|
HC EGD W/CNTRL BLEEDNG ANY METHOD
|
Facility
|
IP
|
$3,914.00
|
|
|
Service Code
|
CPT 43255
|
| Hospital Charge Code |
906743255
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$708.43 |
| Max. Negotiated Rate |
$2,935.50 |
| Rate for Payer: Adventist Health Commercial |
$782.80
|
| Rate for Payer: Cash Price |
$2,152.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,649.78
|
| Rate for Payer: Heritage Provider Network Senior |
$2,649.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$708.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$978.50
|
| Rate for Payer: Multiplan Commercial |
$2,935.50
|
|
|
HC EGD W/DILATION OF GASTRIC OUTL
|
Facility
|
OP
|
$1,969.00
|
|
|
Service Code
|
CPT 43245
|
| Hospital Charge Code |
906743245
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$393.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,352.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,410.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,082.95
|
| Rate for Payer: Cash Price |
$1,082.95
|
| Rate for Payer: Cash Price |
$1,082.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,279.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,651.35
|
| Rate for Payer: Dignity Health Senior |
$2,410.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,410.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,218.81
|
| Rate for Payer: Heritage Provider Network Senior |
$2,964.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$392.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$939.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$356.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,771.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$492.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,037.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,037.00
|
| Rate for Payer: Multiplan Commercial |
$1,476.75
|
| 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 |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,410.32
|
|
|
HC EGD W/DILATION OF GASTRIC OUTL
|
Facility
|
IP
|
$1,969.00
|
|
|
Service Code
|
CPT 43245
|
| Hospital Charge Code |
906743245
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$356.39 |
| Max. Negotiated Rate |
$1,476.75 |
| Rate for Payer: Adventist Health Commercial |
$393.80
|
| Rate for Payer: Cash Price |
$1,082.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,333.01
|
| Rate for Payer: Heritage Provider Network Senior |
$1,333.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$356.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$492.25
|
| Rate for Payer: Multiplan Commercial |
$1,476.75
|
|
|
HC EGD W/DRCTD PLCMT PERCUT GAST
|
Facility
|
OP
|
$3,288.00
|
|
|
Service Code
|
CPT 43246
|
| Hospital Charge Code |
906743246
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$657.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,258.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,410.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,808.40
|
| Rate for Payer: Cash Price |
$1,808.40
|
| Rate for Payer: Cash Price |
$1,808.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,137.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,651.35
|
| Rate for Payer: Dignity Health Senior |
$2,410.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,410.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,035.27
|
| Rate for Payer: Heritage Provider Network Senior |
$2,964.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$392.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,568.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$595.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,771.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$822.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,037.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,037.00
|
| Rate for Payer: Multiplan Commercial |
$2,466.00
|
| 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 |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,410.32
|
|
|
HC EGD W/DRCTD PLCMT PERCUT GAST
|
Facility
|
IP
|
$3,288.00
|
|
|
Service Code
|
CPT 43246
|
| Hospital Charge Code |
906743246
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$595.13 |
| Max. Negotiated Rate |
$2,466.00 |
| Rate for Payer: Adventist Health Commercial |
$657.60
|
| Rate for Payer: Cash Price |
$1,808.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,225.98
|
| Rate for Payer: Heritage Provider Network Senior |
$2,225.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$595.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$822.00
|
| Rate for Payer: Multiplan Commercial |
$2,466.00
|
|
|
HC EGD W ENDO MUCOSAL RESECTION
|
Facility
|
IP
|
$1,425.00
|
|
|
Service Code
|
CPT 43254
|
| Hospital Charge Code |
906743254
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$257.93 |
| Max. Negotiated Rate |
$1,068.75 |
| Rate for Payer: Adventist Health Commercial |
$285.00
|
| Rate for Payer: Cash Price |
$783.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$964.73
|
| Rate for Payer: Heritage Provider Network Senior |
$964.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$356.25
|
| Rate for Payer: Multiplan Commercial |
$1,068.75
|
|
|
HC EGD W ENDO MUCOSAL RESECTION
|
Facility
|
OP
|
$1,425.00
|
|
|
Service Code
|
CPT 43254
|
| Hospital Charge Code |
906743254
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$285.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$978.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,410.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$783.75
|
| Rate for Payer: Cash Price |
$783.75
|
| Rate for Payer: Cash Price |
$783.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$926.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,651.35
|
| Rate for Payer: Dignity Health Senior |
$2,410.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,410.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$882.08
|
| Rate for Payer: Heritage Provider Network Senior |
