|
HC ESOPH DIAG W/BAND LIGATION
|
Facility
|
OP
|
$3,566.00
|
|
|
Service Code
|
CPT 43205
|
| Hospital Charge Code |
906743205
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$297.71 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$713.20
|
| 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 |
$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 |
$1,604.70
|
| Rate for Payer: Cash Price |
$1,604.70
|
| Rate for Payer: Cash Price |
$1,604.70
|
| Rate for Payer: Cigna of CA HMO |
$2,282.24
|
| Rate for Payer: Cigna of CA PPO |
$2,638.84
|
| 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 |
$3,031.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,139.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$297.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,378.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$336.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$855.84
|
| 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 |
$2,852.80
|
| Rate for Payer: Networks By Design Commercial |
$2,317.90
|
| Rate for Payer: Prime Health Services Commercial |
$3,031.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,139.60
|
| 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 ESOPH DIAG W/BAND LIGATION
|
Facility
|
IP
|
$5,335.00
|
|
|
Service Code
|
CPT 43205
|
| Hospital Charge Code |
900501692
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,067.00 |
| Max. Negotiated Rate |
$4,534.75 |
| Rate for Payer: Adventist Health Commercial |
$1,067.00
|
| Rate for Payer: Cash Price |
$2,400.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,134.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,134.00
|
| Rate for Payer: Galaxy Health WC |
$4,534.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,201.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,558.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,032.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,302.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,280.40
|
| Rate for Payer: Multiplan Commercial |
$4,268.00
|
| Rate for Payer: Networks By Design Commercial |
$3,467.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,534.75
|
|
|
HC ESOPH DIAG W/BAND LIGATION
|
Facility
|
OP
|
$5,335.00
|
|
|
Service Code
|
CPT 43205
|
| Hospital Charge Code |
900501692
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$336.70 |
| Max. Negotiated Rate |
$6,427.00 |
| Rate for Payer: Adventist Health Commercial |
$1,067.00
|
| 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 |
$6,427.00
|
| Rate for Payer: Cash Price |
$2,400.75
|
| Rate for Payer: Cash Price |
$2,400.75
|
| Rate for Payer: Cash Price |
$2,400.75
|
| Rate for Payer: Cigna of CA HMO |
$3,414.40
|
| Rate for Payer: Cigna of CA PPO |
$3,947.90
|
| 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 |
$4,534.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,201.00
|
| 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 |
$3,558.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$336.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,280.40
|
| 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 |
$4,268.00
|
| Rate for Payer: Multiplan WC |
$3,840.40
|
| Rate for Payer: Networks By Design Commercial |
$3,467.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,534.75
|
| Rate for Payer: Prime Health Services WC |
$3,801.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,201.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,667.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,667.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,667.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,667.50
|
| 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 ESOPH DIAG W/BLLN DILATION
|
Facility
|
IP
|
$4,573.00
|
|
|
Service Code
|
CPT 43220
|
| Hospital Charge Code |
906743220
|
|
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 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 ESOPH DIAG W/BLLN DILATION
|
Facility
|
OP
|
$3,057.00
|
|
|
Service Code
|
CPT 43220
|
| Hospital Charge Code |
906743220
|
|
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 Permanente of CA Commercial/Self Funded |
$2,039.02
|
| 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 |
$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 ESOPH DIAG W/BX SNGL OR MULTI
|
Facility
|
OP
|
$3,163.00
|
|
|
Service Code
|
CPT 43202
|
| Hospital Charge Code |
906743202
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$304.60 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$632.60
|
| 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 |
$1,423.35
|
| Rate for Payer: Cash Price |
$1,423.35
|
| Rate for Payer: Cash Price |
$1,423.35
|
| Rate for Payer: Cigna of CA HMO |
$2,024.32
|
| Rate for Payer: Cigna of CA PPO |
$2,340.62
|
| 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 |
$2,688.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,897.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$304.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,109.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$344.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$759.12
|
| 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 |
$2,530.40
|
| Rate for Payer: Networks By Design Commercial |
$2,055.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,688.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,897.80
|
| 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 W/BX SNGL OR MULTI
|
Facility
|
IP
|
$4,732.00
|
|
|
Service Code
|
CPT 43202
|
| Hospital Charge Code |
906743202
|
|
Hospital Revenue Code
|
750
|
| 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 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 DIAG W/ENDO US
|
Facility
|
IP
|
$6,729.00
|
|
|
Service Code
|
CPT 43232
|
| Hospital Charge Code |
906743232
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,345.80 |
| Max. Negotiated Rate |
$5,719.65 |
| Rate for Payer: Adventist Health Commercial |
$1,345.80
|
| Rate for Payer: Cash Price |
$3,028.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,691.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,691.60
|
| Rate for Payer: Galaxy Health WC |
