|
HC EEG W/O VID 2-12HR UNMNTRD
|
Facility
|
OP
|
$1,249.00
|
|
|
Service Code
|
CPT 95705
|
| Hospital Charge Code |
900605705
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$249.80 |
| Max. Negotiated Rate |
$3,209.17 |
| Rate for Payer: Adventist Health Commercial |
$249.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$277.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$566.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,209.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$726.54
|
| Rate for Payer: Blue Shield of California Commercial |
$786.87
|
| Rate for Payer: Blue Shield of California EPN |
$495.85
|
| Rate for Payer: Cash Price |
$562.05
|
| Rate for Payer: Cash Price |
$562.05
|
| Rate for Payer: Cash Price |
$562.05
|
| Rate for Payer: Central Health Plan Commercial |
$999.20
|
| Rate for Payer: Cigna of CA HMO |
$799.36
|
| Rate for Payer: Cigna of CA PPO |
$924.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$416.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$305.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$277.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$874.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$458.22
|
| Rate for Payer: EPIC Health Plan Senior |
$305.48
|
| Rate for Payer: Galaxy Health WC |
$1,061.65
|
| Rate for Payer: Global Benefits Group Commercial |
$749.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,124.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$455.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$381.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$277.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$793.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$421.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$388.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$249.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$372.13
|
| Rate for Payer: Multiplan Commercial |
$936.75
|
| Rate for Payer: Networks By Design Commercial |
$811.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$277.71
|
| Rate for Payer: Prime Health Services Commercial |
$1,061.65
|
| Rate for Payer: Prime Health Services Medicare |
$294.37
|
| Rate for Payer: Riverside University Health System MISP |
$305.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$749.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$749.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,039.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,896.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,389.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,272.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$277.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Vantage Medical Group Senior |
$277.71
|
|
|
HC EEG W/O VID 2-12HR UNMNTRD
|
Facility
|
IP
|
$1,249.00
|
|
|
Service Code
|
CPT 95705
|
| Hospital Charge Code |
900605705
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$249.80 |
| Max. Negotiated Rate |
$1,124.10 |
| Rate for Payer: Adventist Health Commercial |
$249.80
|
| Rate for Payer: Cash Price |
$562.05
|
| Rate for Payer: Central Health Plan Commercial |
$999.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$874.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$499.60
|
| Rate for Payer: EPIC Health Plan Senior |
$499.60
|
| Rate for Payer: Galaxy Health WC |
$1,061.65
|
| Rate for Payer: Global Benefits Group Commercial |
$749.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,124.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$793.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$736.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$249.80
|
| Rate for Payer: Multiplan Commercial |
$936.75
|
| Rate for Payer: Networks By Design Commercial |
$811.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,061.65
|
|
|
HC EEG W/O VID EA 12-26HR CNT MNR
|
Facility
|
IP
|
$2,397.00
|
|
|
Service Code
|
CPT 95710
|
| Hospital Charge Code |
900605710
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$479.40 |
| Max. Negotiated Rate |
$2,157.30 |
| Rate for Payer: Adventist Health Commercial |
$479.40
|
| Rate for Payer: Cash Price |
$1,078.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,917.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,677.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$958.80
|
| Rate for Payer: EPIC Health Plan Senior |
$958.80
|
| Rate for Payer: Galaxy Health WC |
$2,037.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,438.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,157.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,522.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,414.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$479.40
|
| Rate for Payer: Multiplan Commercial |
$1,797.75
|
| Rate for Payer: Networks By Design Commercial |
$1,558.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,037.45
|
|
|
HC EEG W/O VID EA 12-26HR CNT MNR
|
Facility
|
OP
|
$2,397.00
|
|
|
Service Code
|
CPT 95710
|
| Hospital Charge Code |
900605710
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$479.40 |
| Max. Negotiated Rate |
$5,891.74 |
| Rate for Payer: Adventist Health Commercial |
$479.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$479.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5,891.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$719.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$527.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$479.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,242.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,394.33
|
| Rate for Payer: Blue Shield of California Commercial |
$1,510.11
|
