|
HC EGD W ENDO MUCOSAL RESECTION
|
Facility
|
OP
|
$2,791.00
|
|
|
Service Code
|
CPT 43254
|
| Hospital Charge Code |
906743254
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$416.24 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$558.20
|
| Rate for Payer: Adventist Health Commercial |
$298.40
|
| 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 |
$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 |
$1,255.95
|
| Rate for Payer: Cash Price |
$1,255.95
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Cash Price |
$1,255.95
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,193.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,232.80
|
| Rate for Payer: Cigna of CA HMO |
$954.88
|
| Rate for Payer: Cigna of CA HMO |
$1,786.24
|
| Rate for Payer: Cigna of CA PPO |
$2,065.34
|
| Rate for Payer: Cigna of CA PPO |
$1,104.08
|
| 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 |
$1,044.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,953.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: Galaxy Health WC |
$2,372.35
|
| Rate for Payer: Galaxy Health WC |
$1,268.20
|
| Rate for Payer: Global Benefits Group Commercial |
$895.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,674.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,342.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,511.90
|
| 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 |
$947.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,772.29
|
| 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 |
$558.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$298.40
|
| 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 |
$2,093.25
|
| Rate for Payer: Multiplan Commercial |
$1,119.00
|
| Rate for Payer: Networks By Design Commercial |
$1,814.15
|
| Rate for Payer: Networks By Design Commercial |
$969.80
|
| 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 |
$1,268.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,372.35
|
| 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 |
$895.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,674.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,961.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,961.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,395.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$746.00
|
| 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 ENDO MUCOSAL RESECTION
|
Facility
|
IP
|
$2,791.00
|
|
|
Service Code
|
CPT 43254
|
| Hospital Charge Code |
906743254
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$558.20 |
| Max. Negotiated Rate |
$2,511.90 |
| Rate for Payer: Adventist Health Commercial |
$558.20
|
| Rate for Payer: Cash Price |
$1,255.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,232.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,953.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,116.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,116.40
|
| Rate for Payer: Galaxy Health WC |
$2,372.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,674.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,511.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,772.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,646.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$558.20
|
| Rate for Payer: Multiplan Commercial |
$2,093.25
|
| Rate for Payer: Networks By Design Commercial |
$1,814.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,372.35
|
|
|
HC EGD W/ENDO US EXAM
|
Facility
|
IP
|
$5,149.00
|
|
|
Service Code
|
CPT 43259
|
| Hospital Charge Code |
906743259
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,029.80 |
| Max. Negotiated Rate |
$4,634.10 |
| Rate for Payer: Adventist Health Commercial |
$1,029.80
|
| Rate for Payer: Cash Price |
$2,317.05
|
| Rate for Payer: Central Health Plan Commercial |
$4,119.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,604.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,059.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,059.60
|
| Rate for Payer: Galaxy Health WC |
$4,376.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,089.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,634.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,269.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,037.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,029.80
|
| Rate for Payer: Multiplan Commercial |
$3,861.75
|
| Rate for Payer: Networks By Design Commercial |
$3,346.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,376.65
|
|
|
HC EGD W/ENDO US EXAM
|
Facility
|
OP
|
$5,149.00
|
|
|
Service Code
|
CPT 43259
|
| Hospital Charge Code |
906743259
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$357.31 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,029.80
|
| Rate for Payer: Adventist Health Commercial |
$687.60
|
| 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 |
$5,036.70
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| 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 |
$2,317.05
|
| Rate for Payer: Cash Price |
$2,317.05
|
| Rate for Payer: Cash Price |
$1,547.10
|
| Rate for Payer: Cash Price |
$2,317.05
|
| Rate for Payer: Cash Price |
$1,547.10
|
| Rate for Payer: Cash Price |
$1,547.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,750.40
|
| Rate for Payer: Central Health Plan Commercial |
$4,119.20
|
| Rate for Payer: Cigna of CA HMO |
$2,200.32
|
| Rate for Payer: Cigna of CA HMO |
$3,295.36
|
| Rate for Payer: Cigna of CA PPO |
$3,810.26
|
| Rate for Payer: Cigna of CA PPO |
$2,544.12
|
| 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 |
$2,406.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,604.30
|
| 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 |
$4,376.65
|
| Rate for Payer: Galaxy Health WC |
$2,922.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,062.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,089.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,094.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,634.10
|
| 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 |
$357.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$357.31
