|
HC ESOPH DIAG W/SNARE
|
Facility
|
IP
|
$5,335.00
|
|
|
Service Code
|
CPT 43217
|
| Hospital Charge Code |
906743217
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,067.00 |
| Max. Negotiated Rate |
$4,534.75 |
| Rate for Payer: Adventist Health Commercial |
$1,067.00
|
| Rate for Payer: Cash Price |
$2,400.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,734.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3,387.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,147.65
|
| 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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,067.00
|
| Rate for Payer: Adventist Health Commercial |
$713.20
|
| 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 |
$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 |
$1,604.70
|
| Rate for Payer: Cash Price |
$2,400.75
|
| Rate for Payer: Cash Price |
$2,400.75
|
| Rate for Payer: Cash Price |
$1,604.70
|
| Rate for Payer: Cash Price |
$1,604.70
|
| Rate for Payer: Cash Price |
$2,400.75
|
| Rate for Payer: Cigna of CA HMO |
$3,414.40
|
| Rate for Payer: Cigna of CA HMO |
$2,282.24
|
| Rate for Payer: Cigna of CA PPO |
$2,638.84
|
| Rate for Payer: Cigna of CA PPO |
$3,947.90
|
| 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 |
$3,734.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,496.20
|
| 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 |
$4,534.75
|
| Rate for Payer: Galaxy Health WC |
$3,031.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,139.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,201.00
|
| 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 |
$238.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$238.93
|
| 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 |
$3,387.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,264.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$270.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$270.22
|
| 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 |
$855.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,280.40
|
| 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 |
$2,852.80
|
| Rate for Payer: Multiplan Commercial |
$4,268.00
|
| Rate for Payer: Networks By Design Commercial |
$3,467.75
|
| Rate for Payer: Networks By Design Commercial |
$2,317.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,534.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,031.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,201.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,139.60
|
| 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 |
$1,783.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,667.50
|
| 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 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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,144.80
|
| Rate for Payer: Adventist Health Commercial |
$612.00
|
| 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 |
$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 |
$6,716.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| 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 |
$1,377.00
|
| Rate for Payer: Cash Price |
$2,575.80
|
| Rate for Payer: Cash Price |
$2,575.80
|
| Rate for Payer: Cash Price |
$1,377.00
|
| Rate for Payer: Cash Price |
$1,377.00
|
| Rate for Payer: Cash Price |
$2,575.80
|
| Rate for Payer: Cigna of CA HMO |
$3,663.36
|
| Rate for Payer: Cigna of CA HMO |
$1,958.40
|
| Rate for Payer: Cigna of CA PPO |
$2,264.40
|
| Rate for Payer: Cigna of CA PPO |
$4,235.76
|
| 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 |
$4,006.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,142.00
|
| 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 |
$4,865.40
|
| Rate for Payer: Galaxy Health WC |
$2,601.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,836.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,434.40
|
| 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 |
$352.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$352.13
|
| 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 |
$3,634.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,943.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$398.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$398.24
|
| 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 |
$734.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,373.76
|
| 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 |
$2,448.00
|
| Rate for Payer: Multiplan Commercial |
$4,579.20
|
| Rate for Payer: Networks By Design Commercial |
$3,720.60
|
| Rate for Payer: Networks By Design Commercial |
$1,989.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,865.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,601.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,434.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,836.00
|
| 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 |
$1,530.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,862.00
|
| 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 |
$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 W/SUBMUC INJ
|
Facility
|
IP
|
$5,724.00
|
|
|
Service Code
|
CPT 43201
|
| Hospital Charge Code |
906743201
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,144.80 |
| Max. Negotiated Rate |
$4,865.40 |
| Rate for Payer: Adventist Health Commercial |
$1,144.80
|
| Rate for Payer: Cash Price |
$2,575.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,006.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,289.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,289.60
|
| Rate for Payer: Galaxy Health WC |
$4,865.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,434.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,634.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,377.16
|
| 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 REP
|
Facility
|
IP
|
$4,573.00
|
|
|
Service Code
|
CPT 43227
|
| Hospital Charge Code |
906743227
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$914.60 |
| Max. Negotiated Rate |
$3,887.05 |
| Rate for Payer: Adventist Health Commercial |
$914.60
|
| Rate for Payer: Cash Price |
$2,057.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,201.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,903.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,698.07
|
| 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 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 |
$32,312.00 |
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Adventist Health Commercial |
$914.60
|
| 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 |
