|
HC ESOPH DIAG FLEX TRANS W ENDO MUC
|
Facility
OP
|
$1,847.00
|
|
|
Service Code
|
CPT 43211
|
| Hospital Charge Code |
906743211
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$401.07 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,108.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$831.15
|
| Rate for Payer: Cash Price |
$831.15
|
| Rate for Payer: Cigna of CA PPO |
$1,366.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Media |
$2,377.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Galaxy Health WC |
$1,569.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,108.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,385.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,899.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,899.02
|
| Rate for Payer: IEHP Medi-Cal |
$3,851.47
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3,851.47
|
| Rate for Payer: IEHP Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,231.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$401.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$443.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Multiplan Commercial |
$1,477.60
|
| Rate for Payer: Networks By Design Commercial |
$1,200.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,569.95
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,615.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,108.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,852.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC ESOPH DIAG RIGID TRANSORAL
|
Facility
IP
|
$3,456.00
|
|
|
Service Code
|
CPT 43191
|
| Hospital Charge Code |
906743191
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$829.44 |
| Max. Negotiated Rate |
$2,937.60 |
| Rate for Payer: Cash Price |
$1,555.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,382.40
|
| Rate for Payer: Galaxy Health WC |
$2,937.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,073.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,305.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,316.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$829.44
|
| Rate for Payer: Multiplan Commercial |
$2,764.80
|
| Rate for Payer: Networks By Design Commercial |
$2,246.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,937.60
|
|
|
HC ESOPH DIAG RIGID TRANSORAL
|
Facility
OP
|
$1,847.00
|
|
|
Service Code
|
CPT 43191
|
| Hospital Charge Code |
906743191
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$210.08 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: BCBS Transplant Transplant |
$1,108.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$831.15
|
| Rate for Payer: Cash Price |
$831.15
|
| Rate for Payer: Cigna of CA PPO |
$1,366.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Media |
$2,377.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Galaxy Health WC |
$1,569.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,108.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,385.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,899.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,899.02
|
| Rate for Payer: IEHP Medi-Cal |
$3,851.47
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3,851.47
|
| Rate for Payer: IEHP Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,231.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$210.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$443.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Multiplan Commercial |
$1,477.60
|
| Rate for Payer: Networks By Design Commercial |
$1,200.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,569.95
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,615.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,108.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,852.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC ESOPH DIAG RIGID W BLLN DILATION
|
Facility
IP
|
$5,222.00
|
|
|
Service Code
|
CPT 43195
|
| Hospital Charge Code |
906743195
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,253.28 |
| Max. Negotiated Rate |
$4,438.70 |
| Rate for Payer: Cash Price |
$2,349.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,088.80
|
| Rate for Payer: Galaxy Health WC |
$4,438.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,133.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,483.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,989.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,253.28
|
| Rate for Payer: Multiplan Commercial |
$4,177.60
|
| Rate for Payer: Networks By Design Commercial |
$3,394.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,438.70
|
|
|
HC ESOPH DIAG RIGID W BLLN DILATION
|
Facility
OP
|
$2,791.00
|
|
|
Service Code
|
CPT 43195
|
| Hospital Charge Code |
906743195
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$297.81 |
| Max. Negotiated Rate |
$7,847.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,177.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,263.53
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,785.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,674.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$1,255.95
|
| Rate for Payer: Cash Price |
$1,255.95
|
| Rate for Payer: Cigna of CA PPO |
$2,065.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,177.54
|
| Rate for Payer: Dignity Health Media |
$4,785.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,263.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,459.79
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,785.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,785.03
|
| Rate for Payer: Galaxy Health WC |
$2,372.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,674.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,093.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,847.45
|
| Rate for Payer: Heritage Provider Network Transplant |
$7,847.45
|
| Rate for Payer: IEHP Medi-Cal |
$7,751.75
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$7,751.75
|
| Rate for Payer: IEHP Medicare Advantage |