|
| 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 |
$2,183.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,269.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$394.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$394.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,029.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$687.60
|
| 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 |
$3,861.75
|
| Rate for Payer: Multiplan Commercial |
$2,578.50
|
| Rate for Payer: Networks By Design Commercial |
$3,346.85
|
| Rate for Payer: Networks By Design Commercial |
$2,234.70
|
| 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 |
$2,922.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,376.65
|
| 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 |
$2,062.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,089.40
|
| 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 |
$2,574.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,719.00
|
| 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 ESPHGSTRC FNDOPLSTY
|
Facility
|
IP
|
$16,070.00
|
|
|
Service Code
|
CPT 43210
|
| Hospital Charge Code |
906743210
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$3,214.00 |
| Max. Negotiated Rate |
$14,463.00 |
| Rate for Payer: Adventist Health Commercial |
$3,214.00
|
| Rate for Payer: Cash Price |
$7,231.50
|
| Rate for Payer: Central Health Plan Commercial |
$12,856.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,249.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,428.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,428.00
|
| Rate for Payer: Galaxy Health WC |
$13,659.50
|
| Rate for Payer: Global Benefits Group Commercial |
$9,642.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,463.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,204.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,481.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,214.00
|
| Rate for Payer: Multiplan Commercial |
$12,052.50
|
| Rate for Payer: Networks By Design Commercial |
$10,445.50
|
| Rate for Payer: Prime Health Services Commercial |
$13,659.50
|
|
|
HC EGD W ESPHGSTRC FNDOPLSTY
|
Facility
|
OP
|
$16,070.00
|
|
|
Service Code
|
CPT 43210
|
| Hospital Charge Code |
906743210
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$640.99 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$3,214.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$13,671.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,507.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,038.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,671.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| 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 |
$7,231.50
|
| Rate for Payer: Cash Price |
$7,231.50
|
| Rate for Payer: Cash Price |
$7,231.50
|
| Rate for Payer: Central Health Plan Commercial |
$12,856.00
|
| Rate for Payer: Cigna of CA HMO |
$10,284.80
|
| Rate for Payer: Cigna of CA PPO |
$11,891.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,507.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,038.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,671.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,249.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,558.37
|
| Rate for Payer: EPIC Health Plan Senior |
$15,038.91
|
| Rate for Payer: Galaxy Health WC |
$13,659.50
|
| Rate for Payer: Global Benefits Group Commercial |
$9,642.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,463.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22,421.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$640.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,671.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,204.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$708.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19,140.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,214.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18,320.13
|
| Rate for Payer: Multiplan Commercial |
$12,052.50
|
| Rate for Payer: Networks By Design Commercial |
$10,445.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13,671.74
|
| Rate for Payer: Prime Health Services Commercial |
$13,659.50
|
| Rate for Payer: Prime Health Services Medicare |
$14,492.04
|
| Rate for Payer: Riverside University Health System MISP |
$15,038.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,642.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16,406.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,035.00
|
| 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 Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$13,671.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,507.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,038.91
|
| Rate for Payer: Vantage Medical Group Senior |
$13,671.74
|
|
|
HC EGD W INJ SCLER ESO
|
Facility
|
OP
|
$4,678.00
|
|
|
Service Code
|
CPT 43243
|
| Hospital Charge Code |
906743243
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$935.60
|
| Rate for Payer: Adventist Health Commercial |
$625.40
|
| 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 |
$1,407.15
|
| Rate for Payer: Cash Price |
$2,105.10
|
| Rate for Payer: Cash Price |
$2,105.10
|
| Rate for Payer: Cash Price |
$1,407.15
|
| Rate for Payer: Cash Price |
$1,407.15
|
| Rate for Payer: Cash Price |
$2,105.10
|
| Rate for Payer: Cash Price |
$1,407.15
|
| Rate for Payer: Cash Price |
$2,105.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,742.40
|
| Rate for Payer: Central Health Plan Commercial |
$2,501.60
|
| Rate for Payer: Cigna of CA HMO |
$2,001.28
|
| Rate for Payer: Cigna of CA HMO |
$2,993.92
|
| Rate for Payer: Cigna of CA PPO |
$3,461.72
|
| Rate for Payer: Cigna of CA PPO |
$2,313.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,274.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,188.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: Galaxy Health WC |
$2,657.95
|
| Rate for Payer: Galaxy Health WC |
$3,976.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,876.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,806.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,210.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,814.30