| Rate for Payer: Blue Shield of California EPN |
$951.61
|
| Rate for Payer: Cash Price |
$1,078.65
|
| Rate for Payer: Cash Price |
$1,078.65
|
| Rate for Payer: Cash Price |
$1,078.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,917.60
|
| Rate for Payer: Cigna of CA HMO |
$1,534.08
|
| Rate for Payer: Cigna of CA PPO |
$1,773.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$719.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$527.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$479.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,677.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$791.90
|
| Rate for Payer: EPIC Health Plan Senior |
$527.93
|
| Rate for Payer: Galaxy Health WC |
$2,037.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,438.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,157.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$787.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,759.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$479.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,522.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,944.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$671.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$479.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$643.12
|
| Rate for Payer: Multiplan Commercial |
$1,797.75
|
| Rate for Payer: Networks By Design Commercial |
$1,558.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$479.94
|
| Rate for Payer: Prime Health Services Commercial |
$2,037.45
|
| Rate for Payer: Prime Health Services Medicare |
$508.74
|
| Rate for Payer: Riverside University Health System MISP |
$527.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,438.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,438.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,039.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,896.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,389.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,272.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$479.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$719.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$527.93
|
| Rate for Payer: Vantage Medical Group Senior |
$479.94
|
|
|
HC EEG W/O VID EA 12-26HR INT MNR
|
Facility
|
OP
|
$2,397.00
|
|
|
Service Code
|
CPT 95709
|
| Hospital Charge Code |
900605709
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$479.40 |
| Max. Negotiated Rate |
$4,712.22 |
| Rate for Payer: Adventist Health Commercial |
$479.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$479.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,712.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$719.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$527.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$479.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,209.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,394.33
|
| Rate for Payer: Blue Shield of California Commercial |
$1,510.11
|
| Rate for Payer: Blue Shield of California EPN |
$951.61
|
| Rate for Payer: Cash Price |
$1,078.65
|
| Rate for Payer: Cash Price |
$1,078.65
|
| Rate for Payer: Cash Price |
$1,078.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,917.60
|
| Rate for Payer: Cigna of CA HMO |
$1,534.08
|
| Rate for Payer: Cigna of CA PPO |
$1,773.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$719.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$527.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$479.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,677.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$791.90
|
| Rate for Payer: EPIC Health Plan Senior |
$527.93
|
| Rate for Payer: Galaxy Health WC |
$2,037.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,438.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,157.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$787.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,012.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$479.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,522.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,118.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$671.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$479.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$643.12
|
| Rate for Payer: Multiplan Commercial |
$1,797.75
|
| Rate for Payer: Networks By Design Commercial |
$1,558.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$479.94
|
| Rate for Payer: Prime Health Services Commercial |
$2,037.45
|
| Rate for Payer: Prime Health Services Medicare |
$508.74
|
| Rate for Payer: Riverside University Health System MISP |
$527.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,438.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,438.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,039.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,896.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,389.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,272.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$479.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$719.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$527.93
|
| Rate for Payer: Vantage Medical Group Senior |
$479.94
|
|
|
HC EEG W/O VID EA 12-26HR INT MNR
|
Facility
|
IP
|
$2,397.00
|
|
|
Service Code
|
CPT 95709
|
| Hospital Charge Code |
900605709
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$479.40 |
| Max. Negotiated Rate |
$2,157.30 |
| Rate for Payer: Adventist Health Commercial |
$479.40
|
| Rate for Payer: Cash Price |
