|
HC EGD FLXBL TRNSORL W DPLMNT OF IG BRTRC BLLN
|
Facility
|
IP
|
$6,904.00
|
|
|
Service Code
|
CPT 43290
|
| Hospital Charge Code |
906743290
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,380.80 |
| Max. Negotiated Rate |
$6,213.60 |
| Rate for Payer: Adventist Health Commercial |
$1,380.80
|
| Rate for Payer: Cash Price |
$3,797.20
|
| Rate for Payer: Central Health Plan Commercial |
$5,523.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,761.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,761.60
|
| Rate for Payer: Galaxy Health WC |
$5,868.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,142.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,213.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,604.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,630.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,273.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,380.80
|
| Rate for Payer: Multiplan Commercial |
$5,178.00
|
| Rate for Payer: Networks By Design Commercial |
$4,487.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,868.40
|
|
|
HC EGD FLXBL TRNSORL W RMVL OF IG BRTRC BLLN
|
Facility
|
IP
|
$3,272.00
|
|
|
Service Code
|
CPT 43291
|
| Hospital Charge Code |
906743291
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$654.40 |
| Max. Negotiated Rate |
$2,944.80 |
| Rate for Payer: Adventist Health Commercial |
$654.40
|
| Rate for Payer: Cash Price |
$1,799.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,617.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,308.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,308.80
|
| Rate for Payer: Galaxy Health WC |
$2,781.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,963.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,944.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,182.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,246.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$654.40
|
| Rate for Payer: Multiplan Commercial |
$2,454.00
|
| Rate for Payer: Networks By Design Commercial |
$2,126.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,781.20
|
|
|
HC EGD FLXBL TRNSORL W RMVL OF IG BRTRC BLLN
|
Facility
|
OP
|
$3,272.00
|
|
|
Service Code
|
CPT 43291
|
| Hospital Charge Code |
906743291
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$639.21 |
| Max. Negotiated Rate |
$7,378.00 |
| Rate for Payer: Adventist Health Commercial |
$654.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,191.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,584.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,921.65
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$1,799.60
|
| Rate for Payer: Cash Price |
$1,799.60
|
| Rate for Payer: Cash Price |
$1,799.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,617.60
|
| Rate for Payer: Cigna of CA HMO |
$2,094.08
|
| Rate for Payer: Cigna of CA PPO |
$2,421.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,608.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,191.26
|
| Rate for Payer: Galaxy Health WC |
$2,781.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,963.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,944.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: InnovAge PACE Commercial |
$1,786.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,182.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$654.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,596.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,596.29
|
| Rate for Payer: Multiplan Commercial |
$2,454.00
|
| Rate for Payer: Networks By Design Commercial |
$2,126.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Prime Health Services Commercial |
$2,781.20
|
| Rate for Payer: Prime Health Services Medicare |
$1,262.74
|
| Rate for Payer: Riverside University Health System MISP |
$1,310.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,963.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,429.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,191.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC EGD INTRMURAL US NDL ASPIRATE BIOPSY ESOPHAGS
|
Facility
|
IP
|
$3,325.00
|
|
|
Service Code
|
CPT 43238
|
| Hospital Charge Code |
906703238
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$665.00 |
| Max. Negotiated Rate |
$2,992.50 |
| Rate for Payer: Adventist Health Commercial |
$665.00
|
| Rate for Payer: Cash Price |
$1,828.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,660.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,330.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,330.00
|
| Rate for Payer: Galaxy Health WC |
$2,826.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,995.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,992.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,217.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,266.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$665.00
|
| Rate for Payer: Multiplan Commercial |
$2,493.75
|
| Rate for Payer: Networks By Design Commercial |
$2,161.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,826.25
|
|
|
HC EGD INTRMURAL US NDL ASPIRATE BIOPSY ESOPHAGS
|
Facility
|
OP
|
$3,325.00
|
|
|
Service Code
|
CPT 43238
|
| Hospital Charge Code |
906703238
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$665.00 |
| Max. Negotiated Rate |
$7,378.00 |
| Rate for Payer: Adventist Health Commercial |
$665.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,410.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,410.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,828.75
|
| Rate for Payer: Cash Price |
$1,828.75
|
| Rate for Payer: Cash Price |
$1,828.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,660.00
|
| Rate for Payer: Cigna of CA HMO |
$2,128.00
|
| Rate for Payer: Cigna of CA PPO |
$2,460.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,651.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,410.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,253.93
|
| Rate for Payer: EPIC Health Plan Senior |
$2,410.32
|
| Rate for Payer: Galaxy Health WC |
$2,826.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,995.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,992.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: InnovAge PACE Commercial |
$3,615.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,217.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,266.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$665.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,229.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,229.83
|
| Rate for Payer: Multiplan Commercial |