|
| 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 |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,985.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,970.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$580.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$580.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,653.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,653.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$625.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$935.60
|
| 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 |
$2,345.25
|
| Rate for Payer: Multiplan Commercial |
$3,508.50
|
| Rate for Payer: Multiplan WC |
$3,840.40
|
| Rate for Payer: Multiplan WC |
$3,840.40
|
| Rate for Payer: Networks By Design Commercial |
$2,032.55
|
| Rate for Payer: Networks By Design Commercial |
$3,040.70
|
| 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 |
$3,976.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,657.95
|
| 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 |
$2,806.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,876.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,563.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,339.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,339.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,563.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,563.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,339.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,339.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,563.50
|
| 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 INJ SCLER ESO
|
Facility
|
IP
|
$4,678.00
|
|
|
Service Code
|
CPT 43243
|
| Hospital Charge Code |
906743243
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$935.60 |
| Max. Negotiated Rate |
$4,210.20 |
| Rate for Payer: Adventist Health Commercial |
$935.60
|
| Rate for Payer: Cash Price |
$2,105.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,742.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,274.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,871.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,871.20
|
| Rate for Payer: Galaxy Health WC |
$3,976.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,806.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,210.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,970.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,760.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$935.60
|
| Rate for Payer: Multiplan Commercial |
$3,508.50
|
| Rate for Payer: Networks By Design Commercial |
$3,040.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,976.30
|
|
|
HC EGD W INJ SCLER ESO
|
Facility
|
OP
|
$4,678.00
|
|
|
Service Code
|
CPT 43243
|
| Hospital Charge Code |
906743243
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$525.10 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$935.60
|
| Rate for Payer: Adventist Health Commercial |
$625.40
|
| 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 |
$2,105.10
|
| Rate for Payer: Cash Price |
$2,105.10
|
| Rate for Payer: Cash Price |
$1,407.15
|
| Rate for Payer: Cash Price |
$2,105.10
|
| Rate for Payer: Cash Price |
$1,407.15
|
| Rate for Payer: Cash Price |
$1,407.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,501.60
|
| Rate for Payer: Central Health Plan Commercial |
$3,742.40
|
| Rate for Payer: Cigna of CA HMO |
$2,001.28
|
| Rate for Payer: Cigna of CA HMO |
$2,993.92
|
| Rate for Payer: Cigna of CA PPO |
$3,461.72
|
| Rate for Payer: Cigna of CA PPO |
$2,313.98
|
| 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 |
$2,188.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,274.60
|
| 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 |
$3,976.30
|
| Rate for Payer: Galaxy Health WC |
$2,657.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,876.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,806.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,814.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,210.20
|
| 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 |
$525.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$525.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,985.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,970.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$580.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$580.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$935.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$625.40
|
| 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 |
$3,508.50
|
| Rate for Payer: Multiplan Commercial |
$2,345.25
|
| Rate for Payer: Networks By Design Commercial |
$3,040.70
|
| Rate for Payer: Networks By Design Commercial |
$2,032.55
|
| 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 |
$2,657.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,976.30
|
| 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 |
$1,876.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,806.80
|
| 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 |
$2,339.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,563.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
|
|
HC EGD W INJ SCLER ESO
|
Facility
|
IP
|
$4,678.00
|
|
|
Service Code
|
CPT 43243
|
| Hospital Charge Code |
906743243
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$935.60 |
| Max. Negotiated Rate |
$4,210.20 |
| Rate for Payer: Adventist Health Commercial |
$935.60
|
| Rate for Payer: Cash Price |
$2,105.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,742.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,274.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,871.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,871.20
|
| Rate for Payer: Galaxy Health WC |
$3,976.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,806.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,210.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,970.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,760.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$935.60
