|
HC EGD W BX SNGL OR MULTI
|
Facility
|
OP
|
$3,105.00
|
|
|
Service Code
|
CPT 43239
|
| Hospital Charge Code |
906743239
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$444.94 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$621.00
|
| Rate for Payer: Adventist Health Commercial |
$1,161.60
|
| 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 |
$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: Cash Price |
$1,397.25
|
| Rate for Payer: Cash Price |
$1,397.25
|
| Rate for Payer: Cash Price |
$2,613.60
|
| Rate for Payer: Cash Price |
$2,613.60
|
| Rate for Payer: Cash Price |
$1,397.25
|
| Rate for Payer: Cash Price |
$2,613.60
|
| Rate for Payer: Cigna of CA HMO |
$3,717.12
|
| Rate for Payer: Cigna of CA HMO |
$1,987.20
|
| Rate for Payer: Cigna of CA PPO |
$2,297.70
|
| Rate for Payer: Cigna of CA PPO |
$4,297.92
|
| 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 |
$4,065.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,173.50
|
| 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 |
$2,639.25
|
| Rate for Payer: Galaxy Health WC |
$4,936.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,484.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,863.00
|
| 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 |
$973.00
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,971.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,688.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$444.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$444.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,254.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,254.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$745.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,393.92
|
| 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 |
$4,646.40
|
| Rate for Payer: Multiplan Commercial |
$2,484.00
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Networks By Design Commercial |
$3,775.20
|
| Rate for Payer: Networks By Design Commercial |
$2,018.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,639.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,936.80
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,484.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,863.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,552.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,904.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,904.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,552.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,552.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,904.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,552.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,904.00
|
| 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 W BX SNGL OR MULTI
|
Facility
|
OP
|
$5,808.00
|
|
|
Service Code
|
CPT 43239
|
| Hospital Charge Code |
906743239
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$393.42 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,161.60
|
| Rate for Payer: Adventist Health Commercial |
$621.00
|
| 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 |
$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 |
$1,397.25
|
| Rate for Payer: Cash Price |
$2,613.60
|
| Rate for Payer: Cash Price |
$2,613.60
|
| Rate for Payer: Cash Price |
$1,397.25
|
| Rate for Payer: Cash Price |
$1,397.25
|
| Rate for Payer: Cash Price |
$2,613.60
|
| Rate for Payer: Cigna of CA HMO |
$3,717.12
|
| Rate for Payer: Cigna of CA HMO |
$1,987.20
|
| Rate for Payer: Cigna of CA PPO |
$2,297.70
|
| Rate for Payer: Cigna of CA PPO |
$4,297.92
|
| 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 |
$4,065.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,173.50
|
| 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 |
$4,936.80
|
| Rate for Payer: Galaxy Health WC |
$2,639.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,863.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,484.80
|
| 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 |
$393.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$393.42
|
| 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 |
$3,688.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,971.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$444.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$444.94
|
| 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 |
$745.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,393.92
|
| 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 |
$2,484.00
|
| Rate for Payer: Multiplan Commercial |
$4,646.40
|
| Rate for Payer: Networks By Design Commercial |
$3,775.20
|
| Rate for Payer: Networks By Design Commercial |
$2,018.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,936.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,639.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,484.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,863.00
|
| 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 |
$1,552.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,904.00
|
| 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 |
$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 W/CNTRL BLEEDNG ANY METHOD
|
Facility
|
OP
|
$6,219.00
|
|
|
Service Code
|
CPT 43255
|
| Hospital Charge Code |
906743255
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$483.49 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,243.80
|
| Rate for Payer: Adventist Health Commercial |
$831.20
|
| 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 |
$1,870.20
|
| Rate for Payer: Cash Price |
$2,798.55
|
| Rate for Payer: Cash Price |
$2,798.55
|
| Rate for Payer: Cash Price |
$1,870.20
|
| Rate for Payer: Cash Price |
$1,870.20
|
| Rate for Payer: Cash Price |
$2,798.55
|
| Rate for Payer: Cigna of CA HMO |
$3,980.16
|
| Rate for Payer: Cigna of CA HMO |
$2,659.84
|
| Rate for Payer: Cigna of CA PPO |
$3,075.44
|
| Rate for Payer: Cigna of CA PPO |
$4,602.06
|
| 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 |