$1,078.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,917.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,677.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$958.80
|
| Rate for Payer: EPIC Health Plan Senior |
$958.80
|
| Rate for Payer: Galaxy Health WC |
$2,037.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,438.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,157.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,522.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,414.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$479.40
|
| Rate for Payer: Multiplan Commercial |
$1,797.75
|
| Rate for Payer: Networks By Design Commercial |
$1,558.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,037.45
|
|
|
HC EEG W/O VID EA 12-26HR UNMNTRD
|
Facility
|
OP
|
$4,168.00
|
|
|
Service Code
|
CPT 95708
|
| Hospital Charge Code |
900605708
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$455.92 |
| Max. Negotiated Rate |
$3,751.20 |
| Rate for Payer: Adventist Health Commercial |
$833.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$479.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$848.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$719.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$527.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$479.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,209.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,424.53
|
| Rate for Payer: Blue Shield of California Commercial |
$2,625.84
|
| Rate for Payer: Blue Shield of California EPN |
$1,654.70
|
| Rate for Payer: Cash Price |
$1,875.60
|
| Rate for Payer: Cash Price |
$1,875.60
|
| Rate for Payer: Cash Price |
$1,875.60
|
| Rate for Payer: Central Health Plan Commercial |
$3,334.40
|
| Rate for Payer: Cigna of CA HMO |
$2,667.52
|
| Rate for Payer: Cigna of CA PPO |
$3,084.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$719.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$527.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$479.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,917.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$791.90
|
| Rate for Payer: EPIC Health Plan Senior |
$527.93
|
| Rate for Payer: Galaxy Health WC |
$3,542.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,500.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,751.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$787.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$455.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$479.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,646.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$503.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$671.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$833.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$643.12
|
| Rate for Payer: Multiplan Commercial |
$3,126.00
|
| Rate for Payer: Networks By Design Commercial |
$2,709.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$479.94
|
| Rate for Payer: Prime Health Services Commercial |
$3,542.80
|
| Rate for Payer: Prime Health Services Medicare |
$508.74
|
| Rate for Payer: Riverside University Health System MISP |
$527.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,500.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,500.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,039.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,896.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,389.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,272.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$479.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$719.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$527.93
|
| Rate for Payer: Vantage Medical Group Senior |
$479.94
|
|
|
HC EEG W/O VID EA 12-26HR UNMNTRD
|
Facility
|
IP
|
$4,168.00
|
|
|
Service Code
|
CPT 95708
|
| Hospital Charge Code |
900605708
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$833.60 |
| Max. Negotiated Rate |
$3,751.20 |
| Rate for Payer: Adventist Health Commercial |
$833.60
|
| Rate for Payer: Cash Price |
$1,875.60
|
| Rate for Payer: Central Health Plan Commercial |
$3,334.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,917.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,667.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,667.20
|
| Rate for Payer: Galaxy Health WC |
$3,542.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,500.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,751.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,646.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,459.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$833.60
|
| Rate for Payer: Multiplan Commercial |
$3,126.00
|
| Rate for Payer: Networks By Design Commercial |
$2,709.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,542.80
|
|
|
HC EF SPEC METABOLIC NONINHERIT
|
Facility
|
OP
|
$1.63
|
|
|
Service Code
|
CPT B4154
|
| Hospital Charge Code |
900541540
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$3.62 |
| Rate for Payer: Adventist Health Commercial |
$0.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.95
|
| Rate for Payer: Blue Shield of California Commercial |
$1.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.65
|
| Rate for Payer: Cash Price |
$0.73
|
| Rate for Payer: Cash Price |
$0.73
|
| Rate for Payer: Central Health Plan Commercial |
$1.30
|
| Rate for Payer: Cigna of CA HMO |
$1.04
|
| Rate for Payer: Cigna of CA PPO |
$1.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.65
|
| Rate for Payer: EPIC Health Plan Senior |
$0.65
|
| Rate for Payer: Galaxy Health WC |
$1.39
|
| Rate for Payer: Global Benefits Group Commercial |
$0.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.14
