|
HC EGD W ENDO MUCOSAL RESECTION
|
Facility
|
OP
|
$1,492.00
|
|
|
Service Code
|
CPT 43254
|
| Hospital Charge Code |
906743254
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$270.05 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$298.40
|
| Rate for Payer: Adventist Health Commercial |
$285.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$880.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$922.06
|
| 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 |
$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 |
$671.40
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Cash Price |
$641.25
|
| Rate for Payer: Cash Price |
$641.25
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Cash Price |
$641.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$926.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$969.80
|
| 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 |
$923.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$882.08
|
| 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 |
$679.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$711.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$270.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$257.93
|
| 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 |
$356.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$373.00
|
| 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 |
$1,119.00
|
| Rate for Payer: Multiplan Commercial |
$1,068.75
|
| 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 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 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: Aetna of CA Non-Gatekeeper |
$917.70
|
| Rate for Payer: Cash Price |
$641.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$964.73
|
| Rate for Payer: Heritage Provider Network Senior |
$964.73
|
| Rate for Payer: Kaiser Foundation Hospitals 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 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: Aetna of CA Non-Gatekeeper |
$2,427.88
|
| Rate for Payer: Cash Price |
$1,696.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,552.29
|
| Rate for Payer: Heritage Provider Network Senior |
$2,552.29
|
| Rate for Payer: Kaiser Foundation Hospitals 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/ENDO US EXAM
|
Facility
|
OP
|
$3,770.00
|
|
|
Service Code
|
CPT 43259
|
| Hospital Charge Code |
906743259
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$754.00
|
| Rate for Payer: Adventist Health Commercial |
$687.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,124.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,329.86
|
| 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 |
$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 |
$1,696.50
|
| Rate for Payer: Cash Price |
$1,696.50
|
| Rate for Payer: Cash Price |
$1,547.10
|
| Rate for Payer: Cash Price |
$1,547.10
|
| Rate for Payer: Cash Price |
$1,696.50
|
| Rate for Payer: Cash Price |
$1,547.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,234.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,450.50
|
| 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 |
$2,333.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,128.12
|
| 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 |
$1,639.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,798.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$682.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$622.28
|
| 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 |
$859.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$942.50
|
| 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 |
$2,827.50
|
| Rate for Payer: Multiplan Commercial |
$2,578.50
|
| 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 |
$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 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 W INJ SCLER ESO
|
Facility
|
OP
|
$4,035.00
|
|
|
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 |
$807.00
|
| Rate for Payer: Adventist Health Commercial |
$625.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,932.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,493.63
|
| 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 |
$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 |
$1,815.75
|
| Rate for Payer: Cash Price |
$1,815.75
|
| Rate for Payer: Cash Price |
$1,407.15
|
| Rate for Payer: Cash Price |
$1,407.15
|
| Rate for Payer: Cash Price |
$1,815.75
|
| Rate for Payer: Cash Price |
$1,407.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,032.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,622.75
|
| 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 |
$2,497.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,935.61
|
| 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 |
$1,491.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,924.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$730.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$565.99
|
| 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 |
$781.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,008.75
|
| 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 |
$3,026.25
|
| Rate for Payer: Multiplan Commercial |
$2,345.25
|
| 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 |
$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 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 W INJ SCLER ESO
|
Facility
|
OP
|
$3,127.00
|
|
|
Service Code
|
CPT 43243
|
| Hospital Charge Code |
906743243
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$565.99 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$625.40
|
| Rate for Payer: Adventist Health Commercial |
$807.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,493.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,932.49
|
| 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 |
$5,158.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,485.33
|
| Rate for Payer: Blue Shield of California Commercial |
$1,916.62
|
| Rate for Payer: Blue Shield of California EPN |
$1,182.01
|
| Rate for Payer: Blue Shield of California EPN |
$1,525.23
|
| Rate for Payer: Cash Price |
$1,815.75
|
| Rate for Payer: Cash Price |
$1,815.75
|
| Rate for Payer: Cash Price |
$1,407.15
|
| Rate for Payer: Cash Price |
$1,815.75
|
| Rate for Payer: Cash Price |
$1,407.15
|
| Rate for Payer: Cash Price |
$1,407.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,032.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,622.75
|
| 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 |
$2,731.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,116.98
|
