|
HC ESOPHAGOSCOPY W/WO SPECIMEN
|
Facility
|
IP
|
$4,593.00
|
|
|
Service Code
|
CPT 43200
|
| Hospital Charge Code |
906743200
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$918.60 |
| Max. Negotiated Rate |
$3,904.05 |
| Rate for Payer: Adventist Health Commercial |
$918.60
|
| Rate for Payer: Cash Price |
$2,066.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,215.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,837.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,837.20
|
| Rate for Payer: Galaxy Health WC |
$3,904.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,755.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,916.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,709.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,102.32
|
| Rate for Payer: Multiplan Commercial |
$3,674.40
|
| Rate for Payer: Networks By Design Commercial |
$2,985.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,904.05
|
|
|
HC ESOPHAGOSCOPY W/WO SPECIMEN
|
Facility
|
OP
|
$4,593.00
|
|
|
Service Code
|
CPT 43200
|
| Hospital Charge Code |
906743200
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$283.33 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$918.60
|
| Rate for Payer: Adventist Health Commercial |
$614.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Cash Price |
$1,381.50
|
| Rate for Payer: Cash Price |
$2,066.85
|
| Rate for Payer: Cash Price |
$2,066.85
|
| Rate for Payer: Cash Price |
$1,381.50
|
| Rate for Payer: Cash Price |
$1,381.50
|
| Rate for Payer: Cash Price |
$2,066.85
|
| Rate for Payer: Cigna of CA HMO |
$2,939.52
|
| Rate for Payer: Cigna of CA HMO |
$1,964.80
|
| Rate for Payer: Cigna of CA PPO |
$2,271.80
|
| Rate for Payer: Cigna of CA PPO |
$3,398.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,215.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,149.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: Galaxy Health WC |
$3,904.05
|
| Rate for Payer: Galaxy Health WC |
$2,609.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,842.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,755.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$283.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$283.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,916.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,949.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$320.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$320.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$736.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,102.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,469.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,469.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,563.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$2,456.00
|
| Rate for Payer: Multiplan Commercial |
$3,674.40
|
| Rate for Payer: Networks By Design Commercial |
$2,985.45
|
| Rate for Payer: Networks By Design Commercial |
$1,995.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,904.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,609.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,755.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,842.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,399.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,399.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,535.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,296.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| 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 HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC ESOPHAGUS CELLVIZIO
|
Facility
|
OP
|
$3,925.00
|
|
|
Service Code
|
CPT 43499
|
| Hospital Charge Code |
906743499
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$785.00 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$785.00
|
| Rate for Payer: Adventist Health Commercial |
$747.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,518.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,397.39
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Cash Price |
$1,681.20
|
| Rate for Payer: Cash Price |
$1,681.20
|
| Rate for Payer: Cash Price |
$1,766.25
|
| Rate for Payer: Cash Price |
$1,766.25
|
| Rate for Payer: Cash Price |
$1,766.25
|
| Rate for Payer: Cash Price |
$1,681.20
|
| Rate for Payer: Cigna of CA HMO |
$2,512.00
|
| Rate for Payer: Cigna of CA HMO |
$2,391.04
|
| Rate for Payer: Cigna of CA PPO |
$2,764.64
|
| Rate for Payer: Cigna of CA PPO |
$2,904.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,747.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: Galaxy Health WC |
$3,175.60
|
| Rate for Payer: Galaxy Health WC |
$3,336.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,241.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,355.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,372.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,492.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$896.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$942.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,469.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,469.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,563.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$3,140.00
|
| Rate for Payer: Multiplan Commercial |
$2,988.80
|
| Rate for Payer: Networks By Design Commercial |
$2,551.25
|
| Rate for Payer: Networks By Design Commercial |
$2,428.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,175.60
|
| Rate for Payer: Prime Health Services Commercial |
$3,336.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,355.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,241.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,399.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,399.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,962.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,868.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| 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 HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC ESOPHAGUS CELLVIZIO
|
Facility
|
IP
|
$3,736.00
|
|
|
Service Code
|
CPT 43499
|
| Hospital Charge Code |
906743499
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$747.20 |
| Max. Negotiated Rate |
$3,175.60 |
| Rate for Payer: Adventist Health Commercial |
$747.20
|
| Rate for Payer: Cash Price |
$1,681.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,494.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,494.40
|
| Rate for Payer: Galaxy Health WC |
$3,175.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,241.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,372.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,204.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$896.64
|
| Rate for Payer: Multiplan Commercial |
$2,988.80
|
| Rate for Payer: Networks By Design Commercial |
$2,428.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,175.60
|
|
|
HC ESOPHAGUS ENDOSCOPY W RMVL FB
|
Facility
|
OP
|
$4,732.00
|
|
|
Service Code
|
CPT 43215
|
| Hospital Charge Code |
900501291
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$424.42 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Prime Health Services WC |
$3,801.22
|
| Rate for Payer: Adventist Health Commercial |
