|
HC EGD FLXBL TRNSORL W RMVL OF IG BRTRC BLLN
|
Facility
|
IP
|
$3,272.00
|
|
|
Service Code
|
CPT 43291
|
| Hospital Charge Code |
906743291
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$654.40 |
| Max. Negotiated Rate |
$2,944.80 |
| Rate for Payer: Adventist Health Commercial |
$654.40
|
| Rate for Payer: Cash Price |
$1,472.40
|
| Rate for Payer: Central Health Plan Commercial |
$2,617.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,290.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,308.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,308.80
|
| 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: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,077.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,930.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$654.40
|
| Rate for Payer: Multiplan Commercial |
$2,454.00
|
| Rate for Payer: Networks By Design Commercial |
$2,126.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,781.20
|
|
|
HC EGD INTRMURAL US NDL ASPIRATE BIOPSY ESOPHAGS
|
Facility
|
OP
|
$3,325.00
|
|
|
Service Code
|
CPT 43238
|
| Hospital Charge Code |
906703238
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$665.00 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$665.00
|
| 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 |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,496.25
|
| Rate for Payer: Cash Price |
$1,496.25
|
| Rate for Payer: Cash Price |
$1,496.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,660.00
|
| Rate for Payer: Cigna of CA HMO |
$2,128.00
|
| Rate for Payer: Cigna of CA PPO |
$2,460.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,327.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: Galaxy Health WC |
$2,826.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,995.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,992.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,111.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,206.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$665.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$2,493.75
|
| Rate for Payer: Networks By Design Commercial |
$2,161.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Prime Health Services Commercial |
$2,826.25
|
| 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 |
$1,995.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,961.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,662.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
|
|
HC EGD INTRMURAL US NDL ASPIRATE BIOPSY ESOPHAGS
|
Facility
|
IP
|
$3,325.00
|
|
|
Service Code
|
CPT 43238
|
| Hospital Charge Code |
906703238
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$665.00 |
| Max. Negotiated Rate |
$2,992.50 |
| Rate for Payer: Adventist Health Commercial |
$665.00
|
| Rate for Payer: Cash Price |
$1,496.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,660.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,327.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,330.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,330.00
|
| Rate for Payer: Galaxy Health WC |
$2,826.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,995.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,992.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,111.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,961.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$665.00
|
| Rate for Payer: Multiplan Commercial |
$2,493.75
|
| Rate for Payer: Networks By Design Commercial |
$2,161.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,826.25
|
|
|
HC EGD LESION ABLATION
|
Facility
|
OP
|
$4,963.00
|
|
|
Service Code
|
CPT 43270
|
| Hospital Charge Code |
900100018
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$362.44 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$992.60
|
| Rate for Payer: Adventist Health Commercial |
$576.60
|
| 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 |
$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 |
$2,233.35
|
| Rate for Payer: Cash Price |
$2,233.35
|
| Rate for Payer: Cash Price |
$1,297.35
|
| Rate for Payer: Cash Price |
$2,233.35
|
| Rate for Payer: Cash Price |
$1,297.35
|
| Rate for Payer: Cash Price |
$1,297.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,306.40
|
| Rate for Payer: Central Health Plan Commercial |
$3,970.40
|
| Rate for Payer: Cigna of CA HMO |
$1,845.12
|
| Rate for Payer: Cigna of CA HMO |
$3,176.32
|
| Rate for Payer: Cigna of CA PPO |
$3,672.62
|
| Rate for Payer: Cigna of CA PPO |
$2,133.42
|
| 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 |
$2,018.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,474.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: Galaxy Health WC |
$4,218.55
|
| Rate for Payer: Galaxy Health WC |
$2,450.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,729.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,977.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,594.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,466.70
|
| 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 |
$362.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$362.44
|
| 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 |
$1,830.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,151.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$400.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$400.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$992.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$576.60
|
| 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 |