$4,353.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,909.20
|
| 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 |
$5,286.15
|
| Rate for Payer: Galaxy Health WC |
$3,532.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,493.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,731.40
|
| 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 |
$483.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$483.49
|
| 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 |
$3,949.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,639.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$546.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$546.80
|
| 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 |
$997.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,492.56
|
| 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 |
$3,324.80
|
| Rate for Payer: Multiplan Commercial |
$4,975.20
|
| Rate for Payer: Networks By Design Commercial |
$4,042.35
|
| Rate for Payer: Networks By Design Commercial |
$2,701.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,286.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,532.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,731.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,493.60
|
| 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 |
$2,078.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,109.50
|
| 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 |
$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/CNTRL BLEEDNG ANY METHOD
|
Facility
|
IP
|
$6,219.00
|
|
|
Service Code
|
CPT 43255
|
| Hospital Charge Code |
906743255
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,243.80 |
| Max. Negotiated Rate |
$5,286.15 |
| Rate for Payer: Adventist Health Commercial |
$1,243.80
|
| Rate for Payer: Cash Price |
$2,798.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,353.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,487.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,487.60
|
| Rate for Payer: Galaxy Health WC |
$5,286.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,731.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,949.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,669.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,492.56
|
| Rate for Payer: Multiplan Commercial |
$4,975.20
|
| Rate for Payer: Networks By Design Commercial |
$4,042.35
|
| Rate for Payer: Prime Health Services Commercial |
$5,286.15
|
|
|
HC EGD W/DILATION OF GASTRIC OUTL
|
Facility
|
IP
|
$5,547.00
|
|
|
Service Code
|
CPT 43245
|
| Hospital Charge Code |
906743245
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,109.40 |
| Max. Negotiated Rate |
$4,714.95 |
| Rate for Payer: Adventist Health Commercial |
$1,109.40
|
| Rate for Payer: Cash Price |
$2,496.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,882.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,218.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,218.80
|
| Rate for Payer: Galaxy Health WC |
$4,714.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,328.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,522.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,272.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,331.28
|
| Rate for Payer: Multiplan Commercial |
$4,437.60
|
| Rate for Payer: Networks By Design Commercial |
$3,605.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,714.95
|
|
|
HC EGD W/DILATION OF GASTRIC OUTL
|
Facility
|
OP
|
$5,547.00
|
|
|
Service Code
|
CPT 43245
|
| Hospital Charge Code |
906743245
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$406.56 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,109.40
|
| Rate for Payer: Adventist Health Commercial |
$741.60
|
| 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: Cash Price |
$1,668.60
|
| Rate for Payer: Cash Price |
$2,496.15
|
| Rate for Payer: Cash Price |
$2,496.15
|
| Rate for Payer: Cash Price |
$1,668.60
|
| Rate for Payer: Cash Price |
$1,668.60
|
| Rate for Payer: Cash Price |
$2,496.15
|
| Rate for Payer: Cigna of CA HMO |
$3,550.08
|
| Rate for Payer: Cigna of CA HMO |
$2,373.12
|
| Rate for Payer: Cigna of CA PPO |
$2,743.92
|
| Rate for Payer: Cigna of CA PPO |
$4,104.78
|
| 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 |
$3,882.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,595.60
|
| 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 |
$4,714.95
|
| Rate for Payer: Galaxy Health WC |
$3,151.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,224.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,328.20
|
| 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 |
$406.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$406.56
|
| 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 |
$3,522.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,354.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$459.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$459.80
|
| 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 |
$889.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,331.28
|
| 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 |
$2,966.40
|
| Rate for Payer: Multiplan Commercial |
$4,437.60
|
| Rate for Payer: Networks By Design Commercial |
$3,605.55
|
| Rate for Payer: Networks By Design Commercial |
$2,410.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,714.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,151.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,328.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,224.80
|
| 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 |
$1,854.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,773.50
|
| 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 |
$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/DRCTD PLCMT PERCUT GAST
|
Facility
|
IP
|
$4,221.00
|
|
|
Service Code
|
CPT 43246
|
| Hospital Charge Code |
906743246
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$844.20 |
| Max. Negotiated Rate |
$3,587.85 |
| Rate for Payer: Cash Price |
