|
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 |
$4,640.35
|
| Rate for Payer: Cash Price |
$4,640.35
|
| 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/INSRT
|
Facility
|
IP
|
$8,437.00
|
|
|
Service Code
|
CPT 43219
|
| Hospital Charge Code |
906743219
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,687.40 |
| Max. Negotiated Rate |
$7,171.45 |
| Rate for Payer: Adventist Health Commercial |
$1,687.40
|
| Rate for Payer: Cash Price |
$4,640.35
|
| 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: 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
|
|
|
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 |
$2,602.60
|
| 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/LESION
|
Facility
|
OP
|
$4,732.00
|
|
|
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 |
$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 |
$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 |
$2,602.60
|
| 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 |
$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 |
$3,156.24
|
| 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 |
$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 |
$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
|
$4,732.00
|
|
|
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 |
$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 |
$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 |
$3,156.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$424.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,135.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,037.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,229.83
|
| Rate for Payer: Multiplan Commercial |
$3,785.60
|
| Rate for Payer: 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/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 |
$2,602.60
|
| 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/SCLEROSIS
|
Facility
|
OP
|
$5,335.00
|
|
|
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 |
$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 |
$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 |
$2,934.25
|
| 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 |
$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 |
$3,558.45
|
| 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 |
$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/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 |
$2,934.25
|
| 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/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 |
$2,934.25
|
| 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/SNARE
|
Facility
|
OP
|
$5,335.00
|
|
|
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 |
$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 |
$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 |
$2,934.25
|
| 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 |
$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 |
$3,558.45
|
| 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 |
$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/SUBMUC INJ
|
Facility
|
OP
|
$5,724.00
|
|
|
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 |
$1,144.80
|
| 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 |
$3,148.20
|
| Rate for Payer: Cash Price |
$3,148.20
|
| Rate for Payer: Cash Price |
$3,148.20
|
| Rate for Payer: Cigna of CA HMO |
$3,663.36
|
| Rate for Payer: Cigna of CA PPO |
$4,235.76
|
| 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 |
$4,865.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,434.40
|
| 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 |
$3,817.91
|
| 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 |
$1,373.76
|
| 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 |
$4,579.20
|
| Rate for Payer: Networks By Design Commercial |
$3,720.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,865.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,434.40
|
| 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/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 |
$3,148.20
|
| 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 |
$2,654.85
|
| Rate for Payer: Cash Price |
$2,654.85
|
| 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 ABLATION
|
Facility
|
IP
|
$4,827.00
|
|
|
Service Code
|
CPT 43228
|
| Hospital Charge Code |
906743228
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$965.40 |
| Max. Negotiated Rate |
$4,102.95 |
| Rate for Payer: Adventist Health Commercial |
$965.40
|
| Rate for Payer: Cash Price |
$2,654.85
|
| 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: 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
|
|
|
HC ESOPH ENDOSCOPY REP
|
Facility
|
OP
|
$4,573.00
|
|
|
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 |
$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 |
$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 |
$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 |
$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 |
$3,050.19
|
| 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 |
$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 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 |
$2,515.15
|
| 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 IMPED FUNC TST GT 1HR-24HR
|
Facility
|
IP
|
$2,388.00
|
|
|
Service Code
|
CPT 91037
|
| Hospital Charge Code |
906791037
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$477.60 |
| Max. Negotiated Rate |
$2,029.80 |
| Rate for Payer: Adventist Health Commercial |
$477.60
|
| Rate for Payer: Cash Price |
$1,313.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$955.20
|
| Rate for Payer: EPIC Health Plan Senior |
$955.20
|
| Rate for Payer: Galaxy Health WC |
$2,029.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,432.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,592.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$909.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,478.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$573.12
|
| Rate for Payer: Multiplan Commercial |
$1,910.40
|