$6,716.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Cash Price |
$1,375.65
|
| Rate for Payer: Cash Price |
$2,057.85
|
| Rate for Payer: Cash Price |
$2,057.85
|
| Rate for Payer: Cash Price |
$1,375.65
|
| Rate for Payer: Cash Price |
$1,375.65
|
| Rate for Payer: Cash Price |
$2,057.85
|
| Rate for Payer: Cigna of CA HMO |
$2,926.72
|
| 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 |
$3,384.02
|
| 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 Medicare Advantage |
$2,468.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,201.10
|
| 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 |
$3,887.05
|
| 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 |
$2,743.80
|
| 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 |
$289.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$289.58
|
| 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 |
$2,903.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,941.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$327.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$327.50
|
| 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 |
$1,097.52
|
| 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 |
$2,445.60
|
| Rate for Payer: Multiplan Commercial |
$3,658.40
|
| Rate for Payer: Networks By Design Commercial |
$2,972.45
|
| Rate for Payer: Networks By Design Commercial |
$1,987.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,887.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,598.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,743.80
|
| 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 |
$2,286.50
|
| 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 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 |
$1,074.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,671.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,516.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,408.92
|
| 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
|
$1,428.00
|
|
|
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 |
$285.60
|
| Rate for Payer: Adventist Health Commercial |
$477.60
|
| 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 |
$416.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$916.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,532.38
|
| 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 |
$1,074.60
|
| Rate for Payer: Cash Price |
$642.60
|
| Rate for Payer: Cash Price |
$642.60
|
| Rate for Payer: Cash Price |
$642.60
|
| Rate for Payer: Cash Price |
$1,074.60
|
| Rate for Payer: Cash Price |
$1,074.60
|
| Rate for Payer: Cigna of CA HMO |
$1,528.32
|
| Rate for Payer: Cigna of CA HMO |
$913.92
|
| Rate for Payer: Cigna of CA PPO |
$1,767.12
|
| Rate for Payer: Cigna of CA PPO |
$1,056.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$416.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$416.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$305.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$305.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$277.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$277.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,671.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$999.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$458.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$458.22
|
| Rate for Payer: EPIC Health Plan Senior |
$305.48
|
| Rate for Payer: EPIC Health Plan Senior |
$305.48
|
| Rate for Payer: Galaxy Health WC |
$1,213.80
|
| Rate for Payer: Galaxy Health WC |
$2,029.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,432.80
|
| Rate for Payer: Global Benefits Group Commercial |
$856.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$455.44
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$455.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$225.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$225.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$277.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$277.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,516.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$906.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$255.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$255.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$388.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$388.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$573.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$349.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$349.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$372.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$372.13
|
| Rate for Payer: Multiplan Commercial |
$1,910.40
|
| Rate for Payer: Multiplan Commercial |
$1,142.40
|
| Rate for Payer: Networks By Design Commercial |
$1,552.20
|
| Rate for Payer: Networks By Design Commercial |
$928.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,029.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,213.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,432.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$856.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$333.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$333.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,194.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$714.00
|
| 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 |
$277.71
|
| Rate for Payer: Upland Medical Group Pediatric |
$277.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Vantage Medical Group Senior |
$277.71
|
| Rate for Payer: Vantage Medical Group Senior |
$277.71
|
|
|
HC ESOPH IMPED FUNC TST UP TO 1HR
|
Facility
|
OP
|
$1,428.00
|
|
|
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 |
$285.60
|
| Rate for Payer: Adventist Health Commercial |
$477.60
|
| 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 |
$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 |
$916.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,532.38
|
| 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 |
$1,074.60
|
| Rate for Payer: Cash Price |
$642.60
|
| Rate for Payer: Cash Price |
$642.60
|
| Rate for Payer: Cash Price |
$642.60
|
| Rate for Payer: Cash Price |
$1,074.60
|
| Rate for Payer: Cash Price |
$1,074.60
|
| Rate for Payer: Cigna of CA HMO |
$1,528.32
|
| Rate for Payer: Cigna of CA HMO |
$913.92
|
| Rate for Payer: Cigna of CA PPO |
$1,767.12
|
| Rate for Payer: Cigna of CA PPO |
$1,056.72
|
| 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 |
$1,671.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$999.60
|
| 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 |
