|
HC ESBL DISK CONFIRMATION
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 87184
|
| Hospital Charge Code |
900912449
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.06 |
| Max. Negotiated Rate |
$68.03 |
| Rate for Payer: Adventist Health Commercial |
$9.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.03
|
| Rate for Payer: Blue Shield of California Commercial |
$30.77
|
| Rate for Payer: Blue Shield of California EPN |
$20.33
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna of CA HMO |
$29.44
|
| Rate for Payer: Cigna of CA PPO |
$34.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.10
|
| Rate for Payer: EPIC Health Plan Senior |
$7.48
|
| Rate for Payer: Galaxy Health WC |
$39.10
|
| Rate for Payer: Global Benefits Group Commercial |
$27.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.02
|
| Rate for Payer: Multiplan Commercial |
$36.80
|
| Rate for Payer: Networks By Design Commercial |
$29.90
|
| Rate for Payer: Prime Health Services Commercial |
$39.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.06
|
| Rate for Payer: United Healthcare All Other HMO |
$6.06
|
| Rate for Payer: United Healthcare HMO Rider |
$6.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.06
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.23
|
| Rate for Payer: Vantage Medical Group Senior |
$7.48
|
|
|
HC ESOPH ACID REFLX TEST
|
Facility
|
IP
|
$3,494.00
|
|
|
Service Code
|
CPT 91034
|
| Hospital Charge Code |
906791033
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$698.80 |
| Max. Negotiated Rate |
$2,969.90 |
| Rate for Payer: Adventist Health Commercial |
$698.80
|
| Rate for Payer: Cash Price |
$1,572.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,397.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,397.60
|
| Rate for Payer: Galaxy Health WC |
$2,969.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,096.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,330.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,331.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,162.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$838.56
|
| Rate for Payer: Multiplan Commercial |
$2,795.20
|
| Rate for Payer: Networks By Design Commercial |
$2,271.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,969.90
|
|
|
HC ESOPH ACID REFLX TEST
|
Facility
|
OP
|
$2,087.00
|
|
|
Service Code
|
CPT 91034
|
| Hospital Charge Code |
906791033
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$130.38 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$417.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$741.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$674.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,281.63
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$939.15
|
| Rate for Payer: Cash Price |
$939.15
|
| Rate for Payer: Cash Price |
$939.15
|
| Rate for Payer: Cigna of CA HMO |
$1,335.68
|
| Rate for Payer: Cigna of CA PPO |
$1,544.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$741.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$674.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$910.14
|
| Rate for Payer: EPIC Health Plan Senior |
$674.18
|
| Rate for Payer: Galaxy Health WC |
$1,773.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,252.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,105.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$130.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$674.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,392.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$147.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$674.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$500.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$849.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$903.40
|
| Rate for Payer: Multiplan Commercial |
$1,669.60
|
| Rate for Payer: Networks By Design Commercial |
$1,356.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,773.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,252.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$809.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$674.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$741.60
|
| Rate for Payer: Vantage Medical Group Senior |
$674.18
|
|
|
HC ESOPHAG DIAG W BALLOON DILATION
|
Facility
|
IP
|
$4,573.00
|
|
|
Service Code
|
CPT 43220
|
| Hospital Charge Code |
909000188
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$914.60 |
| Max. Negotiated Rate |
$3,887.05 |
| Rate for Payer: Adventist Health Commercial |
$914.60
|
| Rate for Payer: Cash Price |
$2,057.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,829.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,829.20
|
| Rate for Payer: Galaxy Health WC |
$3,887.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,743.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,050.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,742.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,830.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,097.52
|
| Rate for Payer: Multiplan Commercial |
$3,658.40
|
| Rate for Payer: Networks By Design Commercial |
$2,972.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,887.05
|
|
|
HC ESOPHAG DIAG W BALLOON DILATION
|
Facility
|
IP
|
$4,573.00
|
|
|
Service Code
|
CPT 43220
|
| Hospital Charge Code |
909000188
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$914.60 |
| Max. Negotiated Rate |
$3,887.05 |
| Rate for Payer: Adventist Health Commercial |
$914.60
|
| Rate for Payer: Cash Price |
$2,057.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,829.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,829.20
|
| Rate for Payer: Galaxy Health WC |
$3,887.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,743.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,050.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,742.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,830.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,097.52
|
| Rate for Payer: Multiplan Commercial |
$3,658.40
|
| Rate for Payer: Networks By Design Commercial |
$2,972.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,887.05
|
|
|
HC ESOPHAG DIAG W BALLOON DILATION
|
Facility
|
OP
|
$3,057.00
|
|
|
Service Code
|
CPT 43220
|
| Hospital Charge Code |
909000188
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$300.22 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$611.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| 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 HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$1,375.65
