|
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
|
|
|
HC EGD W BLLN DLTN ESO
|
Facility
|
IP
|
$3,898.00
|
|
|
Service Code
|
CPT 43249
|
| Hospital Charge Code |
906743249
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$705.54 |
| Max. Negotiated Rate |
$2,923.50 |
| Rate for Payer: Adventist Health Commercial |
$779.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,677.93
|
| Rate for Payer: Cash Price |
$1,754.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,638.95
|
| Rate for Payer: Heritage Provider Network Senior |
$2,638.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$705.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$974.50
|
| Rate for Payer: Multiplan Commercial |
$2,923.50
|
|
|
HC EGD W BLLN DLTN ESO
|
Facility
|
OP
|
$3,553.00
|
|
|
Service Code
|
CPT 43249
|
| Hospital Charge Code |
906743249
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$347.90 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$710.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,440.91
|
| 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 |
$1,598.85
|
| Rate for Payer: Cash Price |
$1,598.85
|
| Rate for Payer: Cash Price |
$1,598.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,309.45
|
| 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 |
$2,199.31
|
| 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 |
$347.90
|
| 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 |
$643.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,805.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$888.25
|
| 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 |
$2,664.75
|
| 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 |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC EGD W BLLN DLTN ESO
|
Facility
|
IP
|
$3,898.00
|
|
|
Service Code
|
CPT 43249
|
| Hospital Charge Code |
906743249
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$705.54 |
| Max. Negotiated Rate |
$2,923.50 |
| Rate for Payer: Adventist Health Commercial |
$779.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,677.93
|
| Rate for Payer: Cash Price |
$1,754.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,638.95
|
| Rate for Payer: Heritage Provider Network Senior |
$2,638.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$705.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$974.50
|
| Rate for Payer: Multiplan Commercial |
$2,923.50
|
|
|
HC EGD W BLLN DLTN ESO
|
Facility
|
OP
|
$3,553.00
|
|
|
Service Code
|
CPT 43249
|
| Hospital Charge Code |
906743249
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$643.09 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$710.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,440.91
|
| 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: Cash Price |
$1,598.85
|
| Rate for Payer: Cash Price |
$1,598.85
|
| Rate for Payer: Cash Price |
$1,598.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,309.45
|
| 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 |
$2,405.38
|
| Rate for Payer: Heritage Provider Network Senior |
$2,405.38
|
| Rate for Payer: Humana Medicare |
$2,377.45
|
| 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: Kaiser Permanente of CA Commercial |
$1,712.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$643.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,805.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$888.25
|
| 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 |
$2,664.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,290.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,187.06
|
| 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 BX SNGL OR MULTI
|
Facility
|
IP
|
$4,217.00
|
|
|
Service Code
|
CPT 43239
|
| Hospital Charge Code |
906743239
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$763.28 |
| Max. Negotiated Rate |
$3,162.75 |
| Rate for Payer: Adventist Health Commercial |
$843.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,897.08
|
| Rate for Payer: Cash Price |
$1,897.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,854.91
|
| Rate for Payer: Heritage Provider Network Senior |
$2,854.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$763.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,054.25
|
| Rate for Payer: Multiplan Commercial |
$3,162.75
|
|
|
HC EGD W BX SNGL OR MULTI
|
Facility
|
OP
|
$3,845.00
|
|
|
Service Code
|
CPT 43239
|
| Hospital Charge Code |
906743239
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$365.32 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$769.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,641.52
|
| 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 |
$1,730.25
|
| Rate for Payer: Cash Price |
$1,730.25
|
| Rate for Payer: Cash Price |
$1,730.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,499.25
|
| 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 |
$2,380.06
|
| 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 |
$365.32
|
| 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 |
$695.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,336.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$961.25
|
| 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 |
$2,883.75
|
| 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 W BX SNGL OR MULTI
|
Facility
|
OP
|
$3,845.00
|
|
|
Service Code
|
CPT 43239
|
| Hospital Charge Code |
906743239
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$695.94 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$769.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,641.52
|
| 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 |
$1,730.25
|
| Rate for Payer: Cash Price |
$1,730.25
|
| Rate for Payer: Cash Price |
$1,730.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,499.25
|
| 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 |
$2,603.06
|
| Rate for Payer: Heritage Provider Network Senior |
$2,603.06
|
| 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 |
$1,853.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$695.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,336.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$961.25
|
| 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 |
$2,883.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,396.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,284.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC EGD W BX SNGL OR MULTI
