|
HC EGD DIAG W/ OR W/O COLLECTION
|
Facility
|
IP
|
$4,487.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
906743235
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$897.40 |
| Max. Negotiated Rate |
$3,813.95 |
| Rate for Payer: Adventist Health Commercial |
$897.40
|
| Rate for Payer: Cash Price |
$2,019.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,140.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,794.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,794.80
|
| Rate for Payer: Galaxy Health WC |
$3,813.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,692.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,849.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,647.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,076.88
|
| Rate for Payer: Multiplan Commercial |
$3,589.60
|
| Rate for Payer: Networks By Design Commercial |
$2,916.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,813.95
|
|
|
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 |
$897.40 |
| Max. Negotiated Rate |
$3,813.95 |
| Rate for Payer: Adventist Health Commercial |
$897.40
|
| Rate for Payer: Cash Price |
$2,019.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,140.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,794.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,794.80
|
| Rate for Payer: Galaxy Health WC |
$3,813.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,692.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,849.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,647.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,076.88
|
| Rate for Payer: Multiplan Commercial |
$3,589.60
|
| Rate for Payer: Networks By Design Commercial |
$2,916.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,813.95
|
|
|
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 |
$425.83 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$897.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| 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 |
$6,716.00
|
| 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 |
$2,871.68
|
| Rate for Payer: Cigna of CA PPO |
$3,320.38
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,140.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: Galaxy Health WC |
$3,813.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,692.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,849.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$425.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,254.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,076.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,469.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$3,589.60
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Networks By Design Commercial |
$2,916.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,813.95
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,692.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,243.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,243.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,243.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,243.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| 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/SUBMUC INJ ANY SUBSTANCE
|
Facility
|
OP
|
$4,487.00
|
|
|
Service Code
|
CPT 43236
|
| Hospital Charge Code |
906743236
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$408.42 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$897.40
|
| Rate for Payer: Adventist Health Commercial |
$599.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| 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 |
$6,716.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Cash Price |
$1,349.10
|
| Rate for Payer: Cash Price |
$2,019.15
|
| Rate for Payer: Cash Price |
$2,019.15
|
| Rate for Payer: Cash Price |
$1,349.10
|
| Rate for Payer: Cash Price |
$1,349.10
|
| Rate for Payer: Cash Price |
$2,019.15
|
| Rate for Payer: Cigna of CA HMO |
$2,871.68
|
| Rate for Payer: Cigna of CA HMO |
$1,918.72
|
| Rate for Payer: Cigna of CA PPO |
$2,218.52
|
| Rate for Payer: Cigna of CA PPO |
$3,320.38
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,140.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,098.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: Galaxy Health WC |
$3,813.95
|
| Rate for Payer: Galaxy Health WC |
$2,548.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,798.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,692.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$408.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$408.42
|
| 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/Self Funded |
$2,849.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,903.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$461.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$461.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$719.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,076.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,469.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,469.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,563.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$2,398.40
|
| Rate for Payer: Multiplan Commercial |
$3,589.60
|
| Rate for Payer: Networks By Design Commercial |
$2,916.55
|
| Rate for Payer: Networks By Design Commercial |
$1,948.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,813.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,548.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,692.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,798.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,399.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,399.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,499.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,243.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| 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/SUBMUC INJ ANY SUBSTANCE
|
Facility
|
IP
|
$4,487.00
|
|
|
Service Code
|
CPT 43236
|
| Hospital Charge Code |
906743236
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$897.40 |
| Max. Negotiated Rate |
$3,813.95 |
| Rate for Payer: Adventist Health Commercial |
$897.40
|
| Rate for Payer: Cash Price |
$2,019.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,140.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,794.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,794.80
|
| Rate for Payer: Galaxy Health WC |
$3,813.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,692.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,849.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,647.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,076.88
|
| Rate for Payer: Multiplan Commercial |