$946.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$2,129.40
|
| Rate for Payer: Cash Price |
$2,129.40
|
| Rate for Payer: Cash Price |
$2,129.40
|
| Rate for Payer: Cigna of CA HMO |
$3,028.48
|
| Rate for Payer: Cigna of CA PPO |
$3,501.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,312.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| 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/Senior |
$4,047.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,004.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$424.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,653.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,135.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,109.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$3,785.60
|
| Rate for Payer: Multiplan WC |
$3,840.40
|
| Rate for Payer: Networks By Design Commercial |
$3,075.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,022.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,839.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,366.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,366.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,366.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,366.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
|
|
HC ESOPHAGUS ENDOSCOPY W RMVL FB
|
Facility
|
IP
|
$4,732.00
|
|
|
Service Code
|
CPT 43215
|
| Hospital Charge Code |
900501291
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$946.40 |
| Max. Negotiated Rate |
$4,022.20 |
| Rate for Payer: Adventist Health Commercial |
$946.40
|
| Rate for Payer: Cash Price |
$2,129.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,312.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,892.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,892.80
|
| Rate for Payer: Galaxy Health WC |
$4,022.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,839.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,004.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,791.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,135.68
|
| Rate for Payer: Multiplan Commercial |
$3,785.60
|
| Rate for Payer: Networks By Design Commercial |
$3,075.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,022.20
|
|
|
HC ESOPHAGUS ENDOSCOPY W/RMVL FB
|
Facility
|
OP
|
$4,732.00
|
|
|
Service Code
|
CPT 43215
|
| Hospital Charge Code |
902100066
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$424.42 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$946.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$2,129.40
|
| Rate for Payer: Cash Price |
$2,129.40
|
| Rate for Payer: Cash Price |
$2,129.40
|
| Rate for Payer: Cigna of CA HMO |
$3,028.48
|
| Rate for Payer: Cigna of CA PPO |
$3,501.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,312.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| 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/Senior |
$4,047.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,004.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$424.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,653.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,135.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,109.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$3,785.60
|
| Rate for Payer: Multiplan WC |
$3,840.40
|
| Rate for Payer: Networks By Design Commercial |
$3,075.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,022.20
|
| Rate for Payer: Prime Health Services WC |
$3,801.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,839.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,366.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,366.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,366.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,366.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
|
|
HC ESOPHAGUS ENDOSCOPY W/RMVL FB
|
Facility
|
IP
|
$4,732.00
|
|
|
Service Code
|
CPT 43215
|
| Hospital Charge Code |
902100066
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$946.40 |
| Max. Negotiated Rate |
$4,022.20 |
| Rate for Payer: Adventist Health Commercial |
$946.40
|
| Rate for Payer: Cash Price |
$2,129.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,312.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,892.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,892.80
|
| Rate for Payer: Galaxy Health WC |
$4,022.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,839.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,004.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,791.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,135.68
|
| Rate for Payer: Multiplan Commercial |
$3,785.60
|
| Rate for Payer: Networks By Design Commercial |
$3,075.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,022.20
|
|
|
HC ESOPH BLLN DISTENSION PROVOCAT
|
Facility
|
OP
|
$712.00
|
|
|
Service Code
|
CPT 91040
|
| Hospital Charge Code |
906791040
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$142.40 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$527.93
|
| Rate for Payer: Adventist Health Commercial |
$142.40
|
| Rate for Payer: Adventist Health Commercial |
$185.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$719.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$719.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$527.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$527.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$479.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$479.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$456.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$594.21
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Cash Price |
$416.70
|
| Rate for Payer: Cash Price |
$320.40
|
| Rate for Payer: Cash Price |
$320.40
|
| Rate for Payer: Cash Price |
$320.40
|
| Rate for Payer: Cash Price |
$416.70
|
| Rate for Payer: Cash Price |
$416.70
|
| Rate for Payer: Cigna of CA HMO |
$592.64
|
| Rate for Payer: Cigna of CA HMO |
$455.68
|
| Rate for Payer: Cigna of CA PPO |
$685.24
|
| Rate for Payer: Cigna of CA PPO |
$526.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$719.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$719.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$527.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$527.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$479.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$479.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$648.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$498.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$791.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$791.90
|
| Rate for Payer: EPIC Health Plan Senior |
$527.93
|
| Rate for Payer: EPIC Health Plan Senior |
$527.93
|
| Rate for Payer: Galaxy Health WC |
$605.20
|
| Rate for Payer: Galaxy Health WC |
$787.10
|
| Rate for Payer: Global Benefits Group Commercial |
$555.60
|
| Rate for Payer: Global Benefits Group Commercial |
