|
HC EEG EXTENDED MONITORING LT 1 HR
|
Facility
|
OP
|
$2,307.00
|
|
|
Service Code
|
CPT 95812
|
| Hospital Charge Code |
900600201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$392.17 |
| Max. Negotiated Rate |
$1,756.00 |
| Rate for Payer: Adventist Health Commercial |
$461.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$628.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,584.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,756.00
|
| Rate for Payer: Cash Price |
$1,038.15
|
| Rate for Payer: Cash Price |
$1,038.15
|
| Rate for Payer: Cash Price |
$1,038.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,499.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: Dignity Health Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,499.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$392.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,561.84
|
| Rate for Payer: Heritage Provider Network Senior |
$1,561.84
|
| Rate for Payer: Humana Medicare |
$392.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$392.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,111.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$417.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$462.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$576.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$494.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$494.13
|
| Rate for Payer: Multiplan Commercial |
$1,730.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$837.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$770.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC EEG EXTENDED MONITORING LT 1 HR
|
Facility
|
IP
|
$2,307.00
|
|
|
Service Code
|
CPT 95812
|
| Hospital Charge Code |
900600201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$417.57 |
| Max. Negotiated Rate |
$1,730.25 |
| Rate for Payer: Adventist Health Commercial |
$461.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,584.91
|
| Rate for Payer: Cash Price |
$1,038.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,561.84
|
| Rate for Payer: Heritage Provider Network Senior |
$1,561.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$417.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$576.75
|
| Rate for Payer: Multiplan Commercial |
$1,730.25
|
|
|
HC EGD BLLN DILA ESOPH 30MM OR GT
|
Facility
|
IP
|
$2,666.00
|
|
|
Service Code
|
CPT 43233
|
| Hospital Charge Code |
906743233
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$482.55 |
| Max. Negotiated Rate |
$1,999.50 |
| Rate for Payer: Adventist Health Commercial |
$533.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,831.54
|
| Rate for Payer: Cash Price |
$1,199.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,804.88
|
| Rate for Payer: Heritage Provider Network Senior |
$1,804.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$482.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$666.50
|
| Rate for Payer: Multiplan Commercial |
$1,999.50
|
|
|
HC EGD BLLN DILA ESOPH 30MM OR GT
|
Facility
|
OP
|
$2,791.00
|
|
|
Service Code
|
CPT 43233
|
| Hospital Charge Code |
906743233
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$314.20 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$558.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,917.42
|
| 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 HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,255.95
|
| Rate for Payer: Cash Price |
$1,255.95
|
| Rate for Payer: Cash Price |
$1,255.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,814.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: Dignity Health Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,377.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,727.63
|
| Rate for Payer: Heritage Provider Network Senior |
$2,924.26
|
| Rate for Payer: Humana Medicare |
$2,377.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$314.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,517.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$505.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,805.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$697.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,995.59
|
| Rate for Payer: Multiplan Commercial |
$2,093.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| 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 DIAG W/ OR W/O COLLECTION
|
Facility
|
IP
|
$5,557.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
902100084
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,005.82 |
| Max. Negotiated Rate |
$4,167.75 |
| Rate for Payer: Adventist Health Commercial |
$1,111.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,817.66
|
| Rate for Payer: Cash Price |
$2,500.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,762.09
|
| Rate for Payer: Heritage Provider Network Senior |
$3,762.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,005.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,389.25
|
| Rate for Payer: Multiplan Commercial |
$4,167.75
|
|
|
HC EGD DIAG W/ OR W/O COLLECTION
|
Facility
|
IP
|
$4,072.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
906743235
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$737.03 |
| Max. Negotiated Rate |
$3,054.00 |
| Rate for Payer: Adventist Health Commercial |
$814.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,797.46
|
| Rate for Payer: Cash Price |
$1,832.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,756.74
|
| Rate for Payer: Heritage Provider Network Senior |
$2,756.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$737.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,018.00
|
| Rate for Payer: Multiplan Commercial |
$3,054.00
|
|
|
HC EGD DIAG W/ OR W/O COLLECTION
|
Facility
|
OP
|
$3,713.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
906743235
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$349.63 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$742.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,550.83
|
| 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 HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,670.85
|
| Rate for Payer: Cash Price |
$1,670.85
|
| Rate for Payer: Cash Price |