$5,719.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,037.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,488.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,563.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,165.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,614.96
|
| Rate for Payer: Multiplan Commercial |
$5,383.20
|
| Rate for Payer: Networks By Design Commercial |
$4,373.85
|
| Rate for Payer: Prime Health Services Commercial |
$5,719.65
|
|
|
HC ESOPH DIAG W/ENDO US
|
Facility
|
OP
|
$4,498.00
|
|
|
Service Code
|
CPT 43232
|
| Hospital Charge Code |
906743232
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$388.42 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$899.60
|
| 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 |
$2,470.08
|
| Rate for Payer: Cash Price |
$2,024.10
|
| Rate for Payer: Cash Price |
$2,024.10
|
| Rate for Payer: Cash Price |
$2,024.10
|
| Rate for Payer: Cigna of CA HMO |
$2,878.72
|
| Rate for Payer: Cigna of CA PPO |
$3,328.52
|
| 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 |
$3,823.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,698.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$388.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,000.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$439.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,079.52
|
| 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 |
$3,598.40
|
| Rate for Payer: Networks By Design Commercial |
$2,923.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,823.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,698.80
|
| 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 W/ENDO US EXAM
|
Facility
|
IP
|
$7,778.00
|
|
|
Service Code
|
CPT 43231
|
| Hospital Charge Code |
906743231
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,555.60 |
| Max. Negotiated Rate |
$6,611.30 |
| Rate for Payer: Adventist Health Commercial |
$1,555.60
|
| Rate for Payer: Cash Price |
$3,500.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,111.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,111.20
|
| Rate for Payer: Galaxy Health WC |
$6,611.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,666.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,187.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,963.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,814.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,866.72
|
| Rate for Payer: Multiplan Commercial |
$6,222.40
|
| Rate for Payer: Networks By Design Commercial |
$5,055.70
|
| Rate for Payer: Prime Health Services Commercial |
$6,611.30
|
|
|
HC ESOPH DIAG W/ENDO US EXAM
|
Facility
|
OP
|
$4,489.00
|
|
|
Service Code
|
CPT 43231
|
| Hospital Charge Code |
906743231
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$334.00 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$897.80
|
| 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 |
$2,470.08
|
| Rate for Payer: Cash Price |
$2,020.05
|
| Rate for Payer: Cash Price |
$2,020.05
|
| Rate for Payer: Cash Price |
$2,020.05
|
| Rate for Payer: Cigna of CA HMO |
$2,872.96
|
| Rate for Payer: Cigna of CA PPO |
$3,321.86
|
| 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 |
$3,815.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,693.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$334.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,994.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$377.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,077.36
|
| 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 |
$3,591.20
|
| Rate for Payer: Networks By Design Commercial |
$2,917.85
|
| Rate for Payer: Prime Health Services Commercial |
$3,815.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,693.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,892.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,410.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,410.32
|
|
|
HC ESOPH DIAG W/INSRT
|
Facility
|
OP
|
$8,437.00
|
|
|
Service Code
|
CPT 43219
|
| Hospital Charge Code |
906743219
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,687.40 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,687.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,171.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,640.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,327.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,181.16
|
| 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 |
$3,796.65
|
| Rate for Payer: Cash Price |
$3,796.65
|
| Rate for Payer: Cigna of CA HMO |
$5,399.68
|
| Rate for Payer: Cigna of CA PPO |
$6,243.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,171.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,171.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,171.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,374.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,374.80
|
| Rate for Payer: Galaxy Health WC |
$7,171.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,062.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,627.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,214.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,222.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,024.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,905.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,905.90
|
| Rate for Payer: Multiplan Commercial |
$6,749.60
|
| Rate for Payer: Networks By Design Commercial |
$5,484.05
|
| Rate for Payer: Prime Health Services Commercial |
$7,171.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,062.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,062.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,218.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,218.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,218.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,218.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,171.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,171.45
|
| Rate for Payer: Vantage Medical Group Senior |
$7,171.45
|
|
|
HC ESOPH DIAG W/LESION
|
Facility
|
IP
|
$4,732.00
|
|
|
Service Code
|