$427.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$787.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$787.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$699.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$699.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$479.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$479.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$588.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$452.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$791.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$791.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$671.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$671.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$604.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$604.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.12
|
| Rate for Payer: Multiplan Commercial |
$740.80
|
| Rate for Payer: Multiplan Commercial |
$569.60
|
| Rate for Payer: Networks By Design Commercial |
$601.90
|
| Rate for Payer: Networks By Design Commercial |
$462.80
|
| Rate for Payer: Prime Health Services Commercial |
$787.10
|
| Rate for Payer: Prime Health Services Commercial |
$605.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$555.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$427.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$575.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$575.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$463.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$356.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| 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 HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$479.94
|
| Rate for Payer: Upland Medical Group Pediatric |
$479.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$719.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$719.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$527.93
|
| Rate for Payer: Vantage Medical Group Senior |
$479.94
|
| Rate for Payer: Vantage Medical Group Senior |
$479.94
|
|
|
HC ESOPH BLLN DISTENSION PROVOCAT
|
Facility
|
IP
|
$712.00
|
|
|
Service Code
|
CPT 91040
|
| Hospital Charge Code |
906791040
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$142.40 |
| Max. Negotiated Rate |
$605.20 |
| Rate for Payer: Adventist Health Commercial |
$142.40
|
| Rate for Payer: Cash Price |
$320.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$498.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.80
|
| Rate for Payer: EPIC Health Plan Senior |
$284.80
|
| Rate for Payer: Galaxy Health WC |
$605.20
|
| Rate for Payer: Global Benefits Group Commercial |
$427.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$452.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$420.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.88
|
| Rate for Payer: Multiplan Commercial |
$569.60
|
| Rate for Payer: Networks By Design Commercial |
$462.80
|
| Rate for Payer: Prime Health Services Commercial |
$605.20
|
|
|
HC ESOPH DIAG DILATION
|
Facility
|
IP
|
$5,717.00
|
|
|
Service Code
|
CPT 43226
|
| Hospital Charge Code |
906743226
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,143.40 |
| Max. Negotiated Rate |
$4,859.45 |
| Rate for Payer: Adventist Health Commercial |
$1,143.40
|
| Rate for Payer: Cash Price |
$2,572.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,001.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,286.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,286.80
|
| Rate for Payer: Galaxy Health WC |
$4,859.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,430.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,630.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,373.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,372.08
|
| Rate for Payer: Multiplan Commercial |
$4,573.60
|
| Rate for Payer: Networks By Design Commercial |
$3,716.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,859.45
|
|
|
HC ESOPH DIAG DILATION
|
Facility
|
OP
|
$5,717.00
|
|
|
Service Code
|
CPT 43226
|
| Hospital Charge Code |
906743226
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$300.22 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,143.40
|
| Rate for Payer: Adventist Health Commercial |
$611.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Cash Price |
$1,375.65
|
| Rate for Payer: Cash Price |
$2,572.65
|
| Rate for Payer: Cash Price |
$2,572.65
|
| Rate for Payer: Cash Price |
$1,375.65
|
| Rate for Payer: Cash Price |
$1,375.65
|
| Rate for Payer: Cash Price |
$2,572.65
|
| Rate for Payer: Cigna of CA HMO |
$3,658.88
|
| Rate for Payer: Cigna of CA HMO |
$1,956.48
|
| Rate for Payer: Cigna of CA PPO |
$2,262.18
|
| Rate for Payer: Cigna of CA PPO |
$4,230.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,001.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,139.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: Galaxy Health WC |
$4,859.45
|
| Rate for Payer: Galaxy Health WC |
$2,598.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,834.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,430.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$300.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$300.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,630.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,941.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$339.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$339.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$733.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,372.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,109.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,109.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,307.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$2,445.60
|
| Rate for Payer: Multiplan Commercial |
$4,573.60
|
| Rate for Payer: Networks By Design Commercial |
$3,716.05
|
| Rate for Payer: Networks By Design Commercial |
$1,987.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,859.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,598.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,430.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,834.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,961.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,961.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,528.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,858.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| 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 HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
|
|
HC ESOPH DIAG FLEX TRANSNASAL
|
Facility
|
IP
|
$2,791.00
|
|
|
Service Code
|
CPT 43197
|
| Hospital Charge Code |
906743197
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$558.20 |
| Max. Negotiated Rate |
$2,372.35 |
| Rate for Payer: Adventist Health Commercial |
$558.20
|
| Rate for Payer: Cash Price |
$1,255.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,953.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,772.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,646.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$669.84
|
| Rate for Payer: Multiplan Commercial |
$2,232.80
|
| Rate for Payer: Networks By Design Commercial |
$1,814.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,372.35
|
|
|
HC ESOPH DIAG FLEX TRANSNASAL
|
Facility
|
OP
|
$2,791.00
|
|
|
Service Code
|
CPT 43197
|
| Hospital Charge Code |
906743197