$1,213.80
|
| Rate for Payer: Galaxy Health WC |
$2,029.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,432.80
|
| Rate for Payer: Global Benefits Group Commercial |
$856.80
|
| 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 |
$191.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$191.25
|
| 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 |
$1,516.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$906.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$216.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$216.30
|
| 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 |
$342.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$573.12
|
| 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 |
$1,910.40
|
| Rate for Payer: Multiplan Commercial |
$1,142.40
|
| Rate for Payer: Networks By Design Commercial |
$1,552.20
|
| Rate for Payer: Networks By Design Commercial |
$928.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,029.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,213.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,432.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$856.80
|
| 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 |
$1,194.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$714.00
|
| 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 Medi-Cal |
$527.93
|
| Rate for Payer: Vantage Medical Group Senior |
$479.94
|
| Rate for Payer: Vantage Medical Group Senior |
$479.94
|
|
|
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 |
$1,074.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,671.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,516.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,408.92
|
| 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 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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,445.20
|
| Rate for Payer: Adventist Health Commercial |
$935.00
|
| 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 |
$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 |
$2,103.75
|
| Rate for Payer: Cash Price |
$3,251.70
|
| Rate for Payer: Cash Price |
$3,251.70
|
| Rate for Payer: Cash Price |
$2,103.75
|
| Rate for Payer: Cash Price |
$2,103.75
|
| Rate for Payer: Cash Price |
$3,251.70
|
| Rate for Payer: Cigna of CA HMO |
$4,624.64
|
| Rate for Payer: Cigna of CA HMO |
$2,992.00
|
| Rate for Payer: Cigna of CA PPO |
$3,459.50
|
| Rate for Payer: Cigna of CA PPO |
$5,347.24
|
| 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 |
$5,058.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,272.50
|
| 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 |
$6,142.10
|
| Rate for Payer: Galaxy Health WC |
$3,973.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,805.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,335.60
|
| 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 |
$300.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$300.85
|
| 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 |
$4,588.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,968.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$340.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$340.25
|
| 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 |
$1,122.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,734.24
|
| 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 |
$3,740.00
|
| Rate for Payer: Multiplan Commercial |
$5,780.80
|
| Rate for Payer: Networks By Design Commercial |
$4,696.90
|
| Rate for Payer: Networks By Design Commercial |
$3,038.75
|
| Rate for Payer: Prime Health Services Commercial |
$6,142.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,973.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,335.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,805.00
|
| 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 |
$2,337.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,613.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| 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 HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| 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 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 |
$3,251.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,058.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$4,588.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,263.34
|
| 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 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 |
$632.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$984.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$892.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$829.54
|
| 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: Adventist Health Commercial |
$320.60
|
| 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 |
$1,195.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,362.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$881.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$773.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,202.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,054.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$902.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,028.65
|
| 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 |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$632.70
|
| Rate for Payer: Cash Price |
$721.35
|
| Rate for Payer: Cash Price |
$721.35
|
| Rate for Payer: Cash Price |
$721.35
|
| Rate for Payer: Cash Price |
$632.70
|
| Rate for Payer: Cash Price |
$632.70
|
| Rate for Payer: Cigna of CA HMO |
$899.84
|
| Rate for Payer: Cigna of CA HMO |
$1,025.92
|
| Rate for Payer: Cigna of CA PPO |
$1,040.44
|
| Rate for Payer: Cigna of CA PPO |
$1,186.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,362.55
|
| 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 Medi-Cal |
$1,362.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,362.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,195.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$984.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,122.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$641.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$562.40
|
| Rate for Payer: EPIC Health Plan Senior |
$641.20
|
| Rate for Payer: EPIC Health Plan Senior |
$562.40
|
| Rate for Payer: Galaxy Health WC |
$1,195.10
|
| Rate for Payer: Galaxy Health WC |
$1,362.55
|
| Rate for Payer: Global Benefits Group Commercial |
$843.60
|
| Rate for Payer: Global Benefits Group Commercial |