|
| Rate for Payer: Multiplan Commercial |
$3,508.50
|
| Rate for Payer: Networks By Design Commercial |
$3,040.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,976.30
|
|
|
HC EGD W/INSRT GIDE WIRE
|
Facility
|
OP
|
$3,955.00
|
|
|
Service Code
|
CPT 43248
|
| Hospital Charge Code |
906743248
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$254.22 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$791.00
|
| Rate for Payer: Adventist Health Commercial |
$528.80
|
| 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 |
$1,779.75
|
| Rate for Payer: Cash Price |
$1,779.75
|
| Rate for Payer: Cash Price |
$1,189.80
|
| Rate for Payer: Cash Price |
$1,779.75
|
| Rate for Payer: Cash Price |
$1,189.80
|
| Rate for Payer: Cash Price |
$1,189.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,115.20
|
| Rate for Payer: Central Health Plan Commercial |
$3,164.00
|
| Rate for Payer: Cigna of CA HMO |
$1,692.16
|
| Rate for Payer: Cigna of CA HMO |
$2,531.20
|
| Rate for Payer: Cigna of CA PPO |
$2,926.70
|
| Rate for Payer: Cigna of CA PPO |
$1,956.56
|
| 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 |
$1,850.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,768.50
|
| 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 |
$3,361.75
|
| Rate for Payer: Galaxy Health WC |
$2,247.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,586.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,373.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,379.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,559.50
|
| 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 |
$254.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$254.22
|
| 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 |
$1,678.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,511.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$280.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$280.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$791.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$528.80
|
| 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 |
$2,966.25
|
| Rate for Payer: Multiplan Commercial |
$1,983.00
|
| Rate for Payer: Networks By Design Commercial |
$2,570.75
|
| Rate for Payer: Networks By Design Commercial |
$1,718.60
|
| 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 |
$2,247.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,361.75
|
| 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 |
$1,586.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,373.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,399.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,399.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,977.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,322.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC EGD W/INSRT GIDE WIRE
|
Facility
|
IP
|
$3,955.00
|
|
|
Service Code
|
CPT 43248
|
| Hospital Charge Code |
906743248
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$791.00 |
| Max. Negotiated Rate |
$3,559.50 |
| Rate for Payer: Adventist Health Commercial |
$791.00
|
| Rate for Payer: Cash Price |
$1,779.75
|
| Rate for Payer: Central Health Plan Commercial |
$3,164.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,768.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,582.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,582.00
|
| Rate for Payer: Galaxy Health WC |
$3,361.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,373.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,559.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,511.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,333.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$791.00
|
| Rate for Payer: Multiplan Commercial |
$2,966.25
|
| Rate for Payer: Networks By Design Commercial |
$2,570.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,361.75
|
|
|
HC EGD W/REMOVAL FOREIGN BODY
|
Facility
|
OP
|
$4,421.00
|
|
|
Service Code
|
CPT 43247
|
| Hospital Charge Code |
906743247
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$439.29 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$884.20
|
| Rate for Payer: Adventist Health Commercial |
$590.80
|
| 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 |
$1,989.45
|
| Rate for Payer: Cash Price |
$1,989.45
|
| Rate for Payer: Cash Price |
$1,329.30
|
| Rate for Payer: Cash Price |
$1,989.45
|
| Rate for Payer: Cash Price |
$1,329.30
|
| Rate for Payer: Cash Price |
$1,329.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,363.20
|
| Rate for Payer: Central Health Plan Commercial |
$3,536.80
|
| Rate for Payer: Cigna of CA HMO |
$1,890.56
|
| Rate for Payer: Cigna of CA HMO |
$2,829.44
|
| Rate for Payer: Cigna of CA PPO |
$3,271.54
|
| Rate for Payer: Cigna of CA PPO |
$2,185.96
|
| 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 |
$2,067.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,094.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: Galaxy Health WC |
$3,757.85
|
| Rate for Payer: Galaxy Health WC |
$2,510.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,772.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,652.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,658.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,978.90
|
| 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 |
$439.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$439.29
|
| 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 |
$1,875.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,807.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$485.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$485.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$884.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$590.80
|
| 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 |
$3,315.75
|
| Rate for Payer: Multiplan Commercial |
$2,215.50
|
| Rate for Payer: Networks By Design Commercial |
$2,873.65
|
| Rate for Payer: Networks By Design Commercial |
$1,920.10
|