$2,493.75
|
| Rate for Payer: Networks By Design Commercial |
$2,161.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Prime Health Services Commercial |
$2,826.25
|
| Rate for Payer: Prime Health Services Medicare |
$2,554.94
|
| Rate for Payer: Riverside University Health System MISP |
$2,651.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,995.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,892.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,410.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,410.32
|
|
|
HC EGD LESION ABLATION
|
Facility
|
IP
|
$2,883.00
|
|
|
Service Code
|
CPT 43270
|
| Hospital Charge Code |
900100018
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$576.60 |
| Max. Negotiated Rate |
$2,594.70 |
| Rate for Payer: Adventist Health Commercial |
$576.60
|
| Rate for Payer: Cash Price |
$1,585.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,306.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,153.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,153.20
|
| Rate for Payer: Galaxy Health WC |
$2,450.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,729.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,594.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,922.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,098.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,784.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$576.60
|
| Rate for Payer: Multiplan Commercial |
$2,162.25
|
| Rate for Payer: Networks By Design Commercial |
$1,873.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,450.55
|
|
|
HC EGD LESION ABLATION
|
Facility
|
OP
|
$2,883.00
|
|
|
Service Code
|
CPT 43270
|
| Hospital Charge Code |
900100018
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$362.44 |
| Max. Negotiated Rate |
$8,114.00 |
| Rate for Payer: Adventist Health Commercial |
$576.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,410.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,410.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,245.30
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$1,585.65
|
| Rate for Payer: Cash Price |
$1,585.65
|
| Rate for Payer: Cash Price |
$1,585.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,306.40
|
| Rate for Payer: Cigna of CA HMO |
$1,845.12
|
| Rate for Payer: Cigna of CA PPO |
$2,133.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,651.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,410.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,253.93
|
| Rate for Payer: EPIC Health Plan Senior |
$2,410.32
|
| Rate for Payer: Galaxy Health WC |
$2,450.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,729.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,594.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$362.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: InnovAge PACE Commercial |
$3,615.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,922.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$400.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$576.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,229.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,229.83
|
| Rate for Payer: Multiplan Commercial |
$2,162.25
|
| Rate for Payer: Networks By Design Commercial |
$1,873.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Prime Health Services Commercial |
$2,450.55
|
| Rate for Payer: Prime Health Services Medicare |
$2,554.94
|
| Rate for Payer: Riverside University Health System MISP |
$2,651.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,729.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,892.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,410.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,410.32
|
|
|
HC EGD & POLYPECTOMY
|
Facility
|
IP
|
$2,245.00
|
|
|
Service Code
|
CPT 43250
|
| Hospital Charge Code |
906743250
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$449.00 |
| Max. Negotiated Rate |
$2,020.50 |
| Rate for Payer: Adventist Health Commercial |
$449.00
|
| Rate for Payer: Cash Price |
$1,234.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,796.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$898.00
|
| Rate for Payer: EPIC Health Plan Senior |
$898.00
|
| Rate for Payer: Galaxy Health WC |
$1,908.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,347.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,020.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,497.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$855.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,389.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$449.00
|
| Rate for Payer: Multiplan Commercial |
$1,683.75
|
| Rate for Payer: Networks By Design Commercial |
$1,459.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,908.25
|
|
|
HC EGD & POLYPECTOMY
|
Facility
|
OP
|
$2,245.00
|
|
|
Service Code
|
CPT 43250
|
| Hospital Charge Code |
906743250
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$421.35 |
| Max. Negotiated Rate |
$7,378.00 |
| Rate for Payer: Adventist Health Commercial |
$449.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,410.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,410.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,245.30
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$1,234.75
|
| Rate for Payer: Cash Price |
$1,234.75
|
| Rate for Payer: Cash Price |
$1,234.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,796.00
|
| Rate for Payer: Cigna of CA HMO |
$1,436.80
|
| Rate for Payer: Cigna of CA PPO |
$1,661.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,651.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,410.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,253.93
|
| Rate for Payer: EPIC Health Plan Senior |
$2,410.32
|
| Rate for Payer: Galaxy Health WC |
$1,908.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,347.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,020.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$421.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: InnovAge PACE Commercial |
$3,615.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,497.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$465.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$449.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,229.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,229.83
|
| Rate for Payer: Multiplan Commercial |
$1,683.75
|
| Rate for Payer: Networks By Design Commercial |
$1,459.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Prime Health Services Commercial |
$1,908.25