$3,589.60
|
| Rate for Payer: Networks By Design Commercial |
$2,916.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,813.95
|
|
|
HC EGD DIAG W WO COLLECTION
|
Facility
|
IP
|
$4,723.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
900501432
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$944.60 |
| Max. Negotiated Rate |
$4,014.55 |
| Rate for Payer: Adventist Health Commercial |
$944.60
|
| Rate for Payer: Cash Price |
$2,125.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,306.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,889.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,889.20
|
| Rate for Payer: Galaxy Health WC |
$4,014.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,833.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,999.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,786.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,133.52
|
| Rate for Payer: Multiplan Commercial |
$3,778.40
|
| Rate for Payer: Networks By Design Commercial |
$3,069.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,014.55
|
|
|
HC EGD DIAG W WO COLLECTION
|
Facility
|
OP
|
$4,723.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
900501432
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$425.83 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$944.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| 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 |
$6,716.00
|
| Rate for Payer: Cash Price |
$2,125.35
|
| Rate for Payer: Cash Price |
$2,125.35
|
| Rate for Payer: Cash Price |
$2,125.35
|
| Rate for Payer: Cigna of CA HMO |
$3,022.72
|
| Rate for Payer: Cigna of CA PPO |
$3,495.02
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,306.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: Galaxy Health WC |
$4,014.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,833.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,999.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$425.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,254.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,133.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,469.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$3,778.40
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Networks By Design Commercial |
$3,069.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,014.55
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,833.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,361.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,361.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,361.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,361.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| 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 ENDO STENT PLACEMENT
|
Facility
|
IP
|
$6,873.00
|
|
|
Service Code
|
CPT 43266
|
| Hospital Charge Code |
900100017
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,374.60 |
| Max. Negotiated Rate |
$5,842.05 |
| Rate for Payer: Adventist Health Commercial |
$1,374.60
|
| Rate for Payer: Cash Price |
$3,092.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,811.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,749.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,749.20
|
| Rate for Payer: Galaxy Health WC |
$5,842.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,123.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,364.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,055.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,649.52
|
| Rate for Payer: Multiplan Commercial |
$5,498.40
|
| Rate for Payer: Networks By Design Commercial |
$4,467.45
|
| Rate for Payer: Prime Health Services Commercial |
$5,842.05
|
|
|
HC EGD ENDO STENT PLACEMENT
|
Facility
|
OP
|
$6,873.00
|
|
|
Service Code
|
CPT 43266
|
| Hospital Charge Code |
900100017
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$336.50 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: EPIC Health Plan Senior |
$8,589.01
|
| Rate for Payer: Galaxy Health WC |
$5,842.05
|
| Rate for Payer: Galaxy Health WC |
$3,904.05
|
| Rate for Payer: Adventist Health Commercial |
$1,374.60
|
| Rate for Payer: Adventist Health Commercial |
$918.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| 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 |
$5,641.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Cash Price |
$2,066.85
|
| Rate for Payer: Cash Price |
$3,092.85
|
| Rate for Payer: Cash Price |
$3,092.85
|
| Rate for Payer: Cash Price |
$2,066.85
|
| Rate for Payer: Cash Price |
$2,066.85
|
| Rate for Payer: Cash Price |
$3,092.85
|
| Rate for Payer: Cigna of CA HMO |
$4,398.72
|
| Rate for Payer: Cigna of CA HMO |
$2,939.52
|
| Rate for Payer: Cigna of CA PPO |
$3,398.82
|
| Rate for Payer: Cigna of CA PPO |
$5,086.02
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,811.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,215.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,883.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,883.51
|
| Rate for Payer: EPIC Health Plan Senior |
$8,589.01
|
| Rate for Payer: Global Benefits Group Commercial |
$2,755.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4,123.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,805.43
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,805.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$336.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$336.50
|
| 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/Self Funded |
$4,364.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,916.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$380.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$380.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,931.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,931.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,102.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,649.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,838.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,838.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,462.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,462.97
|
| Rate for Payer: Multiplan Commercial |
$3,674.40
|
| Rate for Payer: Multiplan Commercial |
$5,498.40
|
| Rate for Payer: Networks By Design Commercial |
$4,467.45
|
| Rate for Payer: Networks By Design Commercial |
$2,985.45
|
| Rate for Payer: Prime Health Services Commercial |
$5,842.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,904.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,123.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,755.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,369.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,369.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,296.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,436.50