$1,670.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,413.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: Dignity Health Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,132.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,298.35
|
| Rate for Payer: Heritage Provider Network Senior |
$1,393.09
|
| Rate for Payer: Humana Medicare |
$1,132.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$349.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,151.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$672.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,336.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$928.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,427.06
|
| Rate for Payer: Multiplan Commercial |
$2,784.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC EGD DIAG W/ OR W/O COLLECTION
|
Facility
|
OP
|
$5,557.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
902100084
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,111.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,817.66
|
| 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 HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$2,500.65
|
| Rate for Payer: Cash Price |
$2,500.65
|
| Rate for Payer: Cash Price |
$2,500.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,612.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: Dignity Health Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,132.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,762.09
|
| Rate for Payer: Heritage Provider Network Senior |
$3,762.09
|
| Rate for Payer: Humana Medicare |
$1,132.59
|
| 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: Kaiser Permanente of CA Commercial |
$2,678.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,005.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,336.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,389.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,427.06
|
| Rate for Payer: Multiplan Commercial |
$4,167.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,017.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,856.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC EGD DIAG W/SUBMUC INJ ANY SUBSTANCE
|
Facility
|
OP
|
$3,713.00
|
|
|
Service Code
|
CPT 43236
|
| Hospital Charge Code |
906743236
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$379.36 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$742.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,550.83
|
| 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 HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$1,670.85
|
| Rate for Payer: Cash Price |
$1,670.85
|
| Rate for Payer: Cash Price |
$1,670.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,413.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: Dignity Health Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,132.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,298.35
|
| Rate for Payer: Heritage Provider Network Senior |
$1,393.09
|
| Rate for Payer: Humana Medicare |
$1,132.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$379.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,151.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$672.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,336.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$928.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,427.06
|
| Rate for Payer: Multiplan Commercial |
$2,784.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC EGD DIAG W/SUBMUC INJ ANY SUBSTANCE
|
Facility
|
IP
|
$4,072.00
|
|
|
Service Code
|
CPT 43236
|
| Hospital Charge Code |
906743236
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$737.03 |
| Max. Negotiated Rate |
$3,054.00 |
| Rate for Payer: Adventist Health Commercial |
$814.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,797.46
|
| Rate for Payer: Cash Price |
$1,832.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,756.74
|
| Rate for Payer: Heritage Provider Network Senior |
$2,756.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$737.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,018.00
|
| Rate for Payer: Multiplan Commercial |
$3,054.00
|
|
|
HC EGD DIAG W WO COLLECTION
|
Facility
|
OP
|
$4,072.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
900501432
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$737.03 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$814.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,797.46
|
| 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 HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$1,832.40
|
| Rate for Payer: Cash Price |
$1,832.40
|
| Rate for Payer: Cash Price |
$1,832.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,646.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: Dignity Health Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,132.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,756.74
|
| Rate for Payer: Heritage Provider Network Senior |
$2,756.74
|
| Rate for Payer: Humana Medicare |
$1,132.59
|
| 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: Kaiser Permanente of CA Commercial |
$1,962.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$737.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,336.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,018.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,427.06
|
| Rate for Payer: Multiplan Commercial |
$3,054.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,478.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,360.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC EGD DIAG W WO COLLECTION
|
Facility
|
IP
|
$4,072.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
900501432
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$737.03 |
| Max. Negotiated Rate |
$3,054.00 |
| Rate for Payer: Adventist Health Commercial |
$814.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,797.46
|
| Rate for Payer: Cash Price |
$1,832.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,756.74
|
| Rate for Payer: Heritage Provider Network Senior |
$2,756.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$737.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,018.00
|
| Rate for Payer: Multiplan Commercial |
$3,054.00
|
|
|
HC EGD ENDO STENT PLACEMENT
|
Facility
|
OP
|
$5,688.00
|
|
|
Service Code
|
CPT 43266
|