|
| Rate for Payer: Prime Health Services Medicare |
$2,554.94
|
| Rate for Payer: Riverside University Health System MISP |
$2,651.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,347.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,892.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,410.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,410.32
|
|
|
HC EGD US TRANSMURAL INJECT MARKER
|
Facility
|
IP
|
$2,253.00
|
|
|
Service Code
|
CPT 43253
|
| Hospital Charge Code |
906743253
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$450.60 |
| Max. Negotiated Rate |
$2,027.70 |
| Rate for Payer: Adventist Health Commercial |
$450.60
|
| Rate for Payer: Cash Price |
$1,239.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,802.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$901.20
|
| Rate for Payer: EPIC Health Plan Senior |
$901.20
|
| Rate for Payer: Galaxy Health WC |
$1,915.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,351.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,027.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,502.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$858.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,394.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$450.60
|
| Rate for Payer: Multiplan Commercial |
$1,689.75
|
| Rate for Payer: Networks By Design Commercial |
$1,464.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,915.05
|
|
|
HC EGD US TRANSMURAL INJECT MARKER
|
Facility
|
OP
|
$2,253.00
|
|
|
Service Code
|
CPT 43253
|
| Hospital Charge Code |
906743253
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$401.50 |
| Max. Negotiated Rate |
$8,114.00 |
| Rate for Payer: Adventist Health Commercial |
$450.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,410.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,410.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,239.15
|
| Rate for Payer: Cash Price |
$1,239.15
|
| Rate for Payer: Cash Price |
$1,239.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,802.40
|
| Rate for Payer: Cigna of CA HMO |
$1,441.92
|
| Rate for Payer: Cigna of CA PPO |
$1,667.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,651.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,410.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,253.93
|
| Rate for Payer: EPIC Health Plan Senior |
$2,410.32
|
| Rate for Payer: Galaxy Health WC |
$1,915.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,351.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,027.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$401.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: InnovAge PACE Commercial |
$3,615.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,502.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$443.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$450.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,229.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,229.83
|
| Rate for Payer: Multiplan Commercial |
$1,689.75
|
| Rate for Payer: Networks By Design Commercial |
$1,464.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Prime Health Services Commercial |
$1,915.05
|
| Rate for Payer: Prime Health Services Medicare |
$2,554.94
|
| Rate for Payer: Riverside University Health System MISP |
$2,651.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,351.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,892.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,410.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,410.32
|
|
|
HC EGD W/ABLTN TUMOR/POLYP/LESION
|
Facility
|
OP
|
$2,977.00
|
|
|
Service Code
|
CPT 43258
|
| Hospital Charge Code |
906743258
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$595.40 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$595.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,530.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,637.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,232.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,441.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,748.39
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$1,637.35
|
| Rate for Payer: Cash Price |
$1,637.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,381.60
|
| Rate for Payer: Cigna of CA HMO |
$1,905.28
|
| Rate for Payer: Cigna of CA PPO |
$2,202.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,530.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,530.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,530.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,190.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,190.80
|
| Rate for Payer: Galaxy Health WC |
$2,530.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,786.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,679.30
|
| Rate for Payer: InnovAge PACE Commercial |
$1,488.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,985.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,134.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,842.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$595.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,083.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,083.90
|
| Rate for Payer: Multiplan Commercial |
$2,232.75
|
| Rate for Payer: Networks By Design Commercial |
$1,935.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,530.45
|
| Rate for Payer: Riverside University Health System MISP |
$1,190.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,786.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,786.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,488.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,488.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,488.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,488.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,530.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,530.45
|
| Rate for Payer: Vantage Medical Group Senior |
$2,530.45
|
|
|
HC EGD W/ABLTN TUMOR/POLYP/LESION
|
Facility
|
IP
|
$2,977.00
|
|
|
Service Code
|
CPT 43258
|
| Hospital Charge Code |
906743258
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$595.40 |
| Max. Negotiated Rate |
$2,679.30 |
| Rate for Payer: Adventist Health Commercial |
$595.40
|
| Rate for Payer: Cash Price |
$1,637.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,381.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,190.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,190.80
|
| Rate for Payer: Galaxy Health WC |