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,808.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,808.19
|
| 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 INTRMURAL US NDL ASPIRATE BIOPSY ESOPHAGS
|
Facility
|
IP
|
$3,325.00
|
|
|
Service Code
|
CPT 43238
|
| Hospital Charge Code |
906703238
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$665.00 |
| Max. Negotiated Rate |
$2,826.25 |
| Rate for Payer: Adventist Health Commercial |
$665.00
|
| Rate for Payer: Cash Price |
$1,496.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,327.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,330.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,330.00
|
| Rate for Payer: Galaxy Health WC |
$2,826.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,995.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,111.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,961.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$798.00
|
| Rate for Payer: Multiplan Commercial |
$2,660.00
|
| Rate for Payer: Networks By Design Commercial |
$2,161.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,826.25
|
|
|
HC EGD INTRMURAL US NDL ASPIRATE BIOPSY ESOPHAGS
|
Facility
|
OP
|
$3,325.00
|
|
|
Service Code
|
CPT 43238
|
| Hospital Charge Code |
906703238
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$665.00 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$665.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| 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 |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$1,496.25
|
| Rate for Payer: Cash Price |
$1,496.25
|
| Rate for Payer: Cash Price |
$1,496.25
|
| Rate for Payer: Cigna of CA HMO |
$2,128.00
|
| Rate for Payer: Cigna of CA PPO |
$2,460.50
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,327.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: Galaxy Health WC |
$2,826.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,995.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,111.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,206.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$798.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,109.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$2,660.00
|
| Rate for Payer: Networks By Design Commercial |
$2,161.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,826.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,995.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,961.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,662.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| 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 LESION ABLATION
|
Facility
|
OP
|
$4,962.00
|
|
|
Service Code
|
CPT 43270
|
| Hospital Charge Code |
900100018
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$354.01 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Cash Price |
$1,297.35
|
| Rate for Payer: Cash Price |
$2,232.90
|
| Rate for Payer: Cash Price |
$2,232.90
|
| Rate for Payer: Cash Price |
$1,297.35
|
| Rate for Payer: Cigna of CA HMO |
$1,845.12
|
| Rate for Payer: Cigna of CA PPO |
$2,133.42
|
| Rate for Payer: Cigna of CA PPO |
$3,671.88
|
| Rate for Payer: Cash Price |
$1,297.35
|
| Rate for Payer: Cash Price |
$2,232.90
|
| Rate for Payer: Cigna of CA HMO |
$3,175.68
|
| Rate for Payer: Adventist Health Commercial |
$992.40
|
| Rate for Payer: Adventist Health Commercial |
$576.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| 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 |
$6,716.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,473.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,018.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: Galaxy Health WC |
$4,217.70
|
| Rate for Payer: Galaxy Health WC |
$2,450.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,729.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,977.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$354.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$354.01
|
| 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/Self Funded |
$3,150.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,830.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$400.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$400.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$691.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,190.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,109.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,109.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,307.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$2,306.40
|
| Rate for Payer: Multiplan Commercial |
$3,969.60
|
| Rate for Payer: Networks By Design Commercial |
$3,225.30
|
| Rate for Payer: Networks By Design Commercial |
$1,873.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,217.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,450.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,977.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,729.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,961.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,961.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,441.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,481.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| 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 LESION ABLATION
|
Facility
|
IP
|
$4,962.00
|
|
|
Service Code
|
CPT 43270
|
| Hospital Charge Code |
900100018
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$992.40 |
| Max. Negotiated Rate |
$4,217.70 |
| Rate for Payer: Adventist Health Commercial |
$992.40
|
| Rate for Payer: Cash Price |
$2,232.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,473.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,984.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,984.80
|
| Rate for Payer: Galaxy Health WC |
$4,217.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,977.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,150.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,927.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,190.88
|
| Rate for Payer: Multiplan Commercial |
$3,969.60
|
| Rate for Payer: Networks By Design Commercial |
$3,225.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,217.70
|
|
|
HC EGD & POLYPECTOMY
|
Facility
|
IP
|
$3,358.00
|
|
|
Service Code
|
CPT 43250
|
| Hospital Charge Code |
906743250
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$671.60 |
| Max. Negotiated Rate |
$2,854.30 |
| Rate for Payer: Adventist Health Commercial |
$671.60
|
| Rate for Payer: Cash Price |