| Hospital Charge Code |
900100017
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$312.47 |
| Max. Negotiated Rate |
$13,529.58 |
| Rate for Payer: Adventist Health Commercial |
$1,137.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,907.66
|
| 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 HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$2,559.60
|
| Rate for Payer: Cash Price |
$2,559.60
|
| Rate for Payer: Cash Price |
$2,559.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,697.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,681.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,832.91
|
| Rate for Payer: Dignity Health Senior |
$7,120.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,120.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,520.87
|
| Rate for Payer: Heritage Provider Network Senior |
$8,758.62
|
| Rate for Payer: Humana Medicare |
$7,120.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$312.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,120.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,529.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,029.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,402.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,422.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,972.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,972.25
|
| Rate for Payer: Multiplan Commercial |
$4,266.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,520.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,039.00
|
| 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 ENDO STENT PLACEMENT
|
Facility
|
IP
|
$4,546.00
|
|
|
Service Code
|
CPT 43266
|
| Hospital Charge Code |
900100017
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$822.83 |
| Max. Negotiated Rate |
$3,409.50 |
| Rate for Payer: Adventist Health Commercial |
$909.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,123.10
|
| Rate for Payer: Cash Price |
$2,045.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,077.64
|
| Rate for Payer: Heritage Provider Network Senior |
$3,077.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$822.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,136.50
|
| Rate for Payer: Multiplan Commercial |
$3,409.50
|
|
|
HC EGD FLXBL TRNSORL W DPLMNT OF IG BRTRC BLLN
|
Facility
|
OP
|
$4,803.00
|
|
|
Service Code
|
CPT 43290
|
| Hospital Charge Code |
906743290
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$960.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,299.66
|
| 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 HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$2,161.35
|
| Rate for Payer: Cash Price |
$2,161.35
|
| Rate for Payer: Cash Price |
$2,161.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,121.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: Dignity Health Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,377.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,973.06
|
| Rate for Payer: Heritage Provider Network Senior |
$2,924.26
|
| Rate for Payer: Humana Medicare |
$2,377.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,517.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$869.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,805.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,200.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,995.59
|
| Rate for Payer: Multiplan Commercial |
$3,602.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC EGD FLXBL TRNSORL W DPLMNT OF IG BRTRC BLLN
|
Facility
|
IP
|
$4,803.00
|
|
|
Service Code
|
CPT 43290
|
| Hospital Charge Code |
906743290
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$869.34 |
| Max. Negotiated Rate |
$3,602.25 |
| Rate for Payer: Adventist Health Commercial |
$960.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,299.66
|
| Rate for Payer: Cash Price |
$2,161.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,251.63
|
| Rate for Payer: Heritage Provider Network Senior |
$3,251.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$869.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,200.75
|
| Rate for Payer: Multiplan Commercial |
$3,602.25
|
|
|
HC EGD FLXBL TRNSORL W RMVL OF IG BRTRC BLLN
|
Facility
|
OP
|
$2,277.00
|
|
|
Service Code
|
CPT 43291
|
| Hospital Charge Code |
906743291
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$412.14 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$455.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,564.30
|
| 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 HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$1,024.65
|
| Rate for Payer: Cash Price |
$1,024.65
|
| Rate for Payer: Cash Price |
$1,024.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,480.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: Dignity Health Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,132.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,409.46
|
| Rate for Payer: Heritage Provider Network Senior |
$1,393.09
|
| Rate for Payer: Humana Medicare |
$1,132.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,151.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$412.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,336.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$569.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,427.06
|
| Rate for Payer: Multiplan Commercial |
$1,707.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC EGD FLXBL TRNSORL W RMVL OF IG BRTRC BLLN
|
Facility
|
IP
|
$2,277.00
|
|
|
Service Code
|
CPT 43291
|
| Hospital Charge Code |
906743291
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$412.14 |
| Max. Negotiated Rate |
$1,707.75 |
| Rate for Payer: Adventist Health Commercial |
$455.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,564.30
|
| Rate for Payer: Cash Price |
$1,024.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,541.53
|
| Rate for Payer: Heritage Provider Network Senior |
$1,541.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$412.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$569.25
|
| Rate for Payer: Multiplan Commercial |
$1,707.75
|
|
|
HC EGD LESION ABLATION
|
Facility
|
IP
|
$3,915.00
|
|
|
Service Code
|
CPT 43270
|
| Hospital Charge Code |
900100018