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$116.34 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$558.20
|
| Rate for Payer: Adventist Health Commercial |
$298.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Cash Price |
$1,255.95
|
| Rate for Payer: Cash Price |
$1,255.95
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Cash Price |
$1,255.95
|
| Rate for Payer: Cigna of CA HMO |
$1,786.24
|
| Rate for Payer: Cigna of CA HMO |
$954.88
|
| Rate for Payer: Cigna of CA PPO |
$1,104.08
|
| Rate for Payer: Cigna of CA PPO |
$2,065.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,953.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,044.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: Galaxy Health WC |
$2,372.35
|
| Rate for Payer: Galaxy Health WC |
$1,268.20
|
| Rate for Payer: Global Benefits Group Commercial |
$895.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,674.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$116.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$116.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,772.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$947.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$131.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$131.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$358.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$669.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,469.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,469.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,563.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$1,193.60
|
| Rate for Payer: Multiplan Commercial |
$2,232.80
|
| Rate for Payer: Networks By Design Commercial |
$1,814.15
|
| Rate for Payer: Networks By Design Commercial |
$969.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,372.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,268.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,674.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$895.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,399.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,399.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$746.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,395.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| 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 HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC ESOPH DIAG FLEX TRANSNASAL BIOPSY
|
Facility
|
IP
|
$2,791.00
|
|
|
Service Code
|
CPT 43198
|
| Hospital Charge Code |
906743198
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$558.20 |
| Max. Negotiated Rate |
$2,372.35 |
| Rate for Payer: Adventist Health Commercial |
$558.20
|
| Rate for Payer: Cash Price |
$1,255.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,953.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,772.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,646.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$669.84
|
| Rate for Payer: Multiplan Commercial |
$2,232.80
|
| Rate for Payer: Networks By Design Commercial |
$1,814.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,372.35
|
|
|
HC ESOPH DIAG FLEX TRANSNASAL BIOPSY
|
Facility
|
OP
|
$2,791.00
|
|
|
Service Code
|
CPT 43198
|
| Hospital Charge Code |
906743198
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$138.23 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$558.20
|
| Rate for Payer: Adventist Health Commercial |
$298.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Cash Price |
$1,255.95
|
| Rate for Payer: Cash Price |
$1,255.95
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Cash Price |
$1,255.95
|
| Rate for Payer: Cigna of CA HMO |
$1,786.24
|
| Rate for Payer: Cigna of CA HMO |
$954.88
|
| Rate for Payer: Cigna of CA PPO |
$1,104.08
|
| Rate for Payer: Cigna of CA PPO |
$2,065.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,953.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,044.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: Galaxy Health WC |
$2,372.35
|
| Rate for Payer: Galaxy Health WC |
$1,268.20
|
| Rate for Payer: Global Benefits Group Commercial |
$895.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,674.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$138.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$138.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,772.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$947.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$156.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$156.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$358.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$669.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,469.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,469.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,563.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$1,193.60
|
| Rate for Payer: Multiplan Commercial |
$2,232.80
|
| Rate for Payer: Networks By Design Commercial |
$1,814.15
|
| Rate for Payer: Networks By Design Commercial |
$969.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,372.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,268.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,674.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$895.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,399.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,399.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$746.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,395.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| 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 HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC ESOPH DIAG FLEX TRANSO DILA W BLLN 30MM
|
Facility
|
IP
|
$3,373.00
|
|
|
Service Code
|
CPT 43214
|
| Hospital Charge Code |
906743214
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$674.60 |
| Max. Negotiated Rate |
$2,867.05 |
| Rate for Payer: Adventist Health Commercial |
$674.60
|
| Rate for Payer: Cash Price |
$1,517.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,361.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,141.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,990.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$809.52
|
| Rate for Payer: Multiplan Commercial |
$2,698.40
|
| Rate for Payer: Networks By Design Commercial |
$2,192.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,867.05
|
|
|
HC ESOPH DIAG FLEX TRANSO DILA W BLLN 30MM
|
Facility
|
OP
|
$3,373.00
|
|
|
Service Code
|
CPT 43214
|
| Hospital Charge Code |
906743214
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$285.21 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Adventist Health Commercial |
$674.60
|
| Rate for Payer: Adventist Health Commercial |
$450.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Cash Price |
$1,013.85
|
| Rate for Payer: Cash Price |
$1,517.85
|
| Rate for Payer: Cash Price |
$1,517.85
|
| Rate for Payer: Cash Price |
$1,013.85
|
| Rate for Payer: Cash Price |
$1,013.85
|
| Rate for Payer: Cash Price |
$1,517.85
|
| Rate for Payer: Cigna of CA HMO |
$2,158.72
|
| Rate for Payer: Cigna of CA HMO |
$1,441.92
|
| Rate for Payer: Cigna of CA PPO |
$1,667.22
|
| Rate for Payer: Cigna of CA PPO |