$2,964.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$392.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$679.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,771.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$356.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,037.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,037.00
|
| Rate for Payer: Multiplan Commercial |
$1,068.75
|
| 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 |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,410.32
|
|
|
HC EGD W/ENDO US EXAM
|
Facility
|
OP
|
$3,770.00
|
|
|
Service Code
|
CPT 43259
|
| Hospital Charge Code |
906743259
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$754.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,589.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,410.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,073.50
|
| Rate for Payer: Cash Price |
$2,073.50
|
| Rate for Payer: Cash Price |
$2,073.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,450.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,651.35
|
| Rate for Payer: Dignity Health Senior |
$2,410.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,410.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,333.63
|
| Rate for Payer: Heritage Provider Network Senior |
$2,964.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$336.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,798.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$682.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,771.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$942.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,037.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,037.00
|
| Rate for Payer: Multiplan Commercial |
$2,827.50
|
| 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 |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,410.32
|
|
|
HC EGD W/ENDO US EXAM
|
Facility
|
IP
|
$3,770.00
|
|
|
Service Code
|
CPT 43259
|
| Hospital Charge Code |
906743259
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$682.37 |
| Max. Negotiated Rate |
$2,827.50 |
| Rate for Payer: Adventist Health Commercial |
$754.00
|
| Rate for Payer: Cash Price |
$2,073.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,552.29
|
| Rate for Payer: Heritage Provider Network Senior |
$2,552.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$682.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$942.50
|
| Rate for Payer: Multiplan Commercial |
$2,827.50
|
|
|
HC EGD W INJ SCLER ESO
|
Facility
|
OP
|
$4,035.00
|
|
|
Service Code
|
CPT 43243
|
| Hospital Charge Code |
906743243
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$807.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,772.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,410.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,219.25
|
| Rate for Payer: Cash Price |
$2,219.25
|
| Rate for Payer: Cash Price |
$2,219.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,622.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,651.35
|
| Rate for Payer: Dignity Health Senior |
$2,410.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,410.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,497.66
|
| Rate for Payer: Heritage Provider Network Senior |
$2,964.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$494.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,924.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$730.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,771.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,008.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,037.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,037.00
|
| Rate for Payer: Multiplan Commercial |
$3,026.25
|
| 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 |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,410.32
|
|
|
HC EGD W INJ SCLER ESO
|
Facility
|
IP
|
$4,035.00
|
|
|
Service Code
|
CPT 43243
|
| Hospital Charge Code |
906743243
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$730.34 |
| Max. Negotiated Rate |
$3,026.25 |
| Rate for Payer: Adventist Health Commercial |
$807.00
|
| Rate for Payer: Cash Price |
$2,219.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,731.70
|
| Rate for Payer: Heritage Provider Network Senior |
$2,731.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$730.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,008.75
|
| Rate for Payer: Multiplan Commercial |
$3,026.25
|
|
|
HC EGD W INJ SCLER ESO
|
Facility
|
IP
|
$4,035.00
|
|
|
Service Code
|
CPT 43243
|
| Hospital Charge Code |
906743243
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$730.34 |
| Max. Negotiated Rate |
$3,026.25 |
| Rate for Payer: Adventist Health Commercial |
$807.00
|
| Rate for Payer: Cash Price |
$2,219.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,731.70
|
| Rate for Payer: Heritage Provider Network Senior |
$2,731.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$730.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,008.75
|
| Rate for Payer: Multiplan Commercial |
$3,026.25
|
|
|
HC EGD W INJ SCLER ESO
|
Facility
|
OP
|
$4,035.00
|
|
|
Service Code
|
CPT 43243
|
| Hospital Charge Code |
906743243
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$807.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,772.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,410.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Cash Price |
$2,219.25
|
| Rate for Payer: Cash Price |
$2,219.25
|
| Rate for Payer: Cash Price |
$2,219.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,622.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,651.35
|
| Rate for Payer: Dignity Health Senior |
$2,410.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,410.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,731.70
|
| Rate for Payer: Heritage Provider Network Senior |
$2,731.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,924.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$730.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,771.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,008.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,037.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,037.00
|
| Rate for Payer: Multiplan Commercial |