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$708.62 |
| Max. Negotiated Rate |
$2,936.25 |
| Rate for Payer: Adventist Health Commercial |
$783.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,689.60
|
| Rate for Payer: Cash Price |
$1,761.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,650.46
|
| Rate for Payer: Heritage Provider Network Senior |
$2,650.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$708.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$978.75
|
| Rate for Payer: Multiplan Commercial |
$2,936.25
|
|
|
HC EGD LESION ABLATION
|
Facility
|
OP
|
$3,571.00
|
|
|
Service Code
|
CPT 43270
|
| Hospital Charge Code |
900100018
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$328.72 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$714.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,453.28
|
| 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 HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$1,606.95
|
| Rate for Payer: Cash Price |
$1,606.95
|
| Rate for Payer: Cash Price |
$1,606.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,321.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: Dignity Health Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,377.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,210.45
|
| Rate for Payer: Heritage Provider Network Senior |
$2,924.26
|
| Rate for Payer: Humana Medicare |
$2,377.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$328.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,517.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$646.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,805.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$892.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,995.59
|
| Rate for Payer: Multiplan Commercial |
$2,678.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| 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
|
OP
|
$2,780.00
|
|
|
Service Code
|
CPT 43250
|
| Hospital Charge Code |
906743250
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$382.15 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$556.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,909.86
|
| 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 HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,807.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: Dignity Health Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,377.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,720.82
|
| Rate for Payer: Heritage Provider Network Senior |
$2,924.26
|
| Rate for Payer: Humana Medicare |
$2,377.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$382.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,517.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$503.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,805.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$695.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,995.59
|
| Rate for Payer: Multiplan Commercial |
$2,085.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| 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
|
$2,439.00
|
|
|
Service Code
|
CPT 43250
|
| Hospital Charge Code |
906743250
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$441.46 |
| Max. Negotiated Rate |
$1,829.25 |
| Rate for Payer: Adventist Health Commercial |
$487.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,675.59
|
| Rate for Payer: Cash Price |
$1,097.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,651.20
|
| Rate for Payer: Heritage Provider Network Senior |
$1,651.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$441.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$609.75
|
| Rate for Payer: Multiplan Commercial |
$1,829.25
|
|
|
HC EGD US TRANSMURAL INJECT MARKER
|
Facility
|
IP
|
$2,666.00
|
|
|
Service Code
|
CPT 43253
|
| Hospital Charge Code |
906743253
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$482.55 |
| Max. Negotiated Rate |
$1,999.50 |
| Rate for Payer: Adventist Health Commercial |
$533.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,831.54
|
| Rate for Payer: Cash Price |
$1,199.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,804.88
|
| Rate for Payer: Heritage Provider Network Senior |
$1,804.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$482.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$666.50
|
| Rate for Payer: Multiplan Commercial |
$1,999.50
|
|
|
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 |
$364.15 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$558.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,917.42
|
| 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 HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,255.95
|
| Rate for Payer: Cash Price |
$1,255.95
|
| Rate for Payer: Cash Price |
$1,255.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,814.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: Dignity Health Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,377.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,727.63
|
| Rate for Payer: Heritage Provider Network Senior |
$2,924.26
|
| Rate for Payer: Humana Medicare |
$2,377.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$364.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,517.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$505.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,805.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$697.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,995.59
|
| Rate for Payer: Multiplan Commercial |
$2,093.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| 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
|
$6,430.00
|
|
|
Service Code
|
CPT 43244
|
| Hospital Charge Code |
906743244
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,163.83 |
| Max. Negotiated Rate |
$4,822.50 |
| Rate for Payer: Adventist Health Commercial |
$1,286.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,417.41
|
| Rate for Payer: Cash Price |
$2,893.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,353.11
|
| Rate for Payer: Heritage Provider Network Senior |
$4,353.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,163.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,607.50
|
| Rate for Payer: Multiplan Commercial |
$4,822.50
|
|