$1,899.45
|
| Rate for Payer: Adventist Health Commercial |
$844.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,954.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,688.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,688.40
|
| Rate for Payer: Galaxy Health WC |
$3,587.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,532.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,680.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,490.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,013.04
|
| Rate for Payer: Multiplan Commercial |
$3,376.80
|
| Rate for Payer: Networks By Design Commercial |
$2,743.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,587.85
|
|
|
HC EGD W/DRCTD PLCMT PERCUT GAST
|
Facility
|
OP
|
$4,221.00
|
|
|
Service Code
|
CPT 43246
|
| Hospital Charge Code |
906743246
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$406.56 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$844.20
|
| Rate for Payer: Adventist Health Commercial |
$557.00
|
| 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 |
$1,253.25
|
| Rate for Payer: Cash Price |
$1,899.45
|
| Rate for Payer: Cash Price |
$1,899.45
|
| Rate for Payer: Cash Price |
$1,253.25
|
| Rate for Payer: Cash Price |
$1,253.25
|
| Rate for Payer: Cash Price |
$1,899.45
|
| Rate for Payer: Cigna of CA HMO |
$2,701.44
|
| Rate for Payer: Cigna of CA HMO |
$1,782.40
|
| Rate for Payer: Cigna of CA PPO |
$2,060.90
|
| Rate for Payer: Cigna of CA PPO |
$3,123.54
|
| 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 |
$2,954.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,949.50
|
| 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 |
$3,587.85
|
| Rate for Payer: Galaxy Health WC |
$2,367.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,671.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,532.60
|
| 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 |
$406.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$406.56
|
| 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 |
$2,680.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,768.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$459.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$459.80
|
| 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 |
$668.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,013.04
|
| 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 |
$2,228.00
|
| Rate for Payer: Multiplan Commercial |
$3,376.80
|
| Rate for Payer: Networks By Design Commercial |
$2,743.65
|
| Rate for Payer: Networks By Design Commercial |
$1,810.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,587.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,367.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,532.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,671.00
|
| 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 |
$1,392.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,110.50
|
| 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 |
$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 ENDO MUCOSAL RESECTION
|
Facility
|
IP
|
$2,791.00
|
|
|
Service Code
|
CPT 43254
|
| Hospital Charge Code |
906743254
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$558.20 |
| Max. Negotiated Rate |
$2,372.35 |
| Rate for Payer: Adventist Health Commercial |
$558.20
|
| Rate for Payer: Cash Price |
$1,255.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,953.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,116.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,116.40
|
| Rate for Payer: Galaxy Health WC |
$2,372.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,674.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,772.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,646.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$669.84
|
| Rate for Payer: Multiplan Commercial |
$2,232.80
|
| Rate for Payer: Networks By Design Commercial |
$1,814.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,372.35
|
|
|
HC EGD W ENDO MUCOSAL RESECTION
|
Facility
|
OP
|
$2,791.00
|
|
|
Service Code
|
CPT 43254
|
| Hospital Charge Code |
906743254
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$406.56 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$558.20
|
| Rate for Payer: Adventist Health Commercial |
$298.40
|
| 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 |
$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 |
$671.40
|
| Rate for Payer: Cash Price |
$1,255.95
|
| Rate for Payer: Cash Price |
$1,255.95
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Cash Price |
$1,255.95
|
| Rate for Payer: Cigna of CA HMO |
$1,786.24
|
| Rate for Payer: Cigna of CA HMO |
$954.88
|
| Rate for Payer: Cigna of CA PPO |
$1,104.08
|
| Rate for Payer: Cigna of CA PPO |
$2,065.34
|
| 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 |
$1,953.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,044.40
|
| 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 |
$2,372.35
|
| Rate for Payer: Galaxy Health WC |
$1,268.20
|
| Rate for Payer: Global Benefits Group Commercial |
$895.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,674.60
|
| 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 |
$406.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$406.56
|
| 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 |
$1,772.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$947.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$459.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$459.80
|
| 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 |
$358.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$669.84
|
| 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 |
$1,193.60
|
| Rate for Payer: Multiplan Commercial |
$2,232.80
|
| Rate for Payer: Networks By Design Commercial |
$1,814.15
|
| Rate for Payer: Networks By Design Commercial |
$969.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,372.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,268.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,674.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$895.20