| Rate for Payer: Heritage Provider Network Senior |
$2,731.70
|
| Rate for Payer: Heritage Provider Network Senior |
$2,116.98
|
| 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 |
$1,924.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,491.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$730.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$565.99
|
| 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 |
$1,008.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$781.75
|
| 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 |
$3,026.25
|
| Rate for Payer: Multiplan Commercial |
$2,345.25
|
| Rate for Payer: Multiplan WC |
$3,840.40
|
| Rate for Payer: Multiplan WC |
$3,840.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,876.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,421.00
|
| Rate for Payer: TriValley Medical Group Senior |
$2,421.00
|
| Rate for Payer: TriValley Medical Group Senior |
$1,876.20
|
| 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 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 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: Aetna of CA Non-Gatekeeper |
$2,598.54
|
| Rate for Payer: Cash Price |
$1,815.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,731.70
|
| Rate for Payer: Heritage Provider Network Senior |
$2,731.70
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
450
|
| Min. Negotiated Rate |
$730.34 |
| Max. Negotiated Rate |
$3,026.25 |
| Rate for Payer: Adventist Health Commercial |
$807.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,598.54
|
| Rate for Payer: Cash Price |
$1,815.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,731.70
|
| Rate for Payer: Heritage Provider Network Senior |
$2,731.70
|
| Rate for Payer: Kaiser Foundation Hospitals 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/INSRT GIDE WIRE
|
Facility
|
OP
|
$2,989.00
|
|
|
Service Code
|
CPT 43248
|
| Hospital Charge Code |
906743248
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$597.80
|
| Rate for Payer: Adventist Health Commercial |
$528.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,633.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,847.20
|
| 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 |
$1,345.05
|
| Rate for Payer: Cash Price |
$1,345.05
|
| Rate for Payer: Cash Price |
$1,189.80
|
| Rate for Payer: Cash Price |
$1,189.80
|
| Rate for Payer: Cash Price |
$1,345.05
|
| Rate for Payer: Cash Price |
$1,189.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,718.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,942.85
|
| 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 |
$1,850.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,636.64
|
| 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 |
$1,261.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,425.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$541.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$478.56
|
| 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 |
$661.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$747.25
|
| 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 |
$2,241.75
|
| Rate for Payer: Multiplan Commercial |
$1,983.00
|
| 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 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: Aetna of CA Non-Gatekeeper |
$1,924.92
|
| Rate for Payer: Cash Price |
$1,345.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,023.55
|
| Rate for Payer: Heritage Provider Network Senior |
$2,023.55
|
| Rate for Payer: Kaiser Foundation Hospitals 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/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: Aetna of CA Non-Gatekeeper |
$2,086.56
|
| Rate for Payer: Cash Price |
$1,458.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,193.48
|
| Rate for Payer: Heritage Provider Network Senior |
$2,193.48
|
| Rate for Payer: Kaiser Foundation Hospitals 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/REMOVAL FOREIGN BODY
|
Facility
|
OP
|
$3,240.00
|
|
|
Service Code
|
CPT 43247
|
| Hospital Charge Code |
906743247
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$648.00
|
| Rate for Payer: Adventist Health Commercial |
$590.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,825.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,002.32
|
| 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 |
$1,458.00
|
| Rate for Payer: Cash Price |
$1,458.00
|
| Rate for Payer: Cash Price |
$1,329.30
|
| Rate for Payer: Cash Price |
$1,329.30
|
| Rate for Payer: Cash Price |
$1,458.00
|
| Rate for Payer: Cash Price |
$1,329.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,920.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,106.00
|
| 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 |
$2,005.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,828.53
|
| 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 |
$1,409.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,545.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$586.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$534.67
|
| 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 |
$738.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$810.00
|
| 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 |
$2,430.00
|
| Rate for Payer: Multiplan Commercial |
$2,215.50
|
| 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 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 |
$356.39 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$393.80
|
| Rate for Payer: Adventist Health Commercial |
$379.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,172.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,216.84
|
| 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 |
$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 |
$886.05
|
| Rate for Payer: Cash Price |
$886.05
|
| Rate for Payer: Cash Price |
$854.10
|
| Rate for Payer: Cash Price |
$854.10
|
| Rate for Payer: Cash Price |
$886.05
|
| Rate for Payer: Cash Price |
$854.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,233.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,279.85
|
| 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 |
$1,218.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,174.86
|
| 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 |
$905.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$939.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$356.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$343.54
|
| 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 |
$474.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$492.25
|
