|
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 |
$2,515.15
|
| Rate for Payer: Cash Price |
$2,515.15
|
| Rate for Payer: Cash Price |
$2,515.15
|
| 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 Permanente of CA Commercial/Self Funded |
$3,050.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$339.53
|
| Rate for Payer: Kaiser Permanente of CA 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 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 |
$2,515.15
|
| 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 Permanente of CA Commercial/Self Funded |
$3,050.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,742.31
|
| Rate for Payer: Kaiser Permanente of CA 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 OPTICAL ENDOMI
|
Facility
|
OP
|
$3,052.00
|
|
|
Service Code
|
CPT 43206
|
| Hospital Charge Code |
906743206
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$610.40 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$610.40
|
| 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: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$1,678.60
|
| Rate for Payer: Cash Price |
$1,678.60
|
| Rate for Payer: Cash Price |
$1,678.60
|
| Rate for Payer: Cigna of CA HMO |
$1,953.28
|
| Rate for Payer: Cigna of CA PPO |
$2,258.48
|
| 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 |
$2,594.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,831.20
|
| 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 Permanente of CA Commercial/Self Funded |
$2,035.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$732.48
|
| 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 |
$2,441.60
|
| Rate for Payer: Networks By Design Commercial |
$1,983.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,594.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,831.20
|
| 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 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 |
$1,678.60
|
| 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 Permanente of CA Commercial/Self Funded |
$2,035.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,162.81
|
| Rate for Payer: Kaiser Permanente of CA 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/WO SPECIMEN
|
Facility
|
OP
|
$4,593.00
|
|
|
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 |
$918.60
|
| 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 |
$2,526.15
|
| Rate for Payer: Cash Price |
$2,526.15
|
| Rate for Payer: Cash Price |
$2,526.15
|
| Rate for Payer: Cigna of CA HMO |
$2,939.52
|
| Rate for Payer: Cigna of CA PPO |
$3,398.82
|
| 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 |
$3,904.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,755.80
|
| 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 Permanente of CA Commercial/Self Funded |
$3,063.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,102.32
|
| 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 |
$3,674.40
|
| Rate for Payer: Networks By Design Commercial |
$2,985.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,904.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,755.80
|
| 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
|
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 |
$2,526.15
|
| 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 Permanente of CA Commercial/Self Funded |
$3,063.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,749.93
|
| Rate for Payer: Kaiser Permanente of CA 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
|
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 |
$2,526.15
|
| 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 Permanente of CA Commercial/Self Funded |
$3,063.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,749.93
|
| Rate for Payer: Kaiser Permanente of CA 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
|
OP
|
$4,593.00
|
|
|
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 |
$918.60
|
| 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 |
$2,526.15
|
| Rate for Payer: Cash Price |
$2,526.15
|
| Rate for Payer: Cash Price |
$2,526.15
|
| Rate for Payer: Cigna of CA HMO |
$2,939.52
|
| Rate for Payer: Cigna of CA PPO |
$3,398.82
|
| 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 |
$3,904.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,755.80
|
| 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 Permanente of CA Commercial/Self Funded |
$3,063.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,102.32
|
| 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 |
$3,674.40
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Networks By Design Commercial |
$2,985.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,904.05
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,755.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,296.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,296.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,296.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,296.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,191.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC ESOPHAGUS CELLVIZIO
|
Facility
|
OP
|
$3,736.00
|
|
|
Service Code
|
CPT 43499
|
| Hospital Charge Code |
906743499
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$747.20 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$747.20
|
| 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 |
$2,294.28
|
| 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 |
$2,054.80
|
| Rate for Payer: Cash Price |
$2,054.80
|
| Rate for Payer: Cash Price |
$2,054.80
|
| Rate for Payer: Cigna of CA HMO |
$2,391.04
|
| Rate for Payer: Cigna of CA PPO |
$2,764.64
|
| 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 |
$3,175.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,241.60
|
| 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 Permanente of CA Commercial/Self Funded |
$2,491.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$896.64
|
| 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 |
$2,988.80
|
| Rate for Payer: Networks By Design Commercial |
$2,428.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,175.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,241.60
|
| 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 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 |
$2,054.80
|
| 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 Permanente of CA Commercial/Self Funded |
$2,491.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,423.42
|
| Rate for Payer: Kaiser Permanente of CA 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 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 |