|
| 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 |
$746.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,395.50
|
| 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 |
$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/ENDO US EXAM
|
Facility
|
IP
|
$5,149.00
|
|
|
Service Code
|
CPT 43259
|
| Hospital Charge Code |
906743259
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,029.80 |
| Max. Negotiated Rate |
$4,376.65 |
| Rate for Payer: Adventist Health Commercial |
$1,029.80
|
| Rate for Payer: Cash Price |
$2,317.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,604.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,059.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,059.60
|
| Rate for Payer: Galaxy Health WC |
$4,376.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,089.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,269.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,037.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,235.76
|
| Rate for Payer: Multiplan Commercial |
$4,119.20
|
| Rate for Payer: Networks By Design Commercial |
$3,346.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,376.65
|
|
|
HC EGD W/ENDO US EXAM
|
Facility
|
OP
|
$5,149.00
|
|
|
Service Code
|
CPT 43259
|
| Hospital Charge Code |
906743259
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$349.00 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,029.80
|
| Rate for Payer: Adventist Health Commercial |
$687.60
|
| 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 |
$2,942.61
|
| Rate for Payer: Blue Shield of California Commercial |
$4,454.70
|
| Rate for Payer: Blue Shield of California Commercial |
$4,454.70
|
| Rate for Payer: Blue Shield of California Commercial |
$2,942.61
|
| Rate for Payer: Cash Price |
$1,547.10
|
| Rate for Payer: Cash Price |
$2,317.05
|
| Rate for Payer: Cash Price |
$2,317.05
|
| Rate for Payer: Cash Price |
$1,547.10
|
| Rate for Payer: Cash Price |
$1,547.10
|
| Rate for Payer: Cash Price |
$2,317.05
|
| Rate for Payer: Cigna of CA HMO |
$3,295.36
|
| Rate for Payer: Cigna of CA HMO |
$2,200.32
|
| Rate for Payer: Cigna of CA PPO |
$2,544.12
|
| Rate for Payer: Cigna of CA PPO |
$3,810.26
|
| 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 |
$3,604.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,406.60
|
| 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 |
$4,376.65
|
| Rate for Payer: Galaxy Health WC |
$2,922.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,062.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,089.40
|
| 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 |
$349.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$349.00
|
| 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 |
$3,269.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,183.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$394.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$394.71
|
| 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 |
$825.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,235.76
|
| 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 |
$2,750.40
|
| Rate for Payer: Multiplan Commercial |
$4,119.20
|
| Rate for Payer: Networks By Design Commercial |
$3,346.85
|
| Rate for Payer: Networks By Design Commercial |
$2,234.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,376.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,922.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,089.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,062.80
|
| 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 |
$1,719.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,574.50
|
| 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 |
$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 INJ SCLER ESO
|
Facility
|
IP
|
$4,678.00
|
|
|
Service Code
|
CPT 43243
|
| Hospital Charge Code |
906743243
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$935.60 |
| Max. Negotiated Rate |
$3,976.30 |
| Rate for Payer: Adventist Health Commercial |
$935.60
|
| Rate for Payer: Cash Price |
$2,105.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,274.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,871.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,871.20
|
| Rate for Payer: Galaxy Health WC |
$3,976.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,806.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,970.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,760.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,122.72
|
| Rate for Payer: Multiplan Commercial |
$3,742.40
|
| Rate for Payer: Networks By Design Commercial |
$3,040.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,976.30
|
|
|
HC EGD W INJ SCLER ESO
|
Facility
|
OP
|
$4,678.00
|
|
|
Service Code
|
CPT 43243
|
| Hospital Charge Code |
906743243
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$512.89 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$935.60
|
| Rate for Payer: Adventist Health Commercial |
$625.40
|
| 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 |
$1,407.15
|
| Rate for Payer: Cash Price |
$2,105.10
|
| Rate for Payer: Cash Price |
$2,105.10
|
| Rate for Payer: Cash Price |
$1,407.15
|
| Rate for Payer: Cash Price |
$1,407.15
|
| Rate for Payer: Cash Price |
$2,105.10
|
| Rate for Payer: Cigna of CA HMO |
$2,993.92
|
| Rate for Payer: Cigna of CA HMO |
$2,001.28
|
| Rate for Payer: Cigna of CA PPO |
$2,313.98
|
| Rate for Payer: Cigna of CA PPO |
$3,461.72
|
| 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 |
$3,274.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,188.90
|
| 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 |
$3,976.30
|
| Rate for Payer: Galaxy Health WC |
$2,657.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,876.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,806.80
|
| 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 |
