|
HC ED EVAL & MGMT HIGH
|
Facility
|
IP
|
$4,944.00
|
|
|
Service Code
|
CPT 99285
|
| Hospital Charge Code |
900509285
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$894.86 |
| Max. Negotiated Rate |
$3,708.00 |
| Rate for Payer: Adventist Health Commercial |
$988.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,183.94
|
| Rate for Payer: Cash Price |
$2,224.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,347.09
|
| Rate for Payer: Heritage Provider Network Senior |
$3,347.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$894.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,236.00
|
| Rate for Payer: Multiplan Commercial |
$3,708.00
|
|
|
HC ED EVAL & MGMT HIGH
|
Facility
|
OP
|
$4,944.00
|
|
|
Service Code
|
CPT 99285
|
| Hospital Charge Code |
900509285
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$765.95 |
| Max. Negotiated Rate |
$3,708.00 |
| Rate for Payer: Adventist Health Commercial |
$988.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,055.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,148.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$842.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$765.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,992.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,348.40
|
| Rate for Payer: Blue Shield of California EPN |
$1,868.83
|
| Rate for Payer: Cash Price |
$2,224.80
|
| Rate for Payer: Cash Price |
$2,224.80
|
| Rate for Payer: Cash Price |
$2,224.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,213.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,148.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$842.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$765.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,213.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$765.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,347.09
|
| Rate for Payer: Heritage Provider Network Senior |
$3,347.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$765.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,358.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$894.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$880.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,236.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,026.37
|
| Rate for Payer: Multiplan Commercial |
$3,708.00
|
| Rate for Payer: Multiplan WC |
$1,241.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,966.40
|
| Rate for Payer: TriValley Medical Group Senior |
$2,966.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,148.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$842.54
|
| Rate for Payer: Vantage Medical Group Senior |
$765.95
|
|
|
HC ED EVAL & MGMT LOW
|
Facility
|
IP
|
$3,074.00
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
900509283
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$556.39 |
| Max. Negotiated Rate |
$2,305.50 |
| Rate for Payer: Adventist Health Commercial |
$614.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,979.66
|
| Rate for Payer: Cash Price |
$1,383.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,081.10
|
| Rate for Payer: Heritage Provider Network Senior |
$2,081.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$556.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$768.50
|
| Rate for Payer: Multiplan Commercial |
$2,305.50
|
|
|
HC ED EVAL & MGMT LOW
|
Facility
|
OP
|
$3,074.00
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
900509283
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$351.09 |
| Max. Negotiated Rate |
$2,305.50 |
| Rate for Payer: Adventist Health Commercial |
$614.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,899.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$526.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$386.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$351.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,992.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,460.15
|
| Rate for Payer: Blue Shield of California EPN |
$1,161.97
|
| Rate for Payer: Cash Price |
$1,383.30
|
| Rate for Payer: Cash Price |
$1,383.30
|
| Rate for Payer: Cash Price |
$1,383.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,998.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$526.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$386.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$351.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,998.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$351.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,081.10
|
| Rate for Payer: Heritage Provider Network Senior |
$2,081.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$351.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,466.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$556.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$403.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$768.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$470.46
|
| Rate for Payer: Multiplan Commercial |
$2,305.50
|
| Rate for Payer: Multiplan WC |
$560.55
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,844.40
|
| Rate for Payer: TriValley Medical Group Senior |
$1,844.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$526.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$386.20
|
| Rate for Payer: Vantage Medical Group Senior |
$351.09
|
|
|
HC ED EVAL & MGMT MINOR
|
Facility
|
IP
|
$1,835.00
|
|
|
Service Code
|
CPT 99282
|
| Hospital Charge Code |
900509282
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$332.13 |
| Max. Negotiated Rate |
$1,376.25 |
| Rate for Payer: Adventist Health Commercial |
$367.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,181.74
|
| Rate for Payer: Cash Price |
$825.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,242.30
|
| Rate for Payer: Heritage Provider Network Senior |
$1,242.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$332.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$458.75
|
| Rate for Payer: Multiplan Commercial |
$1,376.25
|
|
|
HC ED EVAL & MGMT MINOR
|
Facility
|
OP
|
$1,835.00
|
|
|
Service Code
|
CPT 99282
|
| Hospital Charge Code |