|
| Rate for Payer: Cash Price |
$1,375.65
|
| Rate for Payer: Cash Price |
$1,375.65
|
| Rate for Payer: Cigna of CA HMO |
$1,956.48
|
| Rate for Payer: Cigna of CA PPO |
$2,262.18
|
| 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 |
$2,598.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,834.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$300.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,039.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$339.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$733.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,037.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,229.83
|
| Rate for Payer: Multiplan Commercial |
$2,445.60
|
| Rate for Payer: Networks By Design Commercial |
$1,987.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,598.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,834.20
|
| 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 ESOPHAG DIAG W BALLOON DILATION
|
Facility
|
OP
|
$3,057.00
|
|
|
Service Code
|
CPT 43220
|
| Hospital Charge Code |
909000188
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$300.22 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$611.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| 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 HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$1,375.65
|
| Rate for Payer: Cash Price |
$1,375.65
|
| Rate for Payer: Cash Price |
$1,375.65
|
| Rate for Payer: Cigna of CA HMO |
$1,956.48
|
| Rate for Payer: Cigna of CA PPO |
$2,262.18
|
| 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 |
$2,598.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,834.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$300.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,039.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$339.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$733.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,037.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,229.83
|
| Rate for Payer: Multiplan Commercial |
$2,445.60
|
| Rate for Payer: Multiplan WC |
$3,840.40
|
| Rate for Payer: Networks By Design Commercial |
$1,987.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,598.45
|
| Rate for Payer: Prime Health Services WC |
$3,801.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,834.20
|
| 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 ESOPHAGEAL DILATATION
|
Facility
|
IP
|
$1,158.00
|
|
|
Service Code
|
CPT 74360
|
| Hospital Charge Code |
909001829
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$231.60 |
| Max. Negotiated Rate |
$984.30 |
| Rate for Payer: Galaxy Health WC |
$984.30
|
| Rate for Payer: Adventist Health Commercial |
$231.60
|
| Rate for Payer: Cash Price |
$521.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$463.20
|
| Rate for Payer: EPIC Health Plan Senior |
$463.20
|
| Rate for Payer: Global Benefits Group Commercial |
$694.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$772.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$441.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$716.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$277.92
|
| Rate for Payer: Multiplan Commercial |
$926.40
|
| Rate for Payer: Networks By Design Commercial |
$752.70
|
| Rate for Payer: Prime Health Services Commercial |
$984.30
|
|
|
HC ESOPHAGEAL DILATATION
|
Facility
|
OP
|
$1,158.00
|
|
|
Service Code
|
CPT 74360
|
| Hospital Charge Code |
909001829
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$183.09 |
| Max. Negotiated Rate |
$984.30 |
| Rate for Payer: Adventist Health Commercial |
$231.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$759.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$984.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$636.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$868.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$885.14
|
| Rate for Payer: Blue Shield of California Commercial |
$708.70
|
| Rate for Payer: Blue Shield of California EPN |
$467.83
|
| Rate for Payer: Cash Price |
$521.10
|
| Rate for Payer: Cash Price |
$521.10
|
| Rate for Payer: Cigna of CA HMO |
$741.12
|
| Rate for Payer: Cigna of CA PPO |
$856.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$984.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$984.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$984.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$463.20
|
| Rate for Payer: EPIC Health Plan Senior |
$463.20
|
| Rate for Payer: Galaxy Health WC |
$984.30
|
| Rate for Payer: Global Benefits Group Commercial |
$694.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$183.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$772.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$207.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$716.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$277.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$810.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$810.60
|
| Rate for Payer: Multiplan Commercial |
$926.40
|
| Rate for Payer: Networks By Design Commercial |
$752.70
|
| Rate for Payer: Prime Health Services Commercial |
$984.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$694.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$694.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$579.00
|
| Rate for Payer: United Healthcare All Other HMO |
$579.00
|
| Rate for Payer: United Healthcare HMO Rider |
$579.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$579.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$984.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$984.30
|
| Rate for Payer: Vantage Medical Group Senior |
$984.30
|
|
|
HC ESOPHAGOGASTRIC TMPONAD W/BLLN
|
Facility
|
OP
|
$4,353.00
|
|
|
Service Code
|
CPT 43460
|
| Hospital Charge Code |
906743460
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$154.49 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$870.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,700.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,394.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,264.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$1,958.85
|
| Rate for Payer: Cash Price |
$1,958.85
|
| Rate for Payer: Cash Price |
$1,958.85
|
| Rate for Payer: Cigna of CA HMO |
$2,785.92
|
| Rate for Payer: Cigna of CA PPO |