$512.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$512.89
|
| 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 |
$2,970.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,985.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$580.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$580.05
|
| 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 |
$750.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,122.72
|
| 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 |
$2,501.60
|
| Rate for Payer: Multiplan Commercial |
$3,742.40
|
| Rate for Payer: Networks By Design Commercial |
$3,040.70
|
| Rate for Payer: Networks By Design Commercial |
$2,032.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,976.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,657.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,806.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,876.20
|
| 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 |
$1,563.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,339.00
|
| 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 INJ SCLER ESO
|
Facility
|
IP
|
$4,678.00
|
|
|
Service Code
|
CPT 43243
|
| Hospital Charge Code |
906743243
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$935.60 |
| Max. Negotiated Rate |
$3,976.30 |
| Rate for Payer: Adventist Health Commercial |
$935.60
|
| Rate for Payer: Cash Price |
$2,105.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,274.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,871.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,871.20
|
| Rate for Payer: Galaxy Health WC |
$3,976.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,806.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,970.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,760.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,122.72
|
| Rate for Payer: Multiplan Commercial |
$3,742.40
|
| Rate for Payer: Networks By Design Commercial |
$3,040.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,976.30
|
|
|
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 |
$580.05 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$625.40
|
| Rate for Payer: Adventist Health Commercial |
$935.60
|
| 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 |
$1,407.15
|
| Rate for Payer: Cash Price |
$1,407.15
|
| Rate for Payer: Cash Price |
$2,105.10
|
| Rate for Payer: Cash Price |
$2,105.10
|
| Rate for Payer: Cash Price |
$1,407.15
|
| Rate for Payer: Cash Price |
$2,105.10
|
| Rate for Payer: Cigna of CA HMO |
$2,993.92
|
| Rate for Payer: Cigna of CA HMO |
$2,001.28
|
| Rate for Payer: Cigna of CA PPO |
$2,313.98
|
| Rate for Payer: Cigna of CA PPO |
$3,461.72
|
| 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 |
$3,274.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,188.90
|
| 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 |
$2,657.95
|
| Rate for Payer: Galaxy Health WC |
$3,976.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,806.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,876.20
|
| 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 |
$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 |
$1,985.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,970.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$580.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$580.05
|
| 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 |
$750.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,122.72
|
| 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 |
$3,742.40
|
| Rate for Payer: Multiplan Commercial |
$2,501.60
|
| Rate for Payer: Multiplan WC |
$3,840.40
|
| Rate for Payer: Multiplan WC |
$3,840.40
|
| Rate for Payer: Networks By Design Commercial |
$3,040.70
|
| Rate for Payer: Networks By Design Commercial |
$2,032.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,657.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,976.30
|
| 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 |
$2,806.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,876.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,563.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,339.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,339.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,563.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,563.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,339.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,563.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,339.00
|
| 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/INSRT GIDE WIRE
|
Facility
|
OP
|
$3,955.00
|
|
|
Service Code
|
CPT 43248
|
| Hospital Charge Code |
906743248
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$248.30 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$791.00
|
| Rate for Payer: Adventist Health Commercial |
$528.80
|
| 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 |
$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 |
$1,189.80
|
| Rate for Payer: Cash Price |
$1,779.75
|
| Rate for Payer: Cash Price |
$1,779.75
|
| Rate for Payer: Cash Price |
$1,189.80
|
| Rate for Payer: Cash Price |
$1,189.80
|
| Rate for Payer: Cash Price |
$1,779.75
|
| Rate for Payer: Cigna of CA HMO |
$2,531.20
|
| Rate for Payer: Cigna of CA HMO |
$1,692.16
|
| Rate for Payer: Cigna of CA PPO |
$1,956.56
|
| Rate for Payer: Cigna of CA PPO |
$2,926.70
|
| 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 |
$2,768.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,850.80
|
| 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 |
$3,361.75
|
| Rate for Payer: Galaxy Health WC |
$2,247.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,586.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,373.00
|
| 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 |
$248.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$248.30
|
| 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 |
$2,511.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,678.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$280.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$280.82