CPT 43216
|
| Hospital Charge Code |
906743216
|
|
Hospital Revenue Code
|
750
|
| 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 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 DIAG W/LESION
|
Facility
|
OP
|
$3,163.00
|
|
|
Service Code
|
CPT 43216
|
| Hospital Charge Code |
906743216
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$332.74 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$632.60
|
| 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 |
$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 |
$1,423.35
|
| Rate for Payer: Cash Price |
$1,423.35
|
| Rate for Payer: Cash Price |
$1,423.35
|
| Rate for Payer: Cigna of CA HMO |
$2,024.32
|
| Rate for Payer: Cigna of CA PPO |
$2,340.62
|
| 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 |
$2,688.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,897.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$332.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,109.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$376.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$759.12
|
| 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 |
$2,530.40
|
| Rate for Payer: Networks By Design Commercial |
$2,055.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,688.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,897.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,892.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| 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 W/RMVL OF FB
|
Facility
|
OP
|
$3,163.00
|
|
|
Service Code
|
CPT 43215
|
| Hospital Charge Code |
906743215
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$375.28 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$632.60
|
| 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 |
$1,423.35
|
| Rate for Payer: Cash Price |
$1,423.35
|
| Rate for Payer: Cash Price |
$1,423.35
|
| Rate for Payer: Cigna of CA HMO |
$2,024.32
|
| Rate for Payer: Cigna of CA PPO |
$2,340.62
|
| 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 |
$2,688.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,897.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$375.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,109.72
|
| 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 |
$759.12
|
| 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 |
$2,530.40
|
| Rate for Payer: Networks By Design Commercial |
$2,055.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,688.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,897.80
|
| 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 W/RMVL OF FB
|
Facility
|
IP
|
$4,732.00
|
|
|
Service Code
|
CPT 43215
|
| Hospital Charge Code |
906743215
|
|
Hospital Revenue Code
|
750
|
| 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 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 DIAG W/SCLEROSIS
|
Facility
|
IP
|
$5,335.00
|
|
|
Service Code
|
CPT 43204
|
| Hospital Charge Code |
906743204
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,067.00 |
| Max. Negotiated Rate |
$4,534.75 |
| Rate for Payer: Adventist Health Commercial |
$1,067.00
|
| Rate for Payer: Cash Price |
$2,400.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,134.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,134.00
|
| Rate for Payer: Galaxy Health WC |
$4,534.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,201.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,558.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,032.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,302.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,280.40
|
| Rate for Payer: Multiplan Commercial |
$4,268.00
|
| Rate for Payer: Networks By Design Commercial |
$3,467.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,534.75
|
|
|
HC ESOPH DIAG W/SCLEROSIS
|
Facility
|
OP
|
$3,566.00
|
|
|
Service Code
|
CPT 43204
|
| Hospital Charge Code |
906743204
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$469.11 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$713.20
|
| 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 |
$1,845.77
|
| Rate for Payer: Cash Price |
$1,604.70
|
| Rate for Payer: Cash Price |
$1,604.70
|
| Rate for Payer: Cash Price |
$1,604.70
|
| Rate for Payer: Cigna of CA HMO |
$2,282.24
|
| Rate for Payer: Cigna of CA PPO |
$2,638.84
|
| 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 |
$3,031.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,139.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$469.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,378.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$530.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$855.84
|
| 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 |
$2,852.80
|
| Rate for Payer: Networks By Design Commercial |
$2,317.90
|
| Rate for Payer: Prime Health Services Commercial |
$3,031.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,139.60
|
| 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 ESOPH DIAG W/SNARE
|
Facility
|
IP
|
$5,335.00
|
|
|
Service Code
|
CPT 43217
|
| Hospital Charge Code |
906743217
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,067.00 |
| Max. Negotiated Rate |
$4,534.75 |
| Rate for Payer: Adventist Health Commercial |
$1,067.00
|
| Rate for Payer: Cash Price |
$2,400.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,134.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,134.00
|
| Rate for Payer: Galaxy Health WC |
$4,534.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,201.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,558.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,032.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,302.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,280.40
|
| Rate for Payer: Multiplan Commercial |
$4,268.00
|
| Rate for Payer: Networks By Design Commercial |
$3,467.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,534.75
|
|
|
HC ESOPH DIAG W/SNARE
|
Facility
|
OP
|
$3,566.00
|
|
|
Service Code
|
CPT 43217
|
| Hospital Charge Code |
906743217
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$238.93 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$713.20