900509282
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$197.48 |
| Max. Negotiated Rate |
$1,992.00 |
| Rate for Payer: Adventist Health Commercial |
$367.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,134.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$296.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$217.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$197.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,992.00
|
| Rate for Payer: Blue Shield of California Commercial |
$871.62
|
| Rate for Payer: Blue Shield of California EPN |
$693.63
|
| Rate for Payer: Cash Price |
$825.75
|
| Rate for Payer: Cash Price |
$825.75
|
| Rate for Payer: Cash Price |
$825.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,192.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$296.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$217.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$197.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,192.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$197.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,242.30
|
| Rate for Payer: Heritage Provider Network Senior |
$1,242.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$197.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$875.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$332.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$227.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$458.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$264.62
|
| Rate for Payer: Multiplan Commercial |
$1,376.25
|
| Rate for Payer: Multiplan WC |
$320.59
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,101.00
|
| Rate for Payer: TriValley Medical Group Senior |
$1,101.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$296.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$217.23
|
| Rate for Payer: Vantage Medical Group Senior |
$197.48
|
|
|
HC ED EVAL & MGMT MODERATE
|
Facility
|
OP
|
$4,500.00
|
|
|
Service Code
|
CPT 99284
|
| Hospital Charge Code |
900509284
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$536.67 |
| Max. Negotiated Rate |
$3,375.00 |
| Rate for Payer: Adventist Health Commercial |
$900.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,781.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$805.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$590.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$536.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,992.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,137.50
|
| Rate for Payer: Blue Shield of California EPN |
$1,701.00
|
| Rate for Payer: Cash Price |
$2,025.00
|
| Rate for Payer: Cash Price |
$2,025.00
|
| Rate for Payer: Cash Price |
$2,025.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,925.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$805.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$590.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$536.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,925.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$536.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,046.50
|
| Rate for Payer: Heritage Provider Network Senior |
$3,046.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$536.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,146.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$814.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$617.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,125.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$719.14
|
| Rate for Payer: Multiplan Commercial |
$3,375.00
|
| Rate for Payer: Multiplan WC |
$862.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,700.00
|
| Rate for Payer: TriValley Medical Group Senior |
$2,700.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$805.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$590.34
|
| Rate for Payer: Vantage Medical Group Senior |
$536.67
|
|
|
HC ED EVAL & MGMT MODERATE
|
Facility
|
IP
|
$4,500.00
|
|
|
Service Code
|
CPT 99284
|
| Hospital Charge Code |
900509284
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$814.50 |
| Max. Negotiated Rate |
$3,375.00 |
| Rate for Payer: Adventist Health Commercial |
$900.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,898.00
|
| Rate for Payer: Cash Price |
$2,025.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,046.50
|
| Rate for Payer: Heritage Provider Network Senior |
$3,046.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$814.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,125.00
|
| Rate for Payer: Multiplan Commercial |
$3,375.00
|
|
|
HC EEG EXTENDED MONITORING LT 1 HR
|
Facility
|
OP
|
$2,255.00
|
|
|
Service Code
|
CPT 95812
|
| Hospital Charge Code |
900600201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$277.71 |
| Max. Negotiated Rate |
$1,992.00 |
| Rate for Payer: Adventist Health Commercial |
$451.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,393.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,992.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,071.12
|
| Rate for Payer: Blue Shield of California EPN |
$852.39
|
| Rate for Payer: Cash Price |
$1,014.75
|
| Rate for Payer: Cash Price |
$1,014.75
|
| Rate for Payer: Cash Price |
$1,014.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,465.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$416.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$305.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$277.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,465.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$277.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,526.63
|
| Rate for Payer: Heritage Provider Network Senior |
$1,526.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$277.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,075.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$408.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$319.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$563.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$372.13
|
| Rate for Payer: Multiplan Commercial |
$1,691.25
|