|
| Rate for Payer: Multiplan Commercial |
$1.22
|
| Rate for Payer: Networks By Design Commercial |
$1.06
|
| Rate for Payer: Prime Health Services Commercial |
$1.39
|
| Rate for Payer: Riverside University Health System MISP |
$0.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.82
|
| Rate for Payer: United Healthcare All Other HMO |
$0.82
|
| Rate for Payer: United Healthcare HMO Rider |
$0.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1.39
|
|
|
HC EF SPEC METABOLIC NONINHERIT
|
Facility
|
IP
|
$1.63
|
|
|
Service Code
|
CPT B4154
|
| Hospital Charge Code |
900541540
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.47 |
| Rate for Payer: Adventist Health Commercial |
$0.33
|
| Rate for Payer: Cash Price |
$0.73
|
| Rate for Payer: Central Health Plan Commercial |
$1.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.65
|
| Rate for Payer: EPIC Health Plan Senior |
$0.65
|
| Rate for Payer: Galaxy Health WC |
$1.39
|
| Rate for Payer: Global Benefits Group Commercial |
$0.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: Multiplan Commercial |
$1.22
|
| Rate for Payer: Networks By Design Commercial |
$1.06
|
| Rate for Payer: Prime Health Services Commercial |
$1.39
|
|
|
HC EGD BLLN DILA ESOPH 30MM OR GT
|
Facility
|
OP
|
$4,217.00
|
|
|
Service Code
|
CPT 43233
|
| Hospital Charge Code |
906743233
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$346.43 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$843.40
|
| Rate for Payer: Adventist Health Commercial |
$450.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,468.04
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,468.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,897.65
|
| Rate for Payer: Cash Price |
$1,897.65
|
| Rate for Payer: Cash Price |
$1,013.85
|
| Rate for Payer: Cash Price |
$1,897.65
|
| Rate for Payer: Cash Price |
$1,013.85
|
| Rate for Payer: Cash Price |
$1,013.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,802.40
|
| Rate for Payer: Central Health Plan Commercial |
$3,373.60
|
| Rate for Payer: Cigna of CA HMO |
$1,441.92
|
| Rate for Payer: Cigna of CA HMO |
$2,698.88
|
| Rate for Payer: Cigna of CA PPO |
$3,120.58
|
| Rate for Payer: Cigna of CA PPO |
$1,667.22
|
| 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 |
$1,577.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,951.90
|
| 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 |
$3,584.45
|
| 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 |
$2,530.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,027.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,795.30
|
| 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 |
$346.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$346.43
|
| 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 |
$1,430.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,677.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$382.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$382.68
|
| 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 |
$843.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$450.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$3,162.75
|
| Rate for Payer: Multiplan Commercial |
$1,689.75
|
| Rate for Payer: Networks By Design Commercial |
$2,741.05
|
| Rate for Payer: Networks By Design Commercial |
$1,464.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,468.04
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Prime Health Services Commercial |
$1,915.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,584.45
|
| Rate for Payer: Prime Health Services Medicare |
$2,616.12
|
| Rate for Payer: Prime Health Services Medicare |
$2,616.12
|
| Rate for Payer: Riverside University Health System MISP |
$2,714.84
|
| Rate for Payer: Riverside University Health System MISP |
$2,714.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,351.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,530.20
|
| 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 |
$2,108.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,126.50
|
| 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 BLLN DILA ESOPH 30MM OR GT
|
Facility
|
IP
|
$4,217.00
|
|
|
Service Code
|
CPT 43233
|
| Hospital Charge Code |
906743233
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$843.40 |
| Max. Negotiated Rate |
$3,795.30 |
| Rate for Payer: Adventist Health Commercial |
$843.40
|
| Rate for Payer: Cash Price |
$1,897.65
|
| Rate for Payer: Central Health Plan Commercial |
$3,373.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,951.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,686.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,686.80
|
| Rate for Payer: Galaxy Health WC |
$3,584.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,530.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,795.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,677.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,488.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$843.40
|
| Rate for Payer: Multiplan Commercial |
$3,162.75
|
| Rate for Payer: Networks By Design Commercial |
$2,741.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,584.45
|
|
|
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 |
$400.00 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$897.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| 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 Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,898.06
|
| 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: Cash Price |
$2,019.15
|
| Rate for Payer: Central Health Plan Commercial |
$3,589.60
|