$3,221.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,700.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,700.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,700.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,741.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,741.20
|
| Rate for Payer: Galaxy Health WC |
$3,700.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,611.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$154.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,903.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$174.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,694.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,044.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,047.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,047.10
|
| Rate for Payer: Multiplan Commercial |
$3,482.40
|
| Rate for Payer: Networks By Design Commercial |
$2,829.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,700.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,611.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,611.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,700.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,700.05
|
| Rate for Payer: Vantage Medical Group Senior |
$3,700.05
|
|
|
HC ESOPHAGOGASTRIC TMPONAD W/BLLN
|
Facility
|
IP
|
$3,313.00
|
|
|
Service Code
|
CPT 43460
|
| Hospital Charge Code |
906743460
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$662.60 |
| Max. Negotiated Rate |
$2,816.05 |
| Rate for Payer: Adventist Health Commercial |
$662.60
|
| Rate for Payer: Cash Price |
$1,490.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,325.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,325.20
|
| Rate for Payer: Galaxy Health WC |
$2,816.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,987.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,209.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,262.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,050.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$795.12
|
| Rate for Payer: Multiplan Commercial |
$2,650.40
|
| Rate for Payer: Networks By Design Commercial |
$2,153.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,816.05
|
|
|
HC ESOPHAGOSCOPY W BLLN LT 30MM
|
Facility
|
IP
|
$4,573.00
|
|
|
Service Code
|
CPT 43220
|
| Hospital Charge Code |
900501292
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$914.60 |
| Max. Negotiated Rate |
$3,887.05 |
| Rate for Payer: Adventist Health Commercial |
$914.60
|
| Rate for Payer: Cash Price |
$2,057.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,829.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,829.20
|
| Rate for Payer: Galaxy Health WC |
$3,887.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,743.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,050.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,742.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,830.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,097.52
|
| Rate for Payer: Multiplan Commercial |
$3,658.40
|
| Rate for Payer: Networks By Design Commercial |
$2,972.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,887.05
|
|
|
HC ESOPHAGOSCOPY W BLLN LT 30MM
|
Facility
|
OP
|
$4,573.00
|
|
|
Service Code
|
CPT 43220
|
| Hospital Charge Code |
900501292
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$339.53 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$914.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| 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 HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$2,057.85
|
| Rate for Payer: Cash Price |
$2,057.85
|
| Rate for Payer: Cash Price |
$2,057.85
|
| Rate for Payer: Cigna of CA HMO |
$2,926.72
|
| Rate for Payer: Cigna of CA PPO |
$3,384.02
|
| 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 |
$3,887.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,743.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$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: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,050.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$339.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,097.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,037.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,229.83
|
| Rate for Payer: Multiplan Commercial |
$3,658.40
|
| Rate for Payer: Multiplan WC |
$3,840.40
|
| Rate for Payer: Networks By Design Commercial |
$2,972.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,887.05
|
| Rate for Payer: Prime Health Services WC |
$3,801.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,743.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,286.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,286.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,286.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,286.50
|
| 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 ESOPHAGOSCOPY W OPTICAL ENDOMI
|
Facility
|
IP
|
$3,052.00
|
|
|
Service Code
|
CPT 43206
|
| Hospital Charge Code |
906743206
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$610.40 |
| Max. Negotiated Rate |
$2,594.20 |
| Rate for Payer: Adventist Health Commercial |
$610.40
|
| Rate for Payer: Cash Price |
$1,373.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,220.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,220.80
|
| Rate for Payer: Galaxy Health WC |
$2,594.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,831.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,035.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,162.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,889.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$732.48
|
| Rate for Payer: Multiplan Commercial |
$2,441.60
|
| Rate for Payer: Networks By Design Commercial |
$1,983.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,594.20
|
|
|
HC ESOPHAGOSCOPY W OPTICAL ENDOMI
|
Facility
|
OP
|
$2,041.00
|
|
|
Service Code
|
CPT 43206
|
| Hospital Charge Code |
906743206
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$408.20 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$408.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| 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 HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$918.45
|
| Rate for Payer: Cash Price |
$918.45
|
| Rate for Payer: Cash Price |
$918.45
|
| Rate for Payer: Cigna of CA HMO |
$1,306.24
|
| Rate for Payer: Cigna of CA PPO |
$1,510.34
|
| 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 |