$3,026.25
|
| Rate for Payer: Multiplan WC |
$3,840.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,451.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,335.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,410.32
|
|
|
HC EGD W/INSRT GIDE WIRE
|
Facility
|
IP
|
$2,989.00
|
|
|
Service Code
|
CPT 43248
|
| Hospital Charge Code |
906743248
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$541.01 |
| Max. Negotiated Rate |
$2,241.75 |
| Rate for Payer: Adventist Health Commercial |
$597.80
|
| Rate for Payer: Cash Price |
$1,643.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,023.55
|
| Rate for Payer: Heritage Provider Network Senior |
$2,023.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$541.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$747.25
|
| Rate for Payer: Multiplan Commercial |
$2,241.75
|
|
|
HC EGD W/INSRT GIDE WIRE
|
Facility
|
OP
|
$2,989.00
|
|
|
Service Code
|
CPT 43248
|
| Hospital Charge Code |
906743248
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$597.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,053.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,643.95
|
| Rate for Payer: Cash Price |
$1,643.95
|
| Rate for Payer: Cash Price |
$1,643.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,942.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Senior |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,191.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,850.19
|
| Rate for Payer: Heritage Provider Network Senior |
$1,465.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$239.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,425.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$541.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,369.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$747.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,500.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,500.99
|
| Rate for Payer: Multiplan Commercial |
$2,241.75
|
| 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 |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC EGD W/REMOVAL FOREIGN BODY
|
Facility
|
OP
|
$3,240.00
|
|
|
Service Code
|
CPT 43247
|
| Hospital Charge Code |
906743247
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$648.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,225.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,782.00
|
| Rate for Payer: Cash Price |
$1,782.00
|
| Rate for Payer: Cash Price |
$1,782.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,106.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Senior |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,191.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,005.56
|
| Rate for Payer: Heritage Provider Network Senior |
$1,465.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$413.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,545.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$586.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,369.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$810.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,500.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,500.99
|
| Rate for Payer: Multiplan Commercial |
$2,430.00
|
| 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 |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC EGD W/REMOVAL FOREIGN BODY
|
Facility
|
IP
|
$3,240.00
|
|
|
Service Code
|
CPT 43247
|
| Hospital Charge Code |
906743247
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$586.44 |
| Max. Negotiated Rate |
$2,430.00 |
| Rate for Payer: Adventist Health Commercial |
$648.00
|
| Rate for Payer: Cash Price |
$1,782.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,193.48
|
| Rate for Payer: Heritage Provider Network Senior |
$2,193.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$586.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$810.00
|
| Rate for Payer: Multiplan Commercial |
$2,430.00
|
|
|
HC EGD W/REMOV TUMOR/POLYP/LESION
|
Facility
|
OP
|
$1,969.00
|
|
|
Service Code
|
CPT 43251
|
| Hospital Charge Code |
906743251
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$393.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,352.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,410.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,082.95
|
| Rate for Payer: Cash Price |
$1,082.95
|
| Rate for Payer: Cash Price |
$1,082.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,279.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,651.35
|
| Rate for Payer: Dignity Health Senior |
$2,410.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,410.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,218.81
|
| Rate for Payer: Heritage Provider Network Senior |
$2,964.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$939.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$356.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,771.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$492.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,037.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,037.00
|
| Rate for Payer: Multiplan Commercial |
$1,476.75
|
| 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 |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,410.32
|
|
|
HC EGD W/REMOV TUMOR/POLYP/LESION
|
Facility
|
IP
|
$1,969.00
|
|
|
Service Code
|
CPT 43251
|
| Hospital Charge Code |
906743251
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$356.39 |
| Max. Negotiated Rate |
$1,476.75 |
| Rate for Payer: Adventist Health Commercial |
$393.80
|
| Rate for Payer: Cash Price |
$1,082.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,333.01
|
| Rate for Payer: Heritage Provider Network Senior |
$1,333.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$356.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$492.25
|
| Rate for Payer: Multiplan Commercial |
$1,476.75
|
|
|
HC EGD W/TRANSENDO TUBE/CATH PLAC
|
Facility
|
OP
|
$3,148.00
|
|
|
Service Code
|
CPT 43241
|
| Hospital Charge Code |
906743241