$3,722.25
|
| Rate for Payer: Multiplan Commercial |
$2,162.25
|
| Rate for Payer: Networks By Design Commercial |
$3,225.95
|
| Rate for Payer: Networks By Design Commercial |
$1,873.95
|
| 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 |
$2,450.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,218.55
|
| 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 |
$1,729.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,977.80
|
| 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 |
$2,481.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,441.50
|
| 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 LESION ABLATION
|
Facility
|
IP
|
$4,963.00
|
|
|
Service Code
|
CPT 43270
|
| Hospital Charge Code |
900100018
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$992.60 |
| Max. Negotiated Rate |
$4,466.70 |
| Rate for Payer: Adventist Health Commercial |
$992.60
|
| Rate for Payer: Cash Price |
$2,233.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,970.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,474.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,985.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,985.20
|
| Rate for Payer: Galaxy Health WC |
$4,218.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,977.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,466.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,151.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,928.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$992.60
|
| Rate for Payer: Multiplan Commercial |
$3,722.25
|
| Rate for Payer: Networks By Design Commercial |
$3,225.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,218.55
|
|
|
HC EGD & POLYPECTOMY
|
Facility
|
IP
|
$3,358.00
|
|
|
Service Code
|
CPT 43250
|
| Hospital Charge Code |
906743250
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$671.60 |
| Max. Negotiated Rate |
$3,022.20 |
| Rate for Payer: Adventist Health Commercial |
$671.60
|
| Rate for Payer: Cash Price |
$1,511.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,686.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,350.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,343.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,343.20
|
| Rate for Payer: Galaxy Health WC |
$2,854.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,014.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,022.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,132.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,981.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$671.60
|
| Rate for Payer: Multiplan Commercial |
$2,518.50
|
| Rate for Payer: Networks By Design Commercial |
$2,182.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,854.30
|
|
|
HC EGD & POLYPECTOMY
|
Facility
|
OP
|
$3,358.00
|
|
|
Service Code
|
CPT 43250
|
| Hospital Charge Code |
906743250
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$421.35 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$671.60
|
| Rate for Payer: Adventist Health Commercial |
$449.00
|
| 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 |
$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 |
$1,511.10
|
| Rate for Payer: Cash Price |
$1,511.10
|
| Rate for Payer: Cash Price |
$1,010.25
|
| Rate for Payer: Cash Price |
$1,511.10
|
| Rate for Payer: Cash Price |
$1,010.25
|
| Rate for Payer: Cash Price |
$1,010.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,796.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,686.40
|
| Rate for Payer: Cigna of CA HMO |
$1,436.80
|
| Rate for Payer: Cigna of CA HMO |
$2,149.12
|
| Rate for Payer: Cigna of CA PPO |
$2,484.92
|
| Rate for Payer: Cigna of CA PPO |
$1,661.30
|
| 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 |
$1,571.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,350.60
|
| 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 |
$2,854.30
|
| Rate for Payer: Galaxy Health WC |
$1,908.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,347.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,014.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,020.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,022.20
|
| 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 |
$421.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$421.35
|
| 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 |
$1,425.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,132.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$465.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$465.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$671.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$449.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$2,518.50
|
| Rate for Payer: Multiplan Commercial |
$1,683.75
|
| Rate for Payer: Networks By Design Commercial |
$2,182.70
|
| Rate for Payer: Networks By Design Commercial |
$1,459.25
|
| 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 |
$1,908.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,854.30
|
| 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 |
$1,347.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,014.80
|
| 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 |
$1,679.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,122.50
|
| 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 US TRANSMURAL INJECT MARKER
|
Facility
|
OP
|
$4,217.00
|
|
|
Service Code
|
CPT 43253
|
| Hospital Charge Code |
906743253
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$401.50 |