$4,785.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,861.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,785.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$669.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,029.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,411.94
|
| Rate for Payer: Multiplan Commercial |
$2,232.80
|
| Rate for Payer: Networks By Design Commercial |
$1,814.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,372.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5,263.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,674.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,742.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,177.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,263.53
|
| Rate for Payer: Vantage Medical Group Senior |
$4,785.03
|
|
|
HC ESOPH DIAG RIG TRANSO BIOPSY
|
Facility
IP
|
$4,177.00
|
|
|
Service Code
|
CPT 43193
|
| Hospital Charge Code |
906743193
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,002.48 |
| Max. Negotiated Rate |
$3,550.45 |
| Rate for Payer: Cash Price |
$1,879.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,670.80
|
| Rate for Payer: Galaxy Health WC |
$3,550.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,506.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,786.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,591.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,002.48
|
| Rate for Payer: Multiplan Commercial |
$3,341.60
|
| Rate for Payer: Networks By Design Commercial |
$2,715.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,550.45
|
|
|
HC ESOPH DIAG RIG TRANSO BIOPSY
|
Facility
OP
|
$2,791.00
|
|
|
Service Code
|
CPT 43193
|
| Hospital Charge Code |
906743193
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$297.10 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,674.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$1,255.95
|
| Rate for Payer: Cash Price |
$1,255.95
|
| Rate for Payer: Cigna of CA PPO |
$2,065.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Media |
$2,377.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Galaxy Health WC |
$2,372.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,674.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,093.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,899.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,899.02
|
| Rate for Payer: IEHP Medi-Cal |
$3,851.47
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3,851.47
|
| Rate for Payer: IEHP Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,861.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$669.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Multiplan Commercial |
$2,232.80
|
| Rate for Payer: Networks By Design Commercial |
$1,814.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,372.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,615.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,674.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,852.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC ESOPH DIAG RIG TRANSO INJECT
|
Facility
IP
|
$5,222.00
|
|
|
Service Code
|
CPT 43192
|
| Hospital Charge Code |
906743192
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,253.28 |
| Max. Negotiated Rate |
$4,438.70 |
| Rate for Payer: Cash Price |
$2,349.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,088.80
|
| Rate for Payer: Galaxy Health WC |
$4,438.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,133.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,483.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,989.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,253.28
|
| Rate for Payer: Multiplan Commercial |
$4,177.60
|
| Rate for Payer: Networks By Design Commercial |
$3,394.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,438.70
|
|
|
HC ESOPH DIAG RIG TRANSO INJECT
|
Facility
OP
|
$2,791.00
|
|
|
Service Code
|
CPT 43192
|
| Hospital Charge Code |
906743192
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$249.70 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,674.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$1,255.95
|
| Rate for Payer: Cash Price |
$1,255.95
|
| Rate for Payer: Cigna of CA PPO |
$2,065.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Media |
$2,377.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Galaxy Health WC |
$2,372.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,674.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,093.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,899.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,899.02
|
| Rate for Payer: IEHP Medi-Cal |
$3,851.47
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3,851.47
|
| Rate for Payer: IEHP Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,861.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$249.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$669.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Multiplan Commercial |
$2,232.80
|
| Rate for Payer: Networks By Design Commercial |
$1,814.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,372.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,615.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,674.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,852.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC ESOPH DIAG RIG TRANSO RMVL FB
|
Facility
OP
|
$2,791.00
|
|
|
Service Code
|
CPT 43194
|
| Hospital Charge Code |
906743194
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$266.68 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,674.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$1,255.95
|
| Rate for Payer: Cash Price |
$1,255.95
|
| Rate for Payer: Cigna of CA PPO |
$2,065.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Media |
$2,377.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Galaxy Health WC |
$2,372.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,674.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,093.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,899.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,899.02