$1,511.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,350.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,343.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,343.20
|
| Rate for Payer: Galaxy Health WC |
$2,854.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,014.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,132.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,981.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$805.92
|
| Rate for Payer: Multiplan Commercial |
$2,686.40
|
| Rate for Payer: Networks By Design Commercial |
$2,182.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,854.30
|
|
|
HC EGD & POLYPECTOMY
|
Facility
|
OP
|
$3,358.00
|
|
|
Service Code
|
CPT 43250
|
| Hospital Charge Code |
906743250
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$411.55 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$671.60
|
| Rate for Payer: Adventist Health Commercial |
$449.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| 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 |
$6,716.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Cash Price |
$1,010.25
|
| Rate for Payer: Cash Price |
$1,511.10
|
| Rate for Payer: Cash Price |
$1,511.10
|
| Rate for Payer: Cash Price |
$1,010.25
|
| Rate for Payer: Cash Price |
$1,010.25
|
| Rate for Payer: Cash Price |
$1,511.10
|
| Rate for Payer: Cigna of CA HMO |
$2,149.12
|
| Rate for Payer: Cigna of CA HMO |
$1,436.80
|
| Rate for Payer: Cigna of CA PPO |
$1,661.30
|
| Rate for Payer: Cigna of CA PPO |
$2,484.92
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,350.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,571.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: Galaxy Health WC |
$2,854.30
|
| Rate for Payer: Galaxy Health WC |
$1,908.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,347.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,014.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$411.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$411.55
|
| 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/Self Funded |
$2,132.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,425.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$465.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$465.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$538.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$805.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,109.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,109.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,307.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$1,796.00
|
| Rate for Payer: Multiplan Commercial |
$2,686.40
|
| Rate for Payer: Networks By Design Commercial |
$2,182.70
|
| Rate for Payer: Networks By Design Commercial |
$1,459.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,854.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,908.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,014.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,347.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,961.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,961.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,122.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,679.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| 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 US TRANSMURAL INJECT MARKER
|
Facility
|
OP
|
$4,216.00
|
|
|
Service Code
|
CPT 43253
|
| Hospital Charge Code |
906743253
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$392.16 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$843.20
|
| Rate for Payer: Adventist Health Commercial |
$450.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| 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 |
$5,641.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Cash Price |
$1,013.85
|
| Rate for Payer: Cash Price |
$1,897.20
|
| Rate for Payer: Cash Price |
$1,897.20
|
| Rate for Payer: Cash Price |
$1,013.85
|
| Rate for Payer: Cash Price |
$1,013.85
|
| Rate for Payer: Cash Price |
$1,897.20
|
| Rate for Payer: Cigna of CA HMO |
$2,698.24
|
| Rate for Payer: Cigna of CA HMO |
$1,441.92
|
| Rate for Payer: Cigna of CA PPO |
$1,667.22
|
| Rate for Payer: Cigna of CA PPO |
$3,119.84
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,951.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,577.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: Galaxy Health WC |
$3,583.60
|
| Rate for Payer: Galaxy Health WC |
$1,915.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,351.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,529.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$392.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$392.16
|
| 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/Self Funded |
$2,677.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,430.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$443.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$443.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$540.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,011.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,109.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,109.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,307.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$1,802.40
|
| Rate for Payer: Multiplan Commercial |
$3,372.80
|
| Rate for Payer: Networks By Design Commercial |
$2,740.40
|
| Rate for Payer: Networks By Design Commercial |
$1,464.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,583.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,915.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,529.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,351.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,961.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,961.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,126.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,108.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| 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 US TRANSMURAL INJECT MARKER
|
Facility
|
IP
|
$4,216.00
|
|
|
Service Code
|
CPT 43253
|
| Hospital Charge Code |
906743253
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$843.20 |
| Max. Negotiated Rate |
$3,583.60 |
| Rate for Payer: Adventist Health Commercial |
$843.20
|
| Rate for Payer: Cash Price |
$1,897.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,951.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,686.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,686.40
|
| Rate for Payer: Galaxy Health WC |
$3,583.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,529.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,677.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,487.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,011.84