| 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: Health Management Network EPO/PPO |
$4,038.30
|
| 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 |
$897.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$3,365.25
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Networks By Design Commercial |
$2,916.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Preferred Health Network WC |
$1,936.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,813.95
|
| Rate for Payer: Prime Health Services Medicare |
$1,236.52
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Riverside University Health System MISP |
$1,283.18
|
| 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/ OR W/O COLLECTION
|
Facility
|
OP
|
$4,487.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
906743235
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$385.49 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$897.40
|
| Rate for Payer: Adventist Health Commercial |
$599.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,166.53
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,166.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| 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 |
$2,019.15
|
| Rate for Payer: Cash Price |
$1,349.10
|
| Rate for Payer: Cash Price |
$1,349.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,398.40
|
| Rate for Payer: Central Health Plan Commercial |
$3,589.60
|
| Rate for Payer: Cigna of CA HMO |
$1,918.72
|
| Rate for Payer: Cigna of CA HMO |
$2,871.68
|
| Rate for Payer: Cigna of CA PPO |
$3,320.38
|
| Rate for Payer: Cigna of CA PPO |
$2,218.52
|
| 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 |
$2,098.60
|
| 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 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: Health Management Network EPO/PPO |
$2,698.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,038.30
|
| 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 |
$385.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$385.49
|
| 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 |
$1,903.73
|
| 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 Medi-Cal |
$425.83
|
| 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 |
$897.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$599.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$3,365.25
|
| Rate for Payer: Multiplan Commercial |
$2,248.50
|
| Rate for Payer: Networks By Design Commercial |
$2,916.55
|
| Rate for Payer: Networks By Design Commercial |
$1,948.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,166.53
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Prime Health Services Commercial |
$2,548.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,813.95
|
| Rate for Payer: Prime Health Services Medicare |
$1,236.52
|
| Rate for Payer: Prime Health Services Medicare |
$1,236.52
|
| Rate for Payer: Riverside University Health System MISP |
$1,283.18
|
| Rate for Payer: Riverside University Health System MISP |
$1,283.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,798.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,692.20
|
| 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 |
$2,243.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,499.00
|
| 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 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 |
$4,038.30 |
| Rate for Payer: Adventist Health Commercial |
$897.40
|
| Rate for Payer: Cash Price |
$2,019.15
|
| Rate for Payer: Central Health Plan Commercial |
$3,589.60
|
| 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: Health Management Network EPO/PPO |
$4,038.30
|
| 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 |
$897.40
|
| Rate for Payer: Multiplan Commercial |
$3,365.25
|
| 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 |
906743235
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$897.40 |
| Max. Negotiated Rate |
$4,038.30 |
| Rate for Payer: Adventist Health Commercial |
$897.40
|
| Rate for Payer: Cash Price |
$2,019.15
|
| Rate for Payer: Central Health Plan Commercial |
$3,589.60
|
| 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: Health Management Network EPO/PPO |
$4,038.30
|
| 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 |
$897.40
|
| Rate for Payer: Multiplan Commercial |
$3,365.25
|
| Rate for Payer: Networks By Design Commercial |
$2,916.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,813.95
|
|
|
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 |
$418.15 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$897.40
|
| Rate for Payer: Adventist Health Commercial |
$599.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,166.53
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,166.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| 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 |
$2,019.15
|
| Rate for Payer: Cash Price |
$1,349.10
|
| Rate for Payer: Cash Price |
$1,349.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,398.40
|
| Rate for Payer: Central Health Plan Commercial |
$3,589.60
|
| Rate for Payer: Cigna of CA HMO |
$1,918.72
|
| Rate for Payer: Cigna of CA HMO |
$2,871.68
|
| Rate for Payer: Cigna of CA PPO |
$3,320.38
|
| Rate for Payer: Cigna of CA PPO |
$2,218.52
|
| 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 |
$2,098.60
|
| 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 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: Health Management Network EPO/PPO |
$2,698.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,038.30
|
| 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 |
$418.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$418.15