| Rate for Payer: Multiplan WC |
$630.41
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,353.00
|
| Rate for Payer: TriValley Medical Group Senior |
$1,353.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Vantage Medical Group Senior |
$277.71
|
|
|
HC EEG EXTENDED MONITORING LT 1 HR
|
Facility
|
IP
|
$2,255.00
|
|
|
Service Code
|
CPT 95812
|
| Hospital Charge Code |
900600201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$408.15 |
| Max. Negotiated Rate |
$1,691.25 |
| Rate for Payer: Adventist Health Commercial |
$451.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,452.22
|
| Rate for Payer: Cash Price |
$1,014.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,526.63
|
| Rate for Payer: Heritage Provider Network Senior |
$1,526.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$408.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$563.75
|
| Rate for Payer: Multiplan Commercial |
$1,691.25
|
|
|
HC EGD BLLN DILA ESOPH 30MM OR GT
|
Facility
|
IP
|
$2,153.00
|
|
|
Service Code
|
CPT 43233
|
| Hospital Charge Code |
906743233
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$389.69 |
| Max. Negotiated Rate |
$1,614.75 |
| Rate for Payer: Adventist Health Commercial |
$430.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,386.53
|
| Rate for Payer: Cash Price |
$968.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,457.58
|
| Rate for Payer: Heritage Provider Network Senior |
$1,457.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$389.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$538.25
|
| Rate for Payer: Multiplan Commercial |
$1,614.75
|
|
|
HC EGD BLLN DILA ESOPH 30MM OR GT
|
Facility
|
OP
|
$2,253.00
|
|
|
Service Code
|
CPT 43233
|
| Hospital Charge Code |
906743233
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$407.79 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Adventist Health Commercial |
$450.60
|
| Rate for Payer: Adventist Health Commercial |
$430.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,330.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,392.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| 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: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,013.85
|
| Rate for Payer: Cash Price |
$1,013.85
|
| Rate for Payer: Cash Price |
$968.85
|
| Rate for Payer: Cash Price |
$968.85
|
| Rate for Payer: Cash Price |
$1,013.85
|
| Rate for Payer: Cash Price |
$968.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,399.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,464.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,468.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,468.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,394.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,332.71
|
| Rate for Payer: Heritage Provider Network Senior |
$3,035.69
|
| Rate for Payer: Heritage Provider Network Senior |
$3,035.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,026.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,074.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$407.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$389.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,838.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,838.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$538.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$563.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$1,689.75
|
| Rate for Payer: Multiplan Commercial |
$1,614.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
|
|
HC EGD DIAG W/ OR W/O COLLECTION
|
Facility
|
OP
|
$4,487.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
902100084
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$812.15 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$897.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,772.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,131.32
|
| Rate for Payer: Blue Shield of California EPN |
$1,696.09
|
| Rate for Payer: Cash Price |
$2,019.15
|
| Rate for Payer: Cash Price |
$2,019.15
|
| Rate for Payer: Cash Price |
$2,019.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,916.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,166.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,037.70
|
| Rate for Payer: Heritage Provider Network Senior |
$3,037.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,140.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$812.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,341.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,121.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$3,365.25
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,692.20
|
| Rate for Payer: TriValley Medical Group Senior |
$2,692.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC EGD DIAG W/ OR W/O COLLECTION
|
Facility
|
IP
|
$3,288.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
906743235
|
|
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: Aetna of CA Non-Gatekeeper |
$2,117.47
|
| Rate for Payer: Cash Price |
$1,479.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,225.98
|
| Rate for Payer: Heritage Provider Network Senior |
$2,225.98
|
| Rate for Payer: Kaiser Foundation Hospitals 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 DIAG W/ OR W/O COLLECTION
|
Facility
|
OP
|
$3,288.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
906743235
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$657.60
|
| Rate for Payer: Adventist Health Commercial |
$599.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,852.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,031.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| 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: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,479.60
|
| Rate for Payer: Cash Price |
$1,479.60
|
| Rate for Payer: Cash Price |
$1,349.10
|
| Rate for Payer: Cash Price |
$1,349.10
|
| Rate for Payer: Cash Price |
$1,479.60
|
| Rate for Payer: Cash Price |
$1,349.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,948.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,137.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,166.53
