|
HC ESOPH DIAG FLEX TRANS W ENDO MUC
|
Facility
|
OP
|
$2,231.00
|
|
|
Service Code
|
CPT 43211
|
| Hospital Charge Code |
906743211
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$354.63 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$446.20
|
| 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 |
$1,227.05
|
| Rate for Payer: Cash Price |
$1,227.05
|
| Rate for Payer: Cash Price |
$1,227.05
|
| Rate for Payer: Cigna of CA HMO |
$1,427.84
|
| Rate for Payer: Cigna of CA PPO |
$1,650.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,651.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,410.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,253.93
|
| Rate for Payer: EPIC Health Plan Senior |
$2,410.32
|
| Rate for Payer: Galaxy Health WC |
$1,896.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,338.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$354.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,488.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$401.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$535.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,037.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,229.83
|
| Rate for Payer: Multiplan Commercial |
$1,784.80
|
| Rate for Payer: Networks By Design Commercial |
$1,450.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,896.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,338.60
|
| 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 RIGID TRANSORAL
|
Facility
|
IP
|
$2,791.00
|
|
|
Service Code
|
CPT 43191
|
| Hospital Charge Code |
906743191
|
|
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 RIGID TRANSORAL
|
Facility
|
OP
|
$2,791.00
|
|
|
Service Code
|
CPT 43191
|
| Hospital Charge Code |
906743191
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$185.76 |
| 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 |
$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 |
$1,535.05
|
| 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 |
$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 |
$2,372.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,674.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$185.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,861.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$210.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$669.84
|
| 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 |
$2,232.80
|
| 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 |
$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 RIGID W BLLN DILATION
|
Facility
|
OP
|
$4,216.00
|
|
|
Service Code
|
CPT 43195
|
| Hospital Charge Code |
906743195
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$263.32 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$843.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,251.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,317.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,834.04
|
| 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 |
$2,318.80
|
| Rate for Payer: Cash Price |
$2,318.80
|
| Rate for Payer: Cash Price |
$2,318.80
|
| Rate for Payer: Cigna of CA HMO |
$2,698.24
|
| Rate for Payer: Cigna of CA PPO |
$3,119.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,251.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,317.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,834.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,525.95
|
| Rate for Payer: EPIC Health Plan Senior |
$4,834.04
|
| Rate for Payer: Galaxy Health WC |
$3,583.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,529.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,927.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$263.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,834.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,812.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,834.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,011.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,090.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,477.61
|
| Rate for Payer: Multiplan Commercial |
$3,372.80
|
| Rate for Payer: Networks By Design Commercial |
$2,740.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,583.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,529.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,800.85
|
| 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 |
$4,834.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,251.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,317.44
|
| Rate for Payer: Vantage Medical Group Senior |
$4,834.04
|
|
|
HC ESOPH DIAG RIGID W BLLN DILATION
|
Facility
|
IP
|
$4,216.00
|
|
|
Service Code
|
CPT 43195
|
| Hospital Charge Code |
906743195
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$843.20 |
| Max. Negotiated Rate |
$3,583.60 |
| Rate for Payer: Adventist Health Commercial |
$843.20
|
| Rate for Payer: Cash Price |
$2,318.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,686.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,686.40
|
| Rate for Payer: Galaxy Health WC |
$3,583.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,529.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,812.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,606.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,609.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,011.84
|
| Rate for Payer: Multiplan Commercial |
$3,372.80
|
| Rate for Payer: Networks By Design Commercial |
$2,740.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,583.60
|
|
|
HC ESOPH DIAG RIG TRANSO BIOPSY
|
Facility
|
OP
|
$3,373.00
|
|
|
Service Code
|
CPT 43193
|
| Hospital Charge Code |
906743193
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$262.70 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$674.60
|
| 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 |
$1,855.15
|
| 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 |
$262.70
|
| 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 |
$297.10
|
| 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 RIG TRANSO BIOPSY
|
Facility
|
IP
|
$3,373.00
|
|
|
Service Code
|
CPT 43193
|
| Hospital Charge Code |
906743193
|
|
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 RIG TRANSO INJECT
|
Facility
|
IP
|
$4,216.00
|
|
|
Service Code
|
CPT 43192
|
| Hospital Charge Code |
906743192
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$843.20 |
| Max. Negotiated Rate |
$3,583.60 |
| Rate for Payer: Adventist Health Commercial |
$843.20
|
| Rate for Payer: Cash Price |
$2,318.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,686.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,686.40
|
| Rate for Payer: Galaxy Health WC |
$3,583.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,529.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,812.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,606.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,609.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,011.84
|
| Rate for Payer: Multiplan Commercial |
$3,372.80
|
| Rate for Payer: Networks By Design Commercial |
$2,740.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,583.60
|
|
|
HC ESOPH DIAG RIG TRANSO INJECT
|
Facility
|
OP
|
$4,216.00
|
|
|
Service Code
|
CPT 43192
|
| Hospital Charge Code |
906743192
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$220.79 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$843.20
|
| 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 |
$2,318.80
|
| Rate for Payer: Cash Price |
$2,318.80
|
| Rate for Payer: Cash Price |
$2,318.80
|
| Rate for Payer: Cigna of CA HMO |
$2,698.24
|
| Rate for Payer: Cigna of CA PPO |
$3,119.84
|
| 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 |
$3,583.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,529.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$220.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,812.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$249.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,011.84