$2,602.60
|
| 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 Permanente of CA Commercial/Self Funded |
$3,156.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,802.89
|
| Rate for Payer: Kaiser Permanente of CA 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 |
$2,602.60
|
| Rate for Payer: Cash Price |
$2,602.60
|
| Rate for Payer: Cash Price |
$2,602.60
|
| 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 Permanente of CA Commercial/Self Funded |
$3,156.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$424.42
|
| Rate for Payer: Kaiser Permanente of CA 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
|
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 |
$2,602.60
|
| Rate for Payer: Cash Price |
$2,602.60
|
| Rate for Payer: Cash Price |
$2,602.60
|
| 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 Permanente of CA Commercial/Self Funded |
$3,156.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$424.42
|
| Rate for Payer: Kaiser Permanente of CA 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 |
$2,602.60
|
| 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 Permanente of CA Commercial/Self Funded |
$3,156.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,802.89
|
| Rate for Payer: Kaiser Permanente of CA 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 ESOPH BLLN DISTENSION PROVOCAT
|
Facility
|
OP
|
$712.00
|
|
|
Service Code
|
CPT 91040
|
| Hospital Charge Code |
906791040
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$142.40 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$142.40
|
| 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 |
$437.24
|
| 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 |
$391.60
|
| Rate for Payer: Cash Price |
$391.60
|
| Rate for Payer: Cash Price |
$391.60
|
| Rate for Payer: Cigna of CA HMO |
$455.68
|
| Rate for Payer: Cigna of CA PPO |
$526.88
|
| 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 |
$605.20
|
| Rate for Payer: Global Benefits Group Commercial |
$427.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,105.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$699.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$674.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$474.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$791.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$674.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.88
|
| 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 |
$569.60
|
| Rate for Payer: Networks By Design Commercial |
$462.80
|
| Rate for Payer: Prime Health Services Commercial |
$605.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$427.20
|
| 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 ESOPH BLLN DISTENSION PROVOCAT
|
Facility
|
IP
|
$712.00
|
|
|
Service Code
|
CPT 91040
|
| Hospital Charge Code |
906791040
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$142.40 |
| Max. Negotiated Rate |
$605.20 |
| Rate for Payer: Adventist Health Commercial |
$142.40
|
| Rate for Payer: Cash Price |
$391.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.80
|
| Rate for Payer: EPIC Health Plan Senior |
$284.80
|
| Rate for Payer: Galaxy Health WC |
$605.20
|
| Rate for Payer: Global Benefits Group Commercial |
$427.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$474.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$271.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$440.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.88
|
| Rate for Payer: Multiplan Commercial |
$569.60
|
| Rate for Payer: Networks By Design Commercial |
$462.80
|
| Rate for Payer: Prime Health Services Commercial |
$605.20
|
|
|
HC ESOPH DIAG DILATION
|
Facility
|
OP
|
$5,717.00
|
|
|
Service Code
|
CPT 43226
|
| Hospital Charge Code |
906743226
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$300.22 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$1,143.40
|
| 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: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$3,144.35
|
| Rate for Payer: Cash Price |
$3,144.35
|
| Rate for Payer: Cash Price |
$3,144.35
|
| Rate for Payer: Cigna of CA HMO |
$3,658.88
|
| Rate for Payer: Cigna of CA PPO |
$4,230.58
|
| 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 |
$4,859.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,430.20
|
| 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 Permanente of CA Commercial/Self Funded |
$3,813.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$339.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,372.08
|
| 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 |
$4,573.60
|
| Rate for Payer: Networks By Design Commercial |
$3,716.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,859.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,430.20
|
| 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 ESOPH DIAG DILATION
|
Facility
|
IP
|
$5,717.00
|
|
|
Service Code
|
CPT 43226
|
| Hospital Charge Code |
906743226
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,143.40 |
| Max. Negotiated Rate |
$4,859.45 |
| Rate for Payer: Adventist Health Commercial |
$1,143.40
|
| Rate for Payer: Cash Price |
$3,144.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,286.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,286.80
|
| Rate for Payer: Galaxy Health WC |
$4,859.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,430.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,813.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,178.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,538.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,372.08
|
| Rate for Payer: Multiplan Commercial |
$4,573.60
|
| Rate for Payer: Networks By Design Commercial |
$3,716.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,859.45
|
|
|
HC ESOPH DIAG FLEX TRANSNASAL
|
Facility
|
OP
|
$2,791.00
|
|
|
Service Code
|
CPT 43197
|
| Hospital Charge Code |
906743197
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$116.34 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$558.20
|
| 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 |
$1,535.05
|
| Rate for Payer: Cash Price |
$1,535.05
|
| Rate for Payer: Cash Price |
$1,535.05
|
| Rate for Payer: Cigna of CA HMO |
$1,786.24
|
| Rate for Payer: Cigna of CA PPO |
$2,065.34
|
| 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 |
