OP
|
$2,351.00
|
|
|
Service Code
|
CPT 43251
|
| Hospital Charge Code |
906743251
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$470.20 |
| 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 |
$1,410.60
|
| 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 |
$1,057.95
|
| Rate for Payer: Cash Price |
$1,057.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,880.80
|
| Rate for Payer: Cigna of CA PPO |
$1,739.74
|
| 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 |
$1,998.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,410.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,115.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,763.25
|
| 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 |
$1,568.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$470.20
|
| 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 |
$1,763.25
|
| Rate for Payer: Networks By Design Commercial |
$1,528.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,998.35
|
| 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 |
$1,410.60
|
| 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/TRANSENDO TUBE/CATH PLAC
|
Facility
|
OP
|
$3,553.00
|
|
|
Service Code
|
CPT 43241
|
| Hospital Charge Code |
906743241
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$710.60 |
| 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 |
$2,131.80
|
| 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 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/TRANSENDO TUBE/CATH PLAC
|
Facility
|
IP
|
$6,305.00
|
|
|
Service Code
|
CPT 43241
|
| Hospital Charge Code |
906743241
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,261.00 |
| Max. Negotiated Rate |
$5,674.50 |
| Rate for Payer: Cash Price |
$2,837.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,044.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,522.00
|
| Rate for Payer: Galaxy Health WC |
$5,359.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,783.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,674.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,205.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,402.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,261.00
|
| Rate for Payer: Multiplan Commercial |
$4,728.75
|
| Rate for Payer: Networks By Design Commercial |
$4,098.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,359.25
|
|
|
HC EGD W/TRNSMRL DRNG/ PSEUDOCYST
|
Facility
|
OP
|
$3,834.00
|
|
|
Service Code
|
CPT 43240
|
| Hospital Charge Code |
906743240
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$664.92 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,120.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| 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 |
$2,300.40
|
| 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 |
$7,120.83
|
| Rate for Payer: Cash Price |
$1,725.30
|
| Rate for Payer: Cash Price |
$1,725.30
|
| Rate for Payer: Central Health Plan Commercial |
$3,067.20
|
| Rate for Payer: Cigna of CA PPO |
$2,837.16
|
| 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 |
$3,258.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,300.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,450.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,875.50
|
| 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 |
$2,557.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$664.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,120.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$766.80
|
| 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 |
$2,875.50
|
| Rate for Payer: Networks By Design Commercial |
$2,492.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,258.90
|
| 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 |
$2,300.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,545.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| 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 W/TRNSMRL DRNG/ PSEUDOCYST
|
Facility
|
IP
|
$7,094.00
|
|
|
Service Code
|
CPT 43240
|
| Hospital Charge Code |
906743240
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,418.80 |
| Max. Negotiated Rate |
$6,384.60 |
| Rate for Payer: Cash Price |
$3,192.30
|
| Rate for Payer: Central Health Plan Commercial |
$5,675.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,837.60
|
| Rate for Payer: Galaxy Health WC |
$6,029.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,256.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,384.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,731.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,702.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,418.80
|
| Rate for Payer: Multiplan Commercial |
$5,320.50
|
| Rate for Payer: Networks By Design Commercial |
$4,611.10
|
| Rate for Payer: Prime Health Services Commercial |
$6,029.90
|
|
|
HC EGD W/US GUID INTRMRL
|
Facility
|
OP
|
$4,416.00
|
|
|
Service Code
|
CPT 43242
|
| Hospital Charge Code |
906743242
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$476.77 |
| 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 |
$2,649.60
|
| 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 |
$1,987.20
|
| Rate for Payer: Cash Price |
$1,987.20
|
| Rate for Payer: Central Health Plan Commercial |
$3,532.80
|
| Rate for Payer: Cigna of CA PPO |
$3,267.84
|
| 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 |
$3,753.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,649.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,974.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,312.00
|
| 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 |
$2,945.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$476.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$883.20
|
| 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 |
$3,312.00
|
| Rate for Payer: Networks By Design Commercial |
$2,870.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,753.60
|
| 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 |
$2,649.60
|
| 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/US GUID INTRMRL
|
Facility
|
IP
|
$6,608.00
|
|
|
Service Code
|
CPT 43242
|
| Hospital Charge Code |
906743242
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,321.60 |
| Max. Negotiated Rate |
$5,947.20 |
| Rate for Payer: Cash Price |
$2,973.60
|
| Rate for Payer: Central Health Plan Commercial |
$5,286.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,643.20
|
| Rate for Payer: Galaxy Health WC |
$5,616.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,964.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,947.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,407.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,517.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,321.60
|
| Rate for Payer: Multiplan Commercial |
$4,956.00
|
| Rate for Payer: Networks By Design Commercial |
$4,295.20
|
| Rate for Payer: Prime Health Services Commercial |
$5,616.80
|
|
|
HC EGFR
|
Facility
|
IP
|
$503.00
|
|
|
Service Code
|
CPT 81235
|
| Hospital Charge Code |
903800314
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$100.60 |
| Max. Negotiated Rate |
$452.70 |
| Rate for Payer: Cash Price |
$226.35
|
| Rate for Payer: Central Health Plan Commercial |
$402.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.20
|
| Rate for Payer: Galaxy Health WC |
$427.55
|
| Rate for Payer: Global Benefits Group Commercial |
$301.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$452.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$335.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$191.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.60
|
| Rate for Payer: Multiplan Commercial |
$377.25
|