|
| 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 |
$3,372.80
|
| Rate for Payer: Networks By Design Commercial |
$2,740.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,583.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,529.60
|
| 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 RIG TRANSO RMVL FB
|
Facility
|
IP
|
$4,216.00
|
|
|
Service Code
|
CPT 43194
|
| Hospital Charge Code |
906743194
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$843.20 |
| Max. Negotiated Rate |
$3,583.60 |
| Rate for Payer: Adventist Health Commercial |
$843.20
|
| Rate for Payer: Cash Price |
$2,318.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,686.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,686.40
|
| Rate for Payer: Galaxy Health WC |
$3,583.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,529.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,812.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,606.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,609.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,011.84
|
| Rate for Payer: Multiplan Commercial |
$3,372.80
|
| Rate for Payer: Networks By Design Commercial |
$2,740.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,583.60
|
|
|
HC ESOPH DIAG RIG TRANSO RMVL FB
|
Facility
|
OP
|
$4,216.00
|
|
|
Service Code
|
CPT 43194
|
| Hospital Charge Code |
906743194
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$235.80 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$843.20
|
| 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 |
$2,318.80
|
| Rate for Payer: Cash Price |
$2,318.80
|
| Rate for Payer: Cash Price |
$2,318.80
|
| Rate for Payer: Cigna of CA HMO |
$2,698.24
|
| Rate for Payer: Cigna of CA PPO |
$3,119.84
|
| 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 |
$3,583.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,529.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$235.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,812.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$266.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,011.84
|
| 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 |
$3,372.80
|
| Rate for Payer: Networks By Design Commercial |
$2,740.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,583.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,529.60
|
| 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 RIG W INSRT GW DILA
|
Facility
|
OP
|
$3,373.00
|
|
|
Service Code
|
CPT 43196
|
| Hospital Charge Code |
906743196
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$287.10 |
| 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 |
$287.10
|
| 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 |
$324.69
|
| 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 RIG W INSRT GW DILA
|
Facility
|
IP
|
$3,373.00
|
|
|
Service Code
|
CPT 43196
|
| Hospital Charge Code |
906743196
|
|
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 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 |
$2,934.25
|
| Rate for Payer: Cash Price |
$2,934.25
|
| Rate for Payer: Cash Price |
$2,934.25
|
| 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/BAND LIGATION
|
Facility
|
IP
|
$5,335.00
|
|
|
Service Code
|
CPT 43205
|
| Hospital Charge Code |
906743205
|
|
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 |
$2,934.25
|
| 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
|
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 |
$2,934.25
|
| 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 |
906743205
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$297.71 |
| Max. Negotiated Rate |
$11,230.65 |
| 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: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$2,934.25
|
| Rate for Payer: Cash Price |
$2,934.25
|
| Rate for Payer: Cash Price |
$2,934.25
|
| 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 |
$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 |
$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: Networks By Design Commercial |
$3,467.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,534.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,201.00
|
| 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/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 |
$2,515.15
|
| 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 ESOPH DIAG W/BLLN DILATION
|
Facility
|
OP
|
$4,573.00
|
|
|
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 |
$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: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$2,515.15
|
| 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 |
$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 |
$3,050.19
|
| 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: Networks By Design Commercial |
$2,972.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,887.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,743.80
|
| 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 |
$2,602.60
|
| 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 DIAG W/BX SNGL OR MULTI
|
Facility
|
OP
|
$4,732.00
|
|
|
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 |
$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: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$2,602.60
|
| 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 |
$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 |
$3,156.24
|
| 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 |
$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: Networks By Design Commercial |
$3,075.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,022.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,839.20
|
| 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/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 |
$3,700.95
|
| 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
|
$6,729.00
|
|
|
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 |
$1,345.80
|
| 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 |
$3,700.95
|
| Rate for Payer: Cash Price |
$3,700.95
|
| Rate for Payer: Cash Price |
$3,700.95
|
| Rate for Payer: Cigna of CA HMO |
$4,306.56
|
| Rate for Payer: Cigna of CA PPO |
$4,979.46
|
| 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 |
$5,719.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,037.40
|
| 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 |
$4,488.24
|
| 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 |
$1,614.96
|
| 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 |
$5,383.20
|
| Rate for Payer: Networks By Design Commercial |
$4,373.85
|
| Rate for Payer: Prime Health Services Commercial |
$5,719.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,037.40
|
| 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/ENDO US EXAM
|
Facility
|
OP
|
$7,778.00
|
|
|
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 |
$1,555.60
|
| 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 |
$4,277.90
|
| Rate for Payer: Cash Price |
$4,277.90
|
| Rate for Payer: Cash Price |
$4,277.90
|
| Rate for Payer: Cigna of CA HMO |
$4,977.92
|
| Rate for Payer: Cigna of CA PPO |
$5,755.72
|
| 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 |
$6,611.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,666.80
|
| 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 |
$5,187.93
|
| 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 |
$1,866.72
|
| 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 |
$6,222.40
|
| Rate for Payer: Networks By Design Commercial |
$5,055.70
|
| Rate for Payer: Prime Health Services Commercial |
$6,611.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,666.80
|
| 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 |
$4,277.90
|
| 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
|
|