$2,372.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,674.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$116.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,861.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$131.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$669.84
|
| 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 |
$2,232.80
|
| Rate for Payer: Networks By Design Commercial |
$1,814.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,372.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,674.60
|
| 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 ESOPH DIAG FLEX TRANSNASAL
|
Facility
|
IP
|
$2,791.00
|
|
|
Service Code
|
CPT 43197
|
| Hospital Charge Code |
906743197
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$558.20 |
| Max. Negotiated Rate |
$2,372.35 |
| Rate for Payer: Adventist Health Commercial |
$558.20
|
| Rate for Payer: Cash Price |
$1,535.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,116.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,116.40
|
| Rate for Payer: Galaxy Health WC |
$2,372.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,674.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,861.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,063.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,727.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$669.84
|
| 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
|
|
|
HC ESOPH DIAG FLEX TRANSNASAL BIOPSY
|
Facility
|
IP
|
$2,791.00
|
|
|
Service Code
|
CPT 43198
|
| Hospital Charge Code |
906743198
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$558.20 |
| Max. Negotiated Rate |
$2,372.35 |
| Rate for Payer: Adventist Health Commercial |
$558.20
|
| Rate for Payer: Cash Price |
$1,535.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,116.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,116.40
|
| Rate for Payer: Galaxy Health WC |
$2,372.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,674.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,861.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,063.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,727.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$669.84
|
| 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
|
|
|
HC ESOPH DIAG FLEX TRANSNASAL BIOPSY
|
Facility
|
OP
|
$2,791.00
|
|
|
Service Code
|
CPT 43198
|
| Hospital Charge Code |
906743198
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$138.23 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$558.20
|
| 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 |
$1,535.05
|
| Rate for Payer: Cash Price |
$1,535.05
|
| Rate for Payer: Cash Price |
$1,535.05
|
| Rate for Payer: Cigna of CA HMO |
$1,786.24
|
| Rate for Payer: Cigna of CA PPO |
$2,065.34
|
| 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 |
$2,372.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,674.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$138.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,861.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$156.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$669.84
|
| 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 |
$2,232.80
|
| Rate for Payer: Networks By Design Commercial |
$1,814.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,372.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,674.60
|
| 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 ESOPH DIAG FLEX TRANSO DILA W BLLN 30MM
|
Facility
|
OP
|
$3,373.00
|
|
|
Service Code
|
CPT 43214
|
| Hospital Charge Code |
906743214
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$285.21 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$674.60
|
| 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: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$1,855.15
|
| Rate for Payer: Cash Price |
$1,855.15
|
| Rate for Payer: Cash Price |
$1,855.15
|
| Rate for Payer: Cigna of CA HMO |
$2,158.72
|
| Rate for Payer: Cigna of CA PPO |
$2,496.02
|
| 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 |
$2,867.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,023.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$285.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,249.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$322.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$809.52
|
| 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 |
$2,698.40
|
| Rate for Payer: Networks By Design Commercial |
$2,192.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,867.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,023.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,892.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,410.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,410.32
|
|
|
HC ESOPH DIAG FLEX TRANSO DILA W BLLN 30MM
|
Facility
|
IP
|
$3,373.00
|
|
|
Service Code
|
CPT 43214
|
| Hospital Charge Code |
906743214
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$674.60 |
| Max. Negotiated Rate |
$2,867.05 |
| Rate for Payer: Adventist Health Commercial |
$674.60
|
| Rate for Payer: Cash Price |
$1,855.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,349.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,349.20
|
| Rate for Payer: Galaxy Health WC |
$2,867.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,023.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,249.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,285.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,087.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$809.52
|
| Rate for Payer: Multiplan Commercial |
$2,698.40
|
| Rate for Payer: Networks By Design Commercial |
$2,192.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,867.05
|
|
|
HC ESOPH DIAG FLEX TRANS W ENDO MUC
|
Facility
|
IP
|
$2,231.00
|
|
|
Service Code
|
CPT 43211
|
| Hospital Charge Code |
906743211
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$446.20 |
| Max. Negotiated Rate |
$1,896.35 |
| Rate for Payer: Adventist Health Commercial |
$446.20
|
| Rate for Payer: Cash Price |
$1,227.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$892.40
|
| Rate for Payer: EPIC Health Plan Senior |
$892.40
|
| Rate for Payer: Galaxy Health WC |
$1,896.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,338.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,488.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$850.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,380.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$535.44
|
| Rate for Payer: Multiplan Commercial |
$1,784.80
|
| Rate for Payer: Networks By Design Commercial |
$1,450.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,896.35
|
|