|
| Rate for Payer: IEHP Medi-Cal |
$3,851.47
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3,851.47
|
| Rate for Payer: IEHP Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,861.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$266.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$669.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Multiplan Commercial |
$2,232.80
|
| Rate for Payer: Networks By Design Commercial |
$1,814.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,372.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,615.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,674.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,852.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC ESOPH DIAG RIG TRANSO RMVL FB
|
Facility
IP
|
$5,222.00
|
|
|
Service Code
|
CPT 43194
|
| Hospital Charge Code |
906743194
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,253.28 |
| Max. Negotiated Rate |
$4,438.70 |
| Rate for Payer: Cash Price |
$2,349.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,088.80
|
| Rate for Payer: Galaxy Health WC |
$4,438.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,133.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,483.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,989.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,253.28
|
| Rate for Payer: Multiplan Commercial |
$4,177.60
|
| Rate for Payer: Networks By Design Commercial |
$3,394.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,438.70
|
|
|
HC ESOPH DIAG RIG W INSRT GW DILA
|
Facility
IP
|
$4,177.00
|
|
|
Service Code
|
CPT 43196
|
| Hospital Charge Code |
906743196
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,002.48 |
| Max. Negotiated Rate |
$3,550.45 |
| Rate for Payer: Cash Price |
$1,879.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,670.80
|
| Rate for Payer: Galaxy Health WC |
$3,550.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,506.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,786.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,591.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,002.48
|
| Rate for Payer: Multiplan Commercial |
$3,341.60
|
| Rate for Payer: Networks By Design Commercial |
$2,715.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,550.45
|
|
|
HC ESOPH DIAG RIG W INSRT GW DILA
|
Facility
OP
|
$2,791.00
|
|
|
Service Code
|
CPT 43196
|
| Hospital Charge Code |
906743196
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$324.69 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,674.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$1,255.95
|
| Rate for Payer: Cash Price |
$1,255.95
|
| Rate for Payer: Cigna of CA PPO |
$2,065.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Media |
$2,377.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Galaxy Health WC |
$2,372.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,674.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,093.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,899.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,899.02
|
| Rate for Payer: IEHP Medi-Cal |
$3,851.47
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3,851.47
|
| Rate for Payer: IEHP Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,861.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$324.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$669.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Multiplan Commercial |
$2,232.80
|
| Rate for Payer: Networks By Design Commercial |
$1,814.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,372.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,615.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,674.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,852.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC ESOPH DIAG W/BAND LIGATION
|
Facility
OP
|
$4,416.00
|
|
|
Service Code
|
CPT 43205
|
| Hospital Charge Code |
906743205
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$336.70 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: BCBS Transplant Transplant |
$2,649.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$1,987.20
|
| Rate for Payer: Cash Price |
$1,987.20
|
| Rate for Payer: Cigna of CA PPO |
$3,267.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Media |
$2,377.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Galaxy Health WC |
$3,753.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,649.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,312.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,899.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,899.02
|
| Rate for Payer: IEHP Medi-Cal |
$3,851.47
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3,851.47
|
| Rate for Payer: IEHP Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,945.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$336.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,059.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Multiplan Commercial |
$3,532.80
|
| Rate for Payer: Networks By Design Commercial |
$2,870.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,753.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,615.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,649.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,852.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC ESOPH DIAG W/BAND LIGATION
|
Facility
OP
|
$6,608.00
|
|
|
Service Code
|
CPT 43205
|
| Hospital Charge Code |
900501692
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$336.70 |
| Max. Negotiated Rate |
$5,938.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: BCBS Transplant Transplant |
$3,964.80
|
| Rate for Payer: Cash Price |
$2,973.60
|
| Rate for Payer: Cash Price |
$2,973.60
|
| Rate for Payer: Cash Price |
$2,973.60
|
| Rate for Payer: Cigna of CA PPO |
$4,889.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Media |