| 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 |
$2,510.90
|
| Rate for Payer: Prime Health Services Commercial |
$3,757.85
|
| 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 |
$1,772.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,652.60
|
| 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 |
$2,210.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,477.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC EGD W/REMOVAL FOREIGN BODY
|
Facility
|
IP
|
$4,421.00
|
|
|
Service Code
|
CPT 43247
|
| Hospital Charge Code |
906743247
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$884.20 |
| Max. Negotiated Rate |
$3,978.90 |
| Rate for Payer: Adventist Health Commercial |
$884.20
|
| Rate for Payer: Cash Price |
$1,989.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,536.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,094.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,768.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,768.40
|
| Rate for Payer: Galaxy Health WC |
$3,757.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,652.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,978.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,807.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,608.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$884.20
|
| Rate for Payer: Multiplan Commercial |
$3,315.75
|
| Rate for Payer: Networks By Design Commercial |
$2,873.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,757.85
|
|
|
HC EGD W/REMOV TUMOR/POLYP/LESION
|
Facility
|
IP
|
$3,551.00
|
|
|
Service Code
|
CPT 43251
|
| Hospital Charge Code |
906743251
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$710.20 |
| Max. Negotiated Rate |
$3,195.90 |
| Rate for Payer: Adventist Health Commercial |
$710.20
|
| Rate for Payer: Cash Price |
$1,597.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,840.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,485.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,420.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,420.40
|
| Rate for Payer: Galaxy Health WC |
$3,018.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,130.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,195.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,254.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,095.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$710.20
|
| Rate for Payer: Multiplan Commercial |
$2,663.25
|
| Rate for Payer: Networks By Design Commercial |
$2,308.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,018.35
|
|
|
HC EGD W/REMOV TUMOR/POLYP/LESION
|
Facility
|
OP
|
$3,551.00
|
|
|
Service Code
|
CPT 43251
|
| Hospital Charge Code |
906743251
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$710.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$710.20
|
| Rate for Payer: Adventist Health Commercial |
$379.60
|
| 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 |
$1,597.95
|
| Rate for Payer: Cash Price |
$854.10
|
| Rate for Payer: Cash Price |
$854.10
|
| Rate for Payer: Cash Price |
$854.10
|
| Rate for Payer: Cash Price |
$1,597.95
|
| Rate for Payer: Cash Price |
$1,597.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,518.40
|
| Rate for Payer: Central Health Plan Commercial |
$2,840.80
|
| Rate for Payer: Cigna of CA HMO |
$2,272.64
|
| Rate for Payer: Cigna of CA HMO |
$1,214.72
|
| Rate for Payer: Cigna of CA PPO |
$2,627.74
|
| Rate for Payer: Cigna of CA PPO |
$1,404.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,485.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,328.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: Galaxy Health WC |
$3,018.35
|
| Rate for Payer: Galaxy Health WC |
$1,613.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,130.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,138.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,708.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,195.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,254.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,205.23
|
| 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 |
$379.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$710.20
|
| 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 |
$1,423.50
|
| Rate for Payer: Multiplan Commercial |
$2,663.25
|
| Rate for Payer: Networks By Design Commercial |
$2,308.15
|
| Rate for Payer: Networks By Design Commercial |
$1,233.70
|
| 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 |
$3,018.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,613.30
|
| 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 |
$1,138.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,130.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,961.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,961.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,775.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$949.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
|
|
HC EGD W/TRANSENDO TUBE/CATH PLAC
|
Facility
|
IP
|
$5,092.00
|
|
|
Service Code
|
CPT 43241
|
| Hospital Charge Code |
906743241
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,018.40 |
| Max. Negotiated Rate |
$4,582.80 |
| Rate for Payer: Adventist Health Commercial |
$1,018.40
|
| Rate for Payer: Cash Price |
$2,291.40
|
| Rate for Payer: Central Health Plan Commercial |
$4,073.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,564.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,036.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,036.80
|
| Rate for Payer: Galaxy Health WC |
$4,328.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,055.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,582.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,233.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,004.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,018.40
|
| Rate for Payer: Multiplan Commercial |
$3,819.00
|
| Rate for Payer: Networks By Design Commercial |
$3,309.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,328.20
|
|
|
HC EGD W/TRANSENDO TUBE/CATH PLAC
|
Facility
|
OP
|
$5,092.00
|
|
|
Service Code