|
| 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 |
$634.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$949.20
|
| 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 |
$2,115.20
|
| Rate for Payer: Multiplan Commercial |
$3,164.00
|
| Rate for Payer: Networks By Design Commercial |
$2,570.75
|
| Rate for Payer: Networks By Design Commercial |
$1,718.60
|
| Rate for Payer: Prime Health Services Commercial |
$3,361.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,247.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,373.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,586.40
|
| 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 |
$1,322.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,977.50
|
| 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 W/INSRT GIDE WIRE
|
Facility
|
IP
|
$3,955.00
|
|
|
Service Code
|
CPT 43248
|
| Hospital Charge Code |
906743248
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$791.00 |
| Max. Negotiated Rate |
$3,361.75 |
| Rate for Payer: Adventist Health Commercial |
$791.00
|
| Rate for Payer: Cash Price |
$1,779.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,768.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,582.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,582.00
|
| Rate for Payer: Galaxy Health WC |
$3,361.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,373.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,511.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,333.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$949.20
|
| Rate for Payer: Multiplan Commercial |
$3,164.00
|
| Rate for Payer: Networks By Design Commercial |
$2,570.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,361.75
|
|
|
HC EGD W/REMOVAL FOREIGN BODY
|
Facility
|
IP
|
$4,421.00
|
|
|
Service Code
|
CPT 43247
|
| Hospital Charge Code |
906743247
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$884.20 |
| Max. Negotiated Rate |
$3,757.85 |
| Rate for Payer: Adventist Health Commercial |
$884.20
|
| Rate for Payer: Cash Price |
$1,989.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,094.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,768.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,768.40
|
| Rate for Payer: Galaxy Health WC |
$3,757.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,652.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,807.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,608.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,061.04
|
| Rate for Payer: Multiplan Commercial |
$3,536.80
|
| Rate for Payer: Networks By Design Commercial |
$2,873.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,757.85
|
|
|
HC EGD W/REMOVAL FOREIGN BODY
|
Facility
|
OP
|
$4,421.00
|
|
|
Service Code
|
CPT 43247
|
| Hospital Charge Code |
906743247
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$429.07 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$884.20
|
| Rate for Payer: Adventist Health Commercial |
$590.80
|
| 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 |
$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 |
$1,329.30
|
| Rate for Payer: Cash Price |
$1,989.45
|
| Rate for Payer: Cash Price |
$1,989.45
|
| Rate for Payer: Cash Price |
$1,329.30
|
| Rate for Payer: Cash Price |
$1,329.30
|
| Rate for Payer: Cash Price |
$1,989.45
|
| Rate for Payer: Cigna of CA HMO |
$2,829.44
|
| Rate for Payer: Cigna of CA HMO |
$1,890.56
|
| Rate for Payer: Cigna of CA PPO |
$2,185.96
|
| Rate for Payer: Cigna of CA PPO |
$3,271.54
|
| 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 |
$3,094.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,067.80
|
| 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 |
$3,757.85
|
| Rate for Payer: Galaxy Health WC |
$2,510.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,772.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,652.60
|
| 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 |
$429.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$429.07
|
| 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 |
$2,807.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,875.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$485.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$485.26
|
| 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 |
$708.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,061.04
|
| 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 |
$2,363.20
|
| Rate for Payer: Multiplan Commercial |
$3,536.80
|
| Rate for Payer: Networks By Design Commercial |
$2,873.65
|
| Rate for Payer: Networks By Design Commercial |
$1,920.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,757.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,510.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,652.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,772.40
|
| 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 |
$1,477.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,210.50
|
| 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 W/REMOV TUMOR/POLYP/LESION
|
Facility
|
IP
|
$3,551.00
|
|
|
Service Code
|
CPT 43251
|
| Hospital Charge Code |
906743251
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$710.20 |
| Max. Negotiated Rate |
$3,018.35 |
| Rate for Payer: Adventist Health Commercial |
$710.20
|
| Rate for Payer: Cash Price |
$1,597.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,485.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,420.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,420.40
|
| Rate for Payer: Galaxy Health WC |
$3,018.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,130.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,254.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,095.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$852.24
|
| Rate for Payer: Multiplan Commercial |
$2,840.80
|
| Rate for Payer: Networks By Design Commercial |