|
| Rate for Payer: Multiplan Commercial |
$3,372.80
|
| Rate for Payer: Networks By Design Commercial |
$2,740.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,583.60
|
|
|
HC EGD W/BAND/LIG SCLE
|
Facility
|
IP
|
$7,082.00
|
|
|
Service Code
|
CPT 43244
|
| Hospital Charge Code |
906743244
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,416.40 |
| Max. Negotiated Rate |
$6,019.70 |
| Rate for Payer: Adventist Health Commercial |
$1,416.40
|
| Rate for Payer: Cash Price |
$3,186.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,957.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,832.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,832.80
|
| Rate for Payer: Galaxy Health WC |
$6,019.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,249.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,497.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,178.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,699.68
|
| Rate for Payer: Multiplan Commercial |
$5,665.60
|
| Rate for Payer: Networks By Design Commercial |
$4,603.30
|
| Rate for Payer: Prime Health Services Commercial |
$6,019.70
|
|
|
HC EGD W/BAND/LIG SCLE
|
Facility
|
OP
|
$7,082.00
|
|
|
Service Code
|
CPT 43244
|
| Hospital Charge Code |
906743244
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$360.90 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,416.40
|
| Rate for Payer: Adventist Health Commercial |
$946.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| 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 |
$6,716.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Cash Price |
$2,130.30
|
| Rate for Payer: Cash Price |
$3,186.90
|
| Rate for Payer: Cash Price |
$3,186.90
|
| Rate for Payer: Cash Price |
$2,130.30
|
| Rate for Payer: Cash Price |
$2,130.30
|
| Rate for Payer: Cash Price |
$3,186.90
|
| Rate for Payer: Cigna of CA HMO |
$4,532.48
|
| Rate for Payer: Cigna of CA HMO |
$3,029.76
|
| Rate for Payer: Cigna of CA PPO |
$3,503.16
|
| Rate for Payer: Cigna of CA PPO |
$5,240.68
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,957.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,313.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: Galaxy Health WC |
$6,019.70
|
| Rate for Payer: Galaxy Health WC |
$4,023.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,840.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,249.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$360.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$360.90
|
| 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/Self Funded |
$4,497.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,006.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$408.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$408.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,136.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,699.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,109.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,109.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,307.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$3,787.20
|
| Rate for Payer: Multiplan Commercial |
$5,665.60
|
| Rate for Payer: Networks By Design Commercial |
$4,603.30
|
| Rate for Payer: Networks By Design Commercial |
$3,077.10
|
| Rate for Payer: Prime Health Services Commercial |
$6,019.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,023.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,249.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,840.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,961.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,961.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,367.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,541.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| 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 BLLN DLTN ESO
|
Facility
|
IP
|
$4,294.00
|
|
|
Service Code
|
CPT 43249
|
| Hospital Charge Code |
906743249
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$858.80 |
| Max. Negotiated Rate |
$3,649.90 |
| Rate for Payer: Adventist Health Commercial |
$858.80
|
| Rate for Payer: Cash Price |
$1,932.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,005.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,717.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,717.60
|
| Rate for Payer: Galaxy Health WC |
$3,649.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,576.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,726.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,533.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,030.56
|
| Rate for Payer: Multiplan Commercial |
$3,435.20
|
| Rate for Payer: Networks By Design Commercial |
$2,791.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,649.90
|
|
|
HC EGD W BLLN DLTN ESO
|
Facility
|
IP
|
$4,294.00
|
|
|
Service Code
|
CPT 43249
|
| Hospital Charge Code |
906743249
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$858.80 |
| Max. Negotiated Rate |
$3,649.90 |
| Rate for Payer: Adventist Health Commercial |
$858.80
|
| Rate for Payer: Cash Price |
$1,932.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,005.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,717.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,717.60
|
| Rate for Payer: Galaxy Health WC |
$3,649.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,576.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,726.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,533.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,030.56
|
| Rate for Payer: Multiplan Commercial |
$3,435.20
|
| Rate for Payer: Networks By Design Commercial |
$2,791.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,649.90
|
|
|
HC EGD W BLLN DLTN ESO
|
Facility
|
OP
|
$4,294.00
|
|
|
Service Code
|
CPT 43249
|
| Hospital Charge Code |
906743249
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$374.66 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$858.80
|
| Rate for Payer: Adventist Health Commercial |
$573.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| 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 |
$6,716.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Cash Price |
$1,291.05
|
| Rate for Payer: Cash Price |
$1,932.30
|
| Rate for Payer: Cash Price |
$1,932.30
|
| Rate for Payer: Cash Price |
$1,291.05
|
| Rate for Payer: Cash Price |
$1,291.05
|
| Rate for Payer: Cash Price |
$1,932.30
|
| Rate for Payer: Cigna of CA HMO |
$2,748.16
|
| Rate for Payer: Cigna of CA HMO |
$1,836.16
|
| Rate for Payer: Cigna of CA PPO |
$2,123.06
|
| Rate for Payer: Cigna of CA PPO |
$3,177.56
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,005.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,008.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: Galaxy Health WC |