|
Facility
|
IP
|
$4,217.00
|
|
|
Service Code
|
CPT 43239
|
| Hospital Charge Code |
906743239
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$763.28 |
| Max. Negotiated Rate |
$3,162.75 |
| Rate for Payer: Adventist Health Commercial |
$843.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,897.08
|
| Rate for Payer: Cash Price |
$1,897.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,854.91
|
| Rate for Payer: Heritage Provider Network Senior |
$2,854.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$763.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,054.25
|
| Rate for Payer: Multiplan Commercial |
$3,162.75
|
|
|
HC EGD W/CNTRL BLEEDNG ANY METHOD
|
Facility
|
OP
|
$5,146.00
|
|
|
Service Code
|
CPT 43255
|
| Hospital Charge Code |
906743255
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,029.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,535.30
|
| 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 |
$2,315.70
|
| Rate for Payer: Cash Price |
$2,315.70
|
| Rate for Payer: Cash Price |
$2,315.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,344.90
|
| 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 |
$3,185.37
|
| 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 |
$448.95
|
| 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 |
$931.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,805.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,286.50
|
| 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 |
$3,859.50
|
| 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/CNTRL BLEEDNG ANY METHOD
|
Facility
|
IP
|
$5,645.00
|
|
|
Service Code
|
CPT 43255
|
| Hospital Charge Code |
906743255
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,021.74 |
| Max. Negotiated Rate |
$4,233.75 |
| Rate for Payer: Adventist Health Commercial |
$1,129.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,878.12
|
| Rate for Payer: Cash Price |
$2,540.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,821.66
|
| Rate for Payer: Heritage Provider Network Senior |
$3,821.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,021.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,411.25
|
| Rate for Payer: Multiplan Commercial |
$4,233.75
|
|
|
HC EGD W/DILATION OF GASTRIC OUTL
|
Facility
|
OP
|
$4,592.00
|
|
|
Service Code
|
CPT 43245
|
| Hospital Charge Code |
906743245
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$377.52 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$918.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,154.70
|
| 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 |
$2,066.40
|
| Rate for Payer: Cash Price |
$2,066.40
|
| Rate for Payer: Cash Price |
$2,066.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,984.80
|
| 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 |
$2,842.45
|
| 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 |
$377.52
|
| 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 |
$831.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,805.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,148.00
|
| 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 |
$3,444.00
|
| 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 W/DILATION OF GASTRIC OUTL
|
Facility
|
IP
|
$2,439.00
|
|
|
Service Code
|
CPT 43245
|
| Hospital Charge Code |
906743245
|
|
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 W/DRCTD PLCMT PERCUT GAST
|
Facility
|
IP
|
$4,072.00
|
|
|
Service Code
|
CPT 43246
|
| Hospital Charge Code |
906743246
|
|
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 W/DRCTD PLCMT PERCUT GAST
|
Facility
|
OP
|
$3,449.00
|
|
|
Service Code
|
CPT 43246
|
| Hospital Charge Code |
906743246
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$377.52 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$689.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,369.46
|
| 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 |
$1,552.05
|
| Rate for Payer: Cash Price |
$1,552.05
|
| Rate for Payer: Cash Price |
$1,552.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,241.85
|
| 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 |
$2,134.93
|
| 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 |
$377.52
|
| 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 |
$624.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,805.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$862.25
|
| 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 |
$2,586.75
|
| 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 |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC EGD W ENDO MUCOSAL RESECTION
|
Facility
|
IP
|
$1,764.00
|
|
|
Service Code
|
CPT 43254
|
| Hospital Charge Code |
906743254
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$319.28 |
| Max. Negotiated Rate |
$1,323.00 |
| Rate for Payer: Adventist Health Commercial |
$352.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,211.87
|
| Rate for Payer: Cash Price |
$793.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,194.23
|
| Rate for Payer: Heritage Provider Network Senior |
$1,194.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$319.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$441.00
|
| Rate for Payer: Multiplan Commercial |
$1,323.00
|
|
|
HC EGD W ENDO MUCOSAL RESECTION
|
Facility
|
OP
|
$1,847.00
|
|
|
Service Code
|
CPT 43254
|
| Hospital Charge Code |
906743254
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$334.31 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$369.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,268.89
|
| 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 |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$831.15
|
| Rate for Payer: Cash Price |
$831.15
|
| Rate for Payer: Cash Price |
$831.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,200.55
|
| 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 |
$1,143.29
|
| 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 |
$377.52
|
| 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 |
$334.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,805.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$461.75
|
| 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 |
$1,385.25
|
| 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/ENDO US EXAM
|
Facility
|
IP
|
$4,668.00
|
|
|
Service Code
|
CPT 43259