$2,308.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,018.35
|
|
|
HC EGD W/REMOV TUMOR/POLYP/LESION
|
Facility
|
OP
|
$3,551.00
|
|
|
Service Code
|
CPT 43251
|
| Hospital Charge Code |
906743251
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$710.20 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$710.20
|
| Rate for Payer: Adventist Health Commercial |
$379.60
|
| 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 |
$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: Cash Price |
$1,597.95
|
| Rate for Payer: Cash Price |
$854.10
|
| Rate for Payer: Cash Price |
$1,597.95
|
| Rate for Payer: Cash Price |
$854.10
|
| Rate for Payer: Cash Price |
$854.10
|
| Rate for Payer: Cash Price |
$1,597.95
|
| Rate for Payer: Cigna of CA HMO |
$1,214.72
|
| Rate for Payer: Cigna of CA HMO |
$2,272.64
|
| Rate for Payer: Cigna of CA PPO |
$1,404.52
|
| Rate for Payer: Cigna of CA PPO |
$2,627.74
|
| 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 |
$2,485.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,328.60
|
| 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 |
$1,613.30
|
| Rate for Payer: Galaxy Health WC |
$3,018.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,138.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,130.60
|
| 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) 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 |
$1,205.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,254.89
|
| 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 |
$455.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$852.24
|
| 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 |
$2,840.80
|
| Rate for Payer: Multiplan Commercial |
$1,518.40
|
| Rate for Payer: Networks By Design Commercial |
$1,233.70
|
| Rate for Payer: Networks By Design Commercial |
$2,308.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,018.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,613.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,130.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,138.80
|
| 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 |
$1,775.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$949.00
|
| 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/TRANSENDO TUBE/CATH PLAC
|
Facility
|
IP
|
$5,091.00
|
|
|
Service Code
|
CPT 43241
|
| Hospital Charge Code |
906743241
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,018.20 |
| Max. Negotiated Rate |
$4,327.35 |
| Rate for Payer: Adventist Health Commercial |
$1,018.20
|
| Rate for Payer: Cash Price |
$2,290.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,563.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,036.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,036.40
|
| Rate for Payer: Galaxy Health WC |
$4,327.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,054.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,232.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,003.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,221.84
|
| Rate for Payer: Multiplan Commercial |
$4,072.80
|
| Rate for Payer: Networks By Design Commercial |
$3,309.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,327.35
|
|
|
HC EGD W/TRANSENDO TUBE/CATH PLAC
|
Facility
|
OP
|
$5,091.00
|
|
|
Service Code
|
CPT 43241
|
| Hospital Charge Code |
906743241
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,018.20 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,018.20
|
| 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 |
$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: Cash Price |
$2,290.95
|
| Rate for Payer: Cash Price |
$1,291.05
|
| Rate for Payer: Cash Price |
$2,290.95
|
| Rate for Payer: Cash Price |
$1,291.05
|
| Rate for Payer: Cash Price |
$1,291.05
|
| Rate for Payer: Cash Price |
$2,290.95
|
| Rate for Payer: Cigna of CA HMO |
$1,836.16
|
| Rate for Payer: Cigna of CA HMO |
$3,258.24
|
| Rate for Payer: Cigna of CA PPO |
$2,123.06
|
| Rate for Payer: Cigna of CA PPO |
$3,767.34
|
| 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 |
$3,563.70
|
| 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 |
$4,327.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,721.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,054.60
|
| 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) 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 |
$3,232.78
|
| 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 |
$1,221.84
|
| 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 |
$4,072.80
|
| Rate for Payer: Multiplan Commercial |
$2,295.20
|
| Rate for Payer: Networks By Design Commercial |
$1,864.85
|
| Rate for Payer: Networks By Design Commercial |
$3,309.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,327.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,438.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,054.60
|
| 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 |
$2,545.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,434.50
|
| 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 |
$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/TRNSMRL DRNG/ PSEUDOCYST
|
Facility
|
IP
|
$5,728.00
|
|
|
Service Code
|
CPT 43240
|
| Hospital Charge Code |
906743240
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,145.60 |
| Max. Negotiated Rate |
$4,868.80 |
| Rate for Payer: Adventist Health Commercial |
$1,145.60
|
| Rate for Payer: Cash Price |
$2,577.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,009.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,291.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,291.20
|
| Rate for Payer: Galaxy Health WC |
$4,868.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,436.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,637.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,379.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,374.72
|
| Rate for Payer: Multiplan Commercial |
$4,582.40
|
| Rate for Payer: Networks By Design Commercial |
$3,723.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,868.80
|
|