|
| 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 |
$1,903.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,849.24
|
| 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 |
$897.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$599.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$3,365.25
|
| Rate for Payer: Multiplan Commercial |
$2,248.50
|
| Rate for Payer: Networks By Design Commercial |
$2,916.55
|
| Rate for Payer: Networks By Design Commercial |
$1,948.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,166.53
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Prime Health Services Commercial |
$2,548.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,813.95
|
| Rate for Payer: Prime Health Services Medicare |
$1,236.52
|
| Rate for Payer: Prime Health Services Medicare |
$1,236.52
|
| Rate for Payer: Riverside University Health System MISP |
$1,283.18
|
| Rate for Payer: Riverside University Health System MISP |
$1,283.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,798.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,692.20
|
| 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 |
$2,243.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,499.00
|
| 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 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 |
$4,038.30 |
| Rate for Payer: Adventist Health Commercial |
$897.40
|
| Rate for Payer: Cash Price |
$2,019.15
|
| Rate for Payer: Central Health Plan Commercial |
$3,589.60
|
| 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: Health Management Network EPO/PPO |
$4,038.30
|
| 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 |
$897.40
|
| Rate for Payer: Multiplan Commercial |
$3,365.25
|
| 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
|
OP
|
$4,487.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
900501432
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$897.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| 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 Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,898.06
|
| 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: Cash Price |
$2,019.15
|
| Rate for Payer: Central Health Plan Commercial |
$3,589.60
|
| 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: Health Management Network EPO/PPO |
$4,038.30
|
| 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 |
$897.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$3,365.25
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Networks By Design Commercial |
$2,916.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Preferred Health Network WC |
$1,936.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,813.95
|
| Rate for Payer: Prime Health Services Medicare |
$1,236.52
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Riverside University Health System MISP |
$1,283.18
|
| 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 WO COLLECTION
|
Facility
|
IP
|
$4,487.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
900501432
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$897.40 |
| Max. Negotiated Rate |
$4,038.30 |
| Rate for Payer: Adventist Health Commercial |
$897.40
|
| Rate for Payer: Cash Price |
$2,019.15
|
| Rate for Payer: Central Health Plan Commercial |
$3,589.60
|
| 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: Health Management Network EPO/PPO |
$4,038.30
|
| 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 |
$897.40
|
| Rate for Payer: Multiplan Commercial |
$3,365.25
|
| Rate for Payer: Networks By Design Commercial |
$2,916.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,813.95
|
|
|
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 |
$6,185.70 |
| Rate for Payer: Adventist Health Commercial |
$1,374.60
|
| Rate for Payer: Cash Price |
$3,092.85
|
| Rate for Payer: Central Health Plan Commercial |
$5,498.40
|
| 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: Health Management Network EPO/PPO |
$6,185.70
|
| 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 |
$1,374.60
|
| Rate for Payer: Multiplan Commercial |
$5,154.75
|
| 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 |
$344.52 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,374.60
|
| Rate for Payer: Adventist Health Commercial |
$918.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$7,808.19
|
| Rate for Payer: Adventist Health Medi-Cal |
$7,808.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| 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 |
$3,092.85
|
| Rate for Payer: Cash Price |
$2,066.85
|
| Rate for Payer: Cash Price |
$2,066.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,674.40
|
| Rate for Payer: Central Health Plan Commercial |
$5,498.40
|
| Rate for Payer: Cigna of CA HMO |
$2,939.52
|
| Rate for Payer: Cigna of CA HMO |
$4,398.72
|
| Rate for Payer: Cigna of CA PPO |
$5,086.02
|
| Rate for Payer: Cigna of CA PPO |
$3,398.82
|
| 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 |
$3,215.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,811.10
|
| 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: 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: Global Benefits Group Commercial |
$2,755.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4,123.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,133.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,185.70
|
| 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 |
$344.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$344.52
|
| 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 |
$2,916.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,364.35
|