|
CPT 43241
|
| Hospital Charge Code |
906743241
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,018.40 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,018.40
|
| 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 |
$2,291.40
|
| Rate for Payer: Cash Price |
$1,291.05
|
| Rate for Payer: Cash Price |
$1,291.05
|
| Rate for Payer: Cash Price |
$1,291.05
|
| Rate for Payer: Cash Price |
$2,291.40
|
| Rate for Payer: Cash Price |
$2,291.40
|
| Rate for Payer: Central Health Plan Commercial |
$2,295.20
|
| Rate for Payer: Central Health Plan Commercial |
$4,073.60
|
| Rate for Payer: Cigna of CA HMO |
$3,258.88
|
| Rate for Payer: Cigna of CA HMO |
$1,836.16
|
| Rate for Payer: Cigna of CA PPO |
$3,768.08
|
| 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 |
$3,564.40
|
| 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 |
$4,328.20
|
| Rate for Payer: Galaxy Health WC |
$2,438.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,055.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,721.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,582.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,582.80
|
| 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) 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 |
$3,233.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,821.82
|
| 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 |
$573.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,018.40
|
| 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 |
$3,819.00
|
| Rate for Payer: Networks By Design Commercial |
$3,309.80
|
| 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 |
$4,328.20
|
| 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: 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 |
$3,055.20
|
| 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 |
$2,546.00
|
| 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/TRNSMRL DRNG/ PSEUDOCYST
|
Facility
|
IP
|
$5,728.00
|
|
|
Service Code
|
CPT 43240
|
| Hospital Charge Code |
906743240
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,145.60 |
| Max. Negotiated Rate |
$5,155.20 |
| Rate for Payer: Adventist Health Commercial |
$1,145.60
|
| Rate for Payer: Cash Price |
$2,577.60
|
| Rate for Payer: Central Health Plan Commercial |
$4,582.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,009.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,291.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,291.20
|
| Rate for Payer: Galaxy Health WC |
$4,868.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,436.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,155.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,637.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,379.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,145.60
|
| Rate for Payer: Multiplan Commercial |
$4,296.00
|
| Rate for Payer: Networks By Design Commercial |
$3,723.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,868.80
|
|
|
HC EGD W/TRNSMRL DRNG/ PSEUDOCYST
|
Facility
|
OP
|
$5,728.00
|
|
|
Service Code
|
CPT 43240
|
| Hospital Charge Code |
906743240
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$601.93 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,145.60
|
| Rate for Payer: Adventist Health Commercial |
$619.20
|
| 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 |
$2,577.60
|
| Rate for Payer: Cash Price |
$2,577.60
|
| Rate for Payer: Cash Price |
$1,393.20
|
| Rate for Payer: Cash Price |
$2,577.60
|
| Rate for Payer: Cash Price |
$1,393.20
|
| Rate for Payer: Cash Price |
$1,393.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,476.80
|
| Rate for Payer: Central Health Plan Commercial |
$4,582.40
|
| Rate for Payer: Cigna of CA HMO |
$1,981.44
|
| Rate for Payer: Cigna of CA HMO |
$3,665.92
|
| Rate for Payer: Cigna of CA PPO |
$4,238.72
|
| Rate for Payer: Cigna of CA PPO |
$2,291.04
|
| 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 |
$2,167.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,009.60
|
| 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 |
$4,868.80
|
| Rate for Payer: Galaxy Health WC |
$2,631.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,857.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,436.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,786.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,155.20
|
| 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 |
$601.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$601.93
|
| 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 |
$1,965.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,637.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$664.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$664.92
|
| 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 |
$1,145.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$619.20
|
| 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 |
$4,296.00
|
| Rate for Payer: Multiplan Commercial |
$2,322.00
|
| Rate for Payer: Networks By Design Commercial |
$3,723.20
|
| Rate for Payer: Networks By Design Commercial |
$2,012.40
|
| 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 |
$2,631.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,868.80
|
| 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 |
$1,857.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,436.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,369.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,369.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,864.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,548.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| 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 W/US GUID INTRMRL
|
Facility
|
OP
|
$5,336.00
|
|
|
Service Code
|
CPT 43242
|
| Hospital Charge Code |
906743242
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$431.60 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,067.20
|
| Rate for Payer: Adventist Health Commercial |
$713.20
|
| 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 |
$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 |
$2,401.20
|