$2,377.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Galaxy Health WC |
$5,616.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,964.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,956.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,899.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,899.02
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,407.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$336.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,585.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Multiplan Commercial |
$5,286.40
|
| Rate for Payer: Networks By Design Commercial |
$4,295.20
|
| Rate for Payer: Prime Health Services Commercial |
$5,616.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3,964.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,964.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,304.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,304.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,304.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,304.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC ESOPH DIAG W/BAND LIGATION
|
Facility
IP
|
$6,608.00
|
|
|
Service Code
|
CPT 43205
|
| Hospital Charge Code |
906743205
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,585.92 |
| Max. Negotiated Rate |
$5,616.80 |
| Rate for Payer: Cash Price |
$2,973.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,643.20
|
| Rate for Payer: Galaxy Health WC |
$5,616.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,964.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,407.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,517.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,585.92
|
| Rate for Payer: Multiplan Commercial |
$5,286.40
|
| Rate for Payer: Networks By Design Commercial |
$4,295.20
|
| Rate for Payer: Prime Health Services Commercial |
$5,616.80
|
|
|
HC ESOPH DIAG W/BAND LIGATION
|
Facility
IP
|
$6,608.00
|
|
|
Service Code
|
CPT 43205
|
| Hospital Charge Code |
900501692
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,585.92 |
| Max. Negotiated Rate |
$5,616.80 |
| Rate for Payer: Cash Price |
$2,973.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,643.20
|
| Rate for Payer: Galaxy Health WC |
$5,616.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,964.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,407.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,517.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,585.92
|
| Rate for Payer: Multiplan Commercial |
$5,286.40
|
| Rate for Payer: Networks By Design Commercial |
$4,295.20
|
| Rate for Payer: Prime Health Services Commercial |
$5,616.80
|
|
|
HC ESOPH DIAG W/BLLN DILATION
|
Facility
OP
|
$3,785.00
|
|
|
Service Code
|
CPT 43220
|
| Hospital Charge Code |
906743220
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$339.53 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$2,271.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$1,703.25
|
| Rate for Payer: Cash Price |
$1,703.25
|
| Rate for Payer: Cigna of CA PPO |
$2,800.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Media |
$2,377.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Galaxy Health WC |
$3,217.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,271.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,838.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,899.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,899.02
|
| Rate for Payer: IEHP Medi-Cal |
$3,851.47
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3,851.47
|
| Rate for Payer: IEHP Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,524.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$339.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$908.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Multiplan Commercial |
$3,028.00
|
| Rate for Payer: Networks By Design Commercial |
$2,460.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,217.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,615.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,271.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,852.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC ESOPH DIAG W/BLLN DILATION
|
Facility
IP
|
$5,664.00
|
|
|
Service Code
|
CPT 43220
|
| Hospital Charge Code |
906743220
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,359.36 |
| Max. Negotiated Rate |
$4,814.40 |
| Rate for Payer: Cash Price |
$2,548.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,265.60
|
| Rate for Payer: Galaxy Health WC |
$4,814.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,398.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,777.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,157.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,359.36
|
| Rate for Payer: Multiplan Commercial |
$4,531.20
|
| Rate for Payer: Networks By Design Commercial |
$3,681.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,814.40
|
|
|
HC ESOPH DIAG W/BX SNGL OR MULTI
|
Facility
IP
|
$5,861.00
|
|
|
Service Code
|
CPT 43202
|
| Hospital Charge Code |
906743202
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,406.64 |
| Max. Negotiated Rate |
$4,981.85 |
| Rate for Payer: Cash Price |
$2,637.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,344.40
|
| Rate for Payer: Galaxy Health WC |
$4,981.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,516.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,909.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,233.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,406.64
|
| Rate for Payer: Multiplan Commercial |
$4,688.80
|
| Rate for Payer: Networks By Design Commercial |
$3,809.65
|
| Rate for Payer: Prime Health Services Commercial |
$4,981.85
|
|
|
HC ESOPH DIAG W/BX SNGL OR MULTI
|
Facility
OP
|
$3,917.00
|
|
|
Service Code
|
CPT 43202
|
| Hospital Charge Code |
906743202
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$344.49 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$2,350.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$1,762.65