| 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 |
$401.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$401.50
|
| 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 |
$443.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$443.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 US TRANSMURAL INJECT MARKER
|
Facility
|
IP
|
$4,217.00
|
|
|
Service Code
|
CPT 43253
|
| Hospital Charge Code |
906743253
|
|
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 W/BAND/LIG SCLE
|
Facility
|
IP
|
$7,082.00
|
|
|
Service Code
|
CPT 43244
|
| Hospital Charge Code |
906743244
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,416.40 |
| Max. Negotiated Rate |
$6,373.80 |
| Rate for Payer: Adventist Health Commercial |
$1,416.40
|
| Rate for Payer: Cash Price |
$3,186.90
|
| Rate for Payer: Central Health Plan Commercial |
$5,665.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,957.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,832.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,832.80
|
| Rate for Payer: Galaxy Health WC |
$6,019.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,249.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,373.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,497.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,178.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,416.40
|
| Rate for Payer: Multiplan Commercial |
$5,311.50
|
| Rate for Payer: Networks By Design Commercial |
$4,603.30
|
| Rate for Payer: Prime Health Services Commercial |
$6,019.70
|
|
|
HC EGD W/BAND/LIG SCLE
|
Facility
|
OP
|
$7,082.00
|
|
|
Service Code
|
CPT 43244
|
| Hospital Charge Code |
906743244
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$369.49 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,416.40
|
| Rate for Payer: Adventist Health Commercial |
$946.80
|
| 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 |
$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 |
$3,186.90
|
| Rate for Payer: Cash Price |
$3,186.90
|
| Rate for Payer: Cash Price |
$2,130.30
|
| Rate for Payer: Cash Price |
$3,186.90
|
| Rate for Payer: Cash Price |
$2,130.30
|
| Rate for Payer: Cash Price |
$2,130.30
|
| Rate for Payer: Central Health Plan Commercial |
$3,787.20
|
| Rate for Payer: Central Health Plan Commercial |
$5,665.60
|
| Rate for Payer: Cigna of CA HMO |
$3,029.76
|
| Rate for Payer: Cigna of CA HMO |
$4,532.48
|
| Rate for Payer: Cigna of CA PPO |
$5,240.68
|
| Rate for Payer: Cigna of CA PPO |
$3,503.16
|
| 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 |
$3,313.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,957.40
|
| 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 |
$6,019.70
|
| Rate for Payer: Galaxy Health WC |
$4,023.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,840.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,249.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,260.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,373.80
|
| 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 |
$369.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$369.49
|
| 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 |
$3,006.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,497.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$408.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$408.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,416.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$946.80
|
| 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 |
$5,311.50
|
| Rate for Payer: Multiplan Commercial |
$3,550.50
|
| Rate for Payer: Networks By Design Commercial |
$4,603.30
|
| Rate for Payer: Networks By Design Commercial |
$3,077.10
|
| 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 |
$4,023.90
|
| Rate for Payer: Prime Health Services Commercial |
$6,019.70
|
| 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 |
$2,840.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,249.20
|
| 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 |
$3,541.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,367.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
|
|
HC EGD W BLLN DLTN ESO
|
Facility
|
IP
|
$4,294.00
|
|
|
Service Code
|
CPT 43249
|
| Hospital Charge Code |
906743249
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$858.80 |
| Max. Negotiated Rate |
$3,864.60 |
| Rate for Payer: Adventist Health Commercial |
$858.80
|
| Rate for Payer: Cash Price |
$1,932.30
|
| Rate for Payer: Central Health Plan Commercial |
$3,435.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,005.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,717.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,717.60
|
| Rate for Payer: Galaxy Health WC |
$3,649.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,576.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,864.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,726.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,533.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$858.80
|
| Rate for Payer: Multiplan Commercial |
$3,220.50
|
| Rate for Payer: Networks By Design Commercial |
$2,791.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,649.90
|
|
|
HC EGD W BLLN DLTN ESO
|
Facility
|
IP
|
$4,294.00
|
|
|
Service Code
|
CPT 43249
|
| Hospital Charge Code |
906743249
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$858.80 |
| Max. Negotiated Rate |
$3,864.60 |
| Rate for Payer: Adventist Health Commercial |
$858.80
|
| Rate for Payer: Cash Price |
$1,932.30
|