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,166.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,035.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,855.76
|
| Rate for Payer: Heritage Provider Network Senior |
$1,434.83
|
| Rate for Payer: Heritage Provider Network Senior |
$1,434.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,430.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,568.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$595.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$542.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,341.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,341.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$749.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$822.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$2,466.00
|
| Rate for Payer: Multiplan Commercial |
$2,248.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC EGD DIAG W/ OR W/O COLLECTION
|
Facility
|
IP
|
$4,487.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
902100084
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$812.15 |
| Max. Negotiated Rate |
$3,365.25 |
| Rate for Payer: Adventist Health Commercial |
$897.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,889.63
|
| Rate for Payer: Cash Price |
$2,019.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,037.70
|
| Rate for Payer: Heritage Provider Network Senior |
$3,037.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$812.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,121.75
|
| Rate for Payer: Multiplan Commercial |
$3,365.25
|
|
|
HC EGD DIAG W/SUBMUC INJ ANY SUBSTANCE
|
Facility
|
IP
|
$3,414.00
|
|
|
Service Code
|
CPT 43236
|
| Hospital Charge Code |
906743236
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$617.93 |
| Max. Negotiated Rate |
$2,560.50 |
| Rate for Payer: Adventist Health Commercial |
$682.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,198.62
|
| Rate for Payer: Cash Price |
$1,536.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,311.28
|
| Rate for Payer: Heritage Provider Network Senior |
$2,311.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$617.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$853.50
|
| Rate for Payer: Multiplan Commercial |
$2,560.50
|
|
|
HC EGD DIAG W/SUBMUC INJ ANY SUBSTANCE
|
Facility
|
OP
|
$3,414.00
|
|
|
Service Code
|
CPT 43236
|
| Hospital Charge Code |
906743236
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$682.80
|
| Rate for Payer: Adventist Health Commercial |
$599.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,852.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,109.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| 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: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,536.30
|
| Rate for Payer: Cash Price |
$1,536.30
|
| Rate for Payer: Cash Price |
$1,349.10
|
| Rate for Payer: Cash Price |
$1,349.10
|
| Rate for Payer: Cash Price |
$1,536.30
|
| Rate for Payer: Cash Price |
$1,349.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,948.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,219.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,166.53
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,166.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,113.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,855.76
|
| Rate for Payer: Heritage Provider Network Senior |
$1,434.83
|
| Rate for Payer: Heritage Provider Network Senior |
$1,434.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,430.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,628.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$617.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$542.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,341.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,341.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$749.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$853.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$2,560.50
|
| Rate for Payer: Multiplan Commercial |
$2,248.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC EGD DIAG W WO COLLECTION
|
Facility
|
OP
|
$3,288.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
900501432
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$595.13 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$657.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,031.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,561.80
|
| Rate for Payer: Blue Shield of California EPN |
$1,242.86
|
| Rate for Payer: Cash Price |
$1,479.60
|
| Rate for Payer: Cash Price |
$1,479.60
|
| Rate for Payer: Cash Price |
$1,479.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,137.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,166.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,225.98
|
| Rate for Payer: Heritage Provider Network Senior |
$2,225.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,568.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$595.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,341.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$822.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$2,466.00
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,972.80
|
| Rate for Payer: TriValley Medical Group Senior |
$1,972.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC EGD DIAG W WO COLLECTION
|
Facility
|
IP
|
$3,288.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
900501432
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$595.13 |
| Max. Negotiated Rate |
$2,466.00 |
| Rate for Payer: Adventist Health Commercial |
$657.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,117.47
|
| Rate for Payer: Cash Price |
$1,479.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,225.98
|
| Rate for Payer: Heritage Provider Network Senior |
$2,225.98
|
| Rate for Payer: Kaiser Foundation Hospitals 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 ENDO STENT PLACEMENT
|
Facility
|
IP
|
$3,671.00
|
|
|
Service Code
|
CPT 43266
|
| Hospital Charge Code |
900100017