| Rate for Payer: Networks By Design Commercial |
$1,552.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,029.80
|
|
|
HC ESOPH IMPED FUNC TST GT 1HR-24HR
|
Facility
|
OP
|
$2,388.00
|
|
|
Service Code
|
CPT 91037
|
| Hospital Charge Code |
906791037
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$225.49 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$477.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$395.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,466.47
|
| 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 |
$1,313.40
|
| Rate for Payer: Cash Price |
$1,313.40
|
| Rate for Payer: Cash Price |
$1,313.40
|
| Rate for Payer: Cigna of CA HMO |
$1,528.32
|
| Rate for Payer: Cigna of CA PPO |
$1,767.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$435.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$395.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$534.14
|
| Rate for Payer: EPIC Health Plan Senior |
$395.66
|
| Rate for Payer: Galaxy Health WC |
$2,029.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,432.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$648.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$225.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$395.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,592.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$255.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$395.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$573.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$498.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$530.18
|
| Rate for Payer: Multiplan Commercial |
$1,910.40
|
| Rate for Payer: Networks By Design Commercial |
$1,552.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,029.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,432.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$474.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$395.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Vantage Medical Group Senior |
$395.66
|
|
|
HC ESOPH IMPED FUNC TST UP TO 1HR
|
Facility
|
IP
|
$2,388.00
|
|
|
Service Code
|
CPT 91038
|
| Hospital Charge Code |
906791038
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$477.60 |
| Max. Negotiated Rate |
$2,029.80 |
| Rate for Payer: Adventist Health Commercial |
$477.60
|
| Rate for Payer: Cash Price |
$1,313.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$955.20
|
| Rate for Payer: EPIC Health Plan Senior |
$955.20
|
| Rate for Payer: Galaxy Health WC |
$2,029.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,432.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,592.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$909.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,478.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$573.12
|
| Rate for Payer: Multiplan Commercial |
$1,910.40
|
| Rate for Payer: Networks By Design Commercial |
$1,552.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,029.80
|
|
|
HC ESOPH IMPED FUNC TST UP TO 1HR
|
Facility
|
OP
|
$2,388.00
|
|
|
Service Code
|
CPT 91038
|
| Hospital Charge Code |
906791038
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$191.25 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$477.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$741.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$674.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,466.47
|
| 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 |
$1,313.40
|
| Rate for Payer: Cash Price |
$1,313.40
|
| Rate for Payer: Cash Price |
$1,313.40
|
| Rate for Payer: Cigna of CA HMO |
$1,528.32
|
| Rate for Payer: Cigna of CA PPO |
$1,767.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$741.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$674.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$910.14
|
| Rate for Payer: EPIC Health Plan Senior |
$674.18
|
| Rate for Payer: Galaxy Health WC |
$2,029.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,432.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,105.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$191.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$674.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,592.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$216.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$674.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$573.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$849.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$903.40
|
| Rate for Payer: Multiplan Commercial |
$1,910.40
|
| Rate for Payer: Networks By Design Commercial |
$1,552.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,029.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,432.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$809.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$674.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$741.60
|
| Rate for Payer: Vantage Medical Group Senior |
$674.18
|
|
|
HC ESOPH LESION ABLATION
|
Facility
|
IP
|
$7,226.00
|
|
|
Service Code
|
CPT 43229
|
| Hospital Charge Code |
900100016
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,445.20 |
| Max. Negotiated Rate |
$6,142.10 |
| Rate for Payer: Adventist Health Commercial |
$1,445.20
|
| Rate for Payer: Cash Price |
$3,974.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,890.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,890.40
|
| Rate for Payer: Galaxy Health WC |
$6,142.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,335.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,819.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,753.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,472.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,734.24
|
| Rate for Payer: Multiplan Commercial |
$5,780.80
|
| Rate for Payer: Networks By Design Commercial |
$4,696.90
|
| Rate for Payer: Prime Health Services Commercial |
$6,142.10
|
|
|
HC ESOPH LESION ABLATION
|
Facility
|
OP
|
$7,226.00
|
|
|
Service Code
|
CPT 43229
|
| Hospital Charge Code |
900100016
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$300.85 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$1,445.20