| Rate for Payer: Central Health Plan Commercial |
$3,435.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,005.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,717.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,717.60
|
| Rate for Payer: Galaxy Health WC |
$3,649.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,576.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,864.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,726.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,533.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$858.80
|
| Rate for Payer: Multiplan Commercial |
$3,220.50
|
| Rate for Payer: Networks By Design Commercial |
$2,791.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,649.90
|
|
|
HC EGD W BLLN DLTN ESO
|
Facility
|
OP
|
$4,294.00
|
|
|
Service Code
|
CPT 43249
|
| Hospital Charge Code |
906743249
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$383.58 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$858.80
|
| Rate for Payer: Adventist Health Commercial |
$573.80
|
| 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 |
$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 |
$1,932.30
|
| Rate for Payer: Cash Price |
$1,932.30
|
| Rate for Payer: Cash Price |
$1,291.05
|
| Rate for Payer: Cash Price |
$1,932.30
|
| Rate for Payer: Cash Price |
$1,291.05
|
| Rate for Payer: Cash Price |
$1,291.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,295.20
|
| Rate for Payer: Central Health Plan Commercial |
$3,435.20
|
| Rate for Payer: Cigna of CA HMO |
$1,836.16
|
| Rate for Payer: Cigna of CA HMO |
$2,748.16
|
| Rate for Payer: Cigna of CA PPO |
$3,177.56
|
| Rate for Payer: Cigna of CA PPO |
$2,123.06
|
| 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 |
$2,008.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,005.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: Galaxy Health WC |
$3,649.90
|
| Rate for Payer: Galaxy Health WC |
$2,438.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,721.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,576.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,582.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,864.60
|
| 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 |
$383.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$383.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,821.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,726.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$423.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$423.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$858.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$573.80
|
| 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 |
$3,220.50
|
| Rate for Payer: Multiplan Commercial |
$2,151.75
|
| Rate for Payer: Networks By Design Commercial |
$2,791.10
|
| Rate for Payer: Networks By Design Commercial |
$1,864.85
|
| 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 |
$2,438.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,649.90
|
| 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 |
$1,721.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,576.40
|
| 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 |
$2,147.00
|
| 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 BLLN DLTN ESO
|
Facility
|
OP
|
$4,294.00
|
|
|
Service Code
|
CPT 43249
|
| Hospital Charge Code |
906743249
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$858.80
|
| Rate for Payer: Adventist Health Commercial |
$573.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| 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 |
$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: Anthem Blue Cross of CA Workers' Comp |
$3,840.40
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,840.40
|
| Rate for Payer: Cash Price |
$1,291.05
|
| Rate for Payer: Cash Price |
$1,932.30
|
| Rate for Payer: Cash Price |
$1,932.30
|
| Rate for Payer: Cash Price |
$1,291.05
|
| Rate for Payer: Cash Price |
$1,291.05
|
| Rate for Payer: Cash Price |
$1,932.30
|
| Rate for Payer: Cash Price |
$1,291.05
|
| Rate for Payer: Cash Price |
$1,932.30
|
| Rate for Payer: Central Health Plan Commercial |
$3,435.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,295.20
|
| Rate for Payer: Cigna of CA HMO |
$1,836.16
|
| Rate for Payer: Cigna of CA HMO |
$2,748.16
|
| Rate for Payer: Cigna of CA PPO |
$3,177.56
|
| Rate for Payer: Cigna of CA PPO |
$2,123.06
|
| 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 |
$3,005.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,008.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: Galaxy Health WC |
$2,438.65
|
| Rate for Payer: Galaxy Health WC |
$3,649.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,721.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,576.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,864.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,582.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,821.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,726.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$423.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$423.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,653.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,653.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$573.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$858.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$2,151.75
|
| Rate for Payer: Multiplan Commercial |
$3,220.50
|
| Rate for Payer: Multiplan WC |
$3,840.40
|