$3,649.90
|
| Rate for Payer: Galaxy Health WC |
$2,438.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,721.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,576.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$374.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$374.66
|
| 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/Self Funded |
$2,726.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,821.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$423.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$423.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$688.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,030.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,109.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,109.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,307.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$2,295.20
|
| Rate for Payer: Multiplan Commercial |
$3,435.20
|
| Rate for Payer: Networks By Design Commercial |
$2,791.10
|
| Rate for Payer: Networks By Design Commercial |
$1,864.85
|
| Rate for Payer: Prime Health Services Commercial |
$3,649.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,438.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,576.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,721.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,961.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,961.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,434.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,147.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| 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 BLLN DLTN ESO
|
Facility
|
OP
|
$2,869.00
|
|
|
Service Code
|
CPT 43249
|
| Hospital Charge Code |
906743249
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$423.72 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$573.80
|
| Rate for Payer: Adventist Health Commercial |
$858.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| 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 |
$6,716.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$1,291.05
|
| Rate for Payer: Cash Price |
$1,291.05
|
| Rate for Payer: Cash Price |
$1,932.30
|
| Rate for Payer: Cash Price |
$1,932.30
|
| Rate for Payer: Cash Price |
$1,291.05
|
| Rate for Payer: Cash Price |
$1,932.30
|
| Rate for Payer: Cigna of CA HMO |
$2,748.16
|
| Rate for Payer: Cigna of CA HMO |
$1,836.16
|
| Rate for Payer: Cigna of CA PPO |
$2,123.06
|
| Rate for Payer: Cigna of CA PPO |
$3,177.56
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,005.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,008.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: Galaxy Health WC |
$2,438.65
|
| Rate for Payer: Galaxy Health WC |
$3,649.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,576.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,721.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| 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/Self Funded |
$1,821.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,726.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$423.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$423.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,653.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,653.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$688.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,030.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,109.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,109.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,307.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$3,435.20
|
| Rate for Payer: Multiplan Commercial |
$2,295.20
|
| Rate for Payer: Multiplan WC |
$3,840.40
|
| Rate for Payer: Multiplan WC |
$3,840.40
|
| Rate for Payer: Networks By Design Commercial |
$2,791.10
|
| Rate for Payer: Networks By Design Commercial |
$1,864.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,438.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,649.90
|
| Rate for Payer: Prime Health Services WC |
$3,801.22
|
| Rate for Payer: Prime Health Services WC |
$3,801.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,576.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,721.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,434.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,147.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,147.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,434.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,434.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,147.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,434.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,147.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| 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 BX SNGL OR MULTI
|
Facility
|
IP
|
$5,808.00
|
|
|
Service Code
|
CPT 43239
|
| Hospital Charge Code |
906743239
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,161.60 |
| Max. Negotiated Rate |
$4,936.80 |
| Rate for Payer: Adventist Health Commercial |
$1,161.60
|
| Rate for Payer: Cash Price |
$2,613.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,065.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,323.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,323.20
|
| Rate for Payer: Galaxy Health WC |
$4,936.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,484.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,688.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,426.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,393.92
|
| Rate for Payer: Multiplan Commercial |
$4,646.40
|
| Rate for Payer: Networks By Design Commercial |
$3,775.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,936.80
|
|
|
HC EGD W BX SNGL OR MULTI
|
Facility
|
IP
|
$5,808.00
|
|
|
Service Code
|
CPT 43239
|
| Hospital Charge Code |
906743239
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,161.60 |
| Max. Negotiated Rate |
$4,936.80 |
| Rate for Payer: Adventist Health Commercial |
$1,161.60
|
| Rate for Payer: Cash Price |
$2,613.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,065.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,323.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,323.20
|
| Rate for Payer: Galaxy Health WC |
$4,936.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,484.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,688.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,426.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,393.92
|
| Rate for Payer: Multiplan Commercial |
$4,646.40
|
| Rate for Payer: Networks By Design Commercial |
$3,775.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,936.80
|
|