$961.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$892.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,017.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$945.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$829.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$337.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,122.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$984.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,122.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$984.20
|
| Rate for Payer: Multiplan Commercial |
$1,124.80
|
| Rate for Payer: Multiplan Commercial |
$1,282.40
|
| Rate for Payer: Networks By Design Commercial |
$913.90
|
| Rate for Payer: Networks By Design Commercial |
$1,041.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,362.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,195.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$961.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$843.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$843.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$961.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$703.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$801.50
|
| 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: Vantage Medical Group Commercial/Exchange |
$1,362.55
|
| 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 Medi-Cal |
$1,362.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,362.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,195.10
|
|
|
HC ESOPH MOTIL MANOMETRIC
|
Facility
|
OP
|
$2,255.00
|
|
|
Service Code
|
CPT 91010
|
| Hospital Charge Code |
906791010
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$116.10 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Cigna of CA PPO |
$1,827.80
|
| Rate for Payer: Adventist Health Commercial |
$451.00
|
| Rate for Payer: Adventist Health Commercial |
$494.00
|
| 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 |
$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 |
$1,447.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,585.00
|
| 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 |
$1,111.50
|
| Rate for Payer: Cash Price |
$1,014.75
|
| Rate for Payer: Cash Price |
$1,014.75
|
| Rate for Payer: Cash Price |
$1,014.75
|
| Rate for Payer: Cash Price |
$1,111.50
|
| Rate for Payer: Cash Price |
$1,111.50
|
| Rate for Payer: Cigna of CA HMO |
$1,580.80
|
| Rate for Payer: Cigna of CA HMO |
$1,443.20
|
| Rate for Payer: Cigna of CA PPO |
$1,668.70
|
| 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 |
$1,729.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,578.50
|
| 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 |
$1,916.75
|
| Rate for Payer: Galaxy Health WC |
$2,099.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,482.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,353.00
|
| 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 |
$116.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$116.10
|
| 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 |
$1,568.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,431.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$131.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$131.31
|
| 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 |
$541.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$592.80
|
| 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 |
$1,976.00
|
| Rate for Payer: Multiplan Commercial |
$1,804.00
|
| Rate for Payer: Networks By Design Commercial |
$1,605.50
|
| Rate for Payer: Networks By Design Commercial |
$1,465.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,099.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,916.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,482.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,353.00
|
| 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 |
$1,235.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,127.50
|
| 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 Medi-Cal |
$527.93
|
| Rate for Payer: Vantage Medical Group Senior |
$479.94
|
| Rate for Payer: Vantage Medical Group Senior |
$479.94
|
|
|
HC ESOPH MOTIL MANOMETRIC
|
Facility
|
IP
|
$2,470.00
|
|
|
Service Code
|
CPT 91010
|
| Hospital Charge Code |
906791010
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$494.00 |
| Max. Negotiated Rate |
$2,099.50 |
| Rate for Payer: Adventist Health Commercial |
$494.00
|
| Rate for Payer: Cash Price |
$1,111.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,729.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$988.00
|
| Rate for Payer: EPIC Health Plan Senior |
$988.00
|
| Rate for Payer: Galaxy Health WC |
$2,099.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,482.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,568.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,457.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$592.80
|
| 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
|
|
|
HC ESOPHOGRAM
|
Facility
|
OP
|
$1,319.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
909001802
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$63.99 |
| Max. Negotiated Rate |
$1,121.15 |
| Rate for Payer: Adventist Health Commercial |
$263.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$486.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$328.41
|
| Rate for Payer: Blue Shield of California Commercial |
$555.30
|
| Rate for Payer: Blue Shield of California Commercial |
$841.52
|
| Rate for Payer: Cash Price |
$593.55
|
| Rate for Payer: Cash Price |
$593.55
|
| Rate for Payer: Cigna of CA HMO |
$844.16
|
| Rate for Payer: Cigna of CA PPO |
$976.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$923.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: Galaxy Health WC |
$1,121.15
|
| Rate for Payer: Global Benefits Group Commercial |
$791.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$63.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$837.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$316.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$284.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$1,055.20
|
| Rate for Payer: Networks By Design Commercial |
$857.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,121.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$791.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$791.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.73
|
| Rate for Payer: United Healthcare All Other HMO |
$219.73
|
| Rate for Payer: United Healthcare HMO Rider |
$219.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
|
HC ESOPHOGRAM
|
Facility
|
IP
|