| 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 |
$1,374.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$918.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,462.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,462.97
|
| Rate for Payer: Multiplan Commercial |
$5,154.75
|
| Rate for Payer: Multiplan Commercial |
$3,444.75
|
| Rate for Payer: Networks By Design Commercial |
$4,467.45
|
| Rate for Payer: Networks By Design Commercial |
$2,985.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,808.19
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,808.19
|
| Rate for Payer: Prime Health Services Commercial |
$3,904.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,842.05
|
| Rate for Payer: Prime Health Services Medicare |
$8,276.68
|
| Rate for Payer: Prime Health Services Medicare |
$8,276.68
|
| Rate for Payer: Riverside University Health System MISP |
$8,589.01
|
| Rate for Payer: Riverside University Health System MISP |
$8,589.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,755.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,123.80
|
| 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 |
$3,436.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,296.50
|
| 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 FLXBL TRNSORL W DPLMNT OF IG BRTRC BLLN
|
Facility
|
OP
|
$6,904.00
|
|
|
Service Code
|
CPT 43290
|
| Hospital Charge Code |
906743290
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$639.21 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,380.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,468.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$3,106.80
|
| Rate for Payer: Cash Price |
$3,106.80
|
| Rate for Payer: Cash Price |
$3,106.80
|
| Rate for Payer: Central Health Plan Commercial |
$5,523.20
|
| Rate for Payer: Cigna of CA HMO |
$4,418.56
|
| Rate for Payer: Cigna of CA PPO |
$5,108.96
|
| 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 |
$4,832.80
|
| 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 |
$5,868.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,142.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,213.60
|
| 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 |
$4,384.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,380.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$5,178.00
|
| Rate for Payer: Networks By Design Commercial |
$4,487.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Prime Health Services Commercial |
$5,868.40
|
| Rate for Payer: Prime Health Services Medicare |
$2,616.12
|
| Rate for Payer: Riverside University Health System MISP |
$2,714.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,142.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,961.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,452.00
|
| 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 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 FLXBL TRNSORL W DPLMNT OF IG BRTRC BLLN
|
Facility
|
IP
|
$6,904.00
|
|
|
Service Code
|
CPT 43290
|
| Hospital Charge Code |
906743290
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,380.80 |
| Max. Negotiated Rate |
$6,213.60 |
| Rate for Payer: Adventist Health Commercial |
$1,380.80
|
| Rate for Payer: Cash Price |
$3,106.80
|
| Rate for Payer: Central Health Plan Commercial |
$5,523.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,832.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,761.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,761.60
|
| Rate for Payer: Galaxy Health WC |
$5,868.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,142.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,213.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,384.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,073.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,380.80
|
| Rate for Payer: Multiplan Commercial |
$5,178.00
|
| Rate for Payer: Networks By Design Commercial |
$4,487.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,868.40
|
|
|
HC EGD FLXBL TRNSORL W RMVL OF IG BRTRC BLLN
|
Facility
|
OP
|
$3,272.00
|
|
|
Service Code
|
CPT 43291
|
| Hospital Charge Code |
906743291
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$639.21 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$654.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,166.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$1,472.40
|
| Rate for Payer: Cash Price |
$1,472.40
|
| Rate for Payer: Cash Price |
$1,472.40
|
| Rate for Payer: Central Health Plan Commercial |
$2,617.60
|
| Rate for Payer: Cigna of CA HMO |
$2,094.08
|
| Rate for Payer: Cigna of CA PPO |
$2,421.28
|
| 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 |
$2,290.40
|
| 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 |
$2,781.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,963.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,944.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,077.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$654.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$2,454.00
|
| Rate for Payer: Networks By Design Commercial |
$2,126.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Prime Health Services Commercial |
$2,781.20
|
| Rate for Payer: Prime Health Services Medicare |
$1,236.52
|
| Rate for Payer: Riverside University Health System MISP |
$1,283.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,963.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,399.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,636.00
|
| 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 Select/Navigate/Core |
$4,122.00
|
| 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
|
|