| Rate for Payer: Networks By Design Commercial |
$326.95
|
| Rate for Payer: Prime Health Services Commercial |
$427.55
|
|
|
HC EGFR
|
Facility
|
OP
|
$364.00
|
|
|
Service Code
|
CPT 81235
|
| Hospital Charge Code |
903800314
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$63.13 |
| Max. Negotiated Rate |
$1,090.62 |
| Rate for Payer: Adventist Health Medi-Cal |
$324.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,090.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$486.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$357.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$324.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$63.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$77.00
|
| Rate for Payer: Blue Distinction Transplant |
$218.40
|
| Rate for Payer: Blue Shield of California Commercial |
$224.95
|
| Rate for Payer: Blue Shield of California EPN |
$176.90
|
| Rate for Payer: Caremore Medicare Advantage |
$324.58
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Central Health Plan Commercial |
$291.20
|
| Rate for Payer: Cigna of CA HMO |
$232.96
|
| Rate for Payer: Cigna of CA PPO |
$269.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$486.87
|
| Rate for Payer: Dignity Health Media |
$324.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$357.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.18
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$324.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$324.58
|
| Rate for Payer: Galaxy Health WC |
$309.40
|
| Rate for Payer: Global Benefits Group Commercial |
$218.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$327.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$273.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$532.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$535.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$324.58
|
| Rate for Payer: InnovAge PACE Commercial |
$486.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$242.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$342.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$324.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$434.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$434.94
|
| Rate for Payer: Multiplan Commercial |
$273.00
|
| Rate for Payer: Networks By Design Commercial |
$236.60
|
| Rate for Payer: Prime Health Services Commercial |
$309.40
|
| Rate for Payer: Prime Health Services Medicare |
$344.05
|
| Rate for Payer: Riverside University Health System MISP |
$357.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$218.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$218.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$262.91
|
| Rate for Payer: United Healthcare All Other HMO |
$262.91
|
| Rate for Payer: United Healthcare HMO Rider |
$262.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$262.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$486.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$357.04
|
| Rate for Payer: Vantage Medical Group Senior |
$324.58
|
|
|
HC EKOS THROMLYSIS CATH
|
Facility
|
OP
|
$6,704.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,340.80 |
| Max. Negotiated Rate |
$6,033.60 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,698.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,687.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,687.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,734.13
|
| Rate for Payer: Blue Distinction Transplant |
$4,022.40
|
| Rate for Payer: Blue Shield of California Commercial |
$5,028.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,646.98
|
| Rate for Payer: Cash Price |
$3,016.80
|
| Rate for Payer: Central Health Plan Commercial |
$5,363.20
|
| Rate for Payer: Cigna of CA HMO |
$4,692.80
|
| Rate for Payer: Cigna of CA PPO |
$4,692.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,698.40
|
| Rate for Payer: Dignity Health Media |
$5,698.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,698.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,681.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,681.60
|
| Rate for Payer: Galaxy Health WC |
$5,698.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,022.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,033.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,028.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,346.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,471.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,554.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,340.80
|
| Rate for Payer: Multiplan Commercial |
$5,028.00
|
| Rate for Payer: Networks By Design Commercial |
$3,352.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,698.40
|
| Rate for Payer: Riverside University Health System MISP |
$2,681.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,022.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,022.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,352.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,352.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,352.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,352.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,698.40
|
| Rate for Payer: Vantage Medical Group Senior |
$5,698.40
|
|
|
HC EKOS THROMLYSIS CATH
|
Facility
|
IP
|
$6,704.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,340.80 |
| Max. Negotiated Rate |
$6,033.60 |
| Rate for Payer: Blue Shield of California EPN |
$3,579.94
|
| Rate for Payer: Cash Price |
$3,016.80
|
| Rate for Payer: Central Health Plan Commercial |
$5,363.20
|
| Rate for Payer: Cigna of CA HMO |
$4,692.80
|
| Rate for Payer: Cigna of CA PPO |
$4,692.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,681.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,681.60
|
| Rate for Payer: Galaxy Health WC |
$5,698.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,022.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,033.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,471.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,554.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,340.80
|
| Rate for Payer: Multiplan Commercial |
$5,028.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,698.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,531.43
|
| Rate for Payer: United Healthcare All Other HMO |
$2,472.44
|
| Rate for Payer: United Healthcare HMO Rider |
$2,418.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,212.32
|
|
|
HC ELASTIC WITH STAYS
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
CPT L3700
|
| Hospital Charge Code |
903203700
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.80 |
| Max. Negotiated Rate |
$174.60 |
| Rate for Payer: Blue Shield of California EPN |
$103.60
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Central Health Plan Commercial |
$155.20
|
| Rate for Payer: Cigna of CA HMO |
$135.80
|
| Rate for Payer: Cigna of CA PPO |
$135.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$77.60
|
| Rate for Payer: Galaxy Health WC |
$164.90
|
| Rate for Payer: Global Benefits Group Commercial |
$116.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$174.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$129.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.80
|
| Rate for Payer: Multiplan Commercial |
$145.50
|
| Rate for Payer: Networks By Design Commercial |
$97.00
|
| Rate for Payer: Prime Health Services Commercial |
$164.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$73.25
|
| Rate for Payer: United Healthcare All Other HMO |
$71.55
|
| Rate for Payer: United Healthcare HMO Rider |
$70.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.02
|
|