| Rate for Payer: Multiplan WC |
$3,840.40
|
| Rate for Payer: Networks By Design Commercial |
$1,864.85
|
| Rate for Payer: Networks By Design Commercial |
$2,791.10
|
| 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: Preferred Health Network WC |
$3,918.78
|
| Rate for Payer: Preferred Health Network WC |
$3,918.78
|
| Rate for Payer: Prime Health Services Commercial |
$3,649.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,438.65
|
| Rate for Payer: Prime Health Services Medicare |
$2,616.12
|
| Rate for Payer: Prime Health Services Medicare |
$2,616.12
|
| Rate for Payer: Prime Health Services WC |
$3,801.22
|
| Rate for Payer: Prime Health Services WC |
$3,801.22
|
| 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 |
$2,576.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,721.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,434.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,147.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,147.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,434.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,434.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,147.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,147.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,434.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
|
|
HC EGD W BX SNGL OR MULTI
|
Facility
|
OP
|
$5,808.00
|
|
|
Service Code
|
CPT 43239
|
| Hospital Charge Code |
906743239
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$402.79 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,161.60
|
| Rate for Payer: Adventist Health Commercial |
$621.00
|
| 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 |
$2,613.60
|
| 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: Cash Price |
$1,397.25
|
| Rate for Payer: Cash Price |
$1,397.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,484.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,646.40
|
| Rate for Payer: Cigna of CA HMO |
$1,987.20
|
| Rate for Payer: Cigna of CA HMO |
$3,717.12
|
| Rate for Payer: Cigna of CA PPO |
$4,297.92
|
| Rate for Payer: Cigna of CA PPO |
$2,297.70
|
| 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 |
$2,173.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,065.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: Galaxy Health WC |
$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: Health Management Network EPO/PPO |
$2,794.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,227.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$402.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$402.79
|
| 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 |
$1,633.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,161.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$621.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$4,356.00
|
| Rate for Payer: Multiplan Commercial |
$2,328.75
|
| Rate for Payer: Networks By Design Commercial |
$3,775.20
|
| Rate for Payer: Networks By Design Commercial |
$2,018.25
|
| 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 |
$2,639.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,936.80
|
| 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 |
$1,863.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,484.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,399.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,399.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,904.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,552.50
|
| 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 BX SNGL OR MULTI
|
Facility
|
IP
|
$5,808.00
|
|
|
Service Code
|
CPT 43239
|
| Hospital Charge Code |
906743239
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,161.60 |
| Max. Negotiated Rate |
$5,227.20 |
| Rate for Payer: Adventist Health Commercial |
$1,161.60
|
| Rate for Payer: Cash Price |
$2,613.60
|
| Rate for Payer: Central Health Plan Commercial |
$4,646.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,065.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,323.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,323.20
|
| Rate for Payer: Galaxy Health WC |
$4,936.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,484.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,227.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,688.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,426.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,161.60
|
| Rate for Payer: Multiplan Commercial |
$4,356.00
|
| Rate for Payer: Networks By Design Commercial |
$3,775.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,936.80
|
|
|
HC EGD W BX SNGL OR MULTI
|
Facility
|
IP
|
$5,808.00
|
|
|
Service Code
|
CPT 43239
|
| Hospital Charge Code |
906743239
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,161.60 |
| Max. Negotiated Rate |
$5,227.20 |
| Rate for Payer: Adventist Health Commercial |
$1,161.60
|
| Rate for Payer: Cash Price |
$2,613.60
|
| Rate for Payer: Central Health Plan Commercial |
$4,646.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,065.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,323.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,323.20
|
| Rate for Payer: Galaxy Health WC |
$4,936.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,484.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,227.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,688.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,426.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,161.60
|
| Rate for Payer: Multiplan Commercial |