|
| 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 |
$1,845.77
|
| Rate for Payer: Cash Price |
$1,604.70
|
| Rate for Payer: Cash Price |
$1,604.70
|
| Rate for Payer: Cash Price |
$1,604.70
|
| Rate for Payer: Cigna of CA HMO |
$2,282.24
|
| Rate for Payer: Cigna of CA PPO |
$2,638.84
|
| 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 |
$3,031.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,139.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$238.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,378.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$855.84
|
| 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 |
$2,852.80
|
| Rate for Payer: Networks By Design Commercial |
$2,317.90
|
| Rate for Payer: Prime Health Services Commercial |
$3,031.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,139.60
|
| 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 ESOPH DIAG W/SUBMUC INJ
|
Facility
|
OP
|
$3,060.00
|
|
|
Service Code
|
CPT 43201
|
| Hospital Charge Code |
906743201
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$352.13 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$612.00
|
| 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 |
$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 |
$1,377.00
|
| Rate for Payer: Cash Price |
$1,377.00
|
| Rate for Payer: Cash Price |
$1,377.00
|
| Rate for Payer: Cigna of CA HMO |
$1,958.40
|
| Rate for Payer: Cigna of CA PPO |
$2,264.40
|
| 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 |
$2,601.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,836.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$352.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,041.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$398.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$734.40
|
| 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 |
$2,448.00
|
| Rate for Payer: Networks By Design Commercial |
$1,989.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,601.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,836.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,892.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,410.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,410.32
|
|
|
HC ESOPH DIAG W/SUBMUC INJ
|
Facility
|
IP
|
$5,724.00
|
|
|
Service Code
|
CPT 43201
|
| Hospital Charge Code |
906743201
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,144.80 |
| Max. Negotiated Rate |
$4,865.40 |
| Rate for Payer: Adventist Health Commercial |
$1,144.80
|
| Rate for Payer: Cash Price |
$2,575.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,289.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,289.60
|
| Rate for Payer: Galaxy Health WC |
$4,865.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,434.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,817.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,180.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,543.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,373.76
|
| Rate for Payer: Multiplan Commercial |
$4,579.20
|
| Rate for Payer: Networks By Design Commercial |
$3,720.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,865.40
|
|
|
HC ESOPH ENDOSCOPY ABLATION
|
Facility
|
OP
|
$4,827.00
|
|
|
Service Code
|
CPT 43228
|
| Hospital Charge Code |
906743228
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$965.40 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$965.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,102.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,654.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,620.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,964.26
|
| 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 |
$2,172.15
|
| Rate for Payer: Cash Price |
$2,172.15
|
| Rate for Payer: Cigna of CA HMO |
$3,089.28
|
| Rate for Payer: Cigna of CA PPO |
$3,571.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,102.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,102.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,102.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,930.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,930.80
|
| Rate for Payer: Galaxy Health WC |
$4,102.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,896.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,219.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,839.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,987.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,158.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,378.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,378.90
|
| Rate for Payer: Multiplan Commercial |
$3,861.60
|
| Rate for Payer: Networks By Design Commercial |
$3,137.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,102.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,896.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,896.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,413.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,413.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,413.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,413.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,102.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,102.95
|
| Rate for Payer: Vantage Medical Group Senior |
$4,102.95
|
|
|
HC ESOPH ENDOSCOPY REP
|
Facility
|
OP
|
$3,057.00
|
|
|
Service Code
|
CPT 43227
|
| Hospital Charge Code |
906743227
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$289.58 |
| 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 |
$6,427.00
|
| 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 |
$1,375.65
|
| 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 |
$289.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,039.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$327.50
|
| Rate for Payer: Kaiser Permanente of CA 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 ESOPH ENDOSCOPY REP
|
Facility
|
IP
|
$4,573.00
|
|
|
Service Code
|
CPT 43227
|
| Hospital Charge Code |
906743227
|
|
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 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
|
|