$2,530.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,786.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,679.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,985.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,134.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,842.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$595.40
|
| Rate for Payer: Multiplan Commercial |
$2,232.75
|
| Rate for Payer: Networks By Design Commercial |
$1,935.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,530.45
|
|
|
HC EGD W/BAND/LIG SCLE
|
Facility
|
OP
|
$4,734.00
|
|
|
Service Code
|
CPT 43244
|
| Hospital Charge Code |
906743244
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$369.49 |
| Max. Negotiated Rate |
$7,378.00 |
| Rate for Payer: Adventist Health Commercial |
$946.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,410.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,410.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,245.30
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$2,603.70
|
| Rate for Payer: Cash Price |
$2,603.70
|
| Rate for Payer: Cash Price |
$2,603.70
|
| Rate for Payer: Central Health Plan Commercial |
$3,787.20
|
| Rate for Payer: Cigna of CA HMO |
$3,029.76
|
| Rate for Payer: Cigna of CA PPO |
$3,503.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,651.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,410.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,253.93
|
| Rate for Payer: EPIC Health Plan Senior |
$2,410.32
|
| Rate for Payer: Galaxy Health WC |
$4,023.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,840.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,260.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$369.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: InnovAge PACE Commercial |
$3,615.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,157.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$408.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$946.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,229.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,229.83
|
| Rate for Payer: Multiplan Commercial |
$3,550.50
|
| Rate for Payer: Networks By Design Commercial |
$3,077.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Prime Health Services Commercial |
$4,023.90
|
| Rate for Payer: Prime Health Services Medicare |
$2,554.94
|
| Rate for Payer: Riverside University Health System MISP |
$2,651.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,840.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,892.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,410.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,410.32
|
|
|
HC EGD W/BAND/LIG SCLE
|
Facility
|
IP
|
$4,734.00
|
|
|
Service Code
|
CPT 43244
|
| Hospital Charge Code |
906743244
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$946.80 |
| Max. Negotiated Rate |
$4,260.60 |
| Rate for Payer: Adventist Health Commercial |
$946.80
|
| Rate for Payer: Cash Price |
$2,603.70
|
| Rate for Payer: Central Health Plan Commercial |
$3,787.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,893.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,893.60
|
| Rate for Payer: Galaxy Health WC |
$4,023.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,840.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,260.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,157.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,803.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,930.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$946.80
|
| Rate for Payer: Multiplan Commercial |
$3,550.50
|
| Rate for Payer: Networks By Design Commercial |
$3,077.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,023.90
|
|
|
HC EGD W BLLN DLTN ESO
|
Facility
|
OP
|
$2,869.00
|
|
|
Service Code
|
CPT 43249
|
| Hospital Charge Code |
906743249
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$383.58 |
| Max. Negotiated Rate |
$7,378.00 |
| Rate for Payer: Adventist Health Commercial |
$573.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,410.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,410.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,245.30
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$1,577.95
|
| Rate for Payer: Cash Price |
$1,577.95
|
| Rate for Payer: Cash Price |
$1,577.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,295.20
|
| Rate for Payer: Cigna of CA HMO |
$1,836.16
|
| Rate for Payer: Cigna of CA PPO |
$2,123.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,651.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,410.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,253.93
|
| Rate for Payer: EPIC Health Plan Senior |
$2,410.32
|
| Rate for Payer: Galaxy Health WC |
$2,438.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,721.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,582.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$383.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: InnovAge PACE Commercial |
$3,615.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,913.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$423.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$573.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,229.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,229.83
|
| Rate for Payer: Multiplan Commercial |
$2,151.75
|
| Rate for Payer: Networks By Design Commercial |
$1,864.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Prime Health Services Commercial |
$2,438.65
|
| Rate for Payer: Prime Health Services Medicare |
$2,554.94
|
| Rate for Payer: Riverside University Health System MISP |
$2,651.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,721.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,892.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,410.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,410.32
|
|
|
HC EGD W BLLN DLTN ESO
|
Facility
|
IP
|
$2,869.00
|
|
|
Service Code
|
CPT 43249
|
| Hospital Charge Code |
906743249
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$573.80 |
| Max. Negotiated Rate |
$2,582.10 |
| Rate for Payer: Adventist Health Commercial |
$573.80
|
| Rate for Payer: Cash Price |
$1,577.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,295.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,147.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,147.60
|
| Rate for Payer: Galaxy Health WC |
$2,438.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,721.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,582.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,913.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,093.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,775.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$573.80