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$629.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,162.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,410.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,731.40
|
| Rate for Payer: Cash Price |
$1,731.40
|
| Rate for Payer: Cash Price |
$1,731.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,046.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,651.35
|
| Rate for Payer: Dignity Health Senior |
$2,410.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,410.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,948.61
|
| Rate for Payer: Heritage Provider Network Senior |
$2,964.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,501.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$569.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,771.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$787.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,037.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,037.00
|
| Rate for Payer: Multiplan Commercial |
$2,361.00
|
| 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 |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,410.32
|
|
|
HC EGD W/TRANSENDO TUBE/CATH PLAC
|
Facility
|
IP
|
$3,148.00
|
|
|
Service Code
|
CPT 43241
|
| Hospital Charge Code |
906743241
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$569.79 |
| Max. Negotiated Rate |
$2,361.00 |
| Rate for Payer: Adventist Health Commercial |
$629.60
|
| Rate for Payer: Cash Price |
$1,731.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,131.20
|
| Rate for Payer: Heritage Provider Network Senior |
$2,131.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$569.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$787.00
|
| Rate for Payer: Multiplan Commercial |
$2,361.00
|
|
|
HC EGD W/TRNSMRL DRNG/ PSEUDOCYST
|
Facility
|
OP
|
$1,978.00
|
|
|
Service Code
|
CPT 43240
|
| Hospital Charge Code |
906743240
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$11,345.46 |
| Rate for Payer: Adventist Health Commercial |
$395.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,358.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,345.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,320.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,563.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,087.90
|
| Rate for Payer: Cash Price |
$1,087.90
|
| Rate for Payer: Cash Price |
$1,087.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,285.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,345.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,320.00
|
| Rate for Payer: Dignity Health Senior |
$7,563.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,563.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,224.38
|
| Rate for Payer: Heritage Provider Network Senior |
$9,303.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$566.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,563.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$943.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$358.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,698.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$494.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,530.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,530.19
|
| Rate for Payer: Multiplan Commercial |
$1,483.50
|
| 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 |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,345.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,320.00
|
| Rate for Payer: Vantage Medical Group Senior |
$7,563.64
|
|
|
HC EGD W/TRNSMRL DRNG/ PSEUDOCYST
|
Facility
|
IP
|
$1,978.00
|
|
|
Service Code
|
CPT 43240
|
| Hospital Charge Code |
906743240
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$358.02 |
| Max. Negotiated Rate |
$1,483.50 |
| Rate for Payer: Adventist Health Commercial |
$395.60
|
| Rate for Payer: Cash Price |
$1,087.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,339.11
|
| Rate for Payer: Heritage Provider Network Senior |
$1,339.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$358.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$494.50
|
| Rate for Payer: Multiplan Commercial |
$1,483.50
|
|
|
HC EGD W/US GUID INTRMRL
|
Facility
|
OP
|
$3,912.00
|
|
|
Service Code
|
CPT 43242
|
| Hospital Charge Code |
906743242
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$782.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,687.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,410.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,151.60
|
| Rate for Payer: Cash Price |
$2,151.60
|
| Rate for Payer: Cash Price |
$2,151.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,542.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,651.35
|
| Rate for Payer: Dignity Health Senior |
$2,410.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,410.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,421.53
|
| Rate for Payer: Heritage Provider Network Senior |
$2,964.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$406.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,866.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$708.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,771.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$978.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,037.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,037.00
|
| Rate for Payer: Multiplan Commercial |
$2,934.00
|
| 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 |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,410.32
|
|
|
HC EGD W/US GUID INTRMRL
|
Facility
|
IP
|
$3,912.00
|
|
|
Service Code
|
CPT 43242
|
| Hospital Charge Code |
906743242
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$708.07 |
| Max. Negotiated Rate |
$2,934.00 |
| Rate for Payer: Adventist Health Commercial |
$782.40
|
| Rate for Payer: Cash Price |
$2,151.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,648.42
|
| Rate for Payer: Heritage Provider Network Senior |
$2,648.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$708.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$978.00
|
| Rate for Payer: Multiplan Commercial |
$2,934.00
|
|