$1,319.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
909001802
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$263.80 |
| Max. Negotiated Rate |
$1,121.15 |
| Rate for Payer: Adventist Health Commercial |
$263.80
|
| Rate for Payer: Cash Price |
$593.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$923.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$527.60
|
| Rate for Payer: EPIC Health Plan Senior |
$527.60
|
| Rate for Payer: Galaxy Health WC |
$1,121.15
|
| Rate for Payer: Global Benefits Group Commercial |
$791.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$837.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$778.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$316.56
|
| Rate for Payer: Multiplan Commercial |
$1,055.20
|
| Rate for Payer: Networks By Design Commercial |
$857.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,121.15
|
|
|
HC ESOPH RETRO BALLOON
|
Facility
|
OP
|
$2,936.00
|
|
|
Service Code
|
CPT 43213
|
| Hospital Charge Code |
900100015
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$393.42 |
| Max. Negotiated Rate |
$32,312.00 |
| 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: Adventist Health Commercial |
$587.20
|
| Rate for Payer: Adventist Health Commercial |
$392.40
|
| 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 |
$882.90
|
| Rate for Payer: Cash Price |
$1,321.20
|
| Rate for Payer: Cash Price |
$1,321.20
|
| Rate for Payer: Cash Price |
$882.90
|
| Rate for Payer: Cash Price |
$882.90
|
| Rate for Payer: Cash Price |
$1,321.20
|
| Rate for Payer: Cigna of CA HMO |
$1,879.04
|
| Rate for Payer: Cigna of CA HMO |
$1,255.68
|
| Rate for Payer: Cigna of CA PPO |
$1,451.88
|
| Rate for Payer: Cigna of CA PPO |
$2,172.64
|
| 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 |
$2,055.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,373.40
|
| 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 |
$2,495.60
|
| Rate for Payer: Galaxy Health WC |
$1,667.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,177.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,761.60
|
| 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 |
$393.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$393.42
|
| 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 |
$1,864.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,245.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$444.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$444.94
|
| 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 |
$470.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$704.64
|
| 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 |
$1,569.60
|
| Rate for Payer: Multiplan Commercial |
$2,348.80
|
| Rate for Payer: Networks By Design Commercial |
$1,908.40
|
| Rate for Payer: Networks By Design Commercial |
$1,275.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,495.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,667.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,761.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,177.20
|
| 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 |
$981.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,468.00
|
| 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 |
$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 RETRO BALLOON
|
Facility
|
IP
|
$2,936.00
|
|
|
Service Code
|
CPT 43213
|
| Hospital Charge Code |
900100015
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$587.20 |
| Max. Negotiated Rate |
$2,495.60 |
| Rate for Payer: Adventist Health Commercial |
$587.20
|
| Rate for Payer: Cash Price |
$1,321.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,055.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,174.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,174.40
|
| Rate for Payer: Galaxy Health WC |
$2,495.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,761.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,864.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,732.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$704.64
|
| Rate for Payer: Multiplan Commercial |
$2,348.80
|
| Rate for Payer: Networks By Design Commercial |
$1,908.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,495.60
|
|
|
HC ESOPH STENT PLACEMENT
|
Facility
|
IP
|
$12,226.00
|
|
|
Service Code
|
CPT 43212
|
| Hospital Charge Code |
900100014
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,445.20 |
| Max. Negotiated Rate |
$10,392.10 |
| Rate for Payer: Adventist Health Commercial |
$2,445.20
|
| Rate for Payer: Cash Price |
$5,501.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,558.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,890.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,890.40
|
| Rate for Payer: Galaxy Health WC |
$10,392.10
|
| Rate for Payer: Global Benefits Group Commercial |
$7,335.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,763.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,213.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,934.24
|
| Rate for Payer: Multiplan Commercial |
$9,780.80
|
| Rate for Payer: Networks By Design Commercial |
$7,946.90
|
| Rate for Payer: Prime Health Services Commercial |
$10,392.10
|
|
|
HC ESOPH STENT PLACEMENT
|
Facility
|
OP
|
$8,172.00
|
|
|
Service Code
|
CPT 43212
|
| Hospital Charge Code |
900100014
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$277.70 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Cigna of CA PPO |
$9,047.24
|
| Rate for Payer: Cigna of CA PPO |
$6,047.28
|
| Rate for Payer: Adventist Health Commercial |
$1,634.40
|
| Rate for Payer: Adventist Health Commercial |
$2,445.20
|
| 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 |
$11,712.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,589.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,589.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,808.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,808.19
|
| 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 |
$5,501.70
|
| Rate for Payer: Cash Price |
$3,677.40
|
| Rate for Payer: Cash Price |
$3,677.40
|
| Rate for Payer: Cash Price |
$5,501.70
|
| Rate for Payer: Cash Price |
$5,501.70
|
| Rate for Payer: Cash Price |
$3,677.40
|
| Rate for Payer: Cigna of CA HMO |
$5,230.08
|
| Rate for Payer: Cigna of CA HMO |
$7,824.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,589.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,589.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,808.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,808.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,720.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,558.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,883.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,883.51