$1,734.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,224.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,361.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$489.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,037.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,229.83
|
| Rate for Payer: Multiplan Commercial |
$1,632.80
|
| Rate for Payer: Networks By Design Commercial |
$1,326.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,734.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,224.60
|
| 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
|
|
|
HC ESOPHAGOSCOPY W/WO SPECIMEN
|
Facility
|
OP
|
$3,070.00
|
|
|
Service Code
|
CPT 43200
|
| Hospital Charge Code |
906743200
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$283.33 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$614.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| 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 HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$1,381.50
|
| Rate for Payer: Cash Price |
$1,381.50
|
| Rate for Payer: Cash Price |
$1,381.50
|
| Rate for Payer: Cigna of CA HMO |
$1,964.80
|
| Rate for Payer: Cigna of CA PPO |
$2,271.80
|
| 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 |
$2,609.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,842.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$283.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,047.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$320.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$736.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,500.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,596.29
|
| Rate for Payer: Multiplan Commercial |
$2,456.00
|
| Rate for Payer: Networks By Design Commercial |
$1,995.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,609.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,842.00
|
| 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 ESOPHAGOSCOPY W/WO SPECIMEN
|
Facility
|
OP
|
$3,070.00
|
|
|
Service Code
|
CPT 43200
|
| Hospital Charge Code |
906743200
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$320.44 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$614.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| 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 HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$1,381.50
|
| Rate for Payer: Cash Price |
$1,381.50
|
| Rate for Payer: Cash Price |
$1,381.50
|
| Rate for Payer: Cigna of CA HMO |
$1,964.80
|
| Rate for Payer: Cigna of CA PPO |
$2,271.80
|
| 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 |
$2,609.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,842.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$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: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,047.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$320.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$736.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,500.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,596.29
|
| Rate for Payer: Multiplan Commercial |
$2,456.00
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Networks By Design Commercial |
$1,995.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,609.50
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,842.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,535.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,535.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,535.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,535.00
|
| 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 ESOPHAGOSCOPY W/WO SPECIMEN
|
Facility
|
IP
|
$4,593.00
|
|
|
Service Code
|
CPT 43200
|
| Hospital Charge Code |
906743200
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$918.60 |
| Max. Negotiated Rate |
$3,904.05 |
| Rate for Payer: Adventist Health Commercial |
$918.60
|
| Rate for Payer: Cash Price |
$2,066.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,837.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,837.20
|
| Rate for Payer: Galaxy Health WC |
$3,904.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,755.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,063.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,749.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,843.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,102.32
|
| Rate for Payer: Multiplan Commercial |
$3,674.40
|
| Rate for Payer: Networks By Design Commercial |
$2,985.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,904.05
|
|
|
HC ESOPHAGOSCOPY W/WO SPECIMEN
|
Facility
|
IP
|
$4,593.00
|
|
|
Service Code
|
CPT 43200
|
| Hospital Charge Code |
906743200
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$918.60 |
| Max. Negotiated Rate |
$3,904.05 |
| Rate for Payer: Adventist Health Commercial |
$918.60
|
| Rate for Payer: Cash Price |
$2,066.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,837.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,837.20
|
| Rate for Payer: Galaxy Health WC |
$3,904.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,755.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,063.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,749.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,843.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,102.32
|
| Rate for Payer: Multiplan Commercial |
$3,674.40
|
| Rate for Payer: Networks By Design Commercial |
$2,985.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,904.05
|
|
|
HC ESOPHAGUS CELLVIZIO
|
Facility
|
IP
|
$3,736.00
|
|
|
Service Code
|
CPT 43499
|
| Hospital Charge Code |
906743499
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$747.20 |
| Max. Negotiated Rate |
$3,175.60 |
| Rate for Payer: Adventist Health Commercial |
$747.20
|
| Rate for Payer: Cash Price |
$1,681.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,494.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,494.40
|
| Rate for Payer: Galaxy Health WC |
$3,175.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,241.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,491.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,423.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,312.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$896.64
|
| Rate for Payer: Multiplan Commercial |
$2,988.80
|
| Rate for Payer: Networks By Design Commercial |
$2,428.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,175.60
|
|
|
HC ESOPHAGUS CELLVIZIO
|
Facility
|
OP
|
$3,925.00
|
|
|
Service Code
|
CPT 43499
|
| Hospital Charge Code |
906743499