| Rate for Payer: Cash Price |
$2,401.20
|
| Rate for Payer: Cash Price |
$1,604.70
|
| Rate for Payer: Cash Price |
$2,401.20
|
| Rate for Payer: Cash Price |
$1,604.70
|
| Rate for Payer: Cash Price |
$1,604.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,852.80
|
| Rate for Payer: Central Health Plan Commercial |
$4,268.80
|
| Rate for Payer: Cigna of CA HMO |
$2,282.24
|
| Rate for Payer: Cigna of CA HMO |
$3,415.04
|
| Rate for Payer: Cigna of CA PPO |
$3,948.64
|
| Rate for Payer: Cigna of CA PPO |
$2,638.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,496.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,735.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: Galaxy Health WC |
$4,535.60
|
| Rate for Payer: Galaxy Health WC |
$3,031.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,139.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,201.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,209.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,802.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$431.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$431.60
|
| 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 |
$2,264.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,388.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$476.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$476.77
|
| 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 |
$1,067.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$713.20
|
| 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 |
$4,002.00
|
| Rate for Payer: Multiplan Commercial |
$2,674.50
|
| Rate for Payer: Networks By Design Commercial |
$3,468.40
|
| Rate for Payer: Networks By Design Commercial |
$2,317.90
|
| 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 |
$3,031.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,535.60
|
| 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 |
$2,139.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,201.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,961.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,961.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,668.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,783.00
|
| 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/US GUID INTRMRL
|
Facility
|
IP
|
$5,336.00
|
|
|
Service Code
|
CPT 43242
|
| Hospital Charge Code |
906743242
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,067.20 |
| Max. Negotiated Rate |
$4,802.40 |
| Rate for Payer: Adventist Health Commercial |
$1,067.20
|
| Rate for Payer: Cash Price |
$2,401.20
|
| Rate for Payer: Central Health Plan Commercial |
$4,268.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,735.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,134.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,134.40
|
| Rate for Payer: Galaxy Health WC |
$4,535.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,201.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,802.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,388.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,148.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,067.20
|
| Rate for Payer: Multiplan Commercial |
$4,002.00
|
| Rate for Payer: Networks By Design Commercial |
$3,468.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,535.60
|
|
|
HC EGFR
|
Facility
|
OP
|
$356.00
|
|
|
Service Code
|
CPT 81235
|
| Hospital Charge Code |
903800314
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$63.13 |
| Max. Negotiated Rate |
$1,090.62 |
| Rate for Payer: Adventist Health Commercial |
$71.20
|
| Rate for Payer: Adventist Health Commercial |
$98.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$324.58
|
| Rate for Payer: Adventist Health Medi-Cal |
$324.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,090.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,090.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$486.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$486.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$357.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$357.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$324.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$324.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$63.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$63.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$87.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$87.77
|
| Rate for Payer: Blue Shield of California Commercial |
$309.33
|
| Rate for Payer: Blue Shield of California Commercial |
$224.28
|
| Rate for Payer: Blue Shield of California EPN |
$194.93
|
| Rate for Payer: Blue Shield of California EPN |
$141.33
|
| Rate for Payer: Cash Price |
$220.95
|
| Rate for Payer: Cash Price |
$220.95
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Central Health Plan Commercial |
$284.80
|
| Rate for Payer: Central Health Plan Commercial |
$392.80
|
| Rate for Payer: Cigna of CA HMO |
$314.24
|
| Rate for Payer: Cigna of CA HMO |
$227.84
|
| Rate for Payer: Cigna of CA PPO |
$363.34
|
| Rate for Payer: Cigna of CA PPO |
$263.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$486.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$486.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$357.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$357.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$324.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$324.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$249.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$343.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$535.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$535.56
|
| Rate for Payer: EPIC Health Plan Senior |
$357.04
|
| Rate for Payer: EPIC Health Plan Senior |
$357.04
|
| Rate for Payer: Galaxy Health WC |
$417.35
|
| Rate for Payer: Galaxy Health WC |
$302.60
|
| Rate for Payer: Global Benefits Group Commercial |
$294.60
|
| Rate for Payer: Global Benefits Group Commercial |
$213.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$441.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$320.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$532.31