|
| 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 |
$3,974.30
|
| Rate for Payer: Cash Price |
$3,974.30
|
| Rate for Payer: Cash Price |
$3,974.30
|
| Rate for Payer: Cigna of CA HMO |
$4,624.64
|
| Rate for Payer: Cigna of CA PPO |
$5,347.24
|
| 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 |
$6,142.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,335.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,927.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$300.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,834.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,819.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$340.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,834.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,734.24
|
| 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 |
$5,780.80
|
| Rate for Payer: Networks By Design Commercial |
$4,696.90
|
| Rate for Payer: Prime Health Services Commercial |
$6,142.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,335.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,800.85
|
| 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 |
$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 MOTILITY STUDY W/MECH/SI
|
Facility
|
IP
|
$1,406.00
|
|
|
Service Code
|
CPT 91013
|
| Hospital Charge Code |
906791011
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$281.20 |
| Max. Negotiated Rate |
$1,195.10 |
| Rate for Payer: Adventist Health Commercial |
$281.20
|
| Rate for Payer: Cash Price |
$773.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$562.40
|
| Rate for Payer: EPIC Health Plan Senior |
$562.40
|
| Rate for Payer: Galaxy Health WC |
$1,195.10
|
| Rate for Payer: Global Benefits Group Commercial |
$843.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$937.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$535.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$870.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$337.44
|
| Rate for Payer: Multiplan Commercial |
$1,124.80
|
| Rate for Payer: Networks By Design Commercial |
$913.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,195.10
|
|
|
HC ESOPH MOTILITY STUDY W/MECH/SI
|
Facility
|
OP
|
$1,406.00
|
|
|
Service Code
|
CPT 91013
|
| Hospital Charge Code |
906791011
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$34.84 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$281.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,195.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$773.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,054.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$863.42
|
| 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 |
$773.30
|
| Rate for Payer: Cash Price |
$773.30
|
| Rate for Payer: Cash Price |
$773.30
|
| Rate for Payer: Cigna of CA HMO |
$899.84
|
| Rate for Payer: Cigna of CA PPO |
$1,040.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,195.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,195.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,195.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$562.40
|
| Rate for Payer: EPIC Health Plan Senior |
$562.40
|
| Rate for Payer: Galaxy Health WC |
$1,195.10
|
| Rate for Payer: Global Benefits Group Commercial |
$843.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$937.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$870.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$337.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$984.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$984.20
|
| Rate for Payer: Multiplan Commercial |
$1,124.80
|
| Rate for Payer: Networks By Design Commercial |
$913.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,195.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$843.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$843.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,195.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,195.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,195.10
|
|
|
HC ESOPH MOTIL MANOMETRIC
|
Facility
|
OP
|
$2,470.00
|
|
|
Service Code
|
CPT 91010
|
| Hospital Charge Code |
906791010
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$116.10 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Cigna of CA HMO |
$1,580.80
|
| Rate for Payer: Adventist Health Commercial |
$494.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$741.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$674.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,516.83
|
| 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 |
$1,358.50
|
| Rate for Payer: Cash Price |
$1,358.50
|
| Rate for Payer: Cash Price |
$1,358.50
|
| Rate for Payer: Cigna of CA PPO |
$1,827.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$741.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$674.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$910.14
|
| Rate for Payer: EPIC Health Plan Senior |
$674.18
|
| Rate for Payer: Galaxy Health WC |
$2,099.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,482.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,105.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$116.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$674.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,647.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$131.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$674.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$592.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$849.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$903.40
|
| Rate for Payer: Multiplan Commercial |
$1,976.00
|
| Rate for Payer: Networks By Design Commercial |
$1,605.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,099.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,482.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$809.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$674.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$741.60
|
| Rate for Payer: Vantage Medical Group Senior |
$674.18
|
|