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$664.45 |
| Max. Negotiated Rate |
$2,753.25 |
| Rate for Payer: Adventist Health Commercial |
$734.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,364.12
|
| Rate for Payer: Cash Price |
$1,651.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,485.27
|
| Rate for Payer: Heritage Provider Network Senior |
$2,485.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$664.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$917.75
|
| Rate for Payer: Multiplan Commercial |
$2,753.25
|
|
|
HC EGD ENDO STENT PLACEMENT
|
Facility
|
OP
|
$4,593.00
|
|
|
Service Code
|
CPT 43266
|
| Hospital Charge Code |
900100017
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$11,712.28 |
| Rate for Payer: Adventist Health Commercial |
$918.60
|
| Rate for Payer: Adventist Health Commercial |
$734.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,268.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,838.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,589.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,589.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,808.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,808.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| 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: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,066.85
|
| Rate for Payer: Cash Price |
$2,066.85
|
| Rate for Payer: Cash Price |
$1,651.95
|
| Rate for Payer: Cash Price |
$1,651.95
|
| Rate for Payer: Cash Price |
$2,066.85
|
| Rate for Payer: Cash Price |
$1,651.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,386.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,985.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,589.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,589.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,808.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,808.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,808.19
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,808.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,843.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,272.35
|
| Rate for Payer: Heritage Provider Network Senior |
$9,604.07
|
| Rate for Payer: Heritage Provider Network Senior |
$9,604.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,808.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,808.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,751.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,190.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$831.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$664.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,979.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,979.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$917.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,148.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,462.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,462.97
|
| Rate for Payer: Multiplan Commercial |
$3,444.75
|
| Rate for Payer: Multiplan Commercial |
$2,753.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,589.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,589.01
|
| Rate for Payer: Vantage Medical Group Senior |
$7,808.19
|
| Rate for Payer: Vantage Medical Group Senior |
$7,808.19
|
|
|
HC EGD FLXBL TRNSORL W DPLMNT OF IG BRTRC BLLN
|
Facility
|
OP
|
$5,247.00
|
|
|
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 |
$1,049.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,242.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| 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 |
$2,361.15
|
| Rate for Payer: Cash Price |
$2,361.15
|
| Rate for Payer: Cash Price |
$2,361.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,410.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,468.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,247.89
|
| Rate for Payer: Heritage Provider Network Senior |
$3,035.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,502.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$949.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,838.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,311.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$3,935.25
|
| 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 |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
|
|
HC EGD FLXBL TRNSORL W DPLMNT OF IG BRTRC BLLN
|
Facility
|
IP
|
$5,247.00
|
|
|
Service Code
|
CPT 43290
|
| Hospital Charge Code |
906743290
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$949.71 |
| Max. Negotiated Rate |
$3,935.25 |
| Rate for Payer: Adventist Health Commercial |
$1,049.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,379.07
|
| Rate for Payer: Cash Price |
$2,361.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,552.22
|
| Rate for Payer: Heritage Provider Network Senior |
$3,552.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$949.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,311.75
|
| Rate for Payer: Multiplan Commercial |
$3,935.25
|
|
|
HC EGD FLXBL TRNSORL W RMVL OF IG BRTRC BLLN
|
Facility
|
OP
|
$2,487.00
|
|
|
Service Code
|
CPT 43291
|
| Hospital Charge Code |
906743291
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$497.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,536.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| 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 |
$1,119.15
|
| Rate for Payer: Cash Price |
$1,119.15
|
| Rate for Payer: Cash Price |
$1,119.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,616.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,166.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,539.45
|
| Rate for Payer: Heritage Provider Network Senior |
$1,434.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,186.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$450.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,341.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$621.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$1,865.25
|
| 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 |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