|
| Hospital Charge Code |
906743259
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$844.91 |
| Max. Negotiated Rate |
$3,501.00 |
| Rate for Payer: Adventist Health Commercial |
$933.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,206.92
|
| Rate for Payer: Cash Price |
$2,100.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,160.24
|
| Rate for Payer: Heritage Provider Network Senior |
$3,160.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$844.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,167.00
|
| Rate for Payer: Multiplan Commercial |
$3,501.00
|
|
|
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 |
$324.07 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$851.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,925.25
|
| 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 |
$5,379.37
|
| Rate for Payer: Blue Shield of California EPN |
$4,623.32
|
| Rate for Payer: Cash Price |
$1,916.10
|
| Rate for Payer: Cash Price |
$1,916.10
|
| Rate for Payer: Cash Price |
$1,916.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,767.70
|
| 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 |
$2,635.70
|
| 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 |
$324.07
|
| 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 |
$770.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,805.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,064.50
|
| 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 |
$3,193.50
|
| 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 INJ SCLER ESO
|
Facility
|
OP
|
$3,873.00
|
|
|
Service Code
|
CPT 43243
|
| Hospital Charge Code |
906743243
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$774.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,660.75
|
| 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 |
$1,742.85
|
| Rate for Payer: Cash Price |
$1,742.85
|
| Rate for Payer: Cash Price |
$1,742.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,517.45
|
| 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 |
$2,397.39
|
| 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 |
$476.25
|
| 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 |
$701.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,805.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$968.25
|
| 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 |
$2,904.75
|
| 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 |
$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
|
IP
|
$4,247.00
|
|
|
Service Code
|
CPT 43243
|
| Hospital Charge Code |
906743243
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$768.71 |
| Max. Negotiated Rate |
$3,185.25 |
| Rate for Payer: Adventist Health Commercial |
$849.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,917.69
|
| Rate for Payer: Cash Price |
$1,911.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,875.22
|
| Rate for Payer: Heritage Provider Network Senior |
$2,875.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$768.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,061.75
|
| Rate for Payer: Multiplan Commercial |
$3,185.25
|
|
|
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 |
$701.01 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$774.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,660.75
|
| 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: Cash Price |
$1,742.85
|
| Rate for Payer: Cash Price |
$1,742.85
|
| Rate for Payer: Cash Price |
$1,742.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,517.45
|
| 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 |
$2,622.02
|
| Rate for Payer: Heritage Provider Network Senior |
$2,622.02
|
| Rate for Payer: Humana Medicare |
$2,377.45
|
| 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: Kaiser Permanente of CA Commercial |
$1,866.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$701.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,805.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$968.25
|
| 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 |
$2,904.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,406.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,293.97
|
| 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
|
IP
|
$4,247.00
|
|
|
Service Code
|
CPT 43243
|
| Hospital Charge Code |
906743243
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$768.71 |
| Max. Negotiated Rate |
$3,185.25 |
| Rate for Payer: Adventist Health Commercial |
$849.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,917.69
|
| Rate for Payer: Cash Price |
$1,911.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,875.22
|
| Rate for Payer: Heritage Provider Network Senior |
$2,875.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$768.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,061.75
|
| Rate for Payer: Multiplan Commercial |
$3,185.25
|
|
|
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 |
$230.57 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$654.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,249.24
|
| 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 |
$1,473.30
|
| Rate for Payer: Cash Price |
$1,473.30
|
| Rate for Payer: Cash Price |
$1,473.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,128.10
|
| 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 |
$2,026.61
|
| 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 |
$230.57
|
| 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 |
$592.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,336.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$818.50
|
| 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 |
$2,455.50
|
| 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 W/INSRT GIDE WIRE
|
Facility
|
IP
|
$3,591.00
|
|
|
Service Code
|
CPT 43248
|
| Hospital Charge Code |
906743248
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$649.97 |
| Max. Negotiated Rate |
$2,693.25 |
| Rate for Payer: Adventist Health Commercial |
$718.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,467.02
|
| Rate for Payer: Cash Price |
$1,615.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,431.11
|
| Rate for Payer: Heritage Provider Network Senior |
$2,431.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$649.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$897.75
|
| Rate for Payer: Multiplan Commercial |
$2,693.25
|
|