|
| Rate for Payer: Multiplan Commercial |
$2,151.75
|
| Rate for Payer: Networks By Design Commercial |
$1,864.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,438.65
|
|
|
HC EGD W BLLN DLTN ESO
|
Facility
|
IP
|
$2,869.00
|
|
|
Service Code
|
CPT 43249
|
| Hospital Charge Code |
906743249
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$573.80 |
| Max. Negotiated Rate |
$2,582.10 |
| Rate for Payer: Adventist Health Commercial |
$573.80
|
| Rate for Payer: Cash Price |
$1,577.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,295.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,147.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,147.60
|
| Rate for Payer: Galaxy Health WC |
$2,438.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,721.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,582.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,913.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,093.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,775.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$573.80
|
| Rate for Payer: Multiplan Commercial |
$2,151.75
|
| Rate for Payer: Networks By Design Commercial |
$1,864.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,438.65
|
|
|
HC EGD W BLLN DLTN ESO
|
Facility
|
OP
|
$2,869.00
|
|
|
Service Code
|
CPT 43249
|
| Hospital Charge Code |
906743249
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,333.00 |
| Rate for Payer: Adventist Health Commercial |
$573.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,410.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,840.40
|
| Rate for Payer: Cash Price |
$1,577.95
|
| Rate for Payer: Cash Price |
$1,577.95
|
| Rate for Payer: Cash Price |
$1,577.95
|
| Rate for Payer: Cash Price |
$1,577.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,295.20
|
| Rate for Payer: Cigna of CA HMO |
$1,836.16
|
| Rate for Payer: Cigna of CA PPO |
$2,123.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,651.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,410.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,253.93
|
| Rate for Payer: EPIC Health Plan Senior |
$2,410.32
|
| Rate for Payer: Galaxy Health WC |
$2,438.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,721.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,582.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: InnovAge PACE Commercial |
$3,615.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,913.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$423.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$573.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,229.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,229.83
|
| Rate for Payer: Multiplan Commercial |
$2,151.75
|
| Rate for Payer: Multiplan WC |
$3,840.40
|
| Rate for Payer: Networks By Design Commercial |
$1,864.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Preferred Health Network WC |
$3,918.78
|
| Rate for Payer: Prime Health Services Commercial |
$2,438.65
|
| Rate for Payer: Prime Health Services Medicare |
$2,554.94
|
| Rate for Payer: Prime Health Services WC |
$3,801.22
|
| Rate for Payer: Riverside University Health System MISP |
$2,651.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,721.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,434.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,434.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,434.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,434.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,410.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,410.32
|
|
|
HC EGD W BX SNGL OR MULTI
|
Facility
|
OP
|
$3,105.00
|
|
|
Service Code
|
CPT 43239
|
| Hospital Charge Code |
906743239
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,333.00 |
| Rate for Payer: Adventist Health Commercial |
$621.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,898.06
|
| Rate for Payer: Cash Price |
$1,707.75
|
| Rate for Payer: Cash Price |
$1,707.75
|
| Rate for Payer: Cash Price |
$1,707.75
|
| Rate for Payer: Cash Price |
$1,707.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,484.00
|
| Rate for Payer: Cigna of CA HMO |
$1,987.20
|
| Rate for Payer: Cigna of CA PPO |
$2,297.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,608.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,191.26
|
| Rate for Payer: Galaxy Health WC |
$2,639.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,863.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,794.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: InnovAge PACE Commercial |
$1,786.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,071.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$444.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$621.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,596.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,596.29
|
| Rate for Payer: Multiplan Commercial |
$2,328.75
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Networks By Design Commercial |
$2,018.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Preferred Health Network WC |
$1,936.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,639.25
|
| Rate for Payer: Prime Health Services Medicare |
$1,262.74
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Riverside University Health System MISP |
$1,310.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,863.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,552.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,552.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,552.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,552.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,191.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC EGD W BX SNGL OR MULTI
|
Facility
|
IP
|
$3,105.00
|
|
|
Service Code
|
CPT 43239
|
| Hospital Charge Code |
906743239
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$621.00 |
| Max. Negotiated Rate |
$2,794.50 |
| Rate for Payer: Adventist Health Commercial |
$621.00
|
| Rate for Payer: Cash Price |
$1,707.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,484.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,242.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,242.00
|
| Rate for Payer: Galaxy Health WC |
$2,639.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,863.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,794.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,071.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,183.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,921.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$621.00