$2,496.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,361.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,577.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: Galaxy Health WC |
$2,867.05
|
| Rate for Payer: Galaxy Health WC |
$1,915.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,351.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,023.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$285.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$285.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,141.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,430.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$322.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$322.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$540.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$809.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,109.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,109.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,307.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$1,802.40
|
| Rate for Payer: Multiplan Commercial |
$2,698.40
|
| Rate for Payer: Networks By Design Commercial |
$2,192.45
|
| Rate for Payer: Networks By Design Commercial |
$1,464.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,867.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,915.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,023.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,351.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,961.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,961.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,126.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,686.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| 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 HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
|
|
HC ESOPH DIAG FLEX TRANS W ENDO MUC
|
Facility
|
IP
|
$2,231.00
|
|
|
Service Code
|
CPT 43211
|
| Hospital Charge Code |
906743211
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$446.20 |
| Max. Negotiated Rate |
$1,896.35 |
| Rate for Payer: Adventist Health Commercial |
$446.20
|
| Rate for Payer: Cash Price |
$1,003.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,561.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$892.40
|
| Rate for Payer: EPIC Health Plan Senior |
$892.40
|
| Rate for Payer: Galaxy Health WC |
$1,896.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,338.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,416.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,316.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$535.44
|
| Rate for Payer: Multiplan Commercial |
$1,784.80
|
| Rate for Payer: Networks By Design Commercial |
$1,450.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,896.35
|
|
|
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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$446.20
|
| Rate for Payer: Adventist Health Commercial |
$298.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Cash Price |
$1,003.95
|
| Rate for Payer: Cash Price |
$1,003.95
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Cash Price |
$1,003.95
|
| Rate for Payer: Cigna of CA HMO |
$1,427.84
|
| Rate for Payer: Cigna of CA HMO |
$954.88
|
| Rate for Payer: Cigna of CA PPO |
$1,104.08
|
| Rate for Payer: Cigna of CA PPO |
$1,650.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,561.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,044.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: Galaxy Health WC |
$1,896.35
|
| Rate for Payer: Galaxy Health WC |
$1,268.20
|
| Rate for Payer: Global Benefits Group Commercial |
$895.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,338.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$354.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$354.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,416.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$947.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$401.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$401.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$358.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$535.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,109.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,109.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,307.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$1,193.60
|
| Rate for Payer: Multiplan Commercial |
$1,784.80
|
| Rate for Payer: Networks By Design Commercial |
$1,450.15
|
| Rate for Payer: Networks By Design Commercial |
$969.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,896.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,268.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,338.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$895.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,961.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,961.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$746.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,115.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| 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 HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
|
|
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 |
$1,255.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,953.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,772.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,646.69
|
| 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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$558.20
|
| Rate for Payer: Adventist Health Commercial |
$298.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Cash Price |
$1,255.95
|
| Rate for Payer: Cash Price |
$1,255.95
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Cash Price |
$1,255.95
|
| Rate for Payer: Cigna of CA HMO |
$1,786.24
|
| Rate for Payer: Cigna of CA HMO |
$954.88
|
| Rate for Payer: Cigna of CA PPO |
$1,104.08
|
| Rate for Payer: Cigna of CA PPO |
$2,065.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,953.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,044.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: Galaxy Health WC |
$2,372.35
|
| Rate for Payer: Galaxy Health WC |
$1,268.20
|
| Rate for Payer: Global Benefits Group Commercial |
$895.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,674.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$185.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$185.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,772.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$947.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$210.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$210.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$358.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$669.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,109.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,109.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,307.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$1,193.60
|
| Rate for Payer: Multiplan Commercial |
$2,232.80
|
| Rate for Payer: Networks By Design Commercial |
$1,814.15
|
| Rate for Payer: Networks By Design Commercial |