$4,356.00
|
| Rate for Payer: Networks By Design Commercial |
$3,775.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,936.80
|
|
|
HC EGD W BX SNGL OR MULTI
|
Facility
|
OP
|
$5,808.00
|
|
|
Service Code
|
CPT 43239
|
| Hospital Charge Code |
906743239
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$1,161.60
|
| Rate for Payer: Adventist Health Commercial |
$621.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| 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 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: Anthem Blue Cross of CA Workers' Comp |
$1,898.06
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,898.06
|
| 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: Cash Price |
$1,397.25
|
| Rate for Payer: Cash Price |
$2,613.60
|
| Rate for Payer: Central Health Plan Commercial |
$4,646.40
|
| Rate for Payer: Central Health Plan Commercial |
$2,484.00
|
| Rate for Payer: Cigna of CA HMO |
$1,987.20
|
| Rate for Payer: Cigna of CA HMO |
$3,717.12
|
| Rate for Payer: Cigna of CA PPO |
$4,297.92
|
| Rate for Payer: Cigna of CA PPO |
$2,297.70
|
| 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 |
$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 |
$1,863.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,484.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,227.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,794.50
|
| 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 |
$621.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,161.60
|
| 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 |
$2,328.75
|
| Rate for Payer: Multiplan Commercial |
$4,356.00
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Networks By Design Commercial |
$2,018.25
|
| Rate for Payer: Networks By Design Commercial |
$3,775.20
|
| 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: Preferred Health Network WC |
$1,936.80
|
| Rate for Payer: Preferred Health Network WC |
$1,936.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,936.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,639.25
|
| Rate for Payer: Prime Health Services Medicare |
$1,236.52
|
| Rate for Payer: Prime Health Services Medicare |
$1,236.52
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| 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 |
$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 |
$2,904.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,552.50
|
| 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 |
$495.00 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,243.80
|
| Rate for Payer: Adventist Health Commercial |
$831.20
|
| 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 |
$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 |
$2,798.55
|
| Rate for Payer: Cash Price |
$2,798.55
|
| Rate for Payer: Cash Price |
$1,870.20
|
| 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: Central Health Plan Commercial |
$3,324.80
|
| Rate for Payer: Central Health Plan Commercial |
$4,975.20
|
| Rate for Payer: Cigna of CA HMO |
$2,659.84
|
| Rate for Payer: Cigna of CA HMO |
$3,980.16
|
| Rate for Payer: Cigna of CA PPO |
$4,602.06
|
| Rate for Payer: Cigna of CA PPO |
$3,075.44
|
| 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 |
$2,909.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,353.30
|
| 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 |
$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: Health Management Network EPO/PPO |
$3,740.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,597.10
|
| 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 |
$495.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$495.00
|
| 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 |
$2,639.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,949.07
|
| 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 |
$1,243.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$831.20
|
| 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 |
$4,664.25
|
| Rate for Payer: Multiplan Commercial |
$3,117.00
|
| Rate for Payer: Networks By Design Commercial |
$4,042.35
|
| Rate for Payer: Networks By Design Commercial |
$2,701.40
|
| 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 |
$3,532.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,286.15
|
| 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 |
$2,493.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,731.40
|
| 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 |
$3,109.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,078.00
|
| 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/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 |
$5,597.10 |
| Rate for Payer: Adventist Health Commercial |
$1,243.80
|
| Rate for Payer: Cash Price |
$2,798.55
|
| Rate for Payer: Central Health Plan Commercial |
$4,975.20
|
| 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: Health Management Network EPO/PPO |
$5,597.10
|
| 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 |
$1,243.80
|
| Rate for Payer: Multiplan Commercial |
$4,664.25
|
| 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 |
$4,992.30 |
| Rate for Payer: Adventist Health Commercial |
$1,109.40
|
| Rate for Payer: Cash Price |
$2,496.15
|
| Rate for Payer: Central Health Plan Commercial |
$4,437.60
|
| 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: Health Management Network EPO/PPO |
$4,992.30
|
| 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 |
$1,109.40
|
| Rate for Payer: Multiplan Commercial |
$4,160.25
|