|
| Rate for Payer: Cash Price |
$1,762.65
|
| Rate for Payer: Cigna of CA PPO |
$2,898.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Media |
$2,377.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Galaxy Health WC |
$3,329.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,350.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,937.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,899.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,899.02
|
| Rate for Payer: IEHP Medi-Cal |
$3,851.47
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3,851.47
|
| Rate for Payer: IEHP Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,612.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$344.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$940.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Multiplan Commercial |
$3,133.60
|
| Rate for Payer: Networks By Design Commercial |
$2,546.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,329.45
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,615.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,350.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,852.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC ESOPH DIAG W/ENDO US
|
Facility
OP
|
$5,570.00
|
|
|
Service Code
|
CPT 43232
|
| Hospital Charge Code |
906743232
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$439.28 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$3,342.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,612.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,351.09
|
| Rate for Payer: Cash Price |
$2,506.50
|
| Rate for Payer: Cash Price |
$2,506.50
|
| Rate for Payer: Cigna of CA PPO |
$4,121.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Media |
$2,377.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Galaxy Health WC |
$4,734.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,342.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,177.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,899.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,899.02
|
| Rate for Payer: IEHP Medi-Cal |
$3,851.47
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3,851.47
|
| Rate for Payer: IEHP Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,715.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$439.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,336.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Multiplan Commercial |
$4,456.00
|
| Rate for Payer: Networks By Design Commercial |
$3,620.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,734.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,615.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,342.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,852.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC ESOPH DIAG W/ENDO US
|
Facility
IP
|
$8,334.00
|
|
|
Service Code
|
CPT 43232
|
| Hospital Charge Code |
906743232
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,000.16 |
| Max. Negotiated Rate |
$7,083.90 |
| Rate for Payer: Cash Price |
$3,750.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,333.60
|
| Rate for Payer: Galaxy Health WC |
$7,083.90
|
| Rate for Payer: Global Benefits Group Commercial |
$5,000.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,558.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,175.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,000.16
|
| Rate for Payer: Multiplan Commercial |
$6,667.20
|
| Rate for Payer: Networks By Design Commercial |
$5,417.10
|
| Rate for Payer: Prime Health Services Commercial |
$7,083.90
|
|
|
HC ESOPH DIAG W/ENDO US EXAM
|
Facility
IP
|
$9,632.00
|
|
|
Service Code
|
CPT 43231
|
| Hospital Charge Code |
906743231
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,311.68 |
| Max. Negotiated Rate |
$8,187.20 |
| Rate for Payer: Cash Price |
$4,334.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,852.80
|
| Rate for Payer: Galaxy Health WC |
$8,187.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,779.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,424.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,669.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,311.68
|
| Rate for Payer: Multiplan Commercial |
$7,705.60
|
| Rate for Payer: Networks By Design Commercial |
$6,260.80
|
| Rate for Payer: Prime Health Services Commercial |
$8,187.20
|
|
|
HC ESOPH DIAG W/ENDO US EXAM
|
Facility
OP
|
$5,559.00
|
|
|
Service Code
|
CPT 43231
|
| Hospital Charge Code |
906743231
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$377.74 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$3,335.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,612.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,351.09
|
| Rate for Payer: Cash Price |
$2,501.55
|
| Rate for Payer: Cash Price |
$2,501.55
|
| Rate for Payer: Cigna of CA PPO |
$4,113.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Media |
$2,377.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Galaxy Health WC |
$4,725.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,335.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,169.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,899.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,899.02
|
| Rate for Payer: IEHP Medi-Cal |
$3,851.47
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3,851.47
|
| Rate for Payer: IEHP Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,707.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$377.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,334.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Multiplan Commercial |
$4,447.20
|
| Rate for Payer: Networks By Design Commercial |
$3,613.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,725.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,615.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,335.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,852.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