$969.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,372.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,268.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,674.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$895.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,961.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,961.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$746.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,395.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| 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 HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
|
|
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 |
$1,897.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,951.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,677.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,487.44
|
| 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 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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$843.20
|
| Rate for Payer: Adventist Health Commercial |
$450.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,454.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,454.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,958.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,958.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Cash Price |
$1,013.85
|
| Rate for Payer: Cash Price |
$1,897.20
|
| Rate for Payer: Cash Price |
$1,897.20
|
| Rate for Payer: Cash Price |
$1,013.85
|
| Rate for Payer: Cash Price |
$1,013.85
|
| Rate for Payer: Cash Price |
$1,897.20
|
| Rate for Payer: Cigna of CA HMO |
$2,698.24
|
| Rate for Payer: Cigna of CA HMO |
$1,441.92
|
| Rate for Payer: Cigna of CA PPO |
$1,667.22
|
| Rate for Payer: Cigna of CA PPO |
$3,119.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,454.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,454.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,958.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,958.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,951.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,577.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,181.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,181.99
|
| Rate for Payer: EPIC Health Plan Senior |
$5,454.66
|
| Rate for Payer: EPIC Health Plan Senior |
$5,454.66
|
| Rate for Payer: Galaxy Health WC |
$3,583.60
|
| Rate for Payer: Galaxy Health WC |
$1,915.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,351.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,529.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8,132.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8,132.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$263.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$263.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,958.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,958.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,677.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,430.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$297.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$297.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,942.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,942.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$540.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,011.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,248.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,248.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,644.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,644.77
|
| Rate for Payer: Multiplan Commercial |
$1,802.40
|
| Rate for Payer: Multiplan Commercial |
$3,372.80
|
| Rate for Payer: Networks By Design Commercial |
$2,740.40
|
| Rate for Payer: Networks By Design Commercial |
$1,464.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,583.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,915.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,529.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,351.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,950.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,950.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,126.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,108.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| 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 HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,958.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,958.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,454.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,454.66
|
| Rate for Payer: Vantage Medical Group Senior |
$4,958.78
|
| Rate for Payer: Vantage Medical Group Senior |
$4,958.78
|
|
|
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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$674.60
|
| Rate for Payer: Adventist Health Commercial |
$450.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Cash Price |
$1,013.85
|
| Rate for Payer: Cash Price |
$1,517.85
|
| Rate for Payer: Cash Price |
$1,517.85
|
| Rate for Payer: Cash Price |
$1,013.85
|
| Rate for Payer: Cash Price |
$1,013.85
|
| Rate for Payer: Cash Price |
$1,517.85
|
| Rate for Payer: Cigna of CA HMO |
$2,158.72
|
| Rate for Payer: Cigna of CA HMO |
$1,441.92
|
| Rate for Payer: Cigna of CA PPO |
$1,667.22
|
| Rate for Payer: Cigna of CA PPO |
$2,496.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,361.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,577.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: Galaxy Health WC |
$2,867.05
|
| Rate for Payer: Galaxy Health WC |
$1,915.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,351.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,023.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$262.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$262.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,141.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,430.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$297.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$297.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$540.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$809.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,109.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,109.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,307.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$1,802.40
|
| Rate for Payer: Multiplan Commercial |
$2,698.40
|
| Rate for Payer: Networks By Design Commercial |
$2,192.45
|
| Rate for Payer: Networks By Design Commercial |
$1,464.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,867.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,915.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,023.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,351.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,961.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,961.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,126.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,686.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| 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 HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
|