|
| Rate for Payer: EPIC Health Plan Senior |
$8,589.01
|
| Rate for Payer: EPIC Health Plan Senior |
$8,589.01
|
| Rate for Payer: Galaxy Health WC |
$6,946.20
|
| Rate for Payer: Galaxy Health WC |
$10,392.10
|
| Rate for Payer: Global Benefits Group Commercial |
$7,335.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,903.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,805.43
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,805.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$277.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$277.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,808.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,808.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,189.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,763.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$314.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$314.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,931.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,931.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,934.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,961.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,838.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,838.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,462.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,462.97
|
| Rate for Payer: Multiplan Commercial |
$9,780.80
|
| Rate for Payer: Multiplan Commercial |
$6,537.60
|
| Rate for Payer: Networks By Design Commercial |
$5,311.80
|
| Rate for Payer: Networks By Design Commercial |
$7,946.90
|
| Rate for Payer: Prime Health Services Commercial |
$6,946.20
|
| Rate for Payer: Prime Health Services Commercial |
$10,392.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,903.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,335.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,369.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,369.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,113.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,086.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,808.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,808.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,589.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,589.01
|
| Rate for Payer: Vantage Medical Group Senior |
$7,808.19
|
| Rate for Payer: Vantage Medical Group Senior |
$7,808.19
|
|
|
HC ESTABLISH BRAIN CAVITY SHUNT
|
Facility
|
IP
|
$5,529.00
|
|
|
Service Code
|
CPT 62180
|
| Hospital Charge Code |
900501661
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,105.80 |
| Max. Negotiated Rate |
$4,699.65 |
| Rate for Payer: Adventist Health Commercial |
$1,105.80
|
| Rate for Payer: Cash Price |
$2,488.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,870.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,211.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,211.60
|
| Rate for Payer: Galaxy Health WC |
$4,699.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,317.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,510.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,262.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,326.96
|
| Rate for Payer: Multiplan Commercial |
$4,423.20
|
| Rate for Payer: Networks By Design Commercial |
$3,593.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,699.65
|
|
|
HC ESTABLISH BRAIN CAVITY SHUNT
|
Facility
|
OP
|
$5,529.00
|
|
|
Service Code
|
CPT 62180
|
| Hospital Charge Code |
900501661
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$452.71 |
| Max. Negotiated Rate |
$9,323.00 |
| Rate for Payer: Adventist Health Commercial |
$1,105.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,699.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,040.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,146.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,323.00
|
| Rate for Payer: Cash Price |
$2,488.05
|
| Rate for Payer: Cash Price |
$2,488.05
|
| Rate for Payer: Cash Price |
$2,488.05
|
| Rate for Payer: Cigna of CA HMO |
$3,538.56
|
| Rate for Payer: Cigna of CA PPO |
$4,091.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,699.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,699.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,699.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,870.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,211.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,211.60
|
| Rate for Payer: Galaxy Health WC |
$4,699.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,317.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,510.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$452.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,262.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,326.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,870.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,870.30
|
| Rate for Payer: Multiplan Commercial |
$4,423.20
|
| Rate for Payer: Networks By Design Commercial |
$3,593.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,699.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,317.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,764.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,764.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,764.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,764.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,699.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,699.65
|
| Rate for Payer: Vantage Medical Group Senior |
$4,699.65
|
|
|
HC ESTAB OP VISIT HIGH SEVERITY
|
Facility
|
IP
|
$695.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908710010
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$139.00 |
| Max. Negotiated Rate |
$590.75 |
| Rate for Payer: Adventist Health Commercial |
$139.00
|
| Rate for Payer: Cash Price |
$312.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$486.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$278.00
|
| Rate for Payer: EPIC Health Plan Senior |
$278.00
|
| Rate for Payer: Galaxy Health WC |
$590.75
|
| Rate for Payer: Global Benefits Group Commercial |
$417.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$441.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$410.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.80
|
| Rate for Payer: Multiplan Commercial |
$556.00
|
| Rate for Payer: Networks By Design Commercial |
$451.75
|
| Rate for Payer: Prime Health Services Commercial |
$590.75
|
|