|
| Rate for Payer: Multiplan Commercial |
$2,328.75
|
| Rate for Payer: Networks By Design Commercial |
$2,018.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,639.25
|
|
|
HC EGD W BX SNGL OR MULTI
|
Facility
|
OP
|
$3,105.00
|
|
|
Service Code
|
CPT 43239
|
| Hospital Charge Code |
906743239
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$402.79 |
| Max. Negotiated Rate |
$7,378.00 |
| Rate for Payer: Adventist Health Commercial |
$621.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,191.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,245.30
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$1,707.75
|
| Rate for Payer: Cash Price |
$1,707.75
|
| Rate for Payer: Cash Price |
$1,707.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,484.00
|
| Rate for Payer: Cigna of CA HMO |
$1,987.20
|
| Rate for Payer: Cigna of CA PPO |
$2,297.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,608.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,191.26
|
| Rate for Payer: Galaxy Health WC |
$2,639.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,863.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,794.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$402.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: InnovAge PACE Commercial |
$1,786.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,071.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$444.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$621.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,596.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,596.29
|
| Rate for Payer: Multiplan Commercial |
$2,328.75
|
| Rate for Payer: Networks By Design Commercial |
$2,018.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Prime Health Services Commercial |
$2,639.25
|
| Rate for Payer: Prime Health Services Medicare |
$1,262.74
|
| Rate for Payer: Riverside University Health System MISP |
$1,310.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,863.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,429.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,191.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC EGD W BX SNGL OR MULTI
|
Facility
|
IP
|
$3,105.00
|
|
|
Service Code
|
CPT 43239
|
| Hospital Charge Code |
906743239
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$621.00 |
| Max. Negotiated Rate |
$2,794.50 |
| Rate for Payer: Adventist Health Commercial |
$621.00
|
| Rate for Payer: Cash Price |
$1,707.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,484.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,242.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,242.00
|
| Rate for Payer: Galaxy Health WC |
$2,639.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,863.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,794.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,071.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,183.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,921.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$621.00
|
| Rate for Payer: Multiplan Commercial |
$2,328.75
|
| Rate for Payer: Networks By Design Commercial |
$2,018.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,639.25
|
|
|
HC EGD W/CNTRL BLEEDNG ANY METHOD
|
Facility
|
IP
|
$4,156.00
|
|
|
Service Code
|
CPT 43255
|
| Hospital Charge Code |
906743255
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$831.20 |
| Max. Negotiated Rate |
$3,740.40 |
| Rate for Payer: Adventist Health Commercial |
$831.20
|
| Rate for Payer: Cash Price |
$2,285.80
|
| Rate for Payer: Central Health Plan Commercial |
$3,324.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,662.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,662.40
|
| Rate for Payer: Galaxy Health WC |
$3,532.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,493.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,740.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,772.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,583.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,572.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$831.20
|
| Rate for Payer: Multiplan Commercial |
$3,117.00
|
| Rate for Payer: Networks By Design Commercial |
$2,701.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,532.60
|
|
|
HC EGD W/CNTRL BLEEDNG ANY METHOD
|
Facility
|
OP
|
$4,156.00
|
|
|
Service Code
|
CPT 43255
|
| Hospital Charge Code |
906743255
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$495.00 |
| Max. Negotiated Rate |
$7,378.00 |
| Rate for Payer: Adventist Health Commercial |
$831.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,410.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,410.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,245.30
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$2,285.80
|
| Rate for Payer: Cash Price |
$2,285.80
|
| Rate for Payer: Cash Price |
$2,285.80
|
| Rate for Payer: Central Health Plan Commercial |
$3,324.80
|
| Rate for Payer: Cigna of CA HMO |
$2,659.84
|
| Rate for Payer: Cigna of CA PPO |
$3,075.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,651.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,410.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,253.93
|
| Rate for Payer: EPIC Health Plan Senior |
$2,410.32
|
| Rate for Payer: Galaxy Health WC |
$3,532.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,493.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,740.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$495.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: InnovAge PACE Commercial |
$3,615.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,772.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$546.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$831.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,229.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,229.83
|
| Rate for Payer: Multiplan Commercial |
$3,117.00
|
| Rate for Payer: Networks By Design Commercial |
$2,701.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Prime Health Services Commercial |
$3,532.60
|
| Rate for Payer: Prime Health Services Medicare |
$2,554.94
|
| Rate for Payer: Riverside University Health System MISP |
$2,651.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,493.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,892.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,410.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,410.32
|
|