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$785.00 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$785.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| 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 HMO/PPO |
$2,410.34
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$1,766.25
|
| Rate for Payer: Cash Price |
$1,766.25
|
| Rate for Payer: Cash Price |
$1,766.25
|
| Rate for Payer: Cigna of CA HMO |
$2,512.00
|
| Rate for Payer: Cigna of CA PPO |
$2,904.50
|
| 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 |
$3,336.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,355.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,617.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$942.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,500.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,596.29
|
| Rate for Payer: Multiplan Commercial |
$3,140.00
|
| Rate for Payer: Networks By Design Commercial |
$2,551.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,336.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,355.00
|
| 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 ESOPHAGUS ENDOSCOPY W RMVL FB
|
Facility
|
IP
|
$4,732.00
|
|
|
Service Code
|
CPT 43215
|
| Hospital Charge Code |
900501291
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$946.40 |
| Max. Negotiated Rate |
$4,022.20 |
| Rate for Payer: Adventist Health Commercial |
$946.40
|
| Rate for Payer: Cash Price |
$2,129.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,892.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,892.80
|
| Rate for Payer: Galaxy Health WC |
$4,022.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,839.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,156.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,802.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,929.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,135.68
|
| Rate for Payer: Multiplan Commercial |
$3,785.60
|
| Rate for Payer: Networks By Design Commercial |
$3,075.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,022.20
|
|
|
HC ESOPHAGUS ENDOSCOPY W RMVL FB
|
Facility
|
OP
|
$4,732.00
|
|
|
Service Code
|
CPT 43215
|
| Hospital Charge Code |
900501291
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$424.42 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$946.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| 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 HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$2,129.40
|
| Rate for Payer: Cash Price |
$2,129.40
|
| Rate for Payer: Cash Price |
$2,129.40
|
| Rate for Payer: Cigna of CA HMO |
$3,028.48
|
| Rate for Payer: Cigna of CA PPO |
$3,501.68
|
| 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 |
$4,022.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,839.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$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: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,156.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$424.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,135.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,037.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,229.83
|
| Rate for Payer: Multiplan Commercial |
$3,785.60
|
| Rate for Payer: Multiplan WC |
$3,840.40
|
| Rate for Payer: Networks By Design Commercial |
$3,075.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,022.20
|
| Rate for Payer: Prime Health Services WC |
$3,801.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,839.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,366.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,366.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,366.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,366.00
|
| 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 ESOPHAGUS ENDOSCOPY W/RMVL FB
|
Facility
|
IP
|
$4,732.00
|
|
|
Service Code
|
CPT 43215
|
| Hospital Charge Code |
902100066
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$946.40 |
| Max. Negotiated Rate |
$4,022.20 |
| Rate for Payer: Adventist Health Commercial |
$946.40
|
| Rate for Payer: Cash Price |
$2,129.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,892.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,892.80
|
| Rate for Payer: Galaxy Health WC |
$4,022.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,839.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,156.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,802.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,929.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,135.68
|
| Rate for Payer: Multiplan Commercial |
$3,785.60
|
| Rate for Payer: Networks By Design Commercial |
$3,075.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,022.20
|
|
|
HC ESOPHAGUS ENDOSCOPY W/RMVL FB
|
Facility
|
OP
|
$4,732.00
|
|
|
Service Code
|
CPT 43215
|
| Hospital Charge Code |
902100066
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$424.42 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$946.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| 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 HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$2,129.40
|
| Rate for Payer: Cash Price |
$2,129.40
|
| Rate for Payer: Cash Price |
$2,129.40
|
| Rate for Payer: Cigna of CA HMO |
$3,028.48
|
| Rate for Payer: Cigna of CA PPO |
$3,501.68
|
| 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 |
$4,022.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,839.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$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: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,156.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$424.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,135.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,037.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,229.83
|
| Rate for Payer: Multiplan Commercial |
$3,785.60
|
| Rate for Payer: Multiplan WC |
$3,840.40
|
| Rate for Payer: Networks By Design Commercial |
$3,075.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,022.20
|
| Rate for Payer: Prime Health Services WC |
$3,801.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,839.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,366.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,366.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,366.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,366.00
|
| 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
|
|