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$532.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$309.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$309.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$324.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$324.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$226.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$311.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$342.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$342.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$454.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$454.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$434.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$434.94
|
| Rate for Payer: Multiplan Commercial |
$368.25
|
| Rate for Payer: Multiplan Commercial |
$267.00
|
| Rate for Payer: Networks By Design Commercial |
$231.40
|
| Rate for Payer: Networks By Design Commercial |
$319.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$324.58
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$324.58
|
| Rate for Payer: Prime Health Services Commercial |
$417.35
|
| Rate for Payer: Prime Health Services Commercial |
$302.60
|
| Rate for Payer: Prime Health Services Medicare |
$344.05
|
| Rate for Payer: Prime Health Services Medicare |
$344.05
|
| Rate for Payer: Riverside University Health System MISP |
$357.04
|
| Rate for Payer: Riverside University Health System MISP |
$357.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$213.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$294.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$294.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$213.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$262.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$262.91
|
| Rate for Payer: United Healthcare All Other HMO |
$262.91
|
| Rate for Payer: United Healthcare All Other HMO |
$262.91
|
| Rate for Payer: United Healthcare HMO Rider |
$262.91
|
| Rate for Payer: United Healthcare HMO Rider |
$262.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$262.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$262.91
|
| Rate for Payer: Upland Medical Group Pediatric |
$324.58
|
| Rate for Payer: Upland Medical Group Pediatric |
$324.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$486.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$486.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$357.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$357.04
|
| Rate for Payer: Vantage Medical Group Senior |
$324.58
|
| Rate for Payer: Vantage Medical Group Senior |
$324.58
|
|
|
HC EGFR
|
Facility
|
IP
|
$491.00
|
|
|
Service Code
|
CPT 81235
|
| Hospital Charge Code |
903800314
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$98.20 |
| Max. Negotiated Rate |
$441.90 |
| Rate for Payer: Adventist Health Commercial |
$98.20
|
| Rate for Payer: Cash Price |
$220.95
|
| Rate for Payer: Central Health Plan Commercial |
$392.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$343.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$196.40
|
| Rate for Payer: EPIC Health Plan Senior |
$196.40
|
| Rate for Payer: Galaxy Health WC |
$417.35
|
| Rate for Payer: Global Benefits Group Commercial |
$294.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$441.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$311.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$289.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.20
|
| Rate for Payer: Multiplan Commercial |
$368.25
|
| Rate for Payer: Networks By Design Commercial |
$319.15
|
| Rate for Payer: Prime Health Services Commercial |
$417.35
|
|
|
HC EKOS THROMLYSIS CATH
|
Facility
|
OP
|
$6,704.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,340.80 |
| Max. Negotiated Rate |
$6,033.60 |
| Rate for Payer: Adventist Health Commercial |
$1,340.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,698.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,687.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,028.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,676.47
|
| Rate for Payer: Blue Shield of California Commercial |
$5,376.61
|
| Rate for Payer: Blue Shield of California EPN |
$3,378.82
|
| Rate for Payer: Cash Price |
$3,016.80
|
| Rate for Payer: Central Health Plan Commercial |
$5,363.20
|
| Rate for Payer: Cigna of CA HMO |
$4,692.80
|
| Rate for Payer: Cigna of CA PPO |
$4,692.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,698.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,698.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,698.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,692.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,681.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,681.60
|
| Rate for Payer: Galaxy Health WC |
$5,698.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,022.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,033.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,257.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,433.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,955.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,340.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,692.80
|
| Rate for Payer: Multiplan Commercial |
$5,028.00
|
| Rate for Payer: Networks By Design Commercial |
$3,352.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,698.40
|
| Rate for Payer: Riverside University Health System MISP |
$2,681.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,022.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,022.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,516.01
|
| Rate for Payer: United Healthcare All Other HMO |
$2,448.97
|
| Rate for Payer: United Healthcare HMO Rider |
$2,396.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,195.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,698.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,698.40
|
| Rate for Payer: Vantage Medical Group Senior |
$5,698.40
|
|