| 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 |
$416.24 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,109.40
|
| Rate for Payer: Adventist Health Commercial |
$741.60
|
| 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 |
$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 |
$2,496.15
|
| Rate for Payer: Cash Price |
$2,496.15
|
| Rate for Payer: Cash Price |
$1,668.60
|
| 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: Central Health Plan Commercial |
$2,966.40
|
| Rate for Payer: Central Health Plan Commercial |
$4,437.60
|
| Rate for Payer: Cigna of CA HMO |
$2,373.12
|
| Rate for Payer: Cigna of CA HMO |
$3,550.08
|
| Rate for Payer: Cigna of CA PPO |
$4,104.78
|
| Rate for Payer: Cigna of CA PPO |
$2,743.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,595.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,882.90
|
| 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 |
$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: Health Management Network EPO/PPO |
$3,337.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,992.30
|
| 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 |
$416.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$416.24
|
| 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 |
$2,354.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,522.34
|
| 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 |
$1,109.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$741.60
|
| 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 |
$4,160.25
|
| Rate for Payer: Multiplan Commercial |
$2,781.00
|
| Rate for Payer: Networks By Design Commercial |
$3,605.55
|
| Rate for Payer: Networks By Design Commercial |
$2,410.20
|
| 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 |
$3,151.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,714.95
|
| 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 |
$2,224.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,328.20
|
| 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 |
$2,773.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,854.00
|
| 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/DRCTD PLCMT PERCUT GAST
|
Facility
|
OP
|
$4,222.00
|
|
|
Service Code
|
CPT 43246
|
| Hospital Charge Code |
906743246
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$416.24 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$844.40
|
| Rate for Payer: Adventist Health Commercial |
$557.00
|
| 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 |
$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 |
$1,899.90
|
| Rate for Payer: Cash Price |
$1,899.90
|
| Rate for Payer: Cash Price |
$1,253.25
|
| Rate for Payer: Cash Price |
$1,899.90
|
| Rate for Payer: Cash Price |
$1,253.25
|
| Rate for Payer: Cash Price |
$1,253.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,228.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,377.60
|
| Rate for Payer: Cigna of CA HMO |
$1,782.40
|
| Rate for Payer: Cigna of CA HMO |
$2,702.08
|
| Rate for Payer: Cigna of CA PPO |
$3,124.28
|
| Rate for Payer: Cigna of CA PPO |
$2,060.90
|
| 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 |
$1,949.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,955.40
|
| 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 |
$3,588.70
|
| 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 |
$2,533.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,506.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,799.80
|
| 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 |
$416.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$416.24
|
| 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 |
$1,768.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,680.97
|
| 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 |
$844.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$557.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$3,166.50
|
| Rate for Payer: Multiplan Commercial |
$2,088.75
|
| Rate for Payer: Networks By Design Commercial |
$2,744.30
|
| Rate for Payer: Networks By Design Commercial |
$1,810.25
|
| 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 |
$2,367.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,588.70
|
| 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 |
$1,671.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,533.20
|
| 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 |
$2,111.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,392.50
|
| 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
|
$4,222.00
|
|
|
Service Code
|
CPT 43246
|
| Hospital Charge Code |
906743246
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$844.40 |
| Max. Negotiated Rate |
$3,799.80 |
| Rate for Payer: Adventist Health Commercial |
$844.40
|
| Rate for Payer: Cash Price |
$1,899.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,377.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,955.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,688.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,688.80
|
| Rate for Payer: Galaxy Health WC |
$3,588.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,533.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,799.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,680.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,490.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$844.40
|
| Rate for Payer: Multiplan Commercial |
$3,166.50
|
| Rate for Payer: Networks By Design Commercial |
$2,744.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,588.70
|
|