| 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 |
$1,476.75
|
| Rate for Payer: Multiplan Commercial |
$1,423.50
|
| 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 |
$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 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 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: Aetna of CA Non-Gatekeeper |
$1,268.04
|
| Rate for Payer: Cash Price |
$886.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,333.01
|
| Rate for Payer: Heritage Provider Network Senior |
$1,333.01
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$629.60
|
| Rate for Payer: Adventist Health Commercial |
$573.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,773.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,945.46
|
| 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 |
$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 |
$1,416.60
|
| Rate for Payer: Cash Price |
$1,416.60
|
| Rate for Payer: Cash Price |
$1,291.05
|
| Rate for Payer: Cash Price |
$1,291.05
|
| Rate for Payer: Cash Price |
$1,416.60
|
| Rate for Payer: Cash Price |
$1,291.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,864.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,046.20
|
| 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 |
$1,948.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,775.91
|
| 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 |
$1,368.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,501.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$569.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$519.29
|
| 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 |
$717.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$787.00
|
| 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 |
$2,361.00
|
| Rate for Payer: Multiplan Commercial |
$2,151.75
|
| 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 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 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: Aetna of CA Non-Gatekeeper |
$2,027.31
|
| Rate for Payer: Cash Price |
$1,416.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,131.20
|
| Rate for Payer: Heritage Provider Network Senior |
$2,131.20
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
$3,096.00
|
|
|
Service Code
|
CPT 43240
|
| Hospital Charge Code |
906743240
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$11,712.28 |
| Rate for Payer: Adventist Health Commercial |
$619.20
|
| Rate for Payer: Adventist Health Commercial |
$395.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,222.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,913.33
|
| 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 |
$1,393.20
|
| Rate for Payer: Cash Price |
$1,393.20
|
| Rate for Payer: Cash Price |
$890.10
|
| Rate for Payer: Cash Price |
$890.10
|
| Rate for Payer: Cash Price |
$1,393.20
|
| Rate for Payer: Cash Price |
$890.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,285.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,012.40
|
| 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 |
$1,916.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,224.38
|
| 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 |
$943.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,476.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$560.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$358.02
|
| 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 |
$494.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$774.00
|
| 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 |
$2,322.00
|
| Rate for Payer: Multiplan Commercial |
$1,483.50
|
| 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 |
$7,454.00
|
| 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: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| 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 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: Aetna of CA Non-Gatekeeper |
$1,273.83
|
| Rate for Payer: Cash Price |
$890.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,339.11
|
| Rate for Payer: Heritage Provider Network Senior |
$1,339.11
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
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: Aetna of CA Non-Gatekeeper |
$2,519.33
|
| Rate for Payer: Cash Price |
$1,760.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,648.42
|
| Rate for Payer: Heritage Provider Network Senior |
$2,648.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$708.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$978.00
|
| Rate for Payer: Multiplan Commercial |
$2,934.00
|
|
|
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 |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$782.40
|
| Rate for Payer: Adventist Health Commercial |
$713.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,203.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,417.62
|
| 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 |
$1,760.40
|
| Rate for Payer: Cash Price |
$1,760.40
|
| Rate for Payer: Cash Price |
$1,604.70
|
| Rate for Payer: Cash Price |
$1,604.70
|
| Rate for Payer: Cash Price |
$1,760.40
|
| Rate for Payer: Cash Price |
$1,604.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,317.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,542.80
|
| 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 |
$2,421.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,207.35
|
| 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 |
$1,700.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,866.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$708.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$645.45
|
| 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 |
$891.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$978.00
|
| 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 |
$2,934.00
|
| Rate for Payer: Multiplan Commercial |
$2,674.50
|
| 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 |
$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 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 EGFR
|
Facility
|
OP
|
$356.00
|
|
|
Service Code
|
CPT 81235
|
| Hospital Charge Code |
903800314
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$64.44 |
| Max. Negotiated Rate |
$486.87 |
| Rate for Payer: Adventist Health Commercial |
$71.20
|
| Rate for Payer: Adventist Health Commercial |
$98.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$303.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$220.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$486.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$486.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$357.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$357.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$324.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$324.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.40
|
| Rate for Payer: Cash Price |
$220.95
|
| Rate for Payer: Cash Price |
$220.95
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$319.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$231.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$486.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$486.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$357.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$357.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$324.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$324.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$231.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$319.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$324.58
|
| Rate for Payer: EPIC Health Plan Medicare |
$324.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$220.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$303.93
|
| Rate for Payer: Heritage Provider Network Senior |
$220.36
|
| Rate for Payer: Heritage Provider Network Senior |
$303.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$324.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$324.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$234.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$169.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$64.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$88.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$373.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$373.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$434.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$434.94
|
| Rate for Payer: Multiplan Commercial |
$368.25
|
| Rate for Payer: Multiplan Commercial |
$267.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$324.58
|
| Rate for Payer: TriValley Medical Group Commercial |
$324.58
|
| Rate for Payer: TriValley Medical Group Senior |
$324.58
|
| Rate for Payer: TriValley Medical Group Senior |
$324.58
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$350.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$350.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$350.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$350.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$486.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$486.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$357.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$357.04
|
| Rate for Payer: Vantage Medical Group Senior |
$324.58
|
| Rate for Payer: Vantage Medical Group Senior |
$324.58
|
|
|
HC EGFR
|
Facility
|
IP
|
$491.00
|
|
|
Service Code
|
CPT 81235
|
| Hospital Charge Code |
903800314
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$88.87 |
| Max. Negotiated Rate |
$368.25 |
| Rate for Payer: Adventist Health Commercial |
$98.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$316.20
|
| Rate for Payer: Cash Price |
$220.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$332.41
|
| Rate for Payer: Heritage Provider Network Senior |
$332.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$88.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.75
|
| Rate for Payer: Multiplan Commercial |
$368.25
|
|
|
HC EKOS THROMLYSIS CATH
|
Facility
|
OP
|
$6,704.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,340.80 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$1,340.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,143.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,698.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,687.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,028.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,695.01
|
| Rate for Payer: Blue Shield of California EPN |
$2,695.01
|
| Rate for Payer: Cash Price |
$3,016.80
|
| Rate for Payer: Cash Price |
$3,016.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,083.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,698.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,698.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,698.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,290.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,103.95
|
| Rate for Payer: Heritage Provider Network Senior |
$3,103.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,352.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,352.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,352.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,676.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,692.80
|
| Rate for Payer: Multiplan Commercial |
$5,028.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,422.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,219.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,698.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,698.40
|
| Rate for Payer: Vantage Medical Group Senior |
$5,698.40
|
|
|
HC EKOS THROMLYSIS CATH
|
Facility
|
IP
|
$6,704.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,340.80 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$1,340.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,317.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,695.01
|
| Rate for Payer: Blue Shield of California EPN |
$2,695.01
|
| Rate for Payer: Cash Price |
$3,016.80
|
| Rate for Payer: Cash Price |
$3,016.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,083.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,620.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,103.95
|
| Rate for Payer: Heritage Provider Network Senior |
$3,103.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,352.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,352.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,352.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,676.00
|
| Rate for Payer: Multiplan Commercial |
$5,028.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,422.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,219.69
|
|
|
HC ELASTOPLAST
|
Facility
|
OP
|
$12.00
|
|
| Hospital Charge Code |
909001032
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$10.20 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7.32
|
| Rate for Payer: Blue Shield of California EPN |
$5.86
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.43
|
| Rate for Payer: Heritage Provider Network Senior |
$7.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.40
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10.20
|
|
